Hypoglossal Nerve Stimulator Implantation: 2-Incision Technique

Hypoglossal Nerve Stimulator Implantation: 2-Incision Technique Authors: Cheryl Yu, MD1; Nilan Vaghjiani, BS1; Ryan Nord, MD1 1Virginia Commonwealth University School of Medicine, Department of Otolaryngology/ Head and Neck Surgery, Richmond, VA 

Background: 

Obstructive sleep apnea is a worldwide health problem that affects all groups. Given its systemic associations with comorbid diseases, it ultimately increases lifetime risk of mortality and thus, should not be a disorder taken lightly. Although continuous positive airway pressure is thoroughly acknowledged as the gold standard for treating OSA with studied efficacy, adherence remains challenge. Given such, hypoglossal nerve stimulation therapy presents a revolutionary alternative for those with moderate to severe degrees of OSA who are unable to tolerate standard CPAP therapy. It has been studied to be very efficacious in treating the disorder, with reductions in apneas up to 70-80%. The surgery itself is less invasive, now even more so with the 2-incision technique, when compared to other surgical options such as mandibular advancement or other upper airway surgery, with decreased post-operative pain and healing times. Adherence to therapy is generally superior as the majority prefer it over traditional positive airway pressure therapy.  Overall, hypoglossal nerve stimulator implantation is an effective, tolerable long-term alternative treatment option for those with OSA. 

Case Overview: 84-year-old female with BMI of 31 with past medical history significant for hypertension, atrial fibrillation, and obstructive sleep apnea and inability to tolerate CPAP. Polysomnography revealed severe OSA with an AHI of 33 and minimal central or mixed apneas. Preoperative drug induced sleep endoscopy was performed noting complete anterior-posterior collapse of the velum, no collapse at the oropharynx, complete anterior-posterior collapse of the tongue base, and no collapse at the epiglottis. Patient was subsequently deemed an appropriate candidate for hypoglossal nerve stimulator implantation and elected to proceed with the procedure. The following video demonstrates her hypoglossal nerve stimulator implantation via the 2-incision technique detailing the procedure's anatomic landmarks and corresponding steps.

Redo Posterior Fossa Decompression with Duraplasty for the Treatment of Chiari Type I Malformation

Chiari decompression is a common neurosurgical procedure. Chiari malformations present with a number of symptoms including Valsalva-induced headaches, swallowing dysfunction, and sleep apnea. Chiari malformations can also cause syringomyelia and syringobulbia. Surgical procedures used for the treatment of Chiari malformation include bone-only decompression (posterior fossa craniectomy +/- cervical laminectomy), craniectomy/laminectomy with duraplasty, and craniectomy/laminectomy/duraplasty with shrinkage or resection of the cerebellar tonsils. The procedure used depends on the specifics of the patient’s condition and the preference of the surgeon. The patient presented here had undergone a prior Chiari decompression at the age of 20 months. This was bone-only with posterior fossa craniectomy and C1-2 laminectomy. The dura was not opened due to the presence of a venous lake. He initially had improvement in his symptoms. However, his headaches and snoring recurred, balance worsened, and dysphagia never improved. Therefore, a repeat Chiari decompression at the age of 28 months was performed as presented here.

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.

Pediatric Robotic Epiglottopexy

This is a patient with persistant laryngomalacia with stridor and Obstructive sleep apnea at 3 years of age. A flexible laryngoscopy showed prolapse of epiglottis into the airway. The patient had nasotracheal intubation and a suture was place through the anterior tongue to pull it forward while a modified McIvor mouth gag was placed with a short blade to expose the tongue base and epiglottis. The DaVinci robot is then docked with a 30 degree forward lens. A 5mm maryland forceps and a 5 mm bovie is used.The epithelium off the tongue base and the lingual surface of epiglottis is then denuded with a bovie at a setting of 10 after this is done the epiglottis is sutured to the tongue base with a 4.0 vicryl suture. A total of two or three sutures are placed with 3-4 knots on each suture. The patient is extubated and monitered overnight with 2-3 doses of Steroids. DOI: http://dx.doi.org/10.17797/z6vqam37jc

