Nasal Encephalocele: Endoscopic Surgery

Contributors: Vincent Couloigner We describe the excision of a nasal encephalocele obstructing the left nasal fossa with an anterior subcutaneous portion deforming the nasal pyramid in a four-year-old girl using endoscopic surgery combined to a Rethi approach. The anterior skull base defect was reconstructed using autologous conchal cartilage and temporal fascia. Editor Recruited By: Sanjay Parikh, MD, FACS DOI: http://dx.doi.org/10.17797/udewjr2ge7

Microdebrider Assisted Lingual Tonsillectomy

Microdebrider Assisted Lingual Tonsillectomy Adrian Williamson, Michael Kubala MD, Adam Johnson MD PhD, Megan Gaffey MD, and Gresham Richter MD The lingual tonsils are a collection of lymphoid tissue found on the base of the tongue. The lingual tonsils along with the adenoid, tubal tonsils, palatine tonsils make up Waldeyer’s tonsillar ring. Hypertrophy of the lingual tonsils contributes to obstructive sleep apnea and lingual tonsillectomy can alleviate this intermittent airway obstruction.1,2 Lingual tonsil hypertrophy can manifest more rarely with chronic infection or dysphagia. A lingual tonsil grading system has been purposed by Friedman et al 2015, which rates lingual tonsils between grade 0 and grade 4. Friedman et al define grade 0 as absent lingual tonsils and grade 4 lingual tonsils as lymphoid tissue covering the entire base of tongue and rising above the tip of the epiglottis in thickness.3 Lingual tonsillectomy has been approached by a variety of different surgical techniques including electrocautery, CO2 laser, cold ablation (coblation) and microdebridement.4-9 Transoral robotic surgery (TORS) has also been used to improve exposure of the tongue base to perform lingual tonsillectomy.10-13 At this time, there is not enough evidence to support that one of these techniques is superior. Here, we describe the microdebrider assisted lingual tonsillectomy in an 8 year-old female with Down Syndrome. This patient was following in Arkansas Children's Sleep Disorders Center and found to have persistent moderate obstructive sleep apnea despite previous adenoidectomy and palatine tonsillectomy. Unfortunately, she did not tolerate her continuous positive airway pressure (CPAP) device. The patient underwent polysomnography 2 months preoperatively which revealed an oxygen saturation nadir of 90%, an apnea-hypopnea index of 7.7, and an arousal index of 16.9. There was no evidence of central sleep apnea. The patient was referred to otolaryngology to evaluate for possible surgical management. Given the severity of the patient’s symptoms and clinical appearance, a drug induced sleep state endoscopy with possible surgical intervention was planned. The drug induced sleep state endoscopy revealed grade IV lingual tonsil hypertrophy causing obstruction of the airway with collapse of the epiglottis to the posterior pharyngeal wall. A jaw thrust was found to relieve this displacement and airway obstruction. The turbinates and pharyngeal tonsils were not causing significant obstruction of the airway. At this time the decision was made to proceed with microdebrider assisted lingual tonsillectomy. First, microlaryngoscopy and bronchoscopy were performed followed by orotracheal intubation using a Phillips 1 blade and a 0 degree Hopkins rod. Surgical exposure was achieved using suspension laryngoscopy with the Lindholm laryngoscope and the 0 degree Hopkins rod. 1% lidocaine with epinephrine is injected into the base of tongue for hemostatic control using a laryngeal needle under the guidance of the 0 degree Hopkins rod. 1. The 4 mm Tricut Sinus Microdebrider blade was set to 5000 RPM and inserted between the laryngoscope and the lips to resect the lingual tonsils. Oxymetazoline-soaked pledgets were used periodically during resection to maintain hemostasis and proper visualization. A subtotal lingual tonsillectomy was completed with preservation of the fascia overlying the musculature at the base of tongue. She was extubated following surgery and there were no postoperative complications. Four months after postoperatively the patient followed up at Arkansas Children's Sleep Disorders Center and was found to have notable clinical improvement especially with her daytime symptoms. A postoperative polysomnography was not performed given the patient’s clinical improvement.

Double Stage Laryngotracheal Reconstruction with Anterior and Posterior Rib Graft

Double Stage Laryngotracheal Reconstruction with Anterior and Posterior Rib Cartilage Graft.

Microtia Reconstruction: Stage 1

Stage 1 Microtia Repair using rib cartilage and modifications to the Nagata method of auricular formation. DOI#: http://dx.doi.org/10.17797/cquv22l7p3

Endoscopic Posterior Cricoid Split with Rib Grafting for Bilateral Vocal Fold Paralysis

Endoscopic posterior cricoid split with rib grafting can be used in children with bilateral vocal fold immobility due to bilateral vocal fold paralysis or cricoarytenoid joint fixation with posterior glottic stenosis. It is preferred to vocal cordotomy/arytenoidectomy because it is a non-destructive procedure with no impact on voice and swallowing.  It is also preferred to open laryngotracheal reconstruction because it does not disrupt the anterior cricoid ring thereby preserving the "spring" of the cricoid. DOI: http://dx.doi.org/10.17797/gcnyoduseo

Bilateral Cryptotia Repair

Contributors: Shira Koss 6 year old boy suffering from bullying at school as a result of bilateral cryptotia, a very unusual congenital ear anomaly in which the superior helix is buried under temporal skin. DOI#: http://dx.doi.org/10.17797/le4g6c5rk5

Cervical Esophageal Foreign Body Removal

Contributors: Christopher G Tang Rigid cervical esophagoscopy is an excellent procedure for removing cervical esophageal foreign bodies. In this video, it was used to removal an unknown foreign body. DOI: http://dx.doi.org/10.17797/kzn2ovjuve

Bilateral Sagittal Spilt Osteotomy and Genioplasty in Patient with Lymphatic Malformation

Contributors: Michael Golinko, MD,  John Jones, MD, DMD,  Kumar Patel, PA Bilateral sagittal split osteotomy and genioplasty in 5y/o girl with lymphatic malformation. DOI#: https://doi.org/10.17797/hlo056ep2r

LeFort I Osteotomy and Advancement in Patient with Maxillary Hypoplasia

Contributors: Michael Golinko, Kumar Patel and Bridget O'Leary LeFort I osteotomy and advancement in 18y/o female patient with maxillary hypoplasia DOI: https://doi.org/10.17797/1cu3tz50yf

Expansion Sphincter Pharyngoplasty

Contributors: Raj Dedhia, M.D Obstructive sleep apnea is a common disorder with many possible etiologies. Surgical therapy is aimed at reducing or eliminating an area of airway stenosis that predisposes patients to obstructive sleep apnea. Expansion sphincter pharyngoplasty consists of transecting the palatopharyngeus and reinserting it into the lateral soft palate and periosteum of the pterygoid hamulus to widen the pharyngeal airway. DOI #: https://doi.org/10.17797/i9jgkva8m4

Bilateral Cleft Lip Repair

Contributors: Larry Hartzell Repair of the bilateral cleft lip deformity can be challenging to the cleft and craniofacial surgeon.  The goals of an acceptable repair must include precise continuity of the cupid's bow, maximizing philtral length, and establishing a mucosa lined sulcus.  We present an example of a repair of the bilateral incomplete lip as described by Millard. DOI: http://dx.doi.org/10.17797/qefi9lqbam

Endoscopic Excision of Nasolacrimal Duct Cyst

The patient is a 4 week old female infant with right sided epiphora and complete right sided nasal obstruction resulting in respiratory and feeding difficulty.  Physical exam demonstrated a right medial canthal mass consistent with a dacrocystocele. Flexible fiberoptic nasal endoscopy demonstrated an anterior nasal mass below the inferior turbinate occluding the entire right nasal cavity consistent with a nasolacrimal cyst. The etiology is obstruction at the level of Hassner's valve.

Adenoidectomy with Radiofrequency Ablation (Coblator) Technique

Contributors: Soham Roy and Steven Curry Adenoidectomy is among the most common surgical procedures performed in children.  The two major indications are nasopharyngeal airway obstruction and recurrent or chronic infections of the nasopharynx.  This surgery is often carried out with a combined tonsillectomy which is performed for similar indications and depicted here.

Modified Rambo Transcanal Approach for Cochlear Implantation in CHARGE Syndrome

Contributors: Amy M. Moore, and Brandon Isaacson CHARGE syndrome is associated with a variety of temporal bone anomalies and deafness. The lack of surgical landmarks and facial nerve irregularities make cochlear implantation in this population a challenging endeavor. This video describes a safe and efficacious transcanal approach for cochlear implantation that obviates the need to perform a mastoidectomy and facial recess.

CO2 laser wedge excision and steroid injection for Subglottic Stenosis

Contributors: Jan Kasperbauer Subglottic stenosis can occur from a variety of causes and is often treated with balloon dilation +/- CO2 laser radial incisions. This video shows an approach used for many years at our institution (wedge excisions without dilation) with good success.

Myringotomy with Tympanostomy Tube Insertion

Myringotomy with tympanostomy tube insertion is among the most common pediatric operative procedures and is indicated to provide ventilation of the middle ear. Surgical incision in the tympanic membrane (myringotomy) is followed by tympanostomy tube insertion to prevent premature closure of the incision site. The goal of the procedure is to reduce the frequency, duration, and severity of subsequent otitis media episodes and to prevent recurrence of middle ear effusions. Soham Roy (University of Texas at Houston Medical School) Thomas Mitchell (University of Texas at Houston Medical School)

Lingual Tonsillectomy with Epiglottopexy

Posterior displacement of the epiglottis secondary to lingual tonsil hypertrophy is a common cause for persistent obstructive obstructive sleep apnea after adenotonsillectomy in the pediatric population. By use of an operating micorscope an endoscpoic technique for lingual tonsillectomy and a epiglottopexy is described.

Microtia Reconstruction Stage 2

This is the second stage of Microtia Reconstruction, the first stage was depicted in a prior video. The ear is elevated and lateralized to take its 3-dimensional form, and this is accomplished with use of an anteriorly based mastoid fascial flap as well as costal cartilage graft and full thickness skin graft. Editor Recruited By: Michael Golinko, MD

Intracapsular tonsillectomy

Contributors: Dr. James Hamilton Intracapsular tonsillectomy using the microdebrider is demonstrated here in a child with obstructive sleep apnea.

