PUBLISHED: Corneal Staining with Fluorescein

Corneal Staining with Fluorescein
Alexander Martin, OD
Boston Vision

Patient ocular complaints often center around discomfort, foreign body sensation, and/or recent trauma. Determining the cause of the ailment is not always straightforward, and the use of fluorescein can provide valuable information that aids in clinical diagnosis. Many corneal conditions and emergencies can be identified with the aid of fluorescein such as corneal erosion, superficial punctate keratitis, corneal abrasion, foreign bodies, and tracking patterns of foreign bodies. This article and video will demonstrate proper technique to instill fluorescein and examine ocular tissues, as well as some examples of staining defects characteristic of compromised ocular tissues.

PUBLISHED: Pulsed Dye and Fractional CO2 Laser Therapy for Treatment of Burn Scars

Pulsed Dye and Fractional CO2 Laser Therapy for Treatment of Burn Scars
Robert Dabek, MD1Harrison McUmber2Branko Bojovic, MD1,3
1Massachusetts General Hospital
2Tufts University School of Medicine
3Shriners Hospitals for Children – Boston

Burn injuries are often devastating accidents that result in long-term physical and psychosocial consequences and the formation of hypertrophic scars. Laser treatment is a low risk minimally invasive approach to treating such burn scars.

This video discusses the pulsed dye laser (PDL) and fractional ablative CO2 laser, and demonstrates their use in treating the scars on a pediatric patient who suffered from burn injuries 7 years ago in Vietnam.

PUBLISHED: Open Reduction and Internal Fixation of Mandibular Body and Parasymphyseal Fractures with Maxillomandibular Fixation and Broken Tooth Extraction

Open Reduction and Internal Fixation of Mandibular Body and Parasymphyseal Fractures with Maxillomandibular Fixation and Broken Tooth Extraction
Derek Sheen, MD1Cheryl Yu, MD2Sarah Debs, MD2Peter Kwak, MD2Nima Vahidi, MD3Daniel Hawkins, DDS2Thomas Lee, MD, FACS2
1University of Texas Southwestern Medical Center
2Virginia Commonwealth University Medical Center
3Upstate Medical Center

This is a case discussing a 21-year-old male who suffered from both non-comminuted mandibular parasymphyseal and body fractures as a result of a motor vehicle accident, requiring open reduction internal fixation (ORIF) without postoperative maxillomandibular fixation (MMF). The fracture was complicated by a broken tooth root, which required extraction.

After intraoperative MMF, ORIF was performed. The parasymphyseal fracture was plated using two locking four-hole 2-mm thick miniplates utilizing two locking screws on either side of the fracture with one plate along the alveolar surface (monocortical screw) and one along the basal surface (bicortical screw). For the right body fracture, a three-dimensional locking ladder plate was used via a transbuccal trocar approach for additional exposure needed for proper screw placement. Once the hardware was secured, the patient was taken out of MMF and restoration of premorbid occlusion was confirmed. Lastly, watertight mucosal closure was performed using absorbable sutures and Dermabond (cyanoacrylate adhesive).

PUBLISHED: Microscope Drape for Aerosol-Generating Procedures During COVID-19 Pandemic

Microscope Drape for Aerosol-Generating Procedures During COVID-19 Pandemic
C. Scott Brown, MD1Paulo Dominaitis, CST2Fred F. Telischi, MEE, MD, FACS1
1 University of Miami Miller School of Medicine
2 Bascom Palmer Eye Institute

Coronavirus disease 2019 (COVID-19) has emerged as a worldwide pandemic, profoundly impacting healthcare systems. Despite the use of personal protective equipment, concerns remain over the potential transmission of SARS-CoV-2 for otolaryngologists. Transmission occurs via respiratory droplets and aerosolized virus particles, which are generated during specific interventions such suctioning, bone drilling, and the application of diathermy. The mastoid and middle ear mucosa are connected to the nasopharyngeal mucosa and can serve as a potential source of viral particles in an infected patient. This highlights the need for the development and implementation of strategies that minimize aerosol spread.

PUBLISHED: Contracture Release and Full-Thickness Skin Graft to Volar Index Finger with K-Wire Insertion

Contracture Release and Full-Thickness Skin Graft to Volar Index Finger with K-Wire Insertion
Ryan P. Boyle1Jonah Poster2Jonathan Friedstat, MD3
1Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine
2Icahn School of Medicine at Mount Sinai
3Shriners Hospitals for Children – Boston

The complications stemming from a poorly-healed burn wound can lead to functional deficits and overall aesthetically unfavorable results leading to psychological distress. Due to the inquisitive nature of infants and toddlers, and their nature to learn the world with their hands, their sensitive regions like the hands become likely targets for burns.

Superficial burns can be managed on an outpatient basis with spontaneous healing expected in 2 or 3 days with minimal scarring. Deep burns, particularly in pediatric populations, need considerable attention to avoid secondary contracture that leads to deformity.