Adenotonsillectomy: Basic Technique Using Electrocautery

Contributors: Deepak Mehta (Children's Hospital of Pittsburgh of UPMC) Purpose: Adenotonsillectomy is a procedure removing the tonsils and ablating the adenoids. Most commonly this is performed when the tonsils and adenoids have become obstructive, causing sleep disordered breathing or sleep apnea, or are recurrently or chronically infected. Key Instruments: McIvor mouth gag, Curved and Straight Allis clamps, Monopolar electrocautery with insulated blade set at 15W for removal, suction monopolar cautery set at 35 for adenoidectomy and 20 for cauterization of the tonsillar fossa. Anatomical Landmarks: Anterior and posterior pillars of the tonsil, vomer, torus tubarius of the Eustachian tube. Procedure: Tonsillectomy begins by placing the McIvor mouth gag into the oral cavity. The soft palate is palpated to assess for submucous cleft palate. One tonsil is grasped with the Allis clamp and retracted medially. This allows identification of the lateral extent of the tonsil. A mucosal incision is made at or slightly medial to the lateral extent and the fascial plane is entered between the tonsil and the pharyngeal musculature. Continuing in this plane throughout the dissection, the tonsil is effectively removed. The posterior pillar must be preserved. Hemostasis of the tonsillar fossa is achieved using the monopolar electrocautery. The contralateral tonsil is removed similarly. Monopolar adenoidectomy is performed using indirect mirror visualization of the adenoid tissue. Suction electrocautery is used to ablate the adenoid tissue up to the posterior choana and lateral to the torus tubarius. Conflict of Interest: None DOI: http://dx.doi.org/10.17797/xaqg93x7hy

Supraglottoplasty for Laryngomalacia (Cold Steel)

1. Purpose of Surgery: To alleviate upper airway obstruction secondary to laryngomalacia after failed medical management (twice daily proton pump inhbitor, reflux precautions). Indications for surgery are the following: failure to thrive, dysphagia, aspiration, cyanosis, sleep apnea, pulmonary hypertension, core pulmonale, pectus excavatum. Approximately 10% of children with laryngomalacia will meet criteria for surgery. 2. Instruments: Parson's laryngoscope, Medtronic MicroFrance Bouchayer Laryngeal instruments (heart shaped forceps, fine cup forceps, Micro Scissors curved right &left, micro suction), oxymetazoline soaked pledgelet 3. Landmarks: vallecula, epiglottis, aryepiglottic fold, cuneiform cartilage, interarytenoid space 4. Procedure: a. Larynx sprayed with topical 2% lidocaine. and a direct laryngoscopy and bronchoscopy is performed to rule out a synchronous airway lesions. b. Parson's laryngoscope placed in the vallecula and in suspension with the patient spontaneously breathing. Inhalational anesthesia is given through sideport of laryngoscope. c. If the aryepiglottic fold is shortened then it is divided with a curved micro scissor at its attachment to the epiglottis. Division proceeds until the epiglottis is released and it springs anteriorly. (Special care should be taken to not divide the pharyngoepiglottic fold). d. If the cuneiforms cartilage is prolapsing into the airway then it is grasped with a small cup forcep or heart shaped forcep and removed with a curved scissor making sure not to remove mucosa/tissue in the interarytenoid region. e. Hemostasis is achieved with an oxymetazoline soaked pledge let. f. Steps c, d, and e are repeated on the contralateral side. g. Patient remains extubated and transferred to the intensive care unit. Decadron 0.5mg/kg every 8 hours for 24 hours. Twice daily proton pump inhibitor and reflux precautions for at least 30 days and then weaned off. h. Clinical swallow evaluation is performed 4 hours postoperatively and patient resumes age appropriate diet. i. Flexible fiberoptic laryngoscopy is performed one week postoperatively. 5. Conflict of interest: none 6. References: none DOI#: http://dx.doi.org/10.17797/cb0bwa6ggv

Tonsillectomy Using Electrocautery

Contributors: Conor Smith (Arkansas Children's Hospital) and Gresham Richter M.d. (Arkansas Children's Hospital) The removal of tonsils is most often indicated by tonsillar hypertrophy contributing to obstructive sleep apnea or chronic/recurring throat infections from pathogens such as streptococcal bacteria. Electrocautery is the most commonly used technique to safely and effectively excavate the tonsils. DOI: http://dx.doi.org/10.17797/cb233d20mk

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

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.

Intracapsular tonsillectomy

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

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.