Adenoidectomy with Suction Electrocautery Technique

Adenoidectomy is among the most common surgical procedures performed in children. The two major indications are nasopharyngeal airway obstruction and recurrent or chronic infections of the nasopharynx. This surgery is often carried out with a combined tonsillectomy which is performed for similar indications. The technique used in this video is suction electrocautery, a recently developed technique that allows for more precision and minimal blood loss compared with more traditional techniques. Soham Roy (University of Texas Medical School at Houston) Thomas Mitchell (University of Texas Medical School at Houston)

Tonsillectomy with Radiofrequency Ablation (Coblator) Technique

Tonsillectomy is among the most common surgical procedures performed in children. The two major indications are oropharyngeal airway obstruction and recurrent or chronic infections of the oropharynx. In this video, radiofrequency ablation, or Coblation (controlled ablation), is the technique used to ablate the tonsils. This technique uses low-temperature radiofrequency and saline to create a plasma field that dissolves tissue. It is generally safer that high-temperature electrocautery and allows for precise removal of tissue without burning nearby structures. Contributors: Soham Roy (University of Texas at Houston Medical School) Thomas Mitchell (University of Texas at Houston Medical School) Steven Curry (University of Texas at Houston Medical School)

Congenital Nasal Pyriform Aperture Stenosis (CNPAS): Sublabial Approach to Surgical Correction

Congenital nasal pyriform aperture stenosis (CNPAS) is defined as inadequate formation of the pyriform apertures forming the bony nasal openings resulting in respiratory distress and cyanosis soon after birth. Some clues such as worsening distress during feeding and improvement during crying may indicate a nasal cause of respiratory distress rather than distal airway etiology. Inability or difficulty passing a small tube through the nasal cavities may suggest CNPAS. The presenting clinical features of CNPAS can be similar to other obstructive nasal airway anomalies such as choanal atresia. Diagnosis is confirmed via CT scan with a total nasal aperture less than 11mm. CNPAS may occur in isolation or it may be a sign of other developmental abnormalities such as holoprosencephaly, anterior pituitary abnormalities, or encephalocele. Some physical features of holoprosencephaly include closely spaced eyes, facial clefts, a single maxillary mega incisor, microcephaly, nasal malformations, and brain abnormalities (i.e. incomplete separation of the cerebral hemispheres, absent corpus callosum, and pituitary hormone deficiencies). It is important to rule out other associated abnormalities to ensure optimal treatment and intervention. Conservative treatment of CNPAS includes humidification, nasal steroids, nasal decongestants and reflux control. Failure of conservative treatment defined by respiratory or feeding difficulty necessitates more aggressive intervention. The most definitive treatment for CNPAS is surgical intervention to enlarge the pyriform apertures. Contributors: Adam Johnson MD, PhD Abby Nolder MD

Endoscopic Management of a Type IV Branchial Cleft Anomaly

Trans-oral endoscopic approach to exposure of a type IV branchial cleft anomaly sinus tract in the left piriform recess and closure using cauterization and tisseel application. Co-author: Yi-Chun Carol Liu

Mandibular Distraction for Micrognathia in a Neonate

Introduction Patients with Pierre-Robin Sequence (PRS) suffer from micrognathia, glossoptosis, and upper airway obstruction, which is sometimes associated with cleft palate and feeding issues. To overcome these symptoms in our full-term male neonate patient with PRS, mandibular distraction osteogenesis was performed. Methods The patient was intubated after airway endoscopy. A submandibular incision was carried down to the mandible. A distractor was modified to fit the osteotomy site that we marked, and its pin was pulled through an infrauricular incision. Screws secured the plates and the osteotomy was performed. The mandible was distracted 1.8 mm daily for twelve days. Results During distraction, the patient worked with speech therapy. Eventually, he adequately fed orally. He showed no further glossoptosis or obstruction after distraction was completed. Conclusion In our experience, mandibular distraction is a successful way to avoid a surgical airway and promote oral feeding in children with PRS and obstructive symptoms. By: Ravi W Sun, BE Surgeons: Megan M Gaffey, MD Adam B Johnson, MD, PhD Larry D Hartzell, MD Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA Arkansas Children's Hospital, Little Rock, AR, USA Recruited by: Gresham T Richter, MD

Excision of Macrocystic Lymphatic Malformation

Introduction Lymphatic malformations (LM) are composed of dilated, abnormal lymphatic vessels classified as macrocystic (single or multiple cysts >2 cm3), microcystic (<2 cm3), or mixed. This patient is a 5-month-old with a right neck mass consistent with macrocystic lymphatic malformation on MRI. This low-flow vascular malformation required surgical intervention. Methods The site was marked in a natural skin crease. Subplatysmal flaps were raised and malformation was immediately encountered. Blunt soft tissue dissection was performed immediately adjacent to the mass to reflect tissue off the fluid-filled lesion. Neurovascular structures were preserved in this process. Mass was removed in total and Penrose drain and neck dressing were placed. Results A complete resection was performed. LM was confirmed on pathology. Patient is doing well with no deficits noted. The drain was removed after 1 week. One-month follow-up showed no recurrence. Conclusion Macrocystic lymphatic malformations are amenable to surgical resection at low risk and without recurrence. By: Ravi W Sun, BE Surgeons: Luke T Small, MD Gresham Richter, MD Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA Arkansas Children's Hospital, Little Rock, AR, USA Recruited by: Gresham T Richter, MD

Tympanoplasty with tragal cartilage graft, postauricular approach

Tympanoplasty with tragal cartilage graft, postauricular approach Blake Hollowoa, Michael Kubala, Gresham Richter. Introduction Tympanic membrane (TM) perforations arise from multiple conditions including acute otitis media, barotrauma, chronic eustachian tube dysfunction, or as a complication of pressure equalization (PE) tube insertion. Most perforations heal spontaneously or with conservative measures such as ototopical drops and dry ear precautions. Perforations that do not heal can lead to conductive hearing loss, chronic infection, or cholesteatoma. A 6-year-old patient with a persistent TM perforation presented with otalgia and otorrhea. A tympanoplasty with a tragal cartilage graft was performed to repair the patient’s TM perforation. Methods The patient was intubated and the operation carried out under general anesthesia. Facial electrodes were inserted for facial nerve monitoring. The patient was prepped and draped in sterile fashion. The external canal was suctioned and irrigated. A tragal incision was then made to harvest a 1 cm piece of cartilage for the TM graft. The tragal incision was closed with monocryl suture. A postauricular incision was made in the natural skin crease to expose the posterior canal. Canal incisions were made to enter the external canal. A tympanomeatal flap was elevated until the middle ear was entered. The previously harvested tragal cartilage graft was inserted medial to the native TM perforation. Gel-Foam was inserted medial to the graft for support. Tragal perichondrium was inserted lateral to the tragal cartilage graft. Gel-Foam was then inserted lateral to the graft for support. The periosteum and postauricular incision were closed with vicryl suture. The external canal was inspected, then antibiotic ointment and an ear wick was inserted. The patient was dressed using a Glasscock dressing. Results The patient was discharged the same day and seen in clinic two weeks from his surgery. The incisions were healing well with no indications of infection or wound dehiscence. His pain was resolved and an appointment for formal audiology was scheduled for a 3-month follow-up visit. Conclusion Tympanoplasty with a tragal cartilage graft using a postauricular approach is a successful method to surgically correct persistent tympanic membrane perforations.

Total Tonsillectomy

Total Tonsillectomy Sarah Maurrasse MD, Vikash Modi MD Weill Cornell Medicine, Department of Otolaryngology Tonsillectomy is one of the most common surgical procedures performed in children. The two main indications for tonsillectomy are sleep disordered breathing and recurrent infections, both of which are common in the pediatric population. This video includes 1) a detailed introduction including relevant anatomy 2) a discussion of the indications for total tonsillectomy 3) surgical videos and diagrams to explain the steps of the surgical procedure and 4) an explanation of possible post-operative complications.

Partial Tonsillectomy

Partial Tonsillectomy Sarah Maurrasse MD, Vikash Modi MD Weill Cornell Medicine, Department of Otolaryngology Tonsillectomy is one of the most common surgical procedures performed in children. The main indication for partial tonsillectomy is sleep disordered breathing, which includes a spectrum of disorders from primary snoring to obstructive sleep apnea (OSA). This video includes 1) figures of the anatomy relevant to partial tonsillectomy 2) a discussion of the indications for partial tonsillectomy and 3) surgical videos and diagrams that explain the steps of the surgical procedure.

Snare Tonsillectomy

Tonsillectomy is one of the most common surgeries performed today, yet debate continues regarding the best technique to avoid complications. We’ll review one method in this video, snare tonsillectomy, which is a "cold" technique. We'll discuss it's advantages over other methods, and a step-by-step instructional video.

Intraoperative Injection of Methylene Blue Dyed Fibrin Glue For 2nd Branchial Cleft Fistula Excision

The following video depicts the excision of a 2nd branchial cleft fistula in a 12-month-old male. Fibrin glue dyed with methylene blue was used to assist with following the fistula tract to ensure complete excision of the lesion. Branchial cleft anomalies include fistulae, sinuses and cysts and most commonly occur in the lateral neck arising from the second branchial cleft. The patient may be completely asymptomatic, mildly affected or continuously impacted by the lesion. Recurrent inflammation, infections, drainage, and pain are common symptoms associated with these congenital anomalies. Surgery is the standard of care and recommended to alleviate symptoms, but recurrence rates are high, particularly if excision is incomplete. Methylene blue has been used to assist with complete excision of these lesions, but has several key drawbacks including spillage into nearby tissues, incompletely highlighting the lesion, and making the pathological examination more challenging due to significant tissue staining. The addition of fibrin glue to the methylene blue enables for the lesion to be well visualized with the dye without spilling into the adjacent tissue, and thereby reducing the risk of damaging nearby structures. The mixture also allows for efficient pathological examination for correct post-operative confirmation of the diagnosis.

Combined drainage of subperiosteal orbital abscess complicating ethmoiditis

A 4 year-old boy presented to our tertiary center with acute left ethmoiditis and a subperiosteal orbital abscess. He presented with exophtalmia but had no visual impairment or limitation of ocular mobility. CT-scan found a 8 mm large subperiosteal orbital abscess with no further complications. Surgery was decided using a combined approach to drain the abscess and to obtain a bacterial sample: first external (incision in the inner canthus area) and then endonasal (functional endoscopic sinus surgery - FESS) to open the middle meatus and ethmoid. External approach: 10 mm incision in the inner canthus region, elevation of the lamina papyracea periosteum until the abscess was reached. Rubber drain was put in place for irrigation. Endonasal approach: after careful CT-scan examination, endonasal surgery was performed with a 30° rigid endoscope. The middle turbinate was medialised to expose the middle meatus, uncinectomy and antrostomy followed by anterior and posterior ethmoidectomy was performed. Antibiotics were given intravenously for 5 days and saline irrigation on the drain was performed during 2 days. Patient was discharged after 5 days.

