10 Different Sleep Apnea Surgeries Video

This animation quickly goes through 10 different surgical techniques to treat obstructive sleep apnea (OSA): 1) Tonsillectomy and Adenoidectomy , 2) UPPP , 3) Modified UPPP, 4) Expansion Sphincter Pharyngoplasty, 5) Lateral Pharyngoplasty, 6) Lingual Tonsillectomy, 7) Midline Partial Glossectomy, 8) Submucosal Base of Tongue Reduction , 9) Thyrohyoid Approximation, and 10) INSPIRE device. There are many different surgeries to treat OSA given the many different anatomies and causes for sle…

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Expansion Sphincter Pharyngoplasty for OSA Video

UPPP  or uvulopalatopharyngoplasty is the "traditional" surgical procedure to help address  obstructive sleep apnea  in adult patients. However, there are other types of palate surgery beyond UPPP that is occasionally performed to help resolve OSA. The video shown here depicts expansion sphincter pharynoplasty or functional expansion pharyngoplasty. This surgical approach focuses on preventing airway collapse that occurs from the side and in some patients, will achieve a higher…

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Celine Dion Cancels Concerts Due to Patulous Eustachian Tube

Read the full Facebook Post here. On March 21, 2018, Celine Dion announced on Facebook that she is cancelling her concerts in March and April 2018 due to "Patulous Eustachian Tube," a middle ear condition that causes hearing problems. In a normal human middle ear, there is a tunnel that connects to the back of the nose. When pressure builds up in the middle ear such as going up in an airplane, an individual is able to "pop" the ear thereby releasing the pressure and …

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Video of Surgery to Stop Brain Fluid from Leaking Out the Nose

A new video has been uploaded demonstrating the surgical technique of stopping brain fluid (aka, CSF leak) from coming out the nose. Normally, there should be no hole that communicates between the brain and the nose. However, in some patients, this hole may be present secondary to sinus surgery, head trauma, or simply bad luck. In essence, the steps to plug up this abnormal hole are as follows: 1) Fluorescein injected into the spinal fluid before surgery. Fluorescein makes the brain fl…

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Deviated Septum Surgery (Septoplasty) Video

A new video has been uploaded to show how a deviated septum surgery or septoplasty is performed. Both 3D as well as 2D cross-sectional animations are shown.

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Types of CPAP Masks for Sleep Apnea Treatment

A common question for a patient newly diagnosed with obstructive sleep apnea prescribed CPAP treatment is what the masks look like. CPAP is the gold standard treatment for sleep apnea prior to considering any type of surgical treatment . In essence, there are 3 different flavors of CPAP masks illustrated below. Due to the huge variation in face shapes and sizes, there is no "best" CPAP mask and often, a patient may need to try different styles, size, and strap placements before fi…

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Surgeons Should Operate Naked to Decrease Risk of Surgical Site Infections

Image courtesy of adamr at  FreeDigitalPhotos.net This controversial claim was actually made by a well-respected surgeon, Dr. Dellinger , at a well-respected institution, University of Washington Seattle , and published in a well-respected journal, Clinical Infectious Diseases . Although this research article's title is certainly published in jest, there is an underlying more serious message. In any case, the argument goes like this:     • FACT : Humans constantly shed skin flak…

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Blood Thinner Use and Sino-Nasal Surgery (Septum and Sinus Surgery)

Cross-Section showing relationship of septum, sinus, eye, and brain There is an active abhorrence between blood thinner medications and ENT surgeons. Not only do blood thinners markedly increase risk of nosebleeds which often require nasal packing   (even without surgery), but it can complicate any type of sino-nasal surgery, particularly septoplasty and sinus surgery . With septoplasty or sinus surgery (collectively called sino-nasal surgery), not only is the nasal mucosa actively c…

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Ear Skin Tags in Babies and Their Removal

Image by Kalus D. Peter in Wikipedia It is not uncommon that a baby is born with "skin tags" around the front of the ear. They are also NOT the same as the skin tags that develop later in adulthood which are benign and easily removed. Infant skin tags may contain not just skin but also fat and cartilage. Infant ear tags often occur by themselves, but sometimes may occur in association with anomalies of the kidney, inner ear,  craniofacial bones, and potentially other structures. …

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Ancient Maori Technique of Eardrum Perforation Repairs - Chicken Bone and Cobwebs

New Zealand ENT Dr. David Grayson  alerted me via Twitter to the interesting factoid that the Maori (indigenous Polynesians of New Zealand) were performing eardrum perforation repairs using a technique that is startlingly similar to the way eardrum repairs today are performed. Of course, we currently use instruments better than a chicken bone and spider cobwebs. Read the description! This description was documented by Sir Patrick Eisdell Moore (1918-2015). The first video shows actua…