Submental Intubation

Presented is a case of submental intubation performed prior to maxillomandibular advancement for the treatment of obstructive sleep apnea. Submental intubation is a viable alternative to tracheostomy for cases in which nasal intubation is contraindicated (e.g. trauma), or uninterrupted access to the oral cavity is preferred. [1] Briefly, the technique consists of performing oral intubation, and then exteriorizing the endotracheal tube through a tract created from the floor of mouth to the submental triangle. At the end of the case, the tube can be passed into the oral cavity, returning to an oral intubation. Surgeon: Raj C. Dedhia, MD, MSCR, Department of Otolaryngology, Emory University School of Medicine Video Production: Clara Lee, MS4, Emory University School of Medicine

Internal Nasal Valve Stabilization

Dynamic internal nasal valve collapse is common form of nasal valve collapse that can be difficult to address surgically. There have been many surgical techniques described to stabilize and improve the function of the internal nasal valve. Our presented technique is a simple and reproducible surgical technique that has proved reliable in treatment of dynamic internal nasal valve collapse. This video clearly describes and demonstrates our internal nasal valve stabilization technique.

Robotic-assisted Base of Tongue Resection for Adult Sleep Apnea

A 52-year-old female presented for an evaluation for sleep apnea surgery. She complained of choking sensation at night. She had an AHI of 6.7 events per hour, a oxygen saturation nadir of 71%, and BMI of 30.6. She and a prior history of adenotonsillectomy as a child. Flexible examination in the office revealed grade 4 lingual tonsil hypertrophy. She was deemed a candidate for lingual tonsillectomy and was taken to the operating for robotic lingual tonsillectomy. The technique for adult lingual tonsillectomy is shown in step-by-step fashion with tips for good results both operatively and functionally learned from robotic surgery for cancer of the unknown primary origin. Contributors: Jessica Moskovitz, MD, Leila J. Mady, MD, PhD, MPH, Umamaheswar Duvvuri, MD, PhD

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.

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

Transpalatal Advancement Pharyngoplasty

The retropalatal airway is a common site of collapse in obstructive sleep apnea. Transpalatal advancement pharyngoplasty aims to address this site of upper airway collapse by advancing the soft palate anteriorly, increasing the cross-sectional area of the airway and decreasing pharyngeal collapsibility. Surgeon: Raj C. Dedhia1, MD, MSCR Video Production: Yifan Liu1,2, MD, Jason Yu1, MD 1 Perelman School of Medicine, Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania 2 Department of Otorhinolaryngology - Head and Neck, Affiliated Beijing Anzhen Hospital, Capital Medical University

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.

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.

Anand R. Kumar, MD, FACS, FAAP

Johns Hopkins University School of Medicine

• Associate Professor, Departments of Plastic Surgery and Pediatrics

Anand R. Kumar, MD, FACS, FAAP is an Associate Professor in the Departments of Plastic Surgery and Pediatrics at the Johns Hopkins University School of Medicine. A pediatric plastic/craniofacial surgeon and basic science researcher, he conducts investigation into the cellular biology of muscle derived progenitor cells as a source of pathologic heterotopic ossification and for novel regenerative medicine applications. His clinical practice focuses on craniofacial surgery including craniosynostosis, correction of hypertelorism(wide eyes), pediatric and adolescent facial skeletal deformities (Pierre Robin Sequence) with airway obstruction using traditional orthognathic (jaw) surgery and distraction osteogenesis.

Dr. Kumar established the center for facial skeletal surgery and the center for pediatric craniofacial surgery at the University of Pittsburgh Medical Center and now at Johns Hopkins respectively with an emphasis on multidisciplinary care for dentofacial anomalies. He has led efforts to improve outcomes in pediatric sleep apnea using skeletal surgery and distraction osteogenesis for multilevel airway obstruction. In addition, he has participated in multi-institutional trials for improvement of clinical outcomes in neonatal tongue base collapse (Pierre-Robin Sequence).

Dr. Kumar as authored over 30 original scientific publications in peer-reviewed journals and contributed to multiple plastic and orthopedic surgery textbooks over the last 10 years. He serves as a reviewer for many plastic surgery and basic science journals and has been invited as a speaker or panelist to many institutions and at organizational meetings across the United States. He currently serves as Vice President of Communications on the board of the American Society of Maxillofacial Surgeons (ASMS). In addition, he serves on multiple committees in the American Society of Plastic Surgeons and the ASMS.