Grade 1 Microtia Repair Using Autologous Auricular Cartilage Transfer

The goal of auricular reconstruction is to achieve a natural appearance of the reconstructed side with a form that resembles the normal ear and endures over a lifetime. For severe deformities in which major cartilaginous elements are missing, established reconstructive techniques using alloplastic constructs wrapped in temporoparietal fascia or carved costal cartilage grafts may be employed. For cases of minor deformity in which all named cartilaginous components are present, albeit deficient compared to the normal side, transfer of autologous auricular skin and cartilage may be used to achieve symmetry between normal and abnormal ears. This video presents the surgical technique and results of a grade 1 microtia reconstruction using autologous auricular cartilage transfer. This two-stage method of reconstruction avoids the use of autologous rib or alloplastic materials and often avoids the use of skin grafting altogether.

Excision of Macrocystic Lymphatic Malformation

This patient is a 9-month-old with a macrocystic lymphatic malformation (LM) of the left neck. LMs, the second most common type of head and neck vascular malformation, are composed of dilated, abnormal lymphatic vessels thought to occur due to abnormal development of the lymphatic system. A complete resection was performed, and LM was confirmed by pathology. Soft tissue dissection was performed immediately adjacent to the mass to reflect tissue off the fluid-filled lesion. Neurovascular structures were preserved in this process.

Endoscopic Repair of Type IIIB Posterior Laryngeal Cleft

We present a case of a type IIIB posterior laryngeal cleft treated successfully with endoscopic repair.

Excision of Lymphatic Malformation of Tongue

The patient was then nasotracheally intubated, prepped and draped in sterile fashion and the tongue injected with 2 cc lidocaine with epi. Bovie was used to incise lesion in ellipse down to its base which was sent for pathology. A tongue stitch was used for traction. Hemostasis was also achieved with Bovie. The site was closed primarily with vicryl, deep and superficial. Bipolar was used to treat small surface lesions. All instrumentation was then removed and the patient was turned back over to anesthesia, awakened, and transferred to the recovery room extubated in stable condition.

Extended Partial Cricotracheal resection with thyrotracheal anastomosis in Grade IV subglottic stenosis with posterior glottic involvement

The video goes over the steps of an extended partial Cricotracheal resection in a 8 year old child with Grade 4 subglottic stenosis with posterior glottis involvement.

Management of subglottic stenosis with endoscopic stent placement

History of airway stenosis, s/p laryngotracheal reconstruction. Developed restenosis, and balloon dilated three times.

In this video we describe our technique for airway stent insertion and its securing to the neck skin.

Balloon dilation of the airway expanded the airway to its appropriate size. After sizing, an 8mm modified Mehta laryngeal stent with rings (Hood Laboratories, Pembroke, Mass., USA)is inserted in the airway with laryngeal forceps. The scope is inserted into the stent to verify its position. Then a 2.0 prolene stitch is taken through the neck, trachea, stent, and taken out through the contralateral skin. This is performed under visualization with a 2.3mm endoscope through the stent. The needle is then re-inserted through the exit puncture and again taken out next to the entry puncture after passing through a subcutaneous tunnel, without re-entering the stent. A small skin incision is performed between the two prolene threads. Multiple knots are taken over an angiocath, which is then buried under the skin.

The stent is taken out 2-6 weeks after the procedure. A neck incision is performed, the angiocath is identified, the knot is cut and the stent is removed under the vision of the endoscope.

Congenital Cholesteatoma - Endaural Approach Tympanoplasty

N/A

How to Perform Salivary Gland Massage: Instructional Video

Title: How to perform a salivary gland massage - an instructional video Delaney Sheehan, MS; David Thompson, MS; Brittany Foret, MS; Michael Olejniczak, MS; Rohan R. Walvekar, MD* *Corresponding and Senior Author MS - Medical Student Louisiana State University Health Sciences Center, Department of Otolaryngology Head & Neck Surgery, New Orleans, LA 70112 Introduction: Education is a vital component to patient compliance. Salivary gland conditions like sialadenitis, dry mouth and postoperative protocols for sialendoscopy procedures among other procedures on the salivary glands often require a protocol of salivary gland massage; which forms a vital part of salivary gland hygiene i.e. salivary gland massage, hydration and sialogogues. In our search, we did not find a specific educational video demonstrating salivary gland massage. Funding: No external funding. Methods: The Ear Nose and Throat Interest Group at Louisiana State University Health Sciences Center in New Orleans under the supervision of senior author compiled the patient education and instructional video. Summary: Educational video on salivary gland massage is a way to disseminate a resource that can be easily accessed by patients and can be helpful in standardizing technique and also compliance.

Primary Repair of Unilateral Complete Cleft Lip and Nose Deformities

The following video demonstrates the author's method for repairing wide unilateral complete cleft lip and cleft nasal deformities. Details of surgical markings as well as nuances of technique are demonstrated. Video documentation of immediate results as well as progress of healing over the following year are included.

Transoral incision and drainage of retropharyngeal abscess.

Authors: Matthew Kim, Vikash Modi. This is a demonstration of transoral incision and drainage of retropharyngeal abscess in a 5-year-old male who presented with fever and neck stiffness. An initial CT scan with intravenous contrast showed retropharyngeal edema without organized abscess. A repeat scan 4 days later revealed a peripherally enhancing, multi-loculated hypodense collection centered in the left retropharyngeal space. After induction of general anesthesia and orotracheal intubation with a 4.5 cuffed oral RAE endotracheal tube, the patient is placed in suspension with a Crowe-Davis mouth gag. The abscess forms a noticeable bulge in the posterior pharyngeal wall. A flexible suction catheter is passed through the right nasal cavity and used to retract the soft palate and uvula to maximize exposure. After retracting the tonsillar pillars laterally with a Hurd elevator, a Beaver 6400 mini blade is used to make a vertical incision in the pharyngeal mucosa centered over the abscess. There is immediate return of purulence – a culture swab is used to obtain a sample for microbiological testing. A Yankauer suction bluntly enlarges the opening while simultaneously suctioning out purulent debris. The incision is widened superiorly and inferiorly with curved Metzenbaum scissors. Spreading the instrument vertically minimizes risk of vascular injury. An Adson clamp is then used to bluntly explore the abscess cavity laterally and superiorly. Further purulent drainage is expressed. The abscess cavity is further explored and widened with digital dissection. The abscess cavity is copiously irrigated with saline. After confirming hemostasis, the patient was extubated uneventfully. He was started on an oral diet immediately after surgery and discharged the following day.

Pediatric Tracheostomy

The following video demonstrates the authors' method for performing a tracheostomy in a pediatric patient. Details of important anatomical landmarks and surgical technique are demonstrated in the video. Authors: Chrystal Lau, BA. University of Arkansas for Medical Sciences. Brad Stone, BA. University of Arkansas for Medical Sciences. Austin DeHart, MD. Arkansas Children's Hospital. Michael Kubala, MD. University of Arkansas for Medical Sciences. Gresham Richter, MD. Arkansas Children's Hospital.

Inferior Turbinate Trim

Basic Info: A 14-year-old male presented with chronic nasal obstruction and awake stertor. It was discovered that the patient had severe bilateral turbinate hypertrophy. A trial of Flonase and antihistamine was attempted with no improvement. It was recommended that the patient undergo a bilateral nasal turbinate reduction. This procedure is displayed step-wise in the video. Introduction: Chronic nasal obstruction can be caused by inferior turbinate hypertrophy. This video portrays a surgical treatment for turbinate hypertrophy, a turbinate trim with a microdebrider blade. Methods: An Afrin pledget was inserted into each nostril and lidocaine was injected into each inferior turbinate. Each turbinate was medially fractured using a freer. The microdebrider blade was used to trim the inferior 1/3 of each turbinate. A freer was used to out-fracture each inferior turbinate. Afrin pledgets were inserted into each nostril for hemostasis. Results: The inferior one-third of each inferior turbinate was removed via a microdebrider. Patient was sent to recovery in good condition, and Afrin pledgets were removed in recovery once hemostasis was achieved. No adverse reactions were reported by the surgeon or patient. Conclusion: Chronic nasal obstruction can be significantly improved by an inferior turbinate trim and out-fracture. Author: Merit Turner, BS, BS Surgeon: Gresham T. Richter, MD Institutions: Department of Otolaryngology-Head and Neck Surgery, Arkansas Children’s Hospital, Little Rock, AR University of Arkansas for Medical Sciences, Little Rock, AR

Excision of Thyroglossal Duct Cyst (Sistrunk Procedure)

This video demonstrates an excision of a thyroglossal duct cyst with special focus on 1) using the thyrohyoid membrane as a landmark and 2) dissection of the posterior hyoid space, which is the space between the thyrohyoid membrane and the posterior surface of the hyoid bone. Contributors: John Maddalozzo MD, FAAP, FACS; Monica Herron, MPAS, PA-C; Sarah Maurrasse, MD; Jesse Arseneau (editor) Ann & Robert H. Lurie Children's Hospital of Chicago

Saccular Cyst Marsupialization and Ventriculotomy

We present a case of a saccular cyst managed initially with marsupialization followed by ventriculotomy for recurrence.

Transoral Robotic Surgery (TORS) Excision of a Base of Tongue Venolymphatic Malformation in a Pediatric Patient

This video demonstrates successful Transoral Robotic Surgery (TORS) excision of a large, midline, base of tongue venolymphatic malformation after pre-operative embolization in a 6-year-old boy.

Microlaryngoscopy, Bronchoscopy + Supraglottoplasty in COVID-19 Era

This video demonstrates microlaryngoscopy, bronchoscopy (MLB) + supraglottoplasty in a three-month old male with laryngomalacia, with a special focus on appropriate personal protection equipment (PPE) and safe surgical considerations in the setting of a COVID-19 status unknown patient.

Treatment of Chronic Atelectatic Middle Ear with Endoscopic Placement of Cartilage Shield T-tube

Chronic tympanic membrane (TM) atelectasis is a difficult condition with many management challenges and currently has no acceptable gold standard treatment. TM atelectasis is the loss of the normal elasticity of the TM as a result of chronic negative pressure in the middle ear and can be associated with retraction pockets. The under-ventilation of the middle ear and TM retraction can cause ossicular erosion, hearing loss, or cholesteatoma formation. Atelectasis can be halted or reversed with placement of pressure equalization tube (PET). Cartilage tympanoplasty with or without PET has been reported as the preferred material likely due to its higher mechanical stability under negative pressure changes within the middle ear, in addition to its resistance to resorption. This video demonstrates the feasibility of a minimally invasive endoscopic approach of cartilage shield T-tube tympanoplasty as a treatment of chronic TM atelectasis.