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Argentine President Undergoes Vocal Cord Surgery

Image by Casa Rosada in Wikipedia On Dec 20, 2016, media reported that the Argentine President Mauricio Macri underwent a 10 minute office procedure to extract a polyp from the vocal cord. He reportedly went immediately back to work after the procedure. The details are sparse and it is unclear exactly what was done to extract the vocal cord polyp . However, there are only a two ways a vocal cord polyp can be extracted in the office without sedation (that I know of). 1) Trans-nasa…

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Psoriasis Improves After Tonsillectomy

Image by Bobjgalindo in Wikipedia It is felt that certain skin psoriasis conditions may improve if not completely resolve after tonsillectomy . The psoriasis could be anywhere on the body and is hypothesized to be triggered by an abnormal immunological response to streptococcus, an organism commonly found in tonsillitis as well as strep throat. The exact mechanism is unclear but several studies performed over the years found potential benefit, especially for guttate psoriasis and even t…

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Actor Mark Ruffalo Had Surgery to Remove Acoustic Neuroma

Actor Mark Ruffalo suffered from a left acoustic neuroma that required surgical removal in 2001. The surgery left him with a temporary left facial paralysis that took almost one year to resolve causing him to "disappear" from acting for that period of time. Along with his temporary facial paralysis , he also unfortunately permanently lost his left ear hearing. It was only recently that he came forward to fully explain what happened in 2001 given his sudden disappearance from the …

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Large Bulbous Nose Rhinoplasty [VIDEO]

A  new video  has been produced showing how a large nasal tip or bulbous nose is corrected. This video was created with  Dr. Stephen Park  who is a Professor and Vice-Chair of Otolaryngology, Division Chief of Facial Plastic Surgery. This is the third of 5 videos that will be created describing the most common rhinoplasty procedures. The first was  nasal hump removal  which can be watched  here . The second was the saddle nose deformity rhinoplasty . Please keep in mind that although  …

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Saddle Nose Deformity Nose Job [VIDEO]

A  new video  has been produced showing how a "saddle nose" or "ski-slope nose" is corrected. This video was created with  Dr. Stephen Park  who is a Professor and Vice-Chair of Otolaryngology, Division Chief of Facial Plastic Surgery. A saddle nose deformity is when the nose bends downward between the forehead and tip of nose resulting in a shape similar in appearance to a ski jump slope. It could be congenital or acquired. Acquired causes include prior rhinoplasty, in…

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Velopharyngeal Insufficiency (VPI) After UPPP or Uvula Excision Surgery

Image 1 : Normal open position One of the main risks of uvula excision and UPPP (uvulopalatopharyngoplasty) surgery to treat snoring and obstructive sleep apnea is velopharyngeal insufficiency (VPI). This complication is when the soft palate is not able to adequately lift and close off the back of the nose from the throat.  When the VPI is large, food and liquids can come out the nose during swallow and there may be a hyper-nasal speech quality. When the VPI is very small, a patient ma…

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New Video on Sinusitis and Sinus Surgery Explained (Balloon Sinuplasty and Endoscopic Sinus Surgery)

A  new video  has been uploaded to YouTube that explains how sinus infections occur as well as how sinus surgery helps with this condition via balloon sinuplasty or traditional endoscopic sinus surgery . Sinus topics demonstrated in this video include: •  Chronic Sinusitis •  Endoscopic Sinus Surgery •  Balloon Sinuplasty

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How Fast Should an Emergency Tracheostomy Take?

Image courtesy of digitalart at FreeDigitalPhotos.net When faced with an emergency airway situation, a surgical airway may be required in order to save a person's life. Such surgical airways include emergency tracheostomy or cricothyroidotomy. The main question here is how quickly should such a procedure take in order for it to be considered a success? Clearly, it should take less than 4 minutes given that is how long a brain can survive without oxygen before permanent damage sets in…

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Where Does Tinnitus Come From? Ear or Brain?

It is invariable that when a patient comes to an ENT office complaining of tinnitus or ringing of the ears that only they can hear, that they feel this problem stems from purely an inner ear problem. However, the truth is WAY more complicated in that this phantom ringing actually comes more from the brain rather than the ear and as such, treatment (if any possible) is geared more towards the brain rather than the ear. The analogy I often use to explain this phenomenon is phantom limb pain.…

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Flexible Endoscopic Treatment of Zenker's Diverticulum

Having treated many patients with Zenker's Diverticulum using the endoscopic approach, I've had patients from all over the world contact me to determine whether I can help them or not... some specifically asking if I can perform the flexible endoscopic approach. However, I employ a rigid endoscopic approach rather than using a flexible endoscopic technique. For those unfamiliar with this disorder, click here for more information. If you just want to skip to the doctors who perfor…

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