Introduction
It is projected that by 2050, people aged 65 years and older will account for 25% of the population in developed countries. With state of the art medical technologies and novel treatments significantly improving longevity, there is a need more than ever to understand the distinctive needs of the aging population. Not only do we have to understand concepts of frailty, sarcopenia, functional reserve, but also be able to assess our patients social and functional needs, which can be vastly different than younger adults. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - July 4, 2020 Category: ENT & OMF Authors: Ozlem E. Tulunay-Ugur, Selena Briggs Source Type: research

Head and Neck Oncological Surgery and Pearls in the Elderly
To review special considerations of treating head and neck cancer in the elderly population. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - July 4, 2020 Category: ENT & OMF Authors: Adnan Hussaini, Stephanie Johng, Joseph Leider, Eric Wu, Jonathan Giurintano Source Type: research

Operative techniques in otolaryngology: Head and neck microvascular free flap reconstruction in the elderly
According to the National Institute of Aging, the elderly is the fastest growing subset of the population. For the first time in history, people aged 65 and older will outnumber children by 2030.As the number of elderly has increased in the United States and abroad, head and neck cancer in the elderly is becoming more prevalent. Head and neck cancer often requires complex reconstruction after ablation and free flap microsurgery is now being performed with increased frequency on elderly patients. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - July 4, 2020 Category: ENT & OMF Authors: Matthew Pierce, Christine Clark Source Type: research

Geriatric Eustachian Tube Dysfunction
Otologic complaints are a common reason for the elderly to present to an otolaryngologist. Eustachian tube dysfunction in the geriatric population is a common yet poorly researched and described problem. A thorough understanding of the underlying anatomy and pathophysiology, performance of a careful history and work up, and a sound understanding of the available medical and surgical treatments are vital in the management of eustachian tube dysfunction in these patients. Here we review the literature regarding the work up and treatment of geriatric patients with Eustachian tube dysfunction. (Source: Operative Techniques in ...
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - July 4, 2020 Category: ENT & OMF Authors: David J. Lafferty, Brian J. McKinnon Source Type: research

Rhinology: Sinus Surgery in the Older Patient
In 2050 the elderly population will reach a projected 83.7 million and will represent 20% of the population in the United States. Chronic rhinosinusitis remains the 6th most common chronic disease in the geriatric population. It is often disregarded as a secondary problem in patients perceived as frail, with multiple other medical comorbidities and polypharmacy. The pathophysiologic changes that happen in the elderly make for a unique disease that requires special attention. Symptoms can be nonspecific but elderly with chronic sinus disease have a decreased quality of life metrics that can be significantly improved with me...
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - July 4, 2020 Category: ENT & OMF Authors: Alissa Kanaan Source Type: research

Thyroid Surgery in the Elderly
Surgeons across all specialties often hesitate to operate on elder and geriatric patients due to concern for an increased risk of morbidity and mortality. Fortunately, the majority of research demonstrates that performing thyroid surgery in the elderly is safe. The most common indications for thyroid surgery in the elderly include malignancy, multinodular goiters with compressive symptoms, and thyrotoxicosis. Though some debate exists, most studies demonstrate that once comorbidities are properly addressed prior to surgery, the complication rates of thyroid surgery in the elderly are comparable to those of younger patients...
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - July 4, 2020 Category: ENT & OMF Authors: Nicole Ruszkay, David Goldenberg, Guy Slonimsky Source Type: research

Presbylarynx: Anatomy/Physiology, Non-Surgical Treatment, and Surgery
Conclusion: Substsantial increases in knowledge of vocal again have led to improvement in non-surgical and surgical management of Presbyphonia. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - July 4, 2020 Category: ENT & OMF Authors: Robert T. Sataloff, Karen M. Kost Source Type: research