Preauricular Pit/Cyst Excision

This video demonstrates the excision of a preauricular pit/cyst in a pediatric patient. John Maddalozzo, MD Sarah Maurrasse, MD Johanna Wickemeyer, MD Sneha Giri, MD Division of Pediatric Otolaryngology-Head & Neck Surgery Ann & Robert H. Lurie Children's Hospital of Chicago

Closure of H-type tracheoesophageal fistula

We present the case of a 20 months old boy with developmental delay and chromosomal abnormality, who presented with a history of chronic aspiration. He was found to have a laryngeal cleft, which was injected with Prolaryn, then formally repaired, twice. Despite an initial a negative swallow study, the patient had persistent aspiration. A repeat direct laryngoscopy and bronchoscopy finally revealed the presence of an H-type tracheoesophageal fistula (TEF). We describe here the steps of the surgical repair of an H-type tracheoesophageal fistula.

Endoscopic resection of a vallecular cyst in a pediatric patient

Base of tongue masses are rare in the pediatric population, when present they can be remain asymptomatic for years or can cause acute respiratory distress. The differential diagnosis includes dermoid, vallecular cyst, thyroglossal duct cyst, lingual thyroid, lymphangioma, hemangioma, and teratoma (1). Vallecular cysts consist of mucus filled cysts or pseudocysts arising either from the mucosa on the lingual surface of the epiglottis or on the base of tongue (2). These benign mucous retention cysts most commonly present as stridor, difficulty feeding, respiratory distress but they can also remain asymptomatic and can be found incidentally (3,4). Vallecular cysts may occur in isolation, but they can be associated with laryngomalacia and GERD in a significant number of patients(5). Initial screening of the airway is done using flexible fiberoptic laryngoscopy which provides a quick assessment of the larynx and visualization of the cyst(6). Imaging (ultrasonography, CT, MRI) can also be useful for evaluation of the mass and more detailed visualization of the mass and surrounding structures(6). Conservative medical treatment is not adequate for the management of vallecular cysts. Several surgical options have been described, these include aspiration, transoral endoscopic excision, marsupialization and deroofing with CO2 laser or microdebrider (6). There is a high recurrence rate when simple aspiration is performed (7), and there is reported risk of recurrence with marsupialization techniques. Excision using transoral endoscopic technique ensures complete resection with adequate visualization and preservation of surrounding structures and mucosa with low risk of recurrence (4). Here, we describe transoral endoscopic approach for excision of base of tongue cyst in a 3 year-old female. The patient presented with the diagnosis of PFAPA and she was seen to discuss tonsillectomy and adenoidectomy. On physical exam, a 1.5 cm midline base of tongue cyst was seen when she protruded her tongue. The cyst had been increasing in size. Plan was to proceed with tonsillectomy & adenoidectomy and excision of base of tongue cyst. After informed consent was obtained, the patient was brought to the operating room and placed supine on the operating table. Correct patient and procedure were identified and general anesthesia by mask was induced. A laryngeal mask airway was placed first. A red rubber catheter was placed through the left nostril after the Davis mouth gag was inserted with a small tongue blade. The soft palate and uvula were palpated to be normal. The adenoid was mildly enlarged and was cauterized completely with suction cautery. Following that, Afrin was placed in the nasal cavity. The child was intubated with a nasotracheal tube through her left nostril that allowed for exposure. A red rubber catheter was left in her right nostril. The side-biting mouth gag was used. Two separate 2-0 silk sutures were placed in the midline to retract her tongue. A 30-degree telescope was used for visualization of the base of tongue cyst. With the Hurd elevator and other means of retraction, an extended Colorado needle tip with a 45 degree bend at the distal portion, was used to completely remove the base of tongue cyst which was quite deep. At the distal part, there was mucus seen, but the cyst was completely excised. The wound was irrigated thoroughly. There was no bleeding. The side-biting mouth gag was removed and the Davis mouth gag reinserted. A complete tonsillectomy was then performed. She was then extubated without difficulty in the OR and transferred to PACU. Patient was discharged on oxycodone and amoxicillin. On her follow up visits, the oral cavity and tongue were healing well with no evidence of recurrence. Pathology result: consistent with extravasation mucocele. Mucin filled cystic space rimmed by a lympho-histiocytic reaction and granulation tissue. Minor salivary glands w/ dilated ducts focally surrounded by chronic inflammation are present in the surrounding fibromuscular tissue.

How to perform a Tracheostomy on an infant

Authors Gilberto Eduardo Marrugo Pardo Titular professor, Department of Otorhinolaryngology, Universidad Nacional de Colombia, Bogotá, Colombia. Fundación hospital de la misericordia. gemarrugop@unal.edu.co JuanSebastián Parra Charris Department of Otorhinolaryngology, Universidad Nacional de Colombia, Bogotá, Colombia jusparrach@unal.edu.co    

Base of Tongue Reduction: Endoscopic Approach vs. Transoral Robotic Surgical Approach

The video demonstrates successful endoscopic coblation of lingual tonsils and residual palatine tonsils as well as successful TORS reduction of obstructive base of tongue tissue.

Lip Pit Excision

This video shows a pediatric patient with Van der Woude syndrome. He has lip pits that are classic for this syndrome and his family desired surgical correction. This video outlines and shows the steps of the modified simple excision technique as well as discussing tips for a successful surgery.

Non-surgical management: Taping of the Lop Ear

Lop ear is a type of congenital external ear deformation with folding over of the upper third of the ear. Children are often bullied for these noticeable anomalies. Successful management depends on early initiation and parental persistence. We present a nonsurgical, easily replicable and cost-effective method using a dental wax splint secured with steri-strips. This video can be used as an adjunct for telehealth appointments in parent education to reduce delay in treatment and to promote therapy maintenance.

Supraglottoplasty and Epiglottopexy for Sleep-Variant Laryngomalacia

Here we present a 6-year-old girl with sleep-variant laryngomalacia treated successfully with endoscopic epiglottopexy and supraglottoplasty. Johanna L. Wickemeyer, MD1 Sarah E. Maurrasse, MD2,3 Douglas R. Johnston, MD, FACS2,3 Dana M. Thompson, MD, MS, FACS2,3 1Department of Otolaryngology—Head & Neck Surgery, University of Illinois—Chicago, 1855 West Taylor Street, Chicago, IL 60612 2Division of Pediatric Otolaryngology—Head and Neck Surgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL 60611 3Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611

Superficial Parotidectomy for a First Branchial Cleft Cyst

This video demonstrates a superficial parotidectomy approach for the excision of a first branchial cleft cyst in a pediatric patient. This particular patient was a 4-year-old girl who presented with intermittent swelling in the region of the left parotid. On MRI, she was found to have a lobular mass consistent with a first branchial cleft cyst. Here we outline the steps of the recommended surgical procedure. Authors: Sarah Maurrasse, MD1,2; Monica Herron, MPAS, PA-C1; John Maddalozzo MD, FAAP, FACS1,2 Editors: Sarah Maurrasse1,2; Jesse Arseneau1 Voiceover: Vidal Maurrasse 1Ann & Robert H. Lurie Children's Hospital of Chicago 2Northwestern University Feinberg School of Medicine

Successful Placement of Transcutaneous Bone Anchored Hearing Aid in a Pediatric Patient

The Osia System is a transcutaneous bone anchored hearing aid which can be used for the correction of both conductive and sensorineural hearing loss. This video depicts the implantation of the Osia in a pediatric patient with a history of right-sided microtia.

Transcervical Epiglottopexy for management of Type 3 Laryngomalacia

Type 3 Laryngomalacia (LM) is characterized by prolapse of the epiglottis into the airway. Endolaryngeal suturing is technically challenging considering the limited exposure. In the present article we describe a simple technique of Transcervical Epiglottopexy (TE) via an exo-endolaryngeal technique, using an 18-gauge needle prethreathed with a 2-0 prolene suture in a looped fashion inserted through the inferior epiglottis. Another 20 G needle with a 2-0 prolene suture, with one free end is inserted above the previous stitch through the superior epiglottis. The single stitch is passed through the looped stitch, which is then pulled through the neck, leaving a single stitch precisely placed through the epiglottis. We have used this technique safely while achieving epiglottopexy in 3 cases of epiglottic prolapse. We describe a method of Transcervical Epiglottopexy using easily available instruments. This method we believe can easily be adapted for any kind of epiglottic prolapse.

Tongue Reduction (Partial Glossectomy) for Pediatric Macroglossia

This video demonstrates how to perform a tongue reduction using a Y-V advancement technique for pediatric macroglossia.

Myringotomy and Tympanostomy Tube (Ear Tube) Placement

This video demonstrates the required instruments, appropriate set-up, relevant anatomy, and procedural steps for ear tube placement. Sarah Maurrasse, MD; Erik Waldman, MD Yale School of Medicine, Yale New Haven Children's Hospital

Pediatric Laryngeal Reinnervation with Ansa Cervicalis to Recurrent Laryngeal Nerve Anastomosis

Unilateral vocal fold paralysis in children has many different etiologies that can result in difficulties with breathing, swallowing, or phonation. Depending on the severity of symptoms, treatment modalities range from non-surgical interventions, to temporary surgical procedures, or more permanent surgical options. Laryngeal reinnervation has been demonstrated as an appropriate treatment option for children with permanent laryngeal nerve damage and persistent symptoms, but it still not widely performed among pediatric otolaryngologists. In this case, we present a 6 year-old female patient who developed unilateral vocal fold paralysis from a cardiac procedure as an infant, and she subsequently underwent laryngeal reinnervation with ansa cervicalis-to-recurrent laryngeal nerve (ANSA-RLN) anastomosis. The patient tolerated the procedure well with no peri-operative complications and demonstrated symptomatic improvement in voice quality and swallowing at her 3 month follow-up appointment. The goal of this case is to demonstrate the steps of the laryngeal reinnervation procedure and acknowledge its importance as a treatment option for unilateral vocal fold paralysis in pediatric patients.

Authors:

Cori N Walker MD¹, Christopher Blake Sullivan MD¹, Sohit P Kanotra MD¹

Department of ¹Otolaryngology – Head and Neck Surgery

University of Iowa Hospitals and Clinics, Iowa City, IA, USA

Pre-operative marking for the Fisher technique in unilateral cleft lip repair

This video outlines the steps taken for pre-operative markings that need to be made prior to performing unilateral cleft lip repair using the Fisher anatomic subunit approximation technique. The technique has been written about in detail by Dr. David Fisher in his article "Unilateral Cleft Lip Repair: An Anatomical Subunit Approximation Technique". This video simply outlines the markings that are made prior to performing this technique, which are crucial for correctly carrying out the repair.

