Subspecialty Training

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Facial Plastic and Reconstructive Surgery

Resident training in facial plastic and reconstructive surgery is comprehensive; hands-on experience in cosmetic and reconstructive aspects is supplemented by didactic lectures given by the Facial Plastic and Reconstructive Surgery faculty. Exposure to cosmetic procedures is extensive, as over 100 rhinoplasties are performed per year, as well as many blepharoplasties, endoscopic brow lifts and facelifts. Common minimally invasive techniques include injection of Botox® and facial fillers. Residents also have the opportunity to perform aesthetic laser procedures such as hair removal, treatment of veins and irregular pigmentation, and skin resurfacing. We have an aesthetic minor surgery suite, photography suite and an aesthetic staff. The reconstructive experience is likewise broad and comprehensive. The in-depth training experience in maxillofacial trauma includes endoscopic fracture repair techniques. Trauma call alternates on a daily basis with Plastic Surgery. State-of-the-art trauma care is provided at our Level I center and residents have ample opportunities to attend the annual plating workshop. The Head and Neck Reconstruction Team performs 70 to 80 microvascular free flaps annually in addition to a large number of local and regional flap procedures for minor and major head and neck defects. Experience in local flap reconstruction of Mohs defects is extensive as is experience in facial reanimation and microtia repair. A microvascular animal laboratory is available for resident training in microvascular techniques. Both cosmetic and reconstructive procedures are performed at VAMC, KUMC and at KU MedWest Ambulatory Surgery Center. The VAMC experience offers additional exposure to facial reconstruction.
[University of Kansas Facial Plastic and Reconstructive Surgery website]

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Head and Neck Surgery/Skull Base Surgery

The Department of Otolaryngology-Head and Neck Surgery at The University of Kansas has an active program in Head and Neck Surgery and Skull Base Surgery, whose patient accruement area includes all of Kansas and part of western Missouri. All patients are presented prospectively at the multidisciplinary, bi-weekly Head and Neck Surgery Tumor Board in order to obtain a consensus opinion on treatment. A multidisciplinary Thyroid Tumor Board is held monthly to discuss new thyroid malignancy patients.

surgeryWith microvascular reconstruction expertise within the OTOHNS, head and neck oncologic procedures are performed concurrently with reconstructive procedures; thereby shortening patients' anesthetic time and increasing Operating Room efficiency. Training in transfacial and endoscopic surgical approaches to the skull base, endoscopic diverticulectomy, and minimally invasive thyroid/parathyroid surgery is also extensive. This experience at KUMC is supplemented by extensive head and neck experience at Veterans Administration Medical Center and Truman Medical Center and staffed by the same faculty.

The Skull Base Surgery Team works closely with the Head and Neck Surgery Reconstruction Team, as well as with faculty in the Departments of Neurosurgery and Ophthalmology, to provide surgical treatment to anterior, middle, and posterior fossa neoplasms. An active Interventional Radiology division also provides angiographic and endovascular procedure support to the Skull Base Surgery Team. This is supplemented by extensive intra-operative experience with the Xomed Evolution stereotactic surgical guidance system.

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video strobeLaryngology training is most extensive during rotations at KUMC and VAMC. Both institutions have laryngeal laboratories with videostroboscopy instrumentation. An extensive introduction to advanced laryngologic techniques, such as laryngeal EMG, botulinum toxin injections and transnasal esophagoscopy is available during the KUMC Red Team rotation. The rotating resident at KUMC, KU MedWest and the VA Medical Center learns operative microlaryngoscopy with extensive use of laser therapy.

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photo of physician operatingClinical experience in otology/neurotology takes place at three separate sites and is overseen by Drs. Greg Ator, James Lin, and Hinrich Staecker. A complete range of clinical and surgical opportunities are available in the division. Pediatric and adult chronic ear procedures are performed on a regular basis. In addition, middle ear exploration, stapedectomy and ossicular reconstruction are standard at all hospitals. An ample vestibular surgery experience is available with emphasis on conservation procedures for Ménière's disease (intratympanic therapy, endolymphatic sac decompression), with occasional ablative procedures. Our cochlear implant program currently implants Nucleus®, MED-EL and Advanced Bionics devices and performs 70 adult and pediatric cases per year. Lateral skull base procedures and cerebellopontine angle (CPA) surgery are also available as part of the Skull Base Surgery Team. A team approach with members of the Department of Neurosurgery is utilized for many of these cases.

