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Pediatric airway—Assessment and management of stridor
Otolaryngology Head and Neck Surgery Volume 112 Number 5
COURSE 3714-1 One-period course ($20)
Instruction Courses-- Tuesday
Room NOCC-63 3:00-4:00
Avoiding Perils and Pitfalls in Pediatric Bronchoscopy GLENN C. I$AACSON, MD, and SHARON M. TOMASKI,MD Philadelphia, Pa., and Honolulu, Hawaii
Educational objectives: To summarize current concepts in pediatric airway endoscopy and highlight various anesthetic techniques and their uses, depending on airway pathology and select optimal pediatric airway instrumentation and to avoid and manage complications of pediatric airway endoscopy and improve surgical outcome.
Children are not "mini-adults," and a more cautious approach is required when one is evaluating a pediatric airway. A child's airway is more unforgiving because of its smaller size, diminished pulmonary reserve, and increased risk of laryngospasm or bronchospasm. This mini-course will outline the appropriate workup and evaluation of the premature infant, neonatal, and pediatric airway. State-of-the-art pediatric laryngoscopic and bronchoscopic equipment will be highlighted, and proper assembly and use will be demonstrated. Suggested techniques of anesthesia, laryngoscopy, and bronchoscopy in the obstructed and unobstructed airway will be detailed. Methods of telescopic photodocumentaion will be shown and actual pediatric airway endoscopy videos will be seen. This course will be invaluable for residents, the occasional pediatric airway endoscopist, and operating room personnel. Participants are invited to bring challenging cases for discussion.
COURSE 3715-1 One-period course ($20)
Room NOCC-64 3:00-4:00
Endoscopic and External Sinus Surgery: Technique and Anatomy FRANK N. RITI'ER,MD, and JEFFREYTERRELL,MD Ypsilanti and Ann Arbor, Mich.
Educational objectives: To know the anatomy of the paranasal sinus region and adjacent structures and to surgically eradicate sinus disease by external or intranasat endoscopic technique.
Every surgeon relies heavily on a keen knowledge of the original anatomy during the performance of a surgical operation. This is especially true regarding the paranasal sinuses, where congenital or developmental changes, infection, neoplasm, bleeding, injury or prior surgery may distort the salient landmarks and increase the risk of complications. This course stresses the precise anatomic landmarks to guide the surgeon performing external or endoscopic sinus surgery. Slides of anatomic dissections, CT scans, and videotaped dissections will be used to stress the important landmarks for the sinus surgeon. Special attention will also be
P 139
given to the relevant anatomy for endoscopic surgery on the paranasal sinuses and pertinent anatomy and clinical pearls for external or endoscopic control of epistaxis, endoscopic orbital decompression, optic nerve decompression, and endoscopic DCRs. This is a practical course with time for open discussion, questions, and answers.
COURSE 3716-2 Two-period course ($40)
Room NOCC-65 3:00-5:15
Pediatric Airway--Assessment and Management of Stridor SETHPRANSKY,MD, and DONALD B. KEARNS,MD San Diego, Calif.
Educational objectives: To be able to comfortably recognize and treat a multiplicity of pediatric airway problems, to be familiar and comfortable with all modes of endoscopic evaluation of the pediatric airway, and to understand the variety of surgical techniques available for the treatment of pediatric airway problems.
This course is designed to provide the practitioner with improved expertise in the assessment and management of stridor in the pediatric patient. Evaluation of these problems can be difficult and management of airway compromise challenging. The course will review the pediatric airway, beginning in the nose and ending in the lungs. We will concentrate on accurate diagnosis and appropriate intervention with clinical "pearls" described for each case of stridor. Various assessment strategies will be described, including the use of age, airway location, characteristics of stridor, congenital versus acquired lesions, and the clinical picture. The assessment and management protocols will include the premature or previously intubated neonate and extend through causes of stridor in older children. Diagnostic modalities to be described will include the roles of office evaluation including fiberoptic nasopharyngolaryngoscopy, the appropriate use of imaging, and operative endoscopic techniques including microsuspension laryngoscopy, video endoscopy, and laryngeal EMG techniques. There will be a thorough review of instrumentation appropriate for the pediatric airway. The use of microsuspension laryngoscopy with laser for a variety of problems (including supraglottic edema, severe laryngomalacia, subglottic cysts and webs, laryngeal papillomatosis, and subglottic hemangiomata) will be delineated. There will be video tape recordings to exemplify a variety of these procedures. Our approach to the single-stage laryngotracheal reconstruction will be described in detail. Medical management of airway difficulties will also be described, including discussion of less commonly recognized problems such as pediatric gastroesophageal reflux and neonatal rhinitis. We will also describe our use of steroids for pediatric airway problems and in the perioperative period. The successful endoscopic evaluation and treatment of airway abnormalities in children is dependent on a close
Otolaryngology Head and Neck Surgery P140
May 1995
Instruction Courses-- Tuesday
relationship with anesthesia, whereby the two services "share the airway." In our institution, the vast majority of our endoscopic assessment is done under spontaneous ventilation and we will describe the various anesthetic techniques utilized to permit this approach.