Endoscopic Repair of Unilateral Choanal Atresia

This video provides background information regarding the diagnosis and management of choanal atresia and demonstrates the endoscopic repair of a unilateral choanal atresia. Authors: Alexander Moushey1; Kiley Trott, MD2; Sarah E. Maurrasse, MD2 Voiceover: Vidal Maurrasse 1Yale School of Medicine, New Haven, CT 2Department of Surgery, Section of Pediatric Otolaryngology, Yale School of Medicine, Yale New Haven Children’s Hospital

Single Stage Laryngotracheal Reconstruction with Anterior Cartilage Graft

Single Stage Laryngotracheal Reconstruction with Anterior Cartilage Graft Leandro Socolovsky BA1, Rhea Singh BS1, Rajanya S. Petersson MS, MD1,2 1Virginia Commonwealth University School of Medicine, Richmond, VA 2Children’s Hospital of Richmond at VCU, Richmond, VA Overview This is a case of a 3-year-old male, former preterm infant born at 24 weeks with a past medical history of bronchopulmonary dysplasia and tracheomalacia status post tracheostomy for ventilator dependence. He had also developed subglottic stenosis from prolonged intubation. The patient was decannulated with grade 1 subglottic stenosis, and initially did well. However, over several months, the stoma remained fairly patent, prompting repeat direct laryngoscopy and bronchoscopy now demonstrating low grade 2 subglottic stenosis. The decision was made to proceed with laryngotracheal reconstruction with anterior rib cartilage graft, expanding the airway size from a 3.5 uncuffed endotracheal tube (ETT) to a 5.0 uncuffed ETT. The patient was transferred to the ICU and kept intubated and sedated until extubation on post-operative day 3. At 6 weeks postoperatively, direct laryngoscopy showed a well-mucosalized graft, with the airway still sized to a 5.0 ETT. Procedure details Direct laryngoscopy and bronchoscopy on the day of the reconstruction confirmed low grade 2 subglottic stenosis. The patient was intubated with a size 3.5 cuffed ETT for the procedure. Right rib cartilage harvest was performed after the endoscopic airway evaluation, followed by carving of the cartilage graft on the back table. The cartilage was carved into a modified tear drop shape to accommodate the tracheal stoma, with a length of 25mm and a width of 7mm. The intraluminal depth of the graft was sized to the bevel of a 15-blade. A fusiform incision was marked around the previous tracheostomy site. Scar tissue was dissected until the previous tracheostomy tract was clearly visualized and then excised. Once the patent tracheostomy was seen, the trachea and thyroid cartilage were skeletonized superiorly until the thyroid notch was reached. An incision site was marked from the superior aspect of the tracheostomy to the inferior border of the thyroid cartilage to avoid the anterior commissure. The marked incision site was then measured for confirmation of adequate sizing of graft, and confirmed to be 25 mm. A 15-blade was used to make the incision into the airway. An oral RAE tube was trimmed and placed at the inferior aspect of the tracheal incision, after the ETT was backed out, and ventilation continued through the modified oral RAE. The incision was then advanced into the inferior 2mm of the thyroid cartilage without performing laryngofissure, ensuring not to go through the anterior commissure. The patient was nasotracheally intubated with a 5.0 uncuffed ETT in preparation for graft placement, and the modified oral RAE was removed. The nasotracheal tube was advanced just beyond the graft site. The cartilage graft was placed using 4-0 Vicryl pop-off sutures on RB-1 needles in simple interrupted fashion. The sutures were first placed into the graft through the extraluminal side and coming out at the junction of the intraluminal depth and cartilage that would overlap the airway. Then the sutures were placed submucosally through the cartilaginous rings of the trachea, taking care to avoid entering the airway lumen to prevent granulation tissue. A total of 8-12 sutures are typically placed, left untied, and tagged. The graft was then parachuted into position, and all sutures tied to ensure knots are squared. The wound was filled with saline, and a Valsalva at 20cm H2O was performed to ensure there was no air leak. The strap muscles were then loosely closed, and a split Penrose drain was placed with one limb under the strap muscles and the other subcutaneously. The skin was closed in layered fashion with 4-0 Monocryl deep inverted interrupted sutures and 5-0 Monocryl in a running subcuticular manner. The patient was kept intubated and sedated for 3 days per protocol for anterior graft at our institution. Extubation was performed in the pediatric intensive care unit on post-operative day 3. A bronchoscopy was performed through the nasotracheal tube, and the patient was extubated over the bronchoscope. The graft site was visualized on the way out, and noted to be intact, mucosalizing, and without granulation tissue.and ensure it is intact. Humidified support was given via a nasal cannula following extubation. At 6 weeks postoperatively a direct laryngoscopy was performed, noting well-mucosalized graft, and airway still sized to a 5.0 uncuffed ETT. Indications/contraindications for single stage anterior cartilage graft reconstruction Indications Subglottic stenosis (SGS); high grade 1 to grade 2 SGS, failed decannulation for lower grade SGS, suprastomal collapse Proximal tracheal stenosis Other potential indications for rib cartilage grafting (with or without posterior grafting): Glottic stenosis Tracheal stenosis Vocal cord paralysis Laryngeal web Relative Contraindications Ventilator dependence Acute upper or lower respiratory tract infection Untreated concurrent airway obstruction (vocal cord paralysis, tracheomalacia, bronchopulmonary dysplasia, adenotonsillar hypertrophy, choanal atresia) Congestive heart failure (>30% oxygen requirements, weight < 1500g) Instrumentation Setup Patient placed supine with shoulder roll with head facing the anesthesia team. The neck and right anterior chest are prepped and draped in sterile fashion. If tracheostomy tube is present, modified cut down oral RAE, is sewn to chest wall opposite the planned cartilage donor site The anesthesia circuit is placed under sterile drapes in a manner to allow access by the anesthesia team during the procedure Preoperative workup Endoscopic examination of supraglottis, glottis, subglottis, trachea, and bronchi to confirm location of obstruction or stenosis and identify any other lesions or airway concerns. True vocal fold mobility is assessed and palpation of cricoarytenoid joint is performed to determine integrity of posterior glottis. Laryngopharyngeal reflux control may be considered prior to surgery. Discussion and communication with anesthesiologist before, during, and after the case to ensure smooth transitions between airways and during transport to the PICU. Weighted nasogastric feeding tube, if not already present, should be placed prior to beginning procedure, especially if posterior graft is planned. Anatomy and Landmarks Strap musculature Hyoid bone Thyroid cartilage Cricoid cartilage Proximal trachea Advantages Single stage procedure does not require decannulation at later date. Single stage allows for reconstructing the potentially weak area of the anterior tracheal wall at the trach site itself. Disadvantages For single stage procedure patients must be intubated and sedated in an intensive care unit for graft stenting for an adequate period of time. This requires sedation and occasionally paralysis, depending on the patient. Typically, the intubation is 3 days at our institution, but can be up to 5 for anterior grafting. Complications/risks Bleeding, infection, reaction to anesthesia, abnormal scarring, granulation, need for further procedures Graft dislodgement or failure Need for tracheostomy Pneumonia Pneumothorax Vocal cord injury if laryngofissure is performed

Endoscopic Assisted Aural Atresia Repair

Congenital aural atresia (CAA) is a birth defect that describes both aplasia and hypoplasia or stenosis of the external auditory canal (EAC). CAA can be associated with microtia (malformation of the pinna), middle ear and occasionally inner ear malformations. Surgical correction of CAA is a very challenging operation and requires a thorough knowledge of the surgical anatomy of the facial nerve, middle and inner ears. Traditional post-auricular approach or transcanal approach with the help of a microscope usually provides adequate images needed for the procedure. Endosocpic ear surgery provides the advantage of visualization beyond the view provided by the microscope, further refinement of the surgical approach, precise assessment of the ossicular chain mobility and placement of ossicular chain prosthesis if necessary.

Closed Nasal Reduction

Closed nasal reductions are the standard of care for displaced nasal bone fractures. Reduction should occur within 3 weeks of the initial injury, but after swelling has subsided. The success rate is 60-90% in uncomplicated cases, however 6-17% of patients will require a future septorhinoplasty. This procedure was performed under general anesthesia.

Flash Pulse Dye Laser (595nm) Therapy on Facial Capillary Malformation

This video teaches its viewers about facial capillary malformations, possible sequelae, as well as a treatment option, flash pulse dye laser. Authors: Maya Merriweather, BS and Richter T. Gresham, MD FACS Email: mmerriweather@uams.edu and GTRichter@uams.edu Institutions: University of Arkansas for Medical Sciences and Arkansas Children's Hospital

Nasopharyngeal Papillomatosis- A combined Transnasal Transoral Coblation Assisted Approach

Title: Nasopharyngeal Papillomatosis- A combined trans nasal transoral coblation assisted approach Authors - 1. Dr Deepa Shivnani- corresponding author MBBS, DNB Otolaryngology , MNAMS, Fellowship in Pediatric Otolaryngology Children’s Airway & Swallowing Center Manipal Hospital, Bangalore , India email- deepa.shivnani14@gmail.com 2. Dr E V Raman MBBS, DLO , MS Otorhinolaryngology Children’s Airway & Swallowing Center Manipal Hospital, Bangalore Here I am presenting a case of 16 yrs old boy, who had nasal block and occasional cough. Nasal endoscopy revealed an exophytic papillomatous growth in the nasopharynx. MRI showed lesion arising from the nasopharyngeal surface of the soft palate. The lesion was free from the posterior pharyngeal wall. The patient was taken up for the procedure under general anaesthesia. The transoral approach was followed first. The tissue was taken for histopathological examination followed by a traction suture placed over uvula for better visualisation. Once exposed, coblation device was used transorally with 45 degree hopkins rod transorally. The tissue was ablated with coblation and coagulation settings of 9:5 respectively. The base was ablated too, to prevent further recurrence. Tonsillar pillar retractor was then used for better visualisation and exposure. The coblation was then continued. The tissue was removed transorally as much as possible then trans nasal approach was performed. Then, the same coblation device with the same setting was used but the nasal endoscope was changed to O degree Pediatric scope due to space constraints. The lesion was pushed upward with the help of yankaurs suction tip for better exposure and the remaining tissue was removed with the help of same coblation device. The lesion was excised completely and successfully with minimal blood loss. The operative area was confirmed with the 70Degree hopkins rod for complete removal of the lesion. Post operative recovery was uneventful. Combined transoral trans nasal coblation assisted approach is potential to be safer, easier and less invasive than uvulo palato pharyngoplasty in Pediatric age group specially, in the areas which are difficult to access like nasopharyngeal surface of the soft palate what we showed in this video.

