Douglas von Allmen

77 statements · 5 topics

Aerodigestive / ENT · guest expert

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For airway reconstruction, if you have a particularly long suprastomal stent, patients will often gag and wretch because of some of the disruption of the sensation in the hypopharynx and oropharynx as a result of these caustic injuries, these. Patients sometimes tolerate this a little bit better.
quote · Aerodigestive / ENT
The challenge that we face when we deal with pharyngeal stenosis as it relates to caustic congestion is we not only have to deal with the physical obstruction, but we also have to deal with the altered sensation and altered motor function as well.
quote · Aerodigestive / ENT
If it is a true paralysis over time, that muscle atrophies, they have long term voice problems and potentially have issues with aspiration.
quote · Esophageal Atresia
And you can also have lymphatic malformations near glandular tissue that have leaching of the saliva into it and you get a false positive.
quote · Lymphatic Malformation
When you have a cervical component, you can aspirate that and as long as you remove the sublingual gland, it should go away.
quote · Lymphatic Malformation
Second fistulas or H-type fistulas can be really hard to deal with endoscopically sometimes.
quote · Esophageal Atresia

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Douglas's statements about Aerodigestive / ENT 22 statements

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QUAD #5 Pharyngeal Scar Management with Dr. Doug von Allmen

Quotation The challenge that we face when we deal with pharyngeal stenosis as it relates to caustic congestion is we not only have to deal with the physical obstruction, but we also have to deal with the altered sensation and altered motor function as well. Open
Statement In pharyngeal stenosis related to caustic ingestion, clinicians must address not only physical obstruction but also altered sensation and altered motor function Open
Quotation You can see that there's really extensive scarring in the hypopharynx. There's no discernible esophageal inlet. There's also no discernible laryngeal structures as we retract the laryngoscope, you can see that the base of the tongue is essentially scarred to the hypopharyngeal wall. Open
Statement The presented patient had extensive scarring in the hypopharynx with no discernible esophageal inlet and no discernible laryngeal structures, with base of tongue scarred to hypopharyngeal wall Open
Statement After scar tissue removal, the large raw surface area poses a risk of re-scarring Open
Quotation After removal of the scar tissue, we have this big raw surface area. And so the question is how do we prevent this from re-scarring? Open
Statement Some surgeons have used free mucosal grafts to prevent re-scarring after scar tissue removal Open
Statement A modified suprastomal stent can be placed through the glottis and secured with suture, then wrapped with silastic sheeting to increase the stent diameter in the pharynx Open
Quotation For airway reconstruction, if you have a particularly long suprastomal stent, patients will often gag and wretch because of some of the disruption of the sensation in the hypopharynx and oropharynx as a result of these caustic injuries, these. Patients sometimes tolerate this a little bit better. Open
Statement Patients with caustic injuries sometimes tolerate suprastomal stents better than airway reconstruction patients because disrupted sensation in the hypopharynx and oropharynx reduces gagging and retching Open
Statement At one-year follow-up, the presented patient maintained a fairly decent opening to the glottis but remains tracheostomy and G-tube dependent Open
Quotation We did undergo a colon interposition and it was able to get PO taste and certainly has improved management of the secretions, but these can be difficult cases in terms of their long-term outcomes and swallowing dysfunction. Open
Statement The patient underwent colon interposition and was able to get PO taste with improved secretion management, but continues to have swallowing dysfunction Open
Statement In the oropharynx and hypopharynx, a larger caliber balloon is needed for dilation Open
Statement Rotational flaps and free flaps can be used to help break up scarring in pharyngeal stenosis Open
Statement Z-plasty technique can be used to break up scar orientation by rotating mucosal flaps Open
Statement Staged procedures are helpful to avoid creating circumferential scarring again Open
Quotation It's helpful to do this in a staged fashion so that you're not creating circumferential scarring again. Open
Statement Many pharyngeal stenosis patients require tracheostomy, often due to extensive supraglottic scarring Open
Statement Involvement of speech language pathologists and pulmonary colleagues is important to help manage the sequelae of aspiration Open
Statement Pharyngeal stenosis patients warrant long-term surveillance as there is suggestion they may be at increased risk for malignancy, and surveillance for neoplasm development is helpful Open
Quotation There is some suggestion that these patients can be at increased risk for malignancy down the road and surveillance for neoplasm development is helpful. Open
Douglas's statements about Aspiration 22 statements

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QUAD #5 Pharyngeal Scar Management with Dr. Doug von Allmen