COURSE 3718-1 One-period course ($20)
Room NOCC-80 3:00-4:00
Current Concepts in the Management of Sinonasal Neoplasms DALE H. RICE, MD, MAISIE L. SHINDO, MD, and TERRYS, BECKER, MD
COURSE 37 ! 7-1 One-period course ($20)
Room NOCC-66 3:00-4:00
Clinical Management of the Acute Facial Palsies N.J. COKER, MD
Houston, Texas
Educational objectives: To define the natural history, pathogenesis, and management of the acute facial palsies: Bell's palsy, herpes zoster oticus (Ramsay Hunt syndrome), and facial paralysis secondary to infections of the middle ear and to outline the classification, pathogenesis, and medical-surgical interventions for trauma of the facial nerve, including temporal bone fractures, penetrating injuries, and iatrogenic causes.
Sponsored by the American Academy of OtolaryngologyHead and Neck Surgery Committee on Facial Nerve Disorders, this course will update clinicians on the management of the most common causes of acute facial paralysis. The course will consists of summary reviews of natural histories, pathogeneses, electrodiagnostic testing, and medical-surgical managment. Illustrative cases will be presented, and questions from the participants entertained by a panel of expert. First, the course will focus on the infectious etiologies. Increasing evidence indicates that herpes simplex may initiate the inflammatory events leading to entrapment in Bell's palsy. The use of prednisone and acyclovir in the treatment of this and another viral disorder, herpes zoster oticus, will be discussed. The role of decompression surgery is diminishing and is directed to the recurrent palsies. Lastly, the course will review current antimicrobial therapy for middle ear--mastoid infections complicated by facial paralysis and will provide guidelines for surgical intervention. Second, the course classifies the traumatic causes of facial paralysis. Decision algorithms for the management of temporal bone fractures and penetrating injuries of the facial nerve will be presented. The role of surgical intervention in temporal bone fractures remains controversial. The course will close with a discussion of iatrogenic injury.
Los Angeles, Calif.
Educational objectives: To acquire a comprehensive knowledge of the etiology, biologic behavior, histopathology, clinical evaluation, and current management of benign and malignant neoplasms of the sinonasal tract.
This course will provide a comprehensive review of the evaluation and management of benign and malignant sinonasal neoplasms, including inverting papilloma, angiofibroma, various carcinomas, olfactory neuroblastoma, and sarcomas. The tumor behavior and prognosis of each neoplasm will also be discussed. Newer immunohistochemical studies that are currently available for diagnosis and prediction of tumor behavior will be reviewed. The radiographic features on CT, magnetic resonance imaging, and angiography, as well as guidelines on selection of the appropriate imaging studies, will be presented. Various traditional and newer surgical approaches, such as lateral rhinotomy, facial degloving, maxillectomy, orbital exenteration, endoscopic tumor removal, infratemporal fossa dissection, and craniofacial resection will be reviewed, as well as adjuvant therapy such as interventional radiology, radiation therapy, and chemotherapy. Perioperative complications, their management, and means of avoiding such pitfalls will also be discussed. In addition, state-ofthe-art reconstructive techniques for craniofacial defects and prosthetic rehabilitation, including the role of osseointegrated implants, will be presented.
COURSE 3719-2 Two-period course ($40)
Room NOCC-81 3:00-5:15
Prevention and Management of Complications of Ear Surgery RICHARD J. WlET,MD, JEAN-BERNARDCAUSSE,MD, JOHN R. EMMEt"r, MD, JOHN W. HOUSE, MD, and ARNOLDSCHURING, MD
Hinsdale, IlL Columbiers, France, Memphis, Tenn., Los Angeles, Calif., and Warren, Ohio
Educational objectives: To learn how some complications can be avoided, to recognize complications when they occur and act appropriately, and to comply with quality assurance mandates being developed throughout the United States.