Transoral Incision and Drainage of a Massive Retropharyngeal Abscess Involving the Danger Space

Retropharyngeal (RP) abscesses are uncommon yet serious sequala of pediatric head and neck infections. The RP space extends from the skull-base to the carina and is located between the buccopharyngeal fascia, alar fascia, and the carotid sheaths. Immediately deep to this, anterior to the prevertebral fascia, is the “danger space,” allowing infection to spread into the thorax and mediastinum. We present the use of a transoral incision, and suction assisted evacuation for managing a massive RPA with danger space extension. Our patient, a 19 months-old previously healthy female, presented with 10 days of progressive congestion, cough, and fever. Evaluation demonstrated a toxic stridorous child. Chest radiograph demonstrated significant superior mediastinal widening. Subsequent contrasted CT imaging demonstrated a large, rim-enhancing, RP fluid collection extending from the neck to the carina with tracheoesophageal compression and mediastinitis. The patient was taken urgently the OR for drainage. Following bronchoscopy and intubation, a mouth gag was used to expose the RP. Parasagittal incision was made with immediate expression of high volume purulent material. Hemostat dissection was performed to disrupt loculations and extrinsic neck compression was used to evacuate the abscess. To access the deepest components, an eight French tracheal suction catheter was passed to assist with decompression of the mediastinal components until no further material could be evacuated. Copious irrigation was performed and the incision was left open. The patient was kept intubated for 48 hours, before uneventful extubation.

Incomplete Cleft Palate Repair: Von Langenbeck Converted to Two-flap Palatoplasty with Furlow Double Opposing Z-Plasty

Title: Incomplete Cleft Palate Repair: Von Langenbeck Converted to Two-flap Palatoplasty with Furlow Double Opposing Z-Plasty Authors: Nima Vahidi, MD1; Nilan Vaghjiani, BS1; Rajanya Petersson, MS, MD1,2 1Virginia Commonwealth University School of Medicine, Richmond, VA 2Children Hospital of Richmond at VCU, Richmond, VA Overview: 10-month-old male with 18q deletion syndrome, Pierre Robin sequence (cleft palate, glossoptosis, and micrognathia), eustachian tube dysfunction, cardiac disease including ASD, VSD and WPW, pulmonary hypertension, as well as tracheostomy and G-tube dependence. In preoperative evaluation he was noted to have an incomplete cleft palate involving the hard and soft palate. He was noted to have bilateral eustachian tube dysfunction with effusions present. After discussion with family decision was made to proceed with surgical intervention.

Nasal Dermoid Cyst Excision

This is a case of an 8 month old with a midline nasal mass present since birth. Preoperative physical exam and imaging was consistent with a nasal dermoid cyst with no evidence of intracranial extension.

Use of CO2 laser in preparation for cochlear implant via round window

Use of CO2 laser in preparation for cochlear implant via round window

ENDOSCOPIC CARTILAGE MYRINGOPLASTY

This video demonstrates the use of the endoscope in cartilage myringoplasty. DOI# http://dx.doi.org/10.17797/gz02921q1s

Laryngeal Papillomatosis with Microlaryngoscopy and Bronchoscopy with Microdebridement, CO2 Laser Ablation, and Cidofovir Injections.

Anna Celeste Gibson, B.S., Mariah Small, M.D., Gresham Richter, M.D. University of Arkansas for Medical Sciences, Arkansas Children's Hospital Introduction: A papilloma is a benign tumor that is caused by human papillomavirus (HPV) commonly due to the strains 6 and 11. Children acquire these tumors intrapartum from an infected mother. HPV infects natural and metaplastic squamous mucosa which is the type of epithelium that lines the vocal folds. Tumors present as numerous, verrucous outgrowths from the mucosa and can become symptomatic due to mass effect. Common symptoms include hoarseness, dysphonia, aphonia and most concerning, respiratory distress. A 7-year-old patient with dysphonia secondary to laryngeal papillomatosis also known as recurrent respiratory papillomatosis undergoes microlaryngoscopy and bronchoscopy with microdebridement, CO2 laser ablation, and cidofovir injections. Methods: The patient underwent spontaneous ventilation anesthesia and a dental guard was placed. The patient was positioned for microlaryngoscopy and the larynx was visualized and anesthetized with topical lidocaine. A zero-degree Hopkins rods was passed through the supraglottis, glottis and subglottis to document findings. There was supraglottic papillomatosis notably of the laryngeal surface of the left epiglottis, papillomatosis of the bilateral false vocal folds and papillomatosis of the bilateral true vocal folds with right more affected than left and anterior commissure involvement. The scope was then withdrawn and reintroduced to perform bronchoscopy. The scope was advanced through the trachea, carina and primary and secondary bronchi bilaterally. All were within normal limits. The Benjamin-Lindholm laryngoscope was passed into the vallecula and larynx and suspended in a normal fashion. The zero-degree Hopkins rod was used to visualize the larynx. 2 cc of 1% lidocaine with 1:100,000 epinephrine was injected into the bulk of the papillomas and then several biopsies were taken from this area. The microdebrider was used to debulk these areas. Protective eyewear was used by everyone in the operating room. The patient's face was protected with water soaked towels and all oxygen sources were removed from the patient. The CO2 laser was set to 2 watts continuous and used to debulk the papillomas with eschar noted after each application. Care was taken to avoid injury to the deep elements of the true vocal folds. Any residual papillomas at the anterior vocal folds were then injected with 1 cc of cidofovir. All instrumentation was removed, the patient was extubated, awakened, and transferred to the recovery room. Results: The patient was discharged the same day without complications. He will follow up for revision microdebridement, CO2 laser ablation and cidofovir injections. Conclusion: Microlaryngoscopy and bronchoscopy with microdebridement, CO2 laser ablation, and cidofovir injections is a successful solution for laryngeal papillomatosis and has been proven to eradicate the disease in many cases.

Direct Laryngoscopy and Bronchoscopy: Purpose & Setup

This video is an introduction to operative direct laryngoscopy and bronchoscopy (DLB) and will demonstrate 1) How to set up the equipment for a safe and comprehensive DLB and 2) How to assemble a rigid bronchoscope. Authors: Alexander Moushey1; Taher Valika, MD2; Erik H. Waldman, MD3; Sarah E. Maurrasse, MD3 Voiceover: Vidal Maurrasse 1Yale School of Medicine, New Haven, CT 2Department of Surgery, Division of Pediatric Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine 3Department of Surgery, Section of Pediatric Otolaryngology, Yale School of Medicine, Yale New Haven Children’s Hospital

Direct Laryngoscopy and Bronchoscopy: Performing a Diagnostic Exam

This video is an introduction to operative direct laryngoscopy and bronchoscopy (DLB) and demonstrates how to perform a safe and comprehensive exam in the operating room. Authors: Alexander Moushey1; Taher Valika, MD2; Erik H. Waldman, MD3; Sarah E. Maurrasse, MD3 Voiceover: Vidal Maurrasse 1Yale School of Medicine, New Haven, CT 2Department of Surgery, Division of Pediatric Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine 3Department of Surgery, Section of Pediatric Otolaryngology, Yale School of Medicine, Yale New Haven Children’s Hospital

Branchial Cleft Cyst Excision

Branchial cleft cysts are a benign anomaly caused by incomplete obliteration of a primordial branchial cleft.  They typically appear in childhood or adolescence, but can appear at any age. They present as a non-tender, fluctuant mass following an upper respiratory infection, most commonly at the anterior border of the sternocleidomastoid muscle. These lesions are thought to originate during the 4th week of gestation when the branchial arches fail to fuse. The second branchial cleft is the most common site (95%) and cysts from in this distribution can affect cranial nerves VII, IX, and XII. 

Endoscopic Nd:Yag and Bleomycin Injection for the management of a Hypopharyngeal Venous Malformation

Venous malformations (VM) are congenital lesions, frequently affecting the head and neck, with poor respect for tissue planes. Established treatments include observation, sclerotherapy, laser, and surgical resection.1 Lesions affecting the upper airways present unique challenge due to frequent unresectability and difficult access/exposure for alternative standard treatments. We describe our approach of standard endoscopic airway techniques for the administration of advanced treatment modalities including simultaneous laser and sclerotherapy for an extensive airway VM. Our patient is a 16-year-old female with an extensive multi-spatial VM with associated airway obstruction. The patient suffered from severe obstructive sleep apnea (OSA) and continuous positive airway pressure (CPAP) dependence as a result of airway compression. Direct laryngoscopy and bronchoscopy demonstrated extensive venous staining and large vascular channels of the hypopharynx. Lumenis Nd:Yag laser (Yokneam, Israel) via 550 micron fiber was passed under telescopic visualization. Treatment via previously described “polka dot” technique was performed (15W, 0.5 pulse duration) with immediate tissue response. The largest vascular channel was accessed via 25-gauge butterfly needle. Immediate return of blood following lesion puncture confirmed intralesional placement. Reconstituted bleomycin (1 U/kg; max dose = 15 U per treatment) was injected and hemostasis achieved with afrin pledgets. The patient was intubated overnight. She was extubated the next morning and advanced to a regular diet, discharging post-operative day two. Post-operative flexible laryngoscopy demonstrated significant improvement in the treatment areas, and follow up sleep study demonstrated sleep apnea resolution with liberation of her CPAP therapy.

Selective Stapedial tendon and Tensor Tympani tenotomy for the treatment of Middle Ear Myoclonus in a pediatric patient

Objective tinnitus is a rare phenomenon whereby a patient perceives sound in the absence of external auditory stimuli, that is also observed by the examiner. Unlike subjective tinnitus which is thought to be somatosensory and usually difficult to cure, objective tinnitus is more likely to have an identifiable cause amenable to treatment. The differential for objective tinnitus includes aberrant vascular anatomy affecting the temporal bone, patulous eustachian tube function, and abnormal myoclonic activity of the palatal or middle ear muscles.1 We present a 16-year-old female who presented for evaluation of objective tinnitus. On physical examination, an intermittent rhythmic clicking was identified. Visualization of both the tympanic membrane and palate during active audible tinnitus was observed and found to be normal. A hearing test was performed demonstrating normal hearing and speech thresholds as well as normal tympanogram. Acoustic reflex testing demonstrated absent decay in both ears and spontaneous discharge for the right ear in response to both high and very low stimulus indicating abnormal stapedial and tensor tympani function. MRA demonstrated normal vascular anatomy and MRI was obtained demonstrating normal anatomy without lesions of the brainstem, cochleovestibular nerves, or ear or mastoid pathology. The patients was subsequently diagnosed with isolated middle ear myocolonus (MEM). Treatment options including medical versus surgical therapy were discussed as has previously been described. The patient ultimately elected for surgical tenotomy of the stapedial and tensor tympani tendons. Using endoscopic technique, a middle ear exploration was performed. Canal injection was performed with standard tympanomeatal flap elevation was assisted with epinephrine pledgets. The Annular ligament was identified and the middle ear was entered. Additional dissections was performed superiorly, and the chorda tympani nerve was identified and preserved. The stapedial tendon was visualized emanating from the pyramidal eminence to the posterior crus of the stapes. Balluci scissors were used to sharply incise the tendon and the remaining ends were reflected using a Rosen needle to prevent re-anastamosis. Additional dissection along the malleus was performed to gain access to the tensor tympani tendon. A 30 degree angled endoscope was utilized to visualize the tensor tympani tendon extending forward from the cochleariform process to the neck of the malleus. The angled 6400 Beaver blade was used to sharply incise the tendon, requiring multiple passess due to the thickness of the tendon. The sharply incised ends of both tendons were clearly visualized. The tympanomeatal flap was re draped and secured with gel foam packing. The patient was seen in follow up three weeks post operatively with a well healed ear drum, resolution of her objective tinnitus, normal hearing, and absent stapedial reflexes. The patient and mother were happy. Endoscopic stapedial and tensor tympani tenotomy is a feasible technique for isolated MEM in the pediatric population.

