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

video

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.

Transcervical Epiglottopexy for management of Type 3 Laryngomalacia

video

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.

Pediatric Laryngeal Reinnervation with Ansa Cervicalis to Recurrent Laryngeal Nerve Anastomosis

video

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

Joseph W. Turek, MD, PhD

leadership

University of Iowa

• Chief of Pediatric Cardiac Surgery
• Co-Director, University of Iowa Stead Family Congenital Cardiac Center
• Director of Extracorporeal Membrane Oxygenation Services
• Program Director of the Thoracic Surgery Fellowship and Thoracic Integrated Six-Year Residency Programs

Joseph William Turek, MD, PhD graduated from Northwestern University with a BA in Biochemistry in 1994 and received his MD/PhD (Pharmacology) from the University of Illinois – Chicago in 2002.  He completed his general surgery education at Duke University in 2007, where he also completed a cardiothoracic residency in 2010.  During this time he served as a visiting congenital fellow at Texas Children’s Hospital.  He completed a congenital cardiac fellowship at the Children’s Hospital of Philadelphia in 2011.  Dr. Turek was the third John H. Gibbon Jr. Research Scholarship Recipient awarded by the American Association for Thoracic Surgery (2014-2016).  Dr. Turek is Chief of Pediatric Cardiac Surgery and Co-Director, University of Iowa Stead Family Congenital Cardiac Center.  He is also the Director of Extracorporeal Membrane Oxygenation Services and serves as the Program Director of the Thoracic Surgery Fellowship and Thoracic Integrated Six-Year Residency Programs at the University of Iowa Hospitals and Clinics.  His specialties include congenital heart surgery, pediatric heart transplantation and assist devices.  Dr. Turek is quite active nationally, holding board positions and serving on varies committees.  Dr. Turek can be reached at his office number (319) 384-8365 or by e-mail at joseph-turek@uiowa.edu with any questions.

Advanced Salivary Endoscopy: Challenging Cases Diagnosis & Treatment

webinar

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, 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.

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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.

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Meet the Presenters!

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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.

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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.

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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.

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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).

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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.

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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.

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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.

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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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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.

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Introducing a Two-Part Sialendoscopy Series!

news

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, 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.

---

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.

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Meet the Presenters!

---

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.

---

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.

---

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.

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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).

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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.

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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.

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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.

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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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