As an honor student in the biological sciences at the University of California, Irvine, Dr. Kumar received his medical degree from the Albert Einstein College of Medicine. He completed his general surgery residency at the Mayo Clinic Rochester and later completed a second residency in plastic and reconstructive surgery at the University of California, Los Angeles (UCLA). He subsequently completed a pediatric plastic/craniofacial surgery fellowship after his residency at UCLA. In 2004, prior to his academic appointment, Dr. Kumar volunteered for military service and joined the United States Navy until 2010. In Bethesda, MD, he served as director and staff pediatric plastic surgeon of the Military Craniofacial Unit at Walter Reed National Military Medical Center. He served as division chief in plastic and reconstructive surgery at the National Naval Medical Center in Bethesda and on board the United States Naval Support Hospital Ship Comfort. In 2010, Dr. Kumar was recruited to the University of Pittsburgh as the director of facial skeletal surgery until 2013 when he was recruited to Johns Hopkins.

Eric Gantwerker MD MS MMSc (MedEd)

• Pediatric Otolaryngologist at Cohen Children’s Hospital at Northwell Health/Hofstra

Eric Gantwerker, MD, MS, MMSc(MedEd), FACS is a Pediatric Otolaryngologist at Cohen Children’s Hospital at Northwell Health/Hofstra, Associate Professor of Otolaryngology at Zucker School of Medicine at Hofstra/Northwell, and Vice President, MedicalDirector at Level Ex. He holds a Master of Medical Science (MMSc) in Medical Education with a special focus on educational technology, educational research, cognitive science of learning,and curriculum development from Harvard Medical School and a Master of Science in Physiology and Biophysics from Georgetown University. Previous Clinical Instructor at Harvard Medical School, Assistant Professor at UT Southwestern, and Associate Professor ofOtolaryngology and Medical Education at Loyola University Chicago Stritch School of Medicine. Dr. Gantwerker’s clinical focus includes complex aerodigestive disorders, airway reconstruction, children with tracheostomies, persistent obstructive sleep apnea, and quality improvement. His academic interests include professional development, educational technology and gaming, motivational theory, and the cognitive psychology of learning. He speaks nationally and internationally through invited lectureships and workshops on implementation of educational technologies and gaming, motivational theory, the cognitive psychology of learning, and putting theory into practice for health professions’ education.

Pathophysiology and Phenotypes of Sleep Apnea

Symposium of International Sleep Surgery
Day 1: Session 1

• What Causes OSA?
• Phenotypes
• Targeted Treatments Based on phenotypes

Advanced Pediatric Sleep Apnea Treatments

Symposium of International Sleep Surgery
Day 2: Session 4

• T&A Indications and Limitations
• Multilevel Surgery
• Laryngomalacia
• When to Treat, When to Wait?

Neurostimulation for Sleep Apnea

Symposium of International Sleep Surgery
Day 2: Session 3

• Current state of Hypoglossal Nerve Stimulation
• Devices Under Investigation
• Future of Neurostimulation

Multilevel Surgery for Sleep Apnea

Day 2: Session 2

• Role of the Nose
• Base of the Tongue Surgery
• Epiglottic and Hypopharynge Surgery
• Skeletal Surgery for OSA

Palatopharyngeal Procedures for Sleep Apnea and Snoring

Symposium of International Sleep Surgery
Day 2: Session 1

• In Office Palatal Procedures
• Expansion Palatopharyngoplasty
• Outcomes of Palatal Surgery (Snoring and OSA)

Advanced Salivary Endoscopy: Challenging Cases Diagnosis & Treatment

The advanced course will assume a basic understanding of the procedure. It will include complex interventions including endoscopic and combined open (transoral and external procedures), complications and management of complications, approach to revision surgery, in-office procedures, advanced radiology, and will include case studies.

Meet the Course Directors!