Gerald B. Healy, M.D., FACS, FRCSI, FRCS

• Professor of Otolaryngology – Head and Neck Surgery, Harvard Medical School
• Past President, American College of Surgeons
• The Healy Chair in Otolaryngology (Emeritus)
• Otolaryngologist-in-Chief (Emeritus), Children’s Hospital, Boston
• Surgeon-in-chief (Emeritus), Children’s Hospital, Boston

Gerald B. Healy, M.D., was born in Boston, Massachusetts and received his undergraduate degree with honors from Boston College in 1963 and his M.D. degree from Boston University in 1967. He is the emeritus Surgeon-in-Chief and the emeritus Gerald B. Healy Chair in Otolaryngology at Children’s Hospital Boston. Dr. Healy is Professor of Otology and Laryngology at Harvard Medical School.

Dr. Healy is a member of numerous honorary societies, including the American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, the Triological Society, the American Laryngological Association, the American Society of Pediatric Otolaryngology and the American Society of Head and Neck Surgery. He has served as President of the Massachusetts Chapter of the American College of Surgeons, the American Society of Pediatric Otolaryngology, the American Bronchoesopagological Association, and the Triological Society (the leading academic society in the specialty of Otolaryngology-Head and Neck Surgery). He has served as Secretary and President of the American Laryngological Association. He is an Honorary Fellow of the Royal College of Surgeons of Ireland and the Royal College of Surgeons of England. He has served as a Chairman of the Board of Regents of the American College of Surgeons and is a past-President of the College. He was the first Otolaryngologist to be elected President. Presently Dr. Healy is a Senior Fellow at the Institute for Healthcare Improvement, Cambridge, Massachusetts.

In 1986, Dr. Healy was elected to the Board of Directors of the American Board of Otolaryngology and served as its Executive Vice-President until 2004. He has also served as a Director of the American Board of Emergency Medicine. He served as a member of the Board of Registration in Medicine in Massachusetts through 2014.

Dr. Healy served as a former Trustee of the Boston Children’s Hospital and Boystown in Omaha, Nebraska.

An active scholar and lecturer, Dr. Healy is the author of several books and book chapters and/or monographs, and is extensively published in peer-reviewed journals. He has been the principal investigator of NIH funded research addressing diseases affecting infants and children and has been cited for his pioneering work with laser surgery in children. In addition he has lectured in North America, Asia and Europe on health care reform, patient safety, the need to restructure medical education and international medical collaboration.

Cleft Lip Revision: Tips and Tricks

Attendees will learn various tips and tricks to a successful cleft lip revision procedure. There will be a Q&A session to address common challenges and how to address them.

Course Directors

Panelists

Alveolar Bone Graft Surgery: Tips and Tricks

This webinar will focus on the surgical management of alveolar clefts with bone grafting and fistula closure. Our panel of experts will share various techniques and graft source materials including tips and tricks learned along the way. Our guest moderator will lead a panel discussion at the end of the session to discuss some of the controversies and key points in alveolar grafting.

Pediatric Endoscopic Airway Surgery

This webinar will address common and advanced pediatric airway pathology. There will be a focus on video demonstration of advanced surgical endoscopic management of pediatric airway pathology ranging from laryngomalacia to type 3 laryngeal clefts.

Vikash K. Modi, MD, is an Associate Professor and the Chief of Pediatric Otolaryngology - Head & Neck Surgery at New York Presbyterian Hospital- Weill Cornell Medical Center. After receiving his medical degree from the Rutgers Medical School, Dr. Modi completed his residency in Otolaryngology at the University of Southern California - Keck School of Medicine. Following residency, Dr. Modi completed a Pediatric Otolaryngology fellowship at Northwestern University - Children's Memorial Hospital. He founded the Cornell Aerodigestive Center and has one of the largest series of endoscopic posterior cricoid split with rib grafting (presented at ESPO). He also has presented his work on endoscopic repair of laryngeal clefts at ASPO and CEORL. He has been inducted as a Fellow, into the prestigious Triological Society for his thesis paper on airway balloon dilation and currently serves as a Section Editor-Video Editor of The Laryngoscope and is known for his surgical endoscopic airway videos.

Augmented Balloon Dilation with Dr. Michael Rutter

In partnership with our colleagues at Bryan Medical (www.bryanmedical.net), this next installation of CSurgeries’ series on laryngology features Dr. Michael Rutter, Director of UC’s Aerodigestive Center and Professor of Pediatrics, as he presents his approach to Augmented Balloon Dilation. Dr. Rutter will share video content of previous cases along with detailed commentary on his approach.

Dr. Michael Rutter is an ENT surgeon specializing in pediatric otolaryngology with an emphasis on airway problems in children, adolescents and young adults. His interests include tracheal reconstruction and complex airway surgery. Dr. Rutter was honored to receive the 2016 Gabriel Frederick Tucker Award from the American Laryngological Association, and the 2018 Sylvan Stool Teaching Award from the Society for Ear Nose and Throat Advancement in Children (SENTAC). These awards are for his contributions to the field of pediatric laryngology.

Cleft Primary and Revision Rhinoplasty: Tips and Tricks

Tune in for the latest in our series on Cleft Surgery featuring Dr. Raj Vyas from UC Irvine and Dr. Usama Hamdan with the Global Smile Foundation. The discussion will focus on making sure that attendees know proper procedures as well as common complications and how to avoid them.

Larry Hartzell, MD FAAP is an Associate Professor of Otolaryngology Head and Neck Surgery at Arkansas Children’s Hospital. He is the Director of the Pediatric Otolaryngology fellowship. Dr Hartzell also has been the Cleft Team Director in Arkansas since 2012. He is passionate about international humanitarian mission work and dedicates much of his research efforts to cleft surgical and clinical care as well as velopharyngeal insufficiency. Dr Hartzell is actively involved in multiple academic societies and organizations including the AAO-HNS and ACPA.

Dr. Goudy is a professor at Emory University School of Medicine and the director of the division of otolaryngology at Children’s Healthcare in Atlanta. Dr. Goudy’s clinical job involves repair of craniofacial malformations including cleft lip, cleft palate, and Pierre Robin sequence, and he also participates in head and neck tumor resection and reconstruction.

Dr. Hamdan is President and Co-Founder of Global Smile Foundation, a 501C3 Boston-based non-profit foundation that provides comprehensive and integrated pro bono cleft care for underserved patients throughout the world. He has been involved with outreach cleft programs for over three decades. Dr. Hamdan is an Otolaryngologist/Facial Plastic Surgeon with former university appointments at Harvard Medical School, Tufts University School of Medicine and Boston University School of Medicine. For his philanthropic service to the people of Ecuador, he was awarded the Knighthood, “Al Merito Atahualpa” En El Grado De Caballero, by the President of Ecuador in March 2005. He received Honorary Professorship at Universidad de Especialidades Espíritu Santo, School of Medicine, in Ecuador on March 5, 2015 for his contributions in the field of Cleft Lip and Palate.

Dr. Vyas obtained his BS from Stanford and his MD from UCLA before completing integrated plastic surgery residency at Harvard and a fellowship in Craniofacial Surgery at NYU. He is an active clinician, scientist and educator with over 200 peer-reviewed publications and presentations, 20 book chapters, dozens of invited lectures, and multiple NIH and foundational grants. Dr. Vyas is passionate about advancing knowledge and skill for cleft care worldwide, partnering with Global Smile Foundation as both a clinician and Director of Research.

After completing a pediatric craniofacial fellowship at Boston Children’s Hospital, he joined the Division of Plastic and Reconstructive Surgery at Washington University in St. Louis 2011. He is Director of Craniofacial and Medical Director of the Operating Rooms at Saint Louis Children’s Hospital (SLCH). He treats patients with craniosynostosis or other craniofacial abnormalities (congenital or traumatic). He obtained a Master of Science in Clinical Investigation in May 2017 at Washington University to advance his ability to perform high quality clinical research and this program allows him to take advantage of the tremendous resources available for faculty and residents. His research focus is in craniofacial with particular interest in craniosynostosis and cleft lip and palate.

Dr. David Yates MD, DMD, FACS is passionate about serving children with Cranial and Facial deformities and Cleft Lip and Palate. He is a Board Certified Oral and Maxillofacial Surgeon and was recently awarded the inaugural “Physician of the Year” award by El Paso Children’s Hospital. He is the Division Chief of Cranial and Facial Surgery at El Paso Children’s Hospital and has been critical in bringing complex craniofacial surgery to the region. In addition to being a partner with High Desert Oral and Facial Surgery, he directs the craniofacial clinic at El Paso Children’s Hospital and the craniofacial clinic at Providence Memorial Hospital. He has also been integral in starting a clinic for children with Cleft Lip and Palate in Juarez, Mexico at the Hospital De La Familia (FEMAP). He is now happily settled with his wife and four kids serving the greater El Paso/Las Cruces/Juarez region.

The Ins and Outs of Medical Research & Publication

The International Journal of Medical Students and CSurgeries have come together to provide and exclusive inside scoop on the world of medical publications. They will review how to properly research and submit an article along with selecting the best journal to publish through.

Meet our Course Directors!

The International Airway Symposium is coming up on February 4th & 5th. For more information view the itinerary or register here!

Dr. Guri Sandhu

Chief of Service and Professor of Laryngology

Imperial College London

Prof Sandhu founded the National Centre for Airway Reconstruction in the UK. This is one of the largest adult airway services in Europe. He has extensively researched the numerous causes and treatments for laryngotracheal stenosis and manages these patients with a multidisciplinary approach. He has co-produced three textbooks of Laryngology with one on the subject of laryngotracheal stenosis. He is currently the President of the British Laryngological Association.

