Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Principles of Wound Healing

Key Points 1. The tenets of Halstead are highly important in good surgical wound healing. 2. Wound healing occurs in overlapping phases: inflammatory, proliferative, and remodeling phases. 3. A patient’s metabolic issues should always be addressed to promote ideal wound healing. It is wise to prescribe a daily multivitamin. 4. Wounds heal best when kept continually moist (white petrolatum ointment), clean, and protected. 5. Keloid scars…

Facial Plastic and Reconstructive Anatomy and Embryology with Radiologic Correlates

Key Points 1. Formation of the head and neck structures is intimately related to the development of the pharyngeal arches, with each arch carrying an artery, nerve, cartilaginous bar, and muscle. 2. Palate formation requires midline fusion of the medial nasal prominences and palatal shelves. Incomplete fusion results in a spectrum of cleft palate deformities. 3. The superficial muscular aponeurotic system (SMAS) represents a discrete fascial…

Pediatric Head and Neck Tumors

Key Points 1. The location of a neck mass is key to understanding the differential diagnosis. 2. Imaging studies are important in the evaluation of many masses of the head and neck. 3. A neck mass that presents with infectious symptoms may be due to an infected congenital lesion. 4. The choice of treatment of atypical mycobacterial infections of the neck must always consider the risks…

Vascular Anomalies

Key Points 1. The head and neck is the most common site for vascular anomalies. 2. Infantile hemangioma is the most common tumor in infancy. 3. Vascular malformations are classified under the International Society for the Study of Vascular Anomalies (ISSVA) classification based on vessel involvement and flow characteristics (capillary, venous, arterial, lymphatic, combination). 4. Indications for treatment of vascular anomalies include impairment of organ or…

Microtia and Otoplasty

Key Points Otoplasty Options 1. Tape and wax reshaping in the neonatal period 2. Incisionless otoplasty for ears that correct easily with finger pressure 3. Open or traditional otoplasty 4. Creative options such as grafting to cover skin defects or slide rotational flaps to borrow cartilage when it is deficient 5. Autologous rib grafting for microtia or traumatic deformities 6. Awareness of, and colleagues working with,…

Pediatric Hearing Loss

Key Points 1. Early identification of hearing loss, with intervention, is crucial to achieve optimal outcomes for speech and learning in children. 2. Suspect syndromic hearing loss in children with congenital hearing loss and other physical abnormalities. 3. Genetic evaluation of hearing loss requires detailed history and physical exam, family history/pedigree, audiometry and tympanometry, as well as molecular genetic testing. Genetic testing for hearing loss is…

Cleft and Craniofacial Disorders

Key Points 1. The etiology of cleft lip and palate is multifactorial, including both syndromic and nonsyndromic causes. 2. Embryologically, clefts of the lip and primary palate are due to failure of fusion between the medial nasal prominence and the maxillary prominence, the lateral nasal prominence, or both. 3. Fisher anatomic subunit and Millard rotation-advancement are the most common technique for repair of the unilateral cleft…

Congenital Malformations of the Head and Neck

Key Points 1. A Sistrunk procedure involves removal of a thyroglossal duct cyst along with the central portion of the hyoid bone, resulting in decreased recurrence rates of the congenital cyst. 2. Tracheoesophageal anomalies are usually evident at birth because of significant feeding issues and require urgent intervention. 3. Newborns are obligate nasal breathers for at least the first month of life, and the presence of…

Pediatric Adenotonsillar Disease and Obstructive Sleep-disordered Breathing

Key Points 1. There are no studies to date that demonstrate significant alterations in the immune system following an adenotonsillectomy. 2. Penicillin is the initial drug of choice for culture-positive streptococcal infections. Resistance to penicillin or first-generation cephalosporins has not been reported. 3. Obstructive sleep apnea (OSA) requires a polysomnogram (PSG) to make the diagnosis. Obstructive sleep-disordered breathing (oSDB) is a clinical diagnosis. 4. Ibuprofen is…

Chronic Pediatric Airway Diseases

Key Points 1. In the evaluation of pediatric airway disorders, flexible fiber-optic laryngoscopy is the best initial examination modality in the stabilized patient. Additional exams, such as direct laryngoscopy and bronchoscopy, may be indicated. 2. Laryngomalacia and unilateral vocal cord paralysis are the first and second most common causes of stridor in the infant. 3. Choose the smallest endotracheal tube that provides adequate ventilation and limit…