Operative Techniques in Otolaryngology: Hearing Restoration Options
Hearing loss in elderly patients, commonly referred to as age-related hearing loss (ARHL), is an increasingly significant cause of morbidity. ARHL noted to be the second most common illness in the elderly population, and can often be detrimental to the quality of life of patients. Presently, restorative treatment for age-related hearing loss is limited, however, multifactorial rehabilitation and management strategies exist. A pivotal aspect of management in ARHL is the use of amplifying hearing aids and implantable devices. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - July 4, 2020 Category: ENT & OMF Authors: David Guirguis, Kourosh Parham Source Type: research

Cochlear Implantation under Local Anesthesia with Conscious Sedation in the Elderly Patient: Focus on Surgical Technique
As the world's geriatric population continues to grow at an unprecedented rate, an increasing number of elderly patients are seeking hearing rehabilitation strategies, including cochlear implantation (CI). However, CI surgery in elderly patients has been met with trepidation given fears of physical and cognitive complications associated with general anesthesia. Cochlear implant surgery under local anesthesia with conscious sedation (LA-CS) in the elderly population is a safe and feasible alternative to general anesthesia. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - July 4, 2020 Category: ENT & OMF Authors: Nicholas L. Deep, Joseph Connors, J. Thomas Roland Source Type: research

Rhinoplasty in the Aging Patient
Aging can slowly affect the appearance and function of the nose. Rhinoplasty is becoming a more common procedure for older patients seeking reversal of these effects on their nasal form and function. A number of anatomical changes contribute to the classic changes in the aging nose: tip ptosis and a dorsal hump or pseudohump. The preoperative evaluation is critical in this patient population in which comorbidities are almost guaranteed and the risks of general anesthesia may frequently outweigh the benefits of the procedure, especially when solely cosmetic. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - July 4, 2020 Category: ENT & OMF Authors: Erin R. Weatherford Creighton, Jennings R. Boyette Source Type: research

Cochlear Implantation in the Elderly: Outcomes
This review examines the various outcome measures utilized in assessing the safety and efficacy of cochlear implantation (CI) in the elderly population. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - July 4, 2020 Category: ENT & OMF Authors: Jeremy Ruthberg, Varun Adhvaryu, Armine Kocharyan, Selena (Heman-Ackah) Briggs Source Type: research

Sleep Apnea Surgery in the Elderly
With a growing population of elderly patients in the United States seeking treatment for obstructive sleep apnea, age is becoming an increasingly important consideration for sleep surgeons. The effects of OSA on elderly patients may be different for older patients, specifically when it comes to the cardiovascular and mortality risk observed in younger patient populations. Recent reports indicate that traditional structural surgery for elderly patients may be less effective and that postoperative complication rates are higher. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - July 4, 2020 Category: ENT & OMF Authors: Jeffrey J. Stanley Source Type: research

Endoscopic arytenoid abduction lateropexy in paediatric vocal cord paralysis
Vocal Fold Paralysis (VFP) is an uncommon problem in children. Clinical presentation covers a wide range of signs and symptoms. Our objective is to evaluate de efficacy and security of the Endoscopic Arytenoid Abduction Lateropexy (EAAL) in paediatric patients with VCP and to present the results. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - July 3, 2020 Category: ENT & OMF Authors: Roc ío Gutiérrez, Bellia Munzón Patricio, Rodriguez Verónica, Cuestas Giselle, Doormann Flavia, Teyssier Morales Gustavo, Penchyna Jaime, Bellia Munzón Gastón Source Type: research

Hypoglossal Nerve Stimulator Implantation via a Two-Incision Technique
A hypoglossal nerve stimulator currently available for clinical use requires three incisions to implant three separate components. A substantial modification to operative technique described herein moves the device's respiratory sensing lead from the fifth to the second intercostal space, now inserting it transpectorally through the same incision used for the implantable pulse generator. Elimination of a third incision and second lead tunneling procedure minimizes the risk of breast and chest wall injury, reduces operative time, and decreases postoperative pain. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - July 3, 2020 Category: ENT & OMF Authors: David T. Kent, Jordan S. Weiner, Eugene G. Chio, Mark Weidenbecher Source Type: research

Critical Care Surgical Tracheotomy
Tracheotomy is a commonly performed surgical airway to relieve upper airway obstruction, improve pulmonary hygeine, and decrease the risk of damage to the larynx from indwelling endotracheal tubes. Critical Care Intensivists have safely introduced the Percutaneous Dilational Tracheotomy (PDT) into practice, but contraindications and limitations exist for this technique. In patients with indwelling endotracheal tubes who have difficult airways, open surgical tracheotomy is considered advantageous as a definitive airway can be secured throughout the surgery. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - June 5, 2020 Category: ENT & OMF Authors: Yoseph A. Kram, Sungjin A. Song, Macario Camacho, Jeremy Juang, Matthew S. Russell Source Type: research

Editorial Board
(Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - June 1, 2020 Category: ENT & OMF Source Type: research

Coblation Intracapsular Tonsillectomy in Pediatric Patients
Coblation intracapsular tonsillectomy (IT) is a relatively new technique in pediatric tonsillectomy and represents a significant step forward in quality and safety in the treatment of pediatric tonsillar hypertrophy. Studies, and our own clinical experience, suggest that it has equivalent efficacy to total tonsillectomy (TT) in the treatment of sleep-disordered breathing and even recurrent tonsillitis1. Furthermore, children who undergo IT have been shown to experience less pain, have increased PO intake, and be more active than those who undergo TT, particularly by POD 52. (Source: Operative Techniques in Otolaryngology -...
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - June 1, 2020 Category: ENT & OMF Authors: Steven M. Chau, Gurpreet S. Ahuja, Kevin C. Huoh, Nguyen S. Pham Source Type: research

Preoperative assessment of the difficult airway in otolaryngology – implications for operative technique and airway management
Despite a plethora of articles describing airway assessment, there is no magic bullet for difficult airway evaluation. Statistical validation of scoring systems and radiological evaluations appear to be elusive. The reason for our inability to reliably assess every airway is complex. Every airway has a subset of subtly different anatomical variables and when taken in totality may result in difficult bag mask ventilation or difficult intubation. Simply looking at 5-12 risk factors may not be relevant or adequate for an individual. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - May 15, 2020 Category: ENT & OMF Authors: Analee Milner Source Type: research

Preoperative assessment of the difficult airway in otolaryngology- implications for operative technique and airway management
Despite a plethora of articles describing airway assessment, there is no magic bullet for difficult airway evaluation. Statistical validation of scoring systems and radiological evaluations appear to be elusive. The reason for our inability to reliably assess every airway is complex. Every airway has a subset of subtly different anatomical variables and when taken in totality may result in Difficult Bag Mask ventilation (DBMV) or Difficult Intubation (DI). Simply looking at five to 12 risk factors may not be relevant or adequate for an individual. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - May 15, 2020 Category: ENT & OMF Authors: Analee Milner Source Type: research

The Difficult Airway in Severe Facial Trauma
Consideration of the airway is paramount in management of facial fractures in both the acute setting and delayed repair. As experts in laryngotracheal surgery, otolaryngologists often play a key role in airway management in both settings. On presentation, soft tissue edema and prolapse or presence of blood in the airway may complicate placement of an endotracheal tube and may necessitate emergent intervention. During planned fracture repair, surgeons and anesthesiologists must collaborate to determine a precise airway plan due to the inherent conflict of a need for a secure airway and a need for surgical access. (Source: O...
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - May 10, 2020 Category: ENT & OMF Authors: Danielle Kumpf, Robert Saadi, Jessyka G. Lighthall Source Type: research

A multidisciplinary approach for managing the infraglottic difficult airway in the setting of the Coronavirus pandemic
Management of a difficult airway caused by pathology below the glottis is high-risk and requires a shared approach to airway planning and surgical treatment. Access to the trachea requires a careful assessment of the airway since the end-point of laryngoscopy for infraglottic airway management is not visualization of the larynx for tube placement, but access to the laryngotracheal complex in cases where intubation may not be feasible or may preclude surgical access.This work provides a common framework for creating multidisciplinary shared-airway management plans and presents devices and strategies that have in recent year...
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - May 3, 2020 Category: ENT & OMF Authors: S.A.R. Nouraei, M. Girgis, J. Shorthouse, K. El-Boghdadly, I. Ahmad Source Type: research

A multidisciplinary approach for managing the infraglottic difficult airway in the settings of the Coronavirus pandemic
Management of a difficult airway caused by pathology below the glottis is high-risk and requires a shared approach to airway planning and surgical treatment. Access to the trachea requires a careful assessment of the airway since the end-point of laryngoscopy for infraglottic airway management is not visualization of the larynx for tube placement, but access to the laryngotracheal complex in cases where intubation may not be feasible or may preclude surgical access.This work 23 provides a common framework for creating multidisciplinary shared-airway management plans and presents devices and strategies that have in recent y...
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - May 3, 2020 Category: ENT & OMF Authors: S.A.R. Nouraei, M. Girgis, J. Shorthouse, K. El-Boghdadly, I. Ahmad Source Type: research

Multidisciplinary airway response teams: Concept, structure, & implementation
Airway management challenges encompass the anticipated (eg, airway pathology, history of difficult intubation, bleeding) and the unanticipated. Challenging airway situations also occur in patients with existing in situ tracheostomy tubes and laryngectomy stomas or in intubated patients around the time of planned or unplanned extubation. Preparedness to handle difficult airway scenarios requires a structured approach to patient assessment, identification, and planning. Preparedness also necessitates an organized, disseminated, and predefined process to deliver appropriate resources efficiently to the bedside in an emergency...
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - May 3, 2020 Category: ENT & OMF Authors: Joshua H. Atkins, Christopher H. Rassekh Source Type: research

“Cannot Intubate, Cannot Oxygenate” (CICO) rescue by emergency Front of Neck Airway (eFONA)
In airway management, a ``Cannot Intubate, Cannot oxygenate ” emergency, or simply ``CICO” (IPA: kaɪkəʊ), is an inability to restore alveolar oxygenation by means of any non-surgical lifeline (facemask, endotracheal tube, or supraglottic airway device). With ``CICO,” hypoxic brain damage and death will result unless there is rapid resolution. The ab ility of an airway team member to swiftly establish an emergency Front of Neck Airway as a CICO rescue is currently deemed to be an essential skill for everyone that performs tracheal intubations. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - May 3, 2020 Category: ENT & OMF Authors: Wayne Pearce, Jeremy Barr, Kasra Ziai, Neerav Goyal Source Type: research

Contemporary approach to the difficult airway management
A difficult airway can arise as a primary emergent or urgent one, or during an elective procedure, with unexpected and rapid deterioration in oxygenation. Both scenarios may be handled differently. However, open communication and planning between airway specialists involved are critical for a good outcome. Depending on the underlying causes of difficult airway situations, different approaches and management algorithms obtain. The Otolaryngologist-Head and Neck Surgeon (OHNS) should be familiar and comfortable with difficult airway situations, have an open dialogue with the rest of the airway team, and always plan for failu...
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - May 3, 2020 Category: ENT & OMF Authors: Dana Goldenberg, Sonia Vaida Source Type: research

Two curves and three columns –A reappraisal of direct laryngoscopy
Airway management requires an assessment of the 2 curves of the airway and how these are affected by pathology within the head and neck region. The changes in airway curvature due to head and neck positioning as well as regional pathology are correlated with the effects of different airway devices to enable the operator to predict the success or failure of airway management. Airway device groups are not mutually exclusive to specific airway pathologies but may function successfully in a variety of scenarios. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - May 3, 2020 Category: ENT & OMF Authors: Keith B. Greenland Source Type: research

Nasal Dermoid Cyst Excision with a Lateral Rhinotomy Approach through the Nasal Alar Sulcus
Congenital midline nasal masses are uncommon, occurring anywhere from 1 in 20,000 to 1 in 40,000 births.[1] They result from anomalies in neural tube closure between the 3rd and 4th week of gestation.[2] Pediatric nasal midline masses of ectodermal origin include nasal dermoids (ND) and nasal dermoid sinus cysts (NDSC). NDSCs are characterized by intracranial extension whereas NDs are limited to the nasal dorsum, medial canthus, or glabella.[3] NDs are the most common congenital midline nasal mass and develop as a result of failed involution of the neuroectomderm in the prenasal space. (Source: Operative Techniques in Otol...
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - May 3, 2020 Category: ENT & OMF Authors: John W. Lally, Alexandra Ortiz, Jon Robitschek, Michael Demarcantonio Source Type: research

Introduction
It is an honor to serve as an anesthesiologist as a guest editor for this issue on the difficult airway of Operative Techniques in Otolaryngology, especially at a time of unprecedented world-wide interprofessional collaboration in the elaboration of guidelines and strategies to prevent airway complications. Today there are calls for reorganizing care in hospitals by establishing local multidisciplinary airway safety teams responsible for all aspects of advanced airway management, and in particular invasive airway management, that would “take note of current concepts, techniques and existing guidelines from relevant s...
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - May 3, 2020 Category: ENT & OMF Authors: Wayne Pearce Source Type: research

Contemporary approach to the difficult airway
A difficult airway can arise as a primary emergent or urgent one, or during an elective procedure, with unexpected and rapid deterioration in oxygenation. Both scenarios may be handled differently. However, open communication and planning between airway specialists involved are critical for a good outcome. Depending on the underlying causes of difficult airway situations, different approaches and management algorithms obtain. The Otolaryngologist-Head and Neck Surgeon (OHNS) should be familiar and comfortable with difficult airway situations, have an open dialogue with the rest of the airway team, and always plan for failu...
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - May 3, 2020 Category: ENT & OMF Authors: Dana Goldenberg, Sonia Vaida Source Type: research

Two Curves and Three Columns – a reappraisal of direct laryngoscopy
Airway management requires an assessment of the two curves of the airway and how these are affected by pathology within the head and neck region.  The changes in airway curvature due to head and neck positioning as well as regional pathology are correlated with the effects of different airway devices to enable the operator to predict the success or failure of airway management. Airway device groups are not mutually exclusive to specific air way pathologies but may function successfully in a variety of scenarios. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - May 3, 2020 Category: ENT & OMF Authors: Keith B. Greenland Source Type: research

‘Cannot Intubate, Cannot Oxygenate’ (CICO) rescue by emergency Front of Neck Airway (eFONA)
In airway management, a ‘Cannot Intubate, Cannot oxygenate’ emergency, or simply ‘CICO’ (IPA: kaɪkəʊ), is an inability to restore alveolar oxygenation by means of any lifeline (facemask, endotracheal tube or supraglottic airway device) through the upper airway. With ‘CICO’, hypoxic brain damage and death wil l result unless there is rapid resolution. The ability of an airway team member to swiftly establish an emergency Front of Neck Airway (eFONA) as a CICO rescue is currently deemed to be an essential skill for everyone that performs tracheal intubations. (Source: Operative Techniqu...
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - May 3, 2020 Category: ENT & OMF Authors: Wayne Pearce, Jeremy Barr, Kasra Ziai, Neerav Goyal Source Type: research

Multidisciplinary Airway Response Teams: Concept, Structure & Implementation
Airway management challenges encompass the anticipated (e.g. airway pathology, history of difficult intubation, bleeding) and the unanticipated. Challenging airway situations also occur in patients with existing in-situ tracheostomy tubes and laryngectomy stomas or in intubated patients around the time of planned or unplanned extubation. Preparedness to handle difficult airway scenarios requires a structured approach to patient assessment, identification, and planning. Preparedness also necessitates an organized, disseminated, and pre-defined process to deliver appropriate resources efficiently to the bedside in an emergen...
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - May 3, 2020 Category: ENT & OMF Authors: Joshua H. Atkins, Christopher H. Rassekh Source Type: research

The approach and operative implications for the partially obstructed airway with impending or sudden loss of the airway
The otolaryngologist – head and neck surgeon plays a unique role in the acute management of partial airway obstruction due to their familiarity with the surgical instruments and technical skills in establishing both non-surgical and surgical airway access. When a partial airway obstruction deteriorates into impending or sudden airway loss, the surgeon must work intimately with the anesthesiologist and supporting staff to promptly establish an airway to minimize the injuries associated with prolonged hypoxia. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - May 3, 2020 Category: ENT & OMF Authors: Joseph C. Park, Alexander T. Hillel Source Type: research

Multidisciplinary difficult airway challenges: Perioperative management of glottic and supraglottic tumours
Carcinomas of the larynx are common and require multidisciplinary perioperative management with particularly excellent communication between the surgeon and anaesthesiologist. Early preoperative assessment allows for optimisation, prehabilitation and advanced imaging in cases who present without respiratory compromise. On arrival for surgery, thorough airway examination including preoperative endoscopic airway assessment under topical anaesthesia and airway ultrasound will inform planning for airway management. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - May 3, 2020 Category: ENT & OMF Authors: Ross Hofmeyr, Richard Llewellyn, Johannes J. Fagan Source Type: research

A multidisciplinary approach for managing the infraglottic difficult airway
Management of a difficult airway caused by pathology below the glottic inlet is high-risk and requires a shared approach to airway management and surgical treatment. Access to the trachea requires a careful assessment of the airway since the end-point of laryngoscopy for infraglottic airway management is not visualization of the larynx for tube placement, but access to the laryngotracheal complex in cases where intubation may not be feasible, or if performed, may preclude surgical access.This work builds on the two curves and three columns model of laryngoscopy and presents a common framework for creating multidisciplinary...
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - May 3, 2020 Category: ENT & OMF Authors: SAR Nouraei, M Girgis, J Shorthouse, I Ahmad Source Type: research

The Difficult Airway and Thyroid Surgery
This article reviews airway management principles and techniques related to thyroid surgery. This patient population requires a unique preoperative evaluation. Multiple techniques for airway management exist and are utilized on a case-by-case basis. Highlighted in this article are also the special circumstances in thyroid surgery patients in which a difficult airway can present. Adequate preparation for difficult situations is crucial in the management of thyroid surgery patients. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - May 3, 2020 Category: ENT & OMF Authors: Allison Keane, David Goldenberg Source Type: research

Airway Management Principles in Complex Cervicofacial Infections
Complex cervicofacial infections encompass a unique subset of upper and lower airway disorders with both potential to progress into a life-threating clinical condition. In the modern era, treatment of aggressive extracranial infections continues to revolve around the hallmark principles of airway stabilization, broad-spectrum antimicrobials, radiography, and surgical drainage. Approaches to complicated head and neck infections remain a multidisciplinary endeavor involving an experienced team of anesthesiologists, critical care intensivists, and otolaryngologists. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - May 3, 2020 Category: ENT & OMF Authors: Vijay A. Patel, Khaled A. Sedeek, Meghan N. Wilson Source Type: research

The Difficult Airway and Transoral Robotic Surgery
A systematic approach to airway management for TORS will translate to a high-reliability system capable of handling anticipated and unexpected difficult airway situations. Intubation and glottic exposure for surgery need to be considered as distinct but critical components. Pre-operative team briefings can contribute to effective planning and preparedness. Management options for TORS difficult airway should include formal consideration of awake tracheostomy and surgical microdirect laryngoscopy to facilitate intubation. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - May 3, 2020 Category: ENT & OMF Authors: Joshua H. Atkins, Christopher H. Rassekh Source Type: research

Recurrent head and neck tumors in the setting of previous reconstructive surgery and radiation
The approach to a difficult airway in patients presenting with recurrent head and neck tumors in the setting of previous surgery or radiation poses challenges to both anesthesiologists and otolaryngologists. Multidisciplinary planning with close communication is required for effective and safe care. It is critical to understand how each patient's prior surgery and radiation distorts the baseline airway anatomy and what complications may arise when deciding on the primary airway management and back-up plans. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - May 3, 2020 Category: ENT & OMF Authors: Jaime B. Hyman, Shradha D. Khadge, Eliezer Kinberg, Brett Miles, Adam Levine Source Type: research

How to preserve the olfaction in harvesting the nasoseptal flap in endoscopic skull base surgery
The introduction of nasoseptal flap for the skull base defects reconstruction in endoscopic endonasal approaches represents a revolution that dramatically reduced incidence of the cerebrospinal fluid leaks, however it may be associated with comorbidities like olfactory hypofunction. Objectives: We revise our anatomical knowledge and surgical experience in order to describe an easy and safe technique to avoid olfaction hypofunction. Methods (Surgical technique): A simple anatomical surgical landmark proposed for identification of the olfactory area on the septum, based on the anatomy of the lateral nasal wall. (Source: Oper...
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - March 17, 2020 Category: ENT & OMF Authors: Muaid I. Aziz Baban, Paolo Battaglia, Mokarbesh Hadi Mohammed, Davide Locatelli, Abdulrahman Shawkat, Mario Turri-Zanoni, Paolo Castelnuovo Source Type: research

How to preserve the olfaction in harvesting the nasoseptal flap in endoscopic skull base surgery.
The introduction of nasoseptal flap for the skull base defects reconstruction in endoscopic endonasal approaches represents a revolution that dramatically reduced incidence of the cerebrospinal fluid leaks, however it may be associated with comorbidities like olfactory hypofunction. Objectives: We revise our anatomical knowledge and surgical experience in order to describe an easy and safe technique to avoid olfaction hypofunction. Methods (Surgical technique): A simple anatomical surgical landmark proposed for identification of the olfactory area on the septum, based on the anatomy of the lateral nasal wall. (Source: Oper...
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - March 17, 2020 Category: ENT & OMF Authors: Muaid I. Aziz Baban, Paolo Battaglia, Mokarbesh Hadi Mohammed, Davide Locatelli, Abdulrahman Shawkat, Mario Turri-Zanoni, Paolo Castelnuovo Source Type: research

Editorial Board
(Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - March 1, 2020 Category: ENT & OMF Source Type: research

Consortium of Otolaryngology Journal Editors: Collegiality and Contributions
There is a new tradition in the otolaryngology publishing community that is unique to our specialty, so far as we know. Editors-in-Chief of otolaryngology journals in the United States, and intermittently some of our international colleagues such as the Editor of the Journal of Laryngology and Otology (England), sit down together twice a year to discuss topics of mutual interest, maintain lines of communication and friendships, and share perspectives on the evolution of otolaryngology – head and neck surgery and needs that our journals might help address. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - February 19, 2020 Category: ENT & OMF Authors: Robert T. Sataloff, Rakesh Chandra, Edward W. Fisher, David Goldenberg, Ehab Y. Hanna, Jonas Johnson, David W. Kennedy, Dennis H. Kraus, John H. Krouse, Michael Link, Lawrence R. Lustig, Jr. Bert W. O'Malley, Jay F. Piccirillo, Robert Ruben, Sandra Schwar Tags: Editorial Source Type: research

Introduction
This edition of Operative Techniques serves as a comprehensive overview of techniques for lip reconstruction. The lips are a central part of the human face and serve important functional and aesthetic roles. They are quite sensitive to aesthetic discrepancies and their dynamic nature makes their reconstruction challenging. We review surgical and non-surgical reconstructive options for a wide range of size defects with various well-known flaps, oral commissure reconstruction, and a lip considerations in facial paralysis patients. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - January 6, 2020 Category: ENT & OMF Authors: David A. Shaye Source Type: research

Lip Reconstruction: Primary Full Thickness Closure and Superficial Partial Thickness Closure
The lips play a principle role in the lower third of the face. Defects of the lips can result in profound functional and aesthetic consequences. Small to medium sized full thickness defects of the lip are amenable to primary closure and can yield excellent results. Partial thickness cutaneous defects may be amenable to local flap techniques or conversion to a full thickness defect for primary closure. By understanding the anatomic basis, patient factors, defect characteristics, and surgical nuances in primary lip repair, reconstructive surgeons can achieve superior outcomes. (Source: Operative Techniques in Otolaryngology ...
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - January 6, 2020 Category: ENT & OMF Authors: Guanning Nina Lu, Shaun Chandra Desai Source Type: research

Lip Reconstruction Using the Gillies Fan Flap
The Gillies Fan flap is a single-stage composite rotational-advancement flap for reconstruction of medium to large full thickness lower lip defects. It can be thought of as an extension of the Estlander flap. It is nourished by a narrow superiorly-based pedicle of the superior labial artery. Mobilized tissue includes adjacent lower lip tissue as well as tissue from the opposing lateral lip. The oral commissure is distorted with use of this technique, and sometimes requires a second stage for refinement using a commissureplasty, discussed elsewhere in this issue. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - January 6, 2020 Category: ENT & OMF Authors: Prabhat K. Bhama Source Type: research

Unilateral Cleft Lip Repair
Cleft lip is one of the most commonly encountered craniofacial deformities. While comprehensive management of this deformity requires a multidisciplinary team approach, this article will specifically focus on the surgical management of the unilateral cleft lip deformity. As evidenced by the multiple techniques that have been developed for its repair, a functionally and aesthetically pleasing result is challenging to attain. Optimal surgical repair requires a thorough understanding of the underlying anatomy, which is reviewed. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - January 6, 2020 Category: ENT & OMF Authors: Jennifer C. Fuller, David A. Shaye Source Type: research

Nuance in Bilateral Cleft Lip Repair
The management of patients with bilateral cleft lip and palate requires an understanding of anatomy and a focus on function. Comprehensive care in a collaborative multidisciplinary setting is crucial for the future development of these children. The operative technique begins with meticulous measurement and creation of symmetry to set the foundation for successful repair. In severely wide or asymmetric cases, preoperative orthopedics can be used to narrow the cleft prior to surgery. Consistency of design, anticipation of future growth and critical evaluation of results are essential for a cleft surgeon to obtain the best r...
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - January 6, 2020 Category: ENT & OMF Authors: Tsung-yen Hsieh, Mary Roz Timbang, Travis T Tollefson Source Type: research

Estlander Flap for Lip Reconstruction
Lip reconstruction following trauma or extirpative surgery remains a significant challenge to the facial plastic surgeon. Reconstructive efforts have attempted to balance aesthetic outcome with maintenance of function, while avoiding sequelae such as microstomia, oral commissure effacement, dry-wet lip substitution, adynamia, impaired lip sensation, and oral incompetence. Procedures include the eponymous Abbe, Estlander, Karapandzic, McGregor, and Gillies fan flaps, as well as free tissue transfer and mucosal advancement techniques. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - January 5, 2020 Category: ENT & OMF Authors: Michael Eggerstedt, Ryan M. Smith, Peter C. Revenaugh Source Type: research

Lip Reconstruction Using the Sabattini-Abb é Cross-Lip Flap
The lips are important anatomically distinct subunits within the lower face. Due to their prominence, and their location within an observational center of the face, even minor defects may result in conspicuous deformities.1 The lips serve a defining role in facial aesthetics, the concept of modern beauty and the expression of emotion. Functionally, the lips play an integral role in articulation and deglutition, due to their function as an oral sphincter. Lip reconstruction therefore presents a particular challenge to the facial reconstructive surgeon seeking to restore both form and function. (Source: Operative Techniques ...
Source: Operative Techniques in Otolaryngology - Head and Neck Surgery - January 5, 2020 Category: ENT & OMF Authors: Tom Shokri, Jessyka G. Lighthall Source Type: research