Rohan R. Walvekar, MD

Assistant Professor in Head Neck Surgery

University of Pittsburgh/VA Medical Center

Rohan R. Walvekar, MD, earned his doctoral degree from the University of Mumbai. After graduating in 1998, he completed a residency in Otolaryngology and Head Neck Surgery at the TN Medical College & BYL Nair Charitable Hospital, Mumbai, India, with triple honors. Subsequently, he completed two head neck surgery fellowships, and trained at at the Tata Memorial Hospital, Mumbai, which is India's most prestigious cancer institute. After completing an Advanced Head Neck Oncologic Surgery fellowship at the University of Pittsburgh, he became an Assistant Professor in Head Neck Surgery within the Department of Otolaryngology Head Neck Surgery at the University of Pittsburgh/VA Medical Center, prior to joining the LSU Health Sciences Center in July 2008. His clinical interests are head neck surgery and salivary endoscopy. His research interests include evaluating prognostic markers and clinical outcomes of head and neck cancer therapy and treatment of salivary gland disorders.

Barry M Schaitkin, MD

Professor of Otolaryngology

UPMC Pittsburgh

Dr. Schaitkin specializes in the treatment of inflammatory and neoplastic conditions of the salivary glands. He practices at UPMC in the Department of Otolaryngology and is affiliated with UPMC branches all across the city of Pittsburgh. He completed his medical degree and residency at Pennsylvania State University College of Medicine.

Meet the Presenters!

Jolie Chang, MD

Associate Professor, Chief of Sleep Surgery and General Otolaryngology

University of California, San Francisco

Dr. Chang specializes in sleep apnea surgery and minimally invasive approaches to the salivary duct with sialendoscopy. She has interest in studying patient reported outcomes after sialendoscopy procedures.

Mark Marzouk, MD

Clinical Associate Professor of Otolaryngology - Head and Neck Surgery

SUNY Upstate Medical University

Dr. Marzouk completed his residency training in 2010 from the UPMC Department of Otolaryngology. He is currently the Division Chief of Head and Neck Oncologic Surgery in Syracuse. He is also the Associate Program Director of Residency Programs.

David W. Eisele, MD. FACS

Andelot Professor and Director - Department of Otolaryngology-Head and Neck Surgery

Johns Hopkins University School of Medicine

Dr. Eisele is the Past-President of the American Board of Otolaryngology- Head and Neck Surgery and a member of the NCCN Head and Neck Cancer Panel. He has served as a member of the Residency Review Committee for Otolaryngology, as Chair of the Advisory Council for Otolaryngology - Head and Neck Surgery for the American College of Surgeons, President of the American Head and Neck Society, and as Vice-President of the Triological Society. He served as President of the Maryland Society of Otolaryngology and is a former Governor of the American College of Surgeons.

M. Boyd Gillespie, MD, MSc, FACS

Professor and Chair

UTHSC Otolaryngology-Head and Neck Surgery

M. Boyd Gillespie is Professor and Chair of Otolaryngology-Head & Neck Surgery at University of Tennessee Health Science Center. He is a graduate of the Johns Hopkins University School of Medicine where he a completed residency and fellowship in Otolaryngology-Head & Neck Surgery. Dr. Gillespie earned a Masters in Clinical Research at the Medical University of South Carolina, and is board certified in Otolaryngology-Head and Neck Surgery and Sleep Medicine. He has published over 150 academic papers and is editor of the textbook Gland-Preserving Salivary Surgery: A Problem-Based Approach. He is a former Director of the American Board of Otolaryngology-Head & Neck Surgery (ABOHNS) and current member of the otolaryngology section of the Accreditation Council for Graduate Medical Education (ACGME).

M. Allison Ogden, MD FACS

Professor & Vice-Chair of Clinical Operations - Department of Otolaryngology

Washington University School of Medicine

Dr. Ogden is a Professor and Vice-Chair of Clinical Operations in the Department of Otolaryngology at Washington University School of Medicine. She graduated from the Washington University School of Medicine in 2002 and went on to complete her residency there as well in Otolaryngology in 2007. Her clinical interests include sialendoscopy, nasal obstructions, and hearling loss. In 2015 Dr. Ogden was listed in "Best Doctors in America", an honor that continues to this day.

Arjun S. Joshi, MD

Professor of Surgery

The George Washington University School of Medicine & Health Sciences

Arjun Joshi, MD is board-certified in Otolaryngology and Head & Neck surgery by both the American Board of Otolaryngology – Head and Neck Surgery and the Royal College of Physicians and Surgeons of Canada. Dr. Joshi received his medical degree from the State University of New York at Syracuse and completed his residency at The George Washington University Medical Center. His areas of expertise include: Head and Neck Cancer, Head and Neck Masses, Head and Neck Reconstruction, Thyroid and Parathyroid Surgery, and Salivary Endoscopy.

