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Miniseminars P25
MINISEMINARS
function. The last speaker will discuss the current research on
robotic assisted reconstruction and its future advantages and chal-
lenges ahead.
Educational Objectives: 1) Understand the role of transoral
robotic surgery in head and neck cancer. 2) Understand the
current use of robotic reconstructive surgery. 3) Understand
the indications and future potential for robotic-assisted recon-
structive surgery.
Update on Diagnosis and Management of
Primary Hyperparathyroidism
Maisie L. Shindo, MD (moderator); Lisa A. Orloff, MD;
David L. Steward, MD; Brendan C. Stack, Jr, MD
Program Description: The diagnosis and management of primary
hyperparathyroidism is generally straightforward. Cases referred
from endocrinologists for surgery will usually have the clas-
sic laboratory findings and the correct diagnosis. An adenoma
will be localized by imaging in approximately 80% to 85% of
these patients. As increasing referrals are being generated from
primary care physicians rather than endocrinologists, surgeons
will invariably see only partially worked up patients and diag-
nostic dilemmas. The first part of this panel, which is composed
of expert endocrine surgeons with extensive experience in para-
thyroid surgery, will address some of the diagnostic challenges
and their evaluation. The second portion of the panel will focus
on treatment. Minimally invasive parathyroidectomy (MIP) has
become the preferred surgical approach for treatment of primary
hyperparathyroidism. Localization of an adenoma on preopera-
tive imaging is the key to being able to perform a successful
MIP. The panel will discuss pearls and pitfalls in the imaging of
parathyroid adenomas, including the use of ultrasound, sestamibi
parathyroid scan, and CT scans. Thirdly the panel will present
state of the art minimally invasive parathyroidectomy techniques,
such as radioguided surgery, lateral approach, performing MIP
under local/sedation. Cases will also be presented on how to
approach failed explorations.
Educational Objectives: 1) Learn pearls and recognize pitfalls of
challenging cases of hyperparathyroidism. 2) Understand the
principles and techniques of minimally invasive parathyroid-
ectomy. 3) Learn how to improve the yield of preoperative
imaging for primary hyperparathyroidism.
Laryngology/Broncho-Esophagology
Adult Laryngotracheal Stenosis: Past,
Present, and Future
Ahmed M. Soliman, MD (moderator);
Catherine J. Lintzenich, MD; Albert L. Merati, MD;
Kevin Leahy, MD, PhD
Program Description: Adult laryngotracheal stenosis (LTS) is a
very old problem which continues to represent a diagnostic and
treatment challenge for the otolaryngologist. It is distinct in many
ways from similar disease seen in the pediatric population. The
goal of this miniseminar is to outline the evaluation and manage-
ment of this disorder. Presenters will discuss the diagnosis and
treatment of this condition including airway management, as
well as office-based, endoscopic and open procedures. In addi-
tion, recent information on the molecular basis of LTS will be
presented. Challenging cases will be presented for discussion.
Educational Objectives: 1) Be able to list the most common eti-
ologies of laryngotracheal stenosis in adults. 2) Understand
the various treatment options available for the treatment of
laryngotracheal stenosis. 3) Understand the molecular basis of
laryngotracheal stenosis.
Controversies in the Management of
Pediatric Aspiration
Mark E. Gerber, MD (moderator); Karen B. Zur, MD;
Anna H. Messner, MD; James W. Schroeder, MD
Program Description: This miniseminar is supported by the Airway
and Swallowing Committee. It will be an open forum and inter-
active discussion on the management of dysphagia and aspiration
in the pediatric population. The panelists will discuss diagnos-
tic methods as well as medical and surgical treatment options.
They will assist the attendee in understanding the pathophysiol-
ogy and morbidity of chronic aspiration in children. A case pre-
sentation format will be used and the audience will be able to
help determine the focus of the discussion. Attendees will have
the opportunity to submit a case for presentation by emailing to
aspirationaao@me.com prior to the meeting. Each case presented
will have a set of questions developed regarding differential diag-
nosis, evaluation, and treatment for the audience to select prior to
discussion by the panel. The audience response will be a spring-
board for more in-depth discussions. Controversies that will be
reviewed include the use of videofluoroscopic swallow studies
vs fiber optic endoscopic evaluation of swallowing; sialorrhea
management options, including botox, ductal ligation, and sali-
vary gland excision, and surgical management options for per-
sistent aspiration following maximal treatment for sialorrhea and
GERD.
Educational Objectives: 1) Understand diagnostic tests available
for children with dysphagia and aspiration. 2) Formulate algo-
rithm for investigation of children who present with symptoms
of dysphagia and aspiration. 3) Understand treatment options
for mild, moderate, and severe dysphagia and aspiration.
Cricopharyngeal Dysphagia: An
Evidence-Based Approach to
Diagnosis and Management
Robert J. Stachler, MD (moderator); Albert L.