Minimizing or preventing complications of ear and skull base surgery while attempting to obtain an optimal result will remain the challenge of future generations of ear surgeons. This can only be achieved by charting a course of intense training honed through experience. Those who
COURSE 3714-1 One-period course ($20)
Instruction Courses-- Tuesday
Room NOCC-63 3:00-4:00
Avoiding Perils and Pitfalls in Pediatric Bronchoscopy GLENN C. I$AACSON, MD, and SHARON M. TOMASKI,MD Philadelphia, Pa., and Honolulu, Hawaii
Educational objectives: To summarize current concepts in pediatric airway endoscopy and highlight various anesthetic techniques and their uses, depending on airway pathology and select optimal pediatric airway instrumentation and to avoid and manage complications of pediatric airway endoscopy and improve surgical outcome.
Children are not "mini-adults," and a more cautious approach is required when one is evaluating a pediatric airway. A child's airway is more unforgiving because of its smaller size, diminished pulmonary reserve, and increased risk of laryngospasm or bronchospasm. This mini-course will outline the appropriate workup and evaluation of the premature infant, neonatal, and pediatric airway. State-of-the-art pediatric laryngoscopic and bronchoscopic equipment will be highlighted, and proper assembly and use will be demonstrated. Suggested techniques of anesthesia, laryngoscopy, and bronchoscopy in the obstructed and unobstructed airway will be detailed. Methods of telescopic photodocumentaion will be shown and actual pediatric airway endoscopy videos will be seen. This course will be invaluable for residents, the occasional pediatric airway endoscopist, and operating room personnel. Participants are invited to bring challenging cases for discussion.
COURSE 3715-1 One-period course ($20)
Room NOCC-64 3:00-4:00
Endoscopic and External Sinus Surgery: Technique and Anatomy FRANK N. RITI'ER,MD, and JEFFREYTERRELL,MD Ypsilanti and Ann Arbor, Mich.
Educational objectives: To know the anatomy of the paranasal sinus region and adjacent structures and to surgically eradicate sinus disease by external or intranasat endoscopic technique.
Every surgeon relies heavily on a keen knowledge of the original anatomy during the performance of a surgical operation. This is especially true regarding the paranasal sinuses, where congenital or developmental changes, infection, neoplasm, bleeding, injury or prior surgery may distort the salient landmarks and increase the risk of complications. This course stresses the precise anatomic landmarks to guide the surgeon performing external or endoscopic sinus surgery. Slides of anatomic dissections, CT scans, and videotaped dissections will be used to stress the important landmarks for the sinus surgeon. Special attention will also be
P 139
given to the relevant anatomy for endoscopic surgery on the paranasal sinuses and pertinent anatomy and clinical pearls for external or endoscopic control of epistaxis, endoscopic orbital decompression, optic nerve decompression, and endoscopic DCRs. This is a practical course with time for open discussion, questions, and answers.
COURSE 3716-2 Two-period course ($40)
Room NOCC-65 3:00-5:15
Pediatric Airway--Assessment and Management of Stridor SETHPRANSKY,MD, and DONALD B. KEARNS,MD San Diego, Calif.
Educational objectives: To be able to comfortably recognize and treat a multiplicity of pediatric airway problems, to be familiar and comfortable with all modes of endoscopic evaluation of the pediatric airway, and to understand the variety of surgical techniques available for the treatment of pediatric airway problems.
This course is designed to provide the practitioner with improved expertise in the assessment and management of stridor in the pediatric patient. Evaluation of these problems can be difficult and management of airway compromise challenging. The course will review the pediatric airway, beginning in the nose and ending in the lungs. We will concentrate on accurate diagnosis and appropriate intervention with clinical "pearls" described for each case of stridor. Various assessment strategies will be described, including the use of age, airway location, characteristics of stridor, congenital versus acquired lesions, and the clinical picture. The assessment and management protocols will include the premature or previously intubated neonate and extend through causes of stridor in older children. Diagnostic modalities to be described will include the roles of office evaluation including fiberoptic nasopharyngolaryngoscopy, the appropriate use of imaging, and operative endoscopic techniques including microsuspension laryngoscopy, video endoscopy, and laryngeal EMG techniques. There will be a thorough review of instrumentation appropriate for the pediatric airway. The use of microsuspension laryngoscopy with laser for a variety of problems (including supraglottic edema, severe laryngomalacia, subglottic cysts and webs, laryngeal papillomatosis, and subglottic hemangiomata) will be delineated. There will be video tape recordings to exemplify a variety of these procedures. Our approach to the single-stage laryngotracheal reconstruction will be described in detail. Medical management of airway difficulties will also be described, including discussion of less commonly recognized problems such as pediatric gastroesophageal reflux and neonatal rhinitis. We will also describe our use of steroids for pediatric airway problems and in the perioperative period. The successful endoscopic evaluation and treatment of airway abnormalities in children is dependent on a close
Otolaryngology Head and Neck Surgery P140
May 1995
Instruction Courses-- Tuesday
relationship with anesthesia, whereby the two services "share the airway." In our institution, the vast majority of our endoscopic assessment is done under spontaneous ventilation and we will describe the various anesthetic techniques utilized to permit this approach.