Henry T. Hoffman, MD

Professor of Otolaryngology / Professor of Radiation Oncology

University of Iowa Healthcare

Dr. Henry T. Hoffman is an ENT-otolaryngologist in Iowa City, Iowa and is affiliated with University of Iowa Hospitals and Clinics. He received his medical degree from University of California San Diego School of Medicine and has been in practice for more than 20 years.

David M. Cognetti, MD, FACS

Professor and Chair of Department of Otolaryngology-Head & Neck Surgery

Thomas Jefferson University

Dr. Cognetti received his BS in Biology from Georgetown University and his MD from the University of Pittsburgh School of Medicine. He completed a residency in Otolaryngology – Head and Neck Surgery at Thomas Jefferson University before completing a fellowship in Advanced Head and Neck Oncologic Surgery at the University of Pittsburgh Medical Center.  Dr. Cognetti returned to Jefferson, his professional home, as faculty in 2008.

Christopher H. Rassekh, MD, FACS

Professor in Department of Otorhinolaryngology - Head & Neck Surgery / Director of Penn Medicine Sialendoscopy Program

University of Pennsylvania

Christopher H. Rassekh, MD is Professor of Clinical Otorhinolaryngology-Head and Neck Surgery at Penn Medicine. He is the Director of the Penn Medicine Sialendoscopy Program, which provides evaluation of and minimally invasive surgery for diseases that cause swelling of the salivary glands including obstructive diseases such as salivary stones, salivary duct strictures and tumors. Dr. Rassekh sees patients with head and neck tumors including cancers of the mouth, throat, voice box, salivary gland, thyroid and neck and also was a very early adopter of Transoral Robotic Surgery (TORS) for tumors and salivary gland diseases, and is an expert in cranial base surgery. He also is co-chair of the Airway Safety Committee at the Hospital of the University of Pennsylvania.

Pediatric Sleep Apnea: State of the Art 2020

Drs. Stacey Ishman, Christina Baldassari, Erin Kirkham, and Derek Lam explain the role of the sleep endoscopy procedure and review the importance of a sleep study for a surgeon. They will also look forward to the future trends in sleep apnea and discuss their thoughts with the audience.

Introducing a Two-Part Sialendoscopy Series!

Brought to you by our partnership with Cook Medical, we are having a two-part series on Sialendoscopy. The sessions will feed into one another, the first covering basics like a review of instrumentation and set up, as well as some of the most basic interventions you will see.

The second session will assume a basic knowledge of the procedure and will deal with complex interventions including both endoscopic and combined open procedures, advanced radiology, and complication management for revision surgery and in-office procedures.

Meet the Course Directors!

Rohan R. Walvekar, MD

Assistant Professor in Head Neck Surgery

University of Pittsburgh/VA Medical Center

Rohan R. Walvekar, MD, earned his doctoral degree from the University of Mumbai. After graduating in 1998, he completed a residency in Otolaryngology and Head Neck Surgery at the TN Medical College & BYL Nair Charitable Hospital, Mumbai, India, with triple honors. Subsequently, he completed two head neck surgery fellowships, and trained at at the Tata Memorial Hospital, Mumbai, which is India's most prestigious cancer institute. After completing an Advanced Head Neck Oncologic Surgery fellowship at the University of Pittsburgh, he became an Assistant Professor in Head Neck Surgery within the Department of Otolaryngology Head Neck Surgery at the University of Pittsburgh/VA Medical Center, prior to joining the LSU Health Sciences Center in July 2008. His clinical interests are head neck surgery and salivary endoscopy. His research interests include evaluating prognostic markers and clinical outcomes of head and neck cancer therapy and treatment of salivary gland disorders.

Barry M Schaitkin, MD

Professor of Otolaryngology

UPMC Pittsburgh

Dr. Schaitkin specializes in the treatment of inflammatory and neoplastic conditions of the salivary glands. He practices at UPMC in the Department of Otolaryngology and is affiliated with UPMC branches all across the city of Pittsburgh. He completed his medical degree and residency at Pennsylvania State University College of Medicine.

Meet the Presenters!

