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CO2 laser tonsillectomy and adenoidectomy
Otolaryngology Head and Neck Surgery PI60
May 1995
Instruction Courses-- Wednesday
COURSE 4503-2
Two-period course ($40)
Room NOCC-D-3 1:15-3:30
C O 2 Laser Tonsillectomy and A d e n o i d e c t o m y DANIEL P. AKIN, MD, PhD
New Albany, Ind.
Educational objectives: To teach the basic steps of the
CO 2
laser tonsillectomy and adenoidectomy (T&A ), to know its advantages and disadvantages, and to be able to order all the equipment needed to perform a CO2 laser tonsillectomy and adenoidectomy.
The doctors at Akin Medical Center over the last 11 years and in over 2800 cases have observed that the CO 2 laser T&A has the following advantages: (1) less postoperative pain, (2) quicker healing (compared with our previous dissection technique by 2 days), (3) minimal blood loss (1 to 2 ml is typical), (4) operative time reduced (typical 10 minutes), (5) outpatient procedure 99%+, (6) postoperative bleeds <1%, and (7) elimination of palatopharyngeal incompetence. No complications were due to the laser. The course will describe the technique in detail, both by slides as well as by multidirectional videotapes, and also the special equipment used and how to procure it. The areas of controversy will be addressed concerning: (1) justification of equipment cost, (2) risk of using laser in T&A, (3) advantage of CO 2 laser over other lasers, and (4) hemostasis control with the CO 2 laser. The surgeon who attends this course must understand that there is a learning curve to this procedure. Knowing how to do a tonsillectomy by other means and knowing how to use a laser does not mean that this procedure will be quick to learn. In teaching this procedure to other surgeons, it takes about 50 cases to achieve proficiency and "comfort level." This takes the right equipment and a sincere desire to learn this new procedure. Then the goal of a happier patient and a more proficient surgeon will be obtained.
COURSE 4504-2
Two-period course ($40)
Room NOCC-50 1:15-3:30
CSF Leaks: Comprehensive Diagnosis and M a n a g e m e n t DANIEL W. NUSS,MD, and PETERD. COSTANTINO, MD
New Orleans, Lo.
Educational objectives: To understand the mechanisms of CSF leakage and to initiate diagnostic studies to confirm the presence and extent of a CSF fistula and institute appropriate surgical therapy and adjunctive measures to definitively repair CSF fistulas.
The modem era of skull-base surgery has brought with it a number of innovations that have enhanced our ability to diagnose and successfully repair CSF fistulas. Such innovations have amplified the role of the otolaryngologist in solving these challenging and sometimes vexatious clini-
cal problems previously considered mainly within the domain of the neurosurgeon. This course will address each of the following topics concerning diagnosis: 1. Causes of CSF leaks and their influence on treatment 2. Clinical observations that confirm CSF drainage 3. Utility and futility of testing for glucose and protein 4. Use of specific beta-2-transferrin assay for definifive CSF detection 5. Imaging studies for fistula detection and localization, including CT, MR/, CT-cisternography, and radioisotopic scans 6. Nonradiologic studies, such as endoscopic-fluorescein method Discussion of issues relevant to definitive repair of CSF leaks will include: 1. Review of traditional neurosurgical methods 2. Use of fascia grafts and intranasal mucosal flaps 3. Use of newer vascularized soft tissue flaps 4. Biomaterials useful for closing difficult leaks 5. Endoscopic repair of ethmoid and sphenoid leaks 6. Methods for management of multirecurrent fistulas 7. Adjunctive use of lumbar subarachnoid drainage 8. Pharmacologic and anesthetic techniques, and postoperative strategies to improve results
COURSE 4505-1
One-period course ($20)
Room NOCC-51 1:15-2:15
Environmental Factors in Sinus Disease DEAN M. CLERICO, MD
Kingston, Pa.
Educational objectives: To understand the role o f environmental pollutants in sinus disease and to suggest practical methods to patients to limit their exposure to air pollutants.
The medical community is increasingly recognizing the impact of the earth's environment on human health and disease. This issue is crucial to the otorhinolaryngologist because the ears, nose, sinuses, and throat are among the first organs affected by environmental pollutants. The nose and sinuses in particular face and brunt of inhaled toxins in ambient indoor and outdoor air. The purpose of this course is to inform physicians of the effects of air quality on nasal and sinus disease. Topics covered will include outdoor air pollution, indoor air pollution, physicochemical properties of individual pollutants, neurorhinologic responses to inhaled pollutants, results of nasal toxicology studies, and the role of toxic oxygen metabolites (free radicals) in sinus disease. Practical recommendations for patient management will be offered. After attending this course participants will understand the role of environmental air pollution in sinus disease and the mechanisms by which various pollutants produce tissue damage.