Many treatment options exist, but in sensitive areas like the hands and face, full-thickness skin grafts are favored due to their superior healing and decreased likelihood of secondary contracture. This article aims to guide the surgeon in managing a pediatric burn wound with an arsenal of treatment options with the goal of achieving full mobility and functionality of the hand.

PUBLISHED: Flexible Bronchoscopy and Bronchoalveolar Lavage (BAL)

Flexible Bronchoscopy and Bronchoalveolar Lavage (BAL)
Marcus S. Alpert, MDYu Maw Htwe, MD
Penn State Health Milton S. Hershey Medical Center

Flexible bronchoscopy is a commonly utilized endoscopic procedure allowing for direct visualization of the airways, as well as a variety of therapeutic and diagnostic interventions. Common indications of flexible bronchoscopy include evaluation of pulmonary infiltrates, hemoptysis, airway obstruction, foreign body aspiration, tracheal stenosis, bronchopleural fistula, and post-lung transplant.

The procedure involves the insertion of a flexible bronchoscope through the vocal cords and into the lumen of the trachea and bronchi. Direct visualization is provided by fiberoptic video imaging. Bronchoalveolar lavage (BAL) further refers to instillation and subsequent recovery of sterile saline into the airways. In this article, we will detail the technique, considerations, and complications of flexible bronchoscopy and BAL.

PUBLISHED: Acute Subdural Hematoma Evacuation

Acute Subdural Hematoma Evacuation
Vincent Prinz, MDMarcus Czabanka, MD
Charite Hospital Berlin

Subdural hematoma (SDH) is a type of intracranial bleeding that occurs between the dura and the arachnoid membrane surrounding the brain. This video is a step-by-step demonstration of a hematoma evacuation by craniotomy performed on an elderly female patient with an acute-on-chronic SDH.

PUBLISHED: Robotic-Assisted Laparoscopic Left Donor Nephrectomy for Living Kidney Donation

Robotic-Assisted Laparoscopic Left Donor Nephrectomy for Living Kidney Donation
Srilakshmi Atthota, MBBS; Jessica Grasso, PA-C; Leigh Anne Dageforde, MD, MPH
Massachusetts General Hospital

Kidney transplantation is the preferred treatment for patients with end-stage renal disease and is associated with a better quality of life and survival compared to other renal replacement therapies. Compared to deceased donor kidneys, living donor kidney donation is associated with shorter wait times, improved patient and graft survival, and the possibility of preemptive transplantation.

After the initial learning curve, robotic-assisted living donor nephrectomy has similar outcomes compared to open and laparoscopic nephrectomy, and in some settings an overall decreased length of stay. This article presents the case of a robotic-assisted living donor nephrectomy, including evaluation, technique, and considerations for the surgeon preoperatively and intraoperatively.

PUBLISHED: Partial Glossectomy

Partial Glossectomy
Liana Puscas, MD, MHS1C. Scott Brown, MD1Vahagn G. Hambardzumyan, MD2
1Duke University Medical Center
2Yerevan State Medical University, Heratsi Hospital Complex

In this clinical case, a patient presented with a well-circumscribed lesion on her tongue, causing interference with eating as it grew. Despite its benign appearance, an initial in-office biopsy was performed and metastatic breast cancer was found.

Jaw and oral cavity involvement by metastatic disease is very rare, occurring in less than 1% of all oral malignancies. In this video, a partial glossectomy was performed to remove the lesion.

PUBLISHED: Robotic-Assisted Proximal Gastrectomy with a Laparoscopic-Assisted Double-Tract Reconstruction for Proximal Early Gastric Cancer

Robotic-Assisted Proximal Gastrectomy with a Laparoscopic-Assisted Double-Tract Reconstruction for Proximal Early Gastric Cancer
Raja R. Narayan, MD, MPH1,2,3; Jane C. Kim, MD1; Do Joong Park, MD, PhD1
1Seoul National University Hospital
2Dana-Farber Cancer Institute
3Brigham and Women’s Hospital

At most institutions caring for patients with early gastric cancer (EGC), tumors arising in the upper third of the stomach are usually managed with total gastrectomy and Roux-en-Y esophagojejunostomy. Given the impaired quality of life related to associated reflux and vitamin deficiencies, several high-volume centers have sought alternative gastrectomy and reconstruction strategies to total gastrectomy.

In this case, a patient with EGC in the cardia found on screening endoscopy undergoes robotic proximal gastrectomy with double-tract reconstruction. His postoperative course was unremarkable, and he was discharged on postoperative day 7. His pathology demonstrated no residual tumor after preoperative endoscopic submucosal dissection. This video demonstrates the technique of an experienced surgeon performing robotic proximal gastrectomy with double-tract reconstruction.

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