Jolie Chang, MD

Associate Professor, Chief of Sleep Surgery and General Otolaryngology

University of California, San Francisco

Dr. Chang specializes in sleep apnea surgery and minimally invasive approaches to the salivary duct with sialendoscopy. She has interest in studying patient reported outcomes after sialendoscopy procedures.

Mark Marzouk, MD

Clinical Associate Professor of Otolaryngology - Head and Neck Surgery

SUNY Upstate Medical University

Dr. Marzouk completed his residency training in 2010 from the UPMC Department of Otolaryngology. He is currently the Division Chief of Head and Neck Oncologic Surgery in Syracuse. He is also the Associate Program Director of Residency Programs.

David W. Eisele, MD. FACS

Andelot Professor and Director - Department of Otolaryngology-Head and Neck Surgery

Johns Hopkins University School of Medicine

Dr. Eisele is the Past-President of the American Board of Otolaryngology- Head and Neck Surgery and a member of the NCCN Head and Neck Cancer Panel. He has served as a member of the Residency Review Committee for Otolaryngology, as Chair of the Advisory Council for Otolaryngology - Head and Neck Surgery for the American College of Surgeons, President of the American Head and Neck Society, and as Vice-President of the Triological Society. He served as President of the Maryland Society of Otolaryngology and is a former Governor of the American College of Surgeons.

M. Boyd Gillespie, MD, MSc, FACS

Professor and Chair

UTHSC Otolaryngology-Head and Neck Surgery

M. Boyd Gillespie is Professor and Chair of Otolaryngology-Head & Neck Surgery at University of Tennessee Health Science Center. He is a graduate of the Johns Hopkins University School of Medicine where he a completed residency and fellowship in Otolaryngology-Head & Neck Surgery. Dr. Gillespie earned a Masters in Clinical Research at the Medical University of South Carolina, and is board certified in Otolaryngology-Head and Neck Surgery and Sleep Medicine. He has published over 150 academic papers and is editor of the textbook Gland-Preserving Salivary Surgery: A Problem-Based Approach. He is a former Director of the American Board of Otolaryngology-Head & Neck Surgery (ABOHNS) and current member of the otolaryngology section of the Accreditation Council for Graduate Medical Education (ACGME).

M. Allison Ogden, MD FACS

Professor & Vice-Chair of Clinical Operations - Department of Otolaryngology

Washington University School of Medicine

Dr. Ogden is a Professor and Vice-Chair of Clinical Operations in the Department of Otolaryngology at Washington University School of Medicine. She graduated from the Washington University School of Medicine in 2002 and went on to complete her residency there as well in Otolaryngology in 2007. Her clinical interests include sialendoscopy, nasal obstructions, and hearling loss. In 2015 Dr. Ogden was listed in "Best Doctors in America", an honor that continues to this day.

Arjun S. Joshi, MD

Professor of Surgery

The George Washington University School of Medicine & Health Sciences

Arjun Joshi, MD is board-certified in Otolaryngology and Head & Neck surgery by both the American Board of Otolaryngology – Head and Neck Surgery and the Royal College of Physicians and Surgeons of Canada. Dr. Joshi received his medical degree from the State University of New York at Syracuse and completed his residency at The George Washington University Medical Center. His areas of expertise include: Head and Neck Cancer, Head and Neck Masses, Head and Neck Reconstruction, Thyroid and Parathyroid Surgery, and Salivary Endoscopy.

Henry T. Hoffman, MD

Professor of Otolaryngology / Professor of Radiation Oncology

University of Iowa Healthcare

Dr. Henry T. Hoffman is an ENT-otolaryngologist in Iowa City, Iowa and is affiliated with University of Iowa Hospitals and Clinics. He received his medical degree from University of California San Diego School of Medicine and has been in practice for more than 20 years.

David M. Cognetti, MD, FACS

Professor and Chair of Department of Otolaryngology-Head & Neck Surgery

Thomas Jefferson University

Dr. Cognetti received his BS in Biology from Georgetown University and his MD from the University of Pittsburgh School of Medicine. He completed a residency in Otolaryngology – Head and Neck Surgery at Thomas Jefferson University before completing a fellowship in Advanced Head and Neck Oncologic Surgery at the University of Pittsburgh Medical Center. Dr. Cognetti returned to Jefferson, his professional home, as faculty in 2008.

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