Quotation The challenge that we face when we deal with pharyngeal stenosis as it relates to caustic congestion is we not only have to deal with the physical obstruction, but we also have to deal with the altered sensation and altered motor function as well. Open
Statement In pharyngeal stenosis related to caustic ingestion, clinicians must address not only physical obstruction but also altered sensation and altered motor function Open
Statement The presented patient had extensive scarring in the hypopharynx with no discernible esophageal inlet and no discernible laryngeal structures, with base of tongue scarred to hypopharyngeal wall Open
Quotation You can see that there's really extensive scarring in the hypopharynx. There's no discernible esophageal inlet. There's also no discernible laryngeal structures as we retract the laryngoscope, you can see that the base of the tongue is essentially scarred to the hypopharyngeal wall. Open
Statement After scar tissue removal, the large raw surface area poses a risk of re-scarring Open
Quotation After removal of the scar tissue, we have this big raw surface area. And so the question is how do we prevent this from re-scarring? Open
Statement Some surgeons have used free mucosal grafts to prevent re-scarring after scar tissue removal Open
Statement A modified suprastomal stent can be placed through the glottis and secured with suture, then wrapped with silastic sheeting to increase the stent diameter in the pharynx Open
Statement Patients with caustic injuries sometimes tolerate suprastomal stents better than airway reconstruction patients because disrupted sensation in the hypopharynx and oropharynx reduces gagging and retching Open
Quotation For airway reconstruction, if you have a particularly long suprastomal stent, patients will often gag and wretch because of some of the disruption of the sensation in the hypopharynx and oropharynx as a result of these caustic injuries, these. Patients sometimes tolerate this a little bit better. Open
Statement At one-year follow-up, the presented patient maintained a fairly decent opening to the glottis but remains tracheostomy and G-tube dependent Open
Quotation We did undergo a colon interposition and it was able to get PO taste and certainly has improved management of the secretions, but these can be difficult cases in terms of their long-term outcomes and swallowing dysfunction. Open
Statement The patient underwent colon interposition and was able to get PO taste with improved secretion management, but continues to have swallowing dysfunction Open
Statement In the oropharynx and hypopharynx, a larger caliber balloon is needed for dilation Open
Statement Rotational flaps and free flaps can be used to help break up scarring in pharyngeal stenosis Open
Statement Z-plasty technique can be used to break up scar orientation by rotating mucosal flaps Open
Statement Staged procedures are helpful to avoid creating circumferential scarring again Open
Quotation It's helpful to do this in a staged fashion so that you're not creating circumferential scarring again. Open
Statement Many pharyngeal stenosis patients require tracheostomy, often due to extensive supraglottic scarring Open
Statement Involvement of speech language pathologists and pulmonary colleagues is important to help manage the sequelae of aspiration Open
Statement Pharyngeal stenosis patients warrant long-term surveillance as there is suggestion they may be at increased risk for malignancy, and surveillance for neoplasm development is helpful Open
Quotation There is some suggestion that these patients can be at increased risk for malignancy down the road and surveillance for neoplasm development is helpful. Open
Douglas's statements about Esophageal Atresia 10 statements

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Update Course Rewind 2025: The Recurrent TEF Problem

Statement A 7-year-old patient with history of TEF-EA repair presented with chronic cough and food impaction. Open
Statement The patient was referred for esophageal diverticulum and underwent airway evaluation. Open
Statement Esophagoscopy showed a ledge formation at the esophageal anastomosis with a dilated upper pouch. Open
Quotation Second fistulas or H-type fistulas can be really hard to deal with endoscopically sometimes. Open
Statement Second fistulas or H-type fistulas can be very difficult to manage endoscopically. Open
Statement The transtracheal technique involves performing a distal tracheotomy, using bronchoscopy to localize the fistula level, then making a tracheotomy over the fistula to work through and divide the esophageal layers. Open
Statement Recurrent laryngeal nerve injury is underreported. Open
Quotation Recurrent laryngeal nerve injury is underreported. Open
Quotation If it is a true paralysis over time, that muscle atrophies, they have long term voice problems and potentially have issues with aspiration. Open
Statement True recurrent laryngeal nerve paralysis leads to muscle atrophy over time, resulting in long-term voice problems and potential aspiration issues. Open
Douglas's statements about Lymphatic Malformation 13 statements

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Update Course Rewind 2025: Neck Pathologies - The Diagnostic Challenge

Quotation It can be really hard to differentiate a giant granula from a lymphatic malformation. Open
Statement It can be really hard to differentiate a giant ranula from a lymphatic malformation. Open
Quotation The lab tends to have trouble running this thick fluid. Open
Statement The lab tends to have trouble running thick fluid from aspirated neck masses. Open
Statement Lymphatic malformations near glandular tissue can have leaching of saliva into them, resulting in false positive amylase testing. Open
Quotation And you can also have lymphatic malformations near glandular tissue that have leaching of the saliva into it and you get a false positive. Open
Statement Removal of the sublingual gland has been the best practice for ranula treatment. Open
Quotation So from a granular perspective, removal of the sublingual gland has been the best practice. Open
Statement When a ranula has a cervical component, you can aspirate that and as long as you remove the sublingual gland, it should go away. Open
Quotation When you have a cervical component, you can aspirate that and as long as you remove the sublingual gland, it should go away. Open
Statement Micromarsupialization is a new technique for treating ranula with an intraoral component, involving placement of silk sutures through the cyst for 30 days to develop a fistula that spontaneously drains into the mouth. Open
Statement Gene panels now guide medical therapy for lymphatic malformations, particularly PIK3CA mutations which suggest that alpelisib (a PI3K alpha inhibitor) can be useful. Open
Statement For congenital developmental neck masses, you have to deal with the embryological component and etiology to prevent recurrence, not just excise the mass. Open
Douglas's statements about Tracheoesophageal Fistula 10 statements

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Update Course Rewind 2025: The Recurrent TEF Problem

Statement A 7-year-old patient with history of TEF-EA repair presented with chronic cough and food impaction. Open
Statement The patient was referred for esophageal diverticulum and underwent airway evaluation. Open
Statement Esophagoscopy showed a ledge formation at the esophageal anastomosis with a dilated upper pouch. Open
Statement Second fistulas or H-type fistulas can be very difficult to manage endoscopically. Open
Quotation Second fistulas or H-type fistulas can be really hard to deal with endoscopically sometimes. Open
Statement The transtracheal technique involves performing a distal tracheotomy, using bronchoscopy to localize the fistula level, then making a tracheotomy over the fistula to work through and divide the esophageal layers. Open
Statement Recurrent laryngeal nerve injury is underreported. Open
Quotation Recurrent laryngeal nerve injury is underreported. Open
Statement True recurrent laryngeal nerve paralysis leads to muscle atrophy over time, resulting in long-term voice problems and potential aspiration issues. Open
Quotation If it is a true paralysis over time, that muscle atrophies, they have long term voice problems and potentially have issues with aspiration. Open