Merati, MD; Milan R. Amin, MD; Ramon A. Franco,
Jr, MD; Phillip Song, MD
Program Description: For the past decade, the management of a
cricopharyngeal dysphagia including a Zenker’s Diverticulum
P26 Otolaryngology–Head and Neck Surgery 145(2S)
MINISEMINARS
has predominantly been endoscopic. Recent literature has sug-
gested that long-term outcomes may not be as successful with
the endoscopic technique as once believed. The purpose of this
miniseminar is to thoroughly review the literature on this topic
and present the most up to date, evidence-based court room
style debate on this topic. This 90-min miniseminar will review:
1) the normal anatomy of the cricopharyngeus and the upper
esophagus. 2) Methods of assessing this area, ie, radiographic,
endoscopic, manometry, pH probe. 3) Medical management
and its role in this disease process. 4) Surgical techniques: Open
techniques: Diverticulectomy with stapled or hand-sewn clo-
sure, diverticuloplasty, +/- cricopharyngeal myotomy. Closed
(endoscopic) technique: diverticulotomy utilizing stapled, laser,
bovie. 5) What is the appropriate management of the patient
with a When to botox? When to dilate? What are the long-term
results of this management? This miniseminar will be interac-
tive. At numerous times during the discussion questions will
be asked of the audience to keep them involved and enter-
tained. The open vs closed surgical debate will be a court-room
style debate with the Moderator acting as the judge or arbitra-
tor. Each presenter will have 8 mins to define their side of the
argument and to present the data. Four minutes will be allowed
for cross examination or rebuttal, 2 mins for the closing argu-
ment if needed. The audience will give the verdict at the end.
A series of questions will be asked of the jury (audience) at the
end. Events/Schedule: Normal anatomy of the cricopharyngeus
and its assessment: 10 min (Robert Stachler, MD). Medical
and surgical management of cricopharyngeal dysfunction: 20
min (Milan Amin, MD). Introduction of the debate of surgical
management: 7 mins (Milan Amin, MD). Presiding Arbitrator:
Robert J. Stachler, MD. Courtroom: 30 mins total. Pro-open
diverticulectomy: Al Meroti, MD; Pro-endoscopic diverticu-
lectomy: Phil Song, MD, Ramon Franco, MD. Questions and
Answers (Case presentation if time allows): 20 mins. Minisemi-
nar Evaluation for the Audience: This should be an interactive
presentation with questions for the audience to answer and an
opportunity for the audience to give a verdict on which tech-
nique seems to have the best evidence. This is not a question of
right or wrong. It is a question of best evidence. The jury will
be prompted on this very point. Decisions are rendered based on
the best evidence only.
Educational Objectives: 1) Appreciate the newest techniques
available to manage cricopharyngeal dysphagia. 2) Evaluate
and treat cricopharyngeal dysphagia. 3) Become facile with the
medical management currently available to treat CP dysphagia.
Current Management of Adult HPV:
From Papilloma to Cancer
Tanya K. Meyer, MD (moderator); Duane Sewell,
MD; Andrew F. Inglis, MD; James A. Burns, MD;
Gary Leiserowitz, MD
Program Description: Human papilloma virus (HPV) infection
is a major cause of disease. It is causal in respiratory papil-
lomatosis and cervical cancer and is etiologically associated
with cancers of the oropharynx as well as additional anogeni-
tal sites. Our knowledge of the role of HPV in these diseases
is evolving and there are yet many unanswered questions.
Furthermore, the epidemiology of these diseases may change
with trends in increasing promiscuity and the advent of wide-
spread HPV vaccination. Patients have often read extensively
about their diagnosis on the internet and may present with
incomplete/incorrect knowledge and difficult questions about
disease transmission, progression, treatment and transforma-
tion. This miniseminar brings together experts that specialize
in different manifestations of HPV disease: adult and pediatric
clinicians that treat recurrent respiratory papilloma (RRP), a
head and neck surgeon that treats oropharyngeal carcinoma
and actively researches vaccines targeting HPV related malig-
nancy, and a guest clinician from gynecology to give insights
on the treatment of HPV from a different perspective. The
format will focus on case presentations to highlight the spe-
cific topics selected for discussion to include: basic biology of
HPV infection and oncogenesis, treatment strategies for RRP,
adjuvant treatments for RRP, counseling regarding contacts of
patients with HPV related disease, HPV vaccine indications,
and current concepts regarding the role of HPV in oropharyn-
geal cancer. There will be opportunity for the audience to ask
questions throughout the presentation.
Educational Objectives: 1) Understand current RRP management
strategies including surgical techniques, adjuvant medications
and nutritional supplements. 2) Be able to counsel patients on
etiology of RRP, transmission, cancer risk, and vaccination. 3)
Understand how RRP fits in the spectrum of HPV-related disease.
Laryngopharyngeal Reflux (LPR)
Bradley F. Marple, MD (moderator); Marvin P. Fried,
MD (co-moderator); John H. Krouse, MD, PhD;
Gregory N. Postma, MD; Kenneth W. Altman, MD,
PhD; John DelGaudio, MD
Program Description: Objective: Develop a working algorithm
that effectively eliminates dangerous conditions while effi-
ciently provides reasonable alternatives to address LPR symp-
toms. Methods: use an audience response system in combina-
tion with a structured set of questions directed to the audience.
End result: a real world proposed treatment algorithm. White
paper. Possible basis for outcomes assessment study. The
overall goal of this session is to define current practice trends
on the management of laryngopharyngeal reflux (LPR) based
on actual audience participation/input, and the consideration
of appropriate management for a typical patient. Using an
interactive panel format, the moderator will prompt panelists
to present a quick review of epidemiology, symptomatology,
and co-morbid conditions impacting laryngopharyngeal reflux
(LPR); diagnosis/differential diagnosis; current evidence on
diagnostic and therapeutic management; and future research
and management implications. After laying out background,
the moderator/panel will consider real world patient manage-
ment algorithms.