Dr. Julina Ongkasuwan

Director of the Pediatric Voice Clinic

Texas Children’s Hospital

Dr. Ongkasuwan is the Director of the Pediatric Voice Clinic at Texas Children’s Hospital. She is dual fellowship trained in both Pediatric Otolaryngology and Laryngology. When she joined the faculty in 2011, she founded the Texas Children’s Hospital Aerodigestive Program and the Swallow Disorders Clinic. Dr. Ongkasuwan’s clinical and research focus is voice, airway, and swallowing disorders in both adults and children with particular interest in the management of vocal fold movement impairment.

Dr. Chadwan Al Yaghchi

Consultant Laryngologist & ENT Surgeon

Imperial College Healthcare NHS Trust

Mr Chadwan Al Yaghchi is a consultant laryngologist at the National Centre for Airway Reconstruction with a specialist interest in airway stenosis, transgender voice and dysphagia. In addition to his adult service, he is an honorary consultant at The Royal Brompton and Harefield NHS Foundation Trust where he manages children with complex airway, respiratory and swallowing conditions. He holds a PhD in Molecular Oncology from Queen Mary’s University of London.

Meet our Presenters for Day 2!

The International Adult Airway Symposium is coming up this weekend! For more information view the itinerary or register here!

Dr. Vyvy Young

Associate Professor and the Associate Residency Program Director in the Department of Otolaryngology-Head and Neck Surgery

University of California – San Francisco

VyVy Young, MD, is an Associate Professor and the Associate Residency Program Director in the Department of Otolaryngology-Head and Neck Surgery at the University of California – San Francisco. Dr. Young received her undergraduate and medical degrees from the University of Louisville, in Louisville, Kentucky, where she also pursued her Otolaryngology training. She then completed a fellowship in Laryngology and Care of the Professional Voice at the University of Pittsburgh Voice Center. She currently serves the American Academy of Otolaryngology – Head and Neck Surgery as member of the Annual Meeting Program Committee and Executive Committee for ENThealth.org. She is immediate past-chair of the Voice Committee and the Women in Otolaryngology Communications Committee and was recently selected as chair of the Finance and Audit Committee of the American Broncho-Esophagological Association.

Justin Roe, PhD, FRCSLT

Clinical Service Lead - Speech and Language Therapy – National Centre for Airway Reconstruction

Imperial College Healthcare NHS Trust

Dr. Roe is a clinical-academic and service lead, specialising in dysphagia in benign and malignant head and neck disease. He leads the speech and language therapy service for the National Centre for Airway Reconstruction at Imperial College Healthcare NHS Trust and is a consultant and service lead at the Royal Marsden NHS Foundation Trust. He is an Honorary Clinical Senior Lecturer at Imperial College London and an investigator on a number of NIHR portfolio studies. He is currently on an NIHR Imperial Biomedical Research Centre/ Imperial Health Charity funded post-doctoral research fellowship. He is an elected council member for the British Laryngological Association and British Association of Head and Neck Oncologists.

Professor Anil Patel MBBS PhD FRCA

Clinical Anaesthetist / Chairman of Department of Anaesthesia

Royal National ENT & Eastman Dental Hospital

Professor Anil Patel graduated from University College London in 1991. He is a clinical anaesthetist and continues to develop and refine the largest experience of anaesthetising adult airway patients under general anaesthesia (> 6,000 procedures) in the UK, probably Europe and possibly the world. His research interests include all aspects of shared airway and difficult airway management. Professor Patel has been an invited speaker to over 300 national and international meetings in 38 countries. He has over 130+ peer reviewed publications, 25 book chapters, over 4,500 citations and an h-index of 25.

Robbi A. Kupfer, MD

Associate Professor, Department of Otolaryngology-Head & Neck Surgery

University of Michigan

Dr. Kupfer is an Associate Professor of Otolaryngology-Head & Neck Surgery at the University of Michigan who specializes in Laryngology and Bronchoesophagology. She is the Program Director for the Laryngology Fellowship as well as the Otolaryngology Residency at the University of Michigan.

Alexander T. Hillel, MD, FACS

Associate Professor

Johns Hopkins University School of Medicine

Dr. Alexander Hillel is a Laryngologist, Residency Program Director, and Vice Director of Education in the Johns Hopkins Department of Otolaryngology – Head & Neck Surgery. His clinical practice and research centers on the treatment, prevention, and causes of laryngotracheal stenosis (LTS).

Dale Ekbom, MD

Associate Professor of Otolaryngology / Director of Voice Disorders/Laryngology

Mayo Clinic

Residency in Otolaryngology/Head and Neck Surgery at the University of Michigan with a fellowship in Laryngology/Care of the Professional Voice at Vanderbilt University Medical Center. Clinically specializing in voice, especially management of vocal fold paralysis, Zenker’s diverticulum and Cricopharyngeal muscle dysfunction, early laryngeal cancer, and airway compromise due to laryngeal, subglottic, and tracheal stenosis. Research interests include idiopathic subglottic stenosis and GPA with surgical and medical management of the airway, vocal fold paralysis, new injectables using Jellyfish collagen.

Dr. Ricky Thakrar

Consultant Chest Physician

University College London Hospital

Dr. Ricky Thakrar qualified in Medicine from Imperial College London. He trained in Respiratory Medicine at the Royal Brompton Hospital and completed his training in Northwest London. He was appointed to a three-year academic fellowship at UCL where his PhD examined state of the art bronchoscopy techniques for managing cancers arising in central airways and lung. He is a Consultant in Thoracic Medicine and his main interests are in interventional bronchoscopy procedures (laser resection, airway stenting, cryotherapy, photodynamic therapy and brachytherapy) for pre-malignant and malignant disease of the tracheobronchial tree.

Dr. Michael Rutter

Director of the Aerodigestive Center

Cincinnati Children's Hospital

Dr. Rutter is an ENT surgeon specializing in pediatric otolaryngology with an emphasis on airway problems in children, adolescents and young adults. His interests include tracheal reconstruction and complex airway surgery. Always a problem-solver, he strives to involve the patient in their own care by having them help evaluate the issue and then craft a solution together. He was drawn to his career by the challenge and highly individualized nature of pediatric airway problems and management. Dr. Rutter enjoys working in a multidisciplinary team setting and focusing on coordinated care for complex childhood airway conditions. He was honored to receive the 2016 Gabriel Frederick Tucker Award from the American Laryngological Association, and the 2018 Sylvan Stool Teaching Award from the Society for Ear Nose and Throat Advancement in Children (SENTAC). These awards are for his contributions to the field of pediatric laryngology. In addition to caring for patients, he is also dedicated to his research trying to find improvements in airway management.

Christopher T. Wootten, MD, MMHC

Director, Pediatric Otolaryngology—Head and Neck Surgery

Vanderbilt University Medical Center

Dr. Wootten has a longstanding interest in surgical management of congenital and acquired airway disorders.  To better equip himself to lead the Pediatric ENT service through expansion, evolution of practice models, and differentiation into multidisciplinary care, Dr. Wootten obtained a Masters of Management in Health Care at Vanderbilt’s Owen School of Business in 2017.  Areas of his professional research emphasis include airway obstruction in children and adults and aerodigestive care. He innovates minimally invasive surgical techniques in the head and neck.  Dr. Wootten is actively investigating the role of eosinophil and mast cell-based inflammation in the pediatric larynx.

Karla O'Dell, M.D.

Assistant Professor / Co-director

USC Voice Center, Caruso Department of Otolaryngology Head and Neck Surgery @ University of Southern California / USC Center for Airway Intervention and Reconstruction

Karla O’Dell, MD, specializes in head and neck surgery and disorders of the voice, airway and swallowing. She is cofounder and codirector of the USC Airway Intervention & Reconstruction Center (USC Air Center).

Jeanne L. Hatcher, MD, FACS

Co-Director of the Emory Voice Center and Associate Professor of Otolaryngology

Emory University School of Medicine

Dr. Hatcher has been at Emory since 2014 after completing her laryngology fellowship with Dr. Blake Simpson; she specializes in open and endoscopic airway surgery as well as voice disorders. Dr. Hatcher is a member of the ABEA and post-graduate member of the ALA and also serves on the Ethics and Voice Committees for the American Academy of Otolaryngology Head and Neck Surgery.

Mr. Lee Aspland

Patient / Freelance Artist

Lee Aspland Photography

Lee Aspland is a photographer, author and mindful practitioner who creates photography that reflects his feelings about living in such a glorious world. He specializes in Mindful Photography, capturing a fleeting feeling or thought, a hope or fear, a frozen single moment in time.

Gemma Clunie, MSc, BA (Hon), MRCSLT

Clinical Specialist Speech-Language Pathologist (Airways/ENT) and HEE/NIHR Clinical Doctoral Research Fellow

Imperial College Healthcare NHS Trust/ Imperial College London, Department of Surgery & Cancer

Gemma is a Clinical Specialist Speech and Language Therapist with an interest in voice and swallowing disorders that is particularly focused on the benign ENT, head and neck, respiratory and critical care populations. Gemma is a current NIHR/HEE Clinical Doctoral Research Fellow at Imperial College London. Her PhD studies focus on the voice and swallowing difficulties of airway stenosis patients. She is based at Charing Cross Hospital in London where she has worked for the last six years as part of the National Centre for Airway Reconstruction, Europe’s largest centre for the management of airway disorders.

Niall C. Anderson, CPsychol, MSc, BSc

Lead Psychologist (formerly Respiratory Highly Specialist Health Psychologist)

Bart's Health NHS Trust (formerly Central & North West London NHS Foundation Trust)

Niall is a HCPC Registered & BPS Chartered Practitioner Health Psychologist, and BPS RAPPS Registered Supervisor. Niall has specialist experience of working within healthcare systems with people with long-term health conditions at all system levels to support physical, psychological and social wellbeing. Niall worked in the Airway Service at Charing Cross Hospital (London, UK) between January-December 2021 in order to develop and implement the Airway Psychology Service.

Introducing our presenters for the upcoming Cleft Lip Revision webinar!

This webinar comes as the latest in a long line of installments dealing with the Cleft Palate. In this session, attendees will learn various tips and tricks to a successful cleft lip revision procedure. There will be a Q&A session to discuss common challenges and how to address them.

Meet the Course Directors

Meet the Presenters

Introducing our IPAS Course Directors!

The 2022 International Pediatric Airway Symposium is coming up in two weeks! It's time to meet the people responsible for pulling together such an amazing group of surgeons: Our Course Directors!