Training in otology and neurotology begins with didactic lectures given during the annual Temporal Anatomy and Dissection Bone Course. This complements the otology/neurotology lectures given as part of the routine didactic conference and lecture schedule, The annual temporal bone course (6 weeks) includes operative training on cadaveric temporal bones, as well as a detailed curriculum on anatomy, common otologic diseases, and historical, as well as present day, medical and surgical treatments. Residents are also expected to engage in self-directed dissections in the temporal bone laboratory with a minimum of ten bones drilled each year. The complete modern temporal bone dissection facility is available at all times for this educational opportunity. Since almost all otologic procedures can be performed in the laboratory, this is an extremely important part of the resident experience in otology. A special set of instrumentation in also available for use in stapedectomy surgery. The temporal bone lab was renovated in 2008 and is equipped with state-of-the-art equipment.

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Pediatric Otolaryngology

Dr. Nicklaus and patientExperience and training in pediatric otolaryngology is accomplished primarily through a rotation at Children's Mercy Hospital. This is supplemented by the pediatric otolaryngic experience at KUMC and KU MedWest. Extensive tertiary care pediatric otolaryngology is encountered, including the evaluation and treatment of basic and complex pediatric airway problems, (such as, sleep-disordered breathing secondary to adenotonsillar hypertrophy, congenital and subglottic stenosis, laryngo- and tracheomalacia, recurrent respiratory papillomatosis and chronic respiratory insufficiency requiring tracheostomy). In addition, evaluation and surgical treatment of head and neck neoplasms, (such as juvenile nasopharyngeal angiofibromas, rhabdomyosarcomas, lymphomas, and a variety of congenital bronchial cleft/sinus/cysts) will be encountered during the rotation. Residents are also trained in pediatric otology during this rotation through both clinical and surgical cases. The Pediatric Otolaryngology faculty participates actively in multidisciplinary activities, such as a special care clinic for chronic, ventilatory-dependent patients with tracheostomy, NICU rounds and consultations, and assistance with the care of patients with multi-system diseases (such as, endoscopic sinus surgery for cystic fibrosis patients and invasive fungal sinusitis or other sinusitises in those who are immunosuppressed or compromised). There is also the opportunity to experience velopharyngeal insufficiency evaluations (VPI clinic). In addition, Pediatric Otolaryngology is very active in the treatment of a variety of simple and complex head and neck infections.

A biannual bronchoscopy lab is offered as a part of the resident educational curriculum. This lab uses videoscopic equipment to provide additional training and expertise in the performance of upper airway endoscopy.

Emphasis is also placed on the physician-patient-family interaction as a model for practice improvement and for the successful provision of care. The OTOHNS resident involved in pediatric care is expected to work closely with the other pediatric practitioners as a member of the health care team.

During their pediatric otolaryngology rotations, residents are encouraged to participate in research. Opportunities are ample for residents to learn all aspects of research development; including, project design, IRB submission, data collection, abstract submission and manuscript writing. With abstract acceptance, residents are fully supported to attend national pediatric otolaryngology meetings; including, the American Society of Pediatric Otolaryngology and SENTAC (Society of Ear, Nose, Throat for Advancement of Children).

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The resident training in Rhinology consists of a number of lectures and reading sessions during the 24-month lecture cycle. These sessions complement an allergy/immunology rotation during the PGY-3 resident year. Principles of intradermal dilutional testing are taught and experienced in actual practice at the busy allergy clinic. Residents learn the technique and decision-making process involved in determining appropriate concentration, dosage and antigen in immunotherapy treatment. In addition, lecture and reading sessions include the use of modified RAST and other in vitro testing methods and their application to immunotherapy. PGY-3 residents are also sponsored to attend the American Academy of Otolaryngic Allergy Basic Course.

OTOHNS residents receive an extensive surgical experience in endoscopic sinus surgery. State-of-the-art endoscopic powered instrumentation, suction-irrigation endoscopes, and a stereotactic surgical guidance systems enhance training in the most advanced endoscopic techniques (such as, the modified Lothrup procedure, endoscopic leak repairs and endoscopic resections of anterior cranial fossa neoplasms).

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