COURSE 3718-1 One-period course ($20)
Room NOCC-80 3:00-4:00
Current Concepts in the Management of Sinonasal Neoplasms DALE H. RICE, MD, MAISIE L. SHINDO, MD, and TERRYS, BECKER, MD
COURSE 37 ! 7-1 One-period course ($20)
Room NOCC-66 3:00-4:00
Clinical Management of the Acute Facial Palsies N.J. COKER, MD
Houston, Texas
Educational objectives: To define the natural history, pathogenesis, and management of the acute facial palsies: Bell's palsy, herpes zoster oticus (Ramsay Hunt syndrome), and facial paralysis secondary to infections of the middle ear and to outline the classification, pathogenesis, and medical-surgical interventions for trauma of the facial nerve, including temporal bone fractures, penetrating injuries, and iatrogenic causes.
Sponsored by the American Academy of OtolaryngologyHead and Neck Surgery Committee on Facial Nerve Disorders, this course will update clinicians on the management of the most common causes of acute facial paralysis. The course will consists of summary reviews of natural histories, pathogeneses, electrodiagnostic testing, and medical-surgical managment. Illustrative cases will be presented, and questions from the participants entertained by a panel of expert. First, the course will focus on the infectious etiologies. Increasing evidence indicates that herpes simplex may initiate the inflammatory events leading to entrapment in Bell's palsy. The use of prednisone and acyclovir in the treatment of this and another viral disorder, herpes zoster oticus, will be discussed. The role of decompression surgery is diminishing and is directed to the recurrent palsies. Lastly, the course will review current antimicrobial therapy for middle ear--mastoid infections complicated by facial paralysis and will provide guidelines for surgical intervention. Second, the course classifies the traumatic causes of facial paralysis. Decision algorithms for the management of temporal bone fractures and penetrating injuries of the facial nerve will be presented. The role of surgical intervention in temporal bone fractures remains controversial. The course will close with a discussion of iatrogenic injury.
Los Angeles, Calif.
Educational objectives: To acquire a comprehensive knowledge of the etiology, biologic behavior, histopathology, clinical evaluation, and current management of benign and malignant neoplasms of the sinonasal tract.
This course will provide a comprehensive review of the evaluation and management of benign and malignant sinonasal neoplasms, including inverting papilloma, angiofibroma, various carcinomas, olfactory neuroblastoma, and sarcomas. The tumor behavior and prognosis of each neoplasm will also be discussed. Newer immunohistochemical studies that are currently available for diagnosis and prediction of tumor behavior will be reviewed. The radiographic features on CT, magnetic resonance imaging, and angiography, as well as guidelines on selection of the appropriate imaging studies, will be presented. Various traditional and newer surgical approaches, such as lateral rhinotomy, facial degloving, maxillectomy, orbital exenteration, endoscopic tumor removal, infratemporal fossa dissection, and craniofacial resection will be reviewed, as well as adjuvant therapy such as interventional radiology, radiation therapy, and chemotherapy. Perioperative complications, their management, and means of avoiding such pitfalls will also be discussed. In addition, state-ofthe-art reconstructive techniques for craniofacial defects and prosthetic rehabilitation, including the role of osseointegrated implants, will be presented.
COURSE 3719-2 Two-period course ($40)
Room NOCC-81 3:00-5:15
Prevention and Management of Complications of Ear Surgery RICHARD J. WlET,MD, JEAN-BERNARDCAUSSE,MD, JOHN R. EMMEt"r, MD, JOHN W. HOUSE, MD, and ARNOLDSCHURING, MD
Hinsdale, IlL Columbiers, France, Memphis, Tenn., Los Angeles, Calif., and Warren, Ohio
Educational objectives: To learn how some complications can be avoided, to recognize complications when they occur and act appropriately, and to comply with quality assurance mandates being developed throughout the United States.
Minimizing or preventing complications of ear and skull base surgery while attempting to obtain an optimal result will remain the challenge of future generations of ear surgeons. This can only be achieved by charting a course of intense training honed through experience. Those who