Search Results

In this video, a bilateral ultrasound-guided pudendal nerve block is demonstrated on a 15-month-old healthy child undergoing circumcision and penoscrotal fusion repair. After the induction of general anesthesia, a nerve block time-out is conducted. Subsequently, the patient is positioned in the frog-leg stance by an assistant, and the perineum is cleaned using chlorhexidine. Using a high-frequency linear ultrasound probe, the ischiorectal fossa is identified between the ischial tuberosity and the anus at the 3 and 9 o’clock positions relative to the anus. A 22-gauge, 50-millimeter-long Pajunk needle is then inserted using an out-of-plane technique, advanced 1-2 cm deep and medial to the ischial tuberosity, until a subtle change in resistance or “pop” is felt, confirming the correct placement below the sacrospinous ligament. The local anesthetic (0.3 to 0.5 mL/kg of 0.2% Ropivacaine or 0.25% Bupivacaine on each side) is then incrementally injected, observed as spreading medially and beneath the ischial tuberosity. The block is then repeated on the other side. Our patient tolerated the procedure well and did not require any opioids intraoperatively, postoperatively in the post-anesthesia care unit, or at home following discharge.

Intro

A chalazion is a lipogranulomatous inflammation of a meibomian gland in the eyelid that presents as a painless eyelid nodule or swelling. This pediatric patient presented with a chalazion that caused symptoms of eye irritation. The lesion had persisted for many months without improvement in response to warm compresses and eyelid scrubs with baby shampoo. Therefore, she underwent chalazion incision and curettage under sedation.

Methods

This video highlights the steps of chalazion incision and curettage. With a chalazion clamp tightened over the lesion, the eyelid is everted and an incision is made into the tarsus. A curette is used to scrape the walls of the cyst to remove the chalazion contents. At the conclusion of the procedure, the clamp is removed and pressure is applied to the area of the lesion for hemostasis.

Conclusion

Incision and curettage is a safe, relatively quick, and effective procedure for the management of persistent chalazia.

Authors

Michelle L. Huynh, BA

College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA

Muhammad Shamim, MD  

Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA

Christian Ponder, MD

Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA

A. Paula Grigorian, MD

Arkansas Children’s Hospital – Department of Ophthalmology, Little Rock, Arkansas, USA

The procedure was performed at Arkansas Children’s Hospital, Little Rock, AR, USA.

Music by bensound.com.

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.

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

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 penectomy is the surgical standard of care for invasive tumors of the mid to distal penis, but is utilized in cases of distal penile calciphylaxis due to pain. Partial Penectomy is advantageous compared to a total penectomy, as the patient is able to urinate in the standing position.

A 51-year-old man on dialysis for end stage renal disease presented to the emergency department with pain that was increasing in severity for over a month at the glans of the penis.  On examination, the glans of the penis was firm with gangrenous necrosis extending distal to the corona, and the urethral meatus was not identified due to the extensive scarring.  A clinical diagnosis of penile calciphylaxis was determined and a Partial Penectomy was subsequently performed.  Calciphylaxis is a rare life-threatening systemic disease in patients with end stage renal disease due to medial calcification and fibrosis of blood vessels leading to infection and gangrene.  The prognosis for penile calciphylaxis tends to be poor with an overall mortality of 64% with a mean time to death of 2.5 months.