Douglas von Allmen

81 statements · 5 topics

Aerodigestive / ENT · guest expert

Featured statements

▶ Ep 21 · 3:09
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
▶ Ep 21 · 0:52
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
▶ Ep 76 · 1:52
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
▶ Ep 5 · 1:28
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
▶ Ep 5 · 2:16
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
▶ Ep 4 · 5:13
It's helpful to do this in a staged fashion so that you're not creating circumferential scarring again.
quote · Aspiration

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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

▶ Ep 21 · 0:52
quote 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. ↗
▶ Ep 21 · 0:52
clinical In pharyngeal stenosis related to caustic ingestion, clinicians must address not only physical obstruction but also altered sensation and altered motor function ↗
▶ Ep 21 · 1:48
quote 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. ↗
▶ Ep 21 · 1:48
clinical 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 ↗
▶ Ep 21 · 2:10
quote 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? ↗
▶ Ep 21 · 2:10
clinical After scar tissue removal, the large raw surface area poses a risk of re-scarring ↗
▶ Ep 21 · 2:19
clinical Some surgeons have used free mucosal grafts to prevent re-scarring after scar tissue removal ↗
▶ Ep 21 · 2:22
clinical 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 ↗
▶ Ep 21 · 3:09
clinical 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 ↗
▶ Ep 21 · 3:09
quote 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. ↗
▶ Ep 21 · 3:36
clinical At one-year follow-up, the presented patient maintained a fairly decent opening to the glottis but remains tracheostomy and G-tube dependent ↗
▶ Ep 21 · 3:53
clinical The patient underwent colon interposition and was able to get PO taste with improved secretion management, but continues to have swallowing dysfunction ↗
▶ Ep 21 · 3:53
quote 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. ↗
▶ Ep 21 · 4:15
clinical In the oropharynx and hypopharynx, a larger caliber balloon is needed for dilation ↗
▶ Ep 21 · 4:46
clinical Rotational flaps and free flaps can be used to help break up scarring in pharyngeal stenosis ↗
▶ Ep 21 · 5:04
clinical Z-plasty technique can be used to break up scar orientation by rotating mucosal flaps ↗
▶ Ep 21 · 5:13
quote It's helpful to do this in a staged fashion so that you're not creating circumferential scarring again. ↗
▶ Ep 21 · 5:13
clinical Staged procedures are helpful to avoid creating circumferential scarring again ↗
▶ Ep 21 · 5:35
clinical Many pharyngeal stenosis patients require tracheostomy, often due to extensive supraglottic scarring ↗
▶ Ep 21 · 6:03
clinical Involvement of speech language pathologists and pulmonary colleagues is important to help manage the sequelae of aspiration ↗
▶ Ep 21 · 6:11
clinical 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 ↗
▶ Ep 21 · 6:15
quote There is some suggestion that these patients can be at increased risk for malignancy down the road and surveillance for neoplasm development is helpful. ↗
Douglas's statements about Aspiration 22 statements

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

▶ Ep 4 · 0:52
clinical In pharyngeal stenosis related to caustic ingestion, clinicians must address not only physical obstruction but also altered sensation and altered motor function ↗
▶ Ep 4 · 0:52
quote 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. ↗
▶ Ep 4 · 1:48
quote 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. ↗
▶ Ep 4 · 1:48
clinical 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 ↗
▶ Ep 4 · 2:10
clinical After scar tissue removal, the large raw surface area poses a risk of re-scarring ↗
▶ Ep 4 · 2:10
quote 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? ↗
▶ Ep 4 · 2:19
clinical Some surgeons have used free mucosal grafts to prevent re-scarring after scar tissue removal ↗
▶ Ep 4 · 2:22
clinical 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 ↗
▶ Ep 4 · 3:09
clinical 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 ↗
▶ Ep 4 · 3:09
quote 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. ↗
▶ Ep 4 · 3:36
clinical At one-year follow-up, the presented patient maintained a fairly decent opening to the glottis but remains tracheostomy and G-tube dependent ↗
▶ Ep 4 · 3:53
clinical The patient underwent colon interposition and was able to get PO taste with improved secretion management, but continues to have swallowing dysfunction ↗
▶ Ep 4 · 3:53
quote 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. ↗
▶ Ep 4 · 4:15
clinical In the oropharynx and hypopharynx, a larger caliber balloon is needed for dilation ↗
▶ Ep 4 · 4:46
clinical Rotational flaps and free flaps can be used to help break up scarring in pharyngeal stenosis ↗
▶ Ep 4 · 5:04
clinical Z-plasty technique can be used to break up scar orientation by rotating mucosal flaps ↗
▶ Ep 4 · 5:13
quote It's helpful to do this in a staged fashion so that you're not creating circumferential scarring again. ↗
▶ Ep 4 · 5:13
clinical Staged procedures are helpful to avoid creating circumferential scarring again ↗
▶ Ep 4 · 5:35
clinical Many pharyngeal stenosis patients require tracheostomy, often due to extensive supraglottic scarring ↗