May 1995
Instruction Courses-- Wednesday
COURSE 4503-2
Two-period course ($40)
Room NOCC-D-3 1:15-3:30
C O 2 Laser Tonsillectomy and A d e n o i d e c t o m y DANIEL P. AKIN, MD, PhD
New Albany, Ind.
Educational objectives: To teach the basic steps of the
CO 2
laser tonsillectomy and adenoidectomy (T&A ), to know its advantages and disadvantages, and to be able to order all the equipment needed to perform a CO2 laser tonsillectomy and adenoidectomy.
The doctors at Akin Medical Center over the last 11 years and in over 2800 cases have observed that the CO 2 laser T&A has the following advantages: (1) less postoperative pain, (2) quicker healing (compared with our previous dissection technique by 2 days), (3) minimal blood loss (1 to 2 ml is typical), (4) operative time reduced (typical 10 minutes), (5) outpatient procedure 99%+, (6) postoperative bleeds <1%, and (7) elimination of palatopharyngeal incompetence. No complications were due to the laser. The course will describe the technique in detail, both by slides as well as by multidirectional videotapes, and also the special equipment used and how to procure it. The areas of controversy will be addressed concerning: (1) justification of equipment cost, (2) risk of using laser in T&A, (3) advantage of CO 2 laser over other lasers, and (4) hemostasis control with the CO 2 laser. The surgeon who attends this course must understand that there is a learning curve to this procedure. Knowing how to do a tonsillectomy by other means and knowing how to use a laser does not mean that this procedure will be quick to learn. In teaching this procedure to other surgeons, it takes about 50 cases to achieve proficiency and "comfort level." This takes the right equipment and a sincere desire to learn this new procedure. Then the goal of a happier patient and a more proficient surgeon will be obtained.
COURSE 4504-2
Two-period course ($40)
Room NOCC-50 1:15-3:30
CSF Leaks: Comprehensive Diagnosis and M a n a g e m e n t DANIEL W. NUSS,MD, and PETERD. COSTANTINO, MD
New Orleans, Lo.
Educational objectives: To understand the mechanisms of CSF leakage and to initiate diagnostic studies to confirm the presence and extent of a CSF fistula and institute appropriate surgical therapy and adjunctive measures to definitively repair CSF fistulas.
The modem era of skull-base surgery has brought with it a number of innovations that have enhanced our ability to diagnose and successfully repair CSF fistulas. Such innovations have amplified the role of the otolaryngologist in solving these challenging and sometimes vexatious clini-
cal problems previously considered mainly within the domain of the neurosurgeon. This course will address each of the following topics concerning diagnosis: 1. Causes of CSF leaks and their influence on treatment 2. Clinical observations that confirm CSF drainage 3. Utility and futility of testing for glucose and protein 4. Use of specific beta-2-transferrin assay for definifive CSF detection 5. Imaging studies for fistula detection and localization, including CT, MR/, CT-cisternography, and radioisotopic scans 6. Nonradiologic studies, such as endoscopic-fluorescein method Discussion of issues relevant to definitive repair of CSF leaks will include: 1. Review of traditional neurosurgical methods 2. Use of fascia grafts and intranasal mucosal flaps 3. Use of newer vascularized soft tissue flaps 4. Biomaterials useful for closing difficult leaks 5. Endoscopic repair of ethmoid and sphenoid leaks 6. Methods for management of multirecurrent fistulas 7. Adjunctive use of lumbar subarachnoid drainage 8. Pharmacologic and anesthetic techniques, and postoperative strategies to improve results
COURSE 4505-1
One-period course ($20)
Room NOCC-51 1:15-2:15
Environmental Factors in Sinus Disease DEAN M. CLERICO, MD
Kingston, Pa.
Educational objectives: To understand the role o f environmental pollutants in sinus disease and to suggest practical methods to patients to limit their exposure to air pollutants.
The medical community is increasingly recognizing the impact of the earth's environment on human health and disease. This issue is crucial to the otorhinolaryngologist because the ears, nose, sinuses, and throat are among the first organs affected by environmental pollutants. The nose and sinuses in particular face and brunt of inhaled toxins in ambient indoor and outdoor air. The purpose of this course is to inform physicians of the effects of air quality on nasal and sinus disease. Topics covered will include outdoor air pollution, indoor air pollution, physicochemical properties of individual pollutants, neurorhinologic responses to inhaled pollutants, results of nasal toxicology studies, and the role of toxic oxygen metabolites (free radicals) in sinus disease. Practical recommendations for patient management will be offered. After attending this course participants will understand the role of environmental air pollution in sinus disease and the mechanisms by which various pollutants produce tissue damage.