The Acute Pediatric Airway

* I am a military service member or federal/contracted employee of the United States government. This work was prepared as part of my official duties. Title 17 U.S.C. 105 provides that ‘copyright protection under this title is not available for any work of the United States Government.’ Title 17 U.S.C. 101 defines a U.S. Government work as work prepared by a military service member or employee…

Pediatric ENT Anatomy and Embryology With Radiology Correlates

Questions 1 How does the size and shape of the external auditory canal differ between children and adults? In adults, the EAC has a near-sigmoid shape with the cartilaginous portion angling posteriorly and superiorly and the bony portion angling anterior inferiorly. Pulling the helix posterosuperiorly straightens the EAC and allows for better visualization of the tympanic membrane. In the infant the EAC is nearly straight. It…

Temporal Bone Trauma

Key Points 1. The temporal bone is made up of five components (squamous, tympanic, petrous, mastoid, styloid), and fractures generally follow natural lines of weakness at the sutures, canals, and foramina in the bone. 2. The petrous bone is extremely solid and protects the auditory and vestibular organs within the otic capsule in temporal bone trauma. 3. CT scan classification of temporal bone fractures often does…

Neurotology

Key points 1. Neurotology involves the treatment of patients with lateral skull base disorders, encompassing surgery of the entire temporal bone and associated approaches to the middle fossa, posterior fossa, and brainstem. 2. The cerebellopontine angle (CPA) is the junction of the cerebellum and pons, in which a variety of pathologies may arise, of which vestibular schwannomas comprise the vast majority (70%–90%). A cistern of cerebrospinal…

Surgery for Vertigo

Key Points 1. Most forms of vertigo are not managed surgically. Most patients with vertigo can attain significant improvement with conservative nonsurgical measures. 2. Ménière’s disease is a clinical diagnosis based on these features: Two or more definitive episodes of vertigo lasting 20 minutes to 12 hour Hearing loss involving the low to mid-frequencies on at least one occasion before, during, or after an episode of vertigo Fluctuating…

Facial Nerve

Key Points 1. In addition to motor fibers, the facial nerve carries visceral motor, general sensory, and special sensory fibers to the following structures: Parasympathetic input to the lacrimal, submandibular, and sublingual glands Taste from the tongue (special sensory) Sensation from ear canal skin (general sensory) 2. The facial nerve is anatomically divided into three segments: Intracranial (pontine, cerebellar-pontine angle, and internal auditory canal); 23 to…

Cholesteatoma

Key Points 1. Multiple techniques exist for removal of cholesteatomas. 2. Canal wall-up procedures maintain a physiologic ear canal but may have increased risk of residual and recurrent disease. 3. Canal wall-down procedures provide superior visualization of disease during surgery but may require periodic cleaning, difficulty with hearing aids, and water restriction. 4. Ossiculoplasty may be needed to improve hearing if ossicles are damaged. 5. Oto-endoscopy…

Otosclerosis

Key Points Pathophysiology of otosclerosis 1. Otosclerosis involves the otic capsule. 2. Originates from altered bony metabolism with ongoing resorption and deposition of disorganized bone. 3. Results in fixation of the ossicular chain, typically the stapes, producing conductive hearing loss. 4. Can also rarely involve the cochlea, resulting in “cochlear otosclerosis”. 5. Possible contributing factors include genetics, measles infection, autoimmunity, multiple endocrine abnormalities, and low fluoride…

Tympanomastoidectomy and Ossicular Chain Reconstruction

Key Points 1. Key landmarks for a mastoidectomy are the tegmen, sigmoid sinus, lateral semicircular canal, incus, and posterior canal wall. 2. A mastoidectomy is the surgical removal of mastoid air cells. It is indicated for certain types of infection, cholesteatoma, and approaches to other landmarks in the temporal bone. 3. Different types of mastoidectomies are performed based on the extent of the ear disease and…

Complications of Otitis Media

Key Points Pathophysiology and etiology of the complications of otitis media (OM) OM results in complications by different mechanisms. Preformed pathways increase the risk of spread of infection from the middle ear and mastoid to other areas. The three main routes of spread of OM are hematogenous, direct extension, and thrombophlebitis. Most common pathogens associated with complications in AOM are S. pneumonia , H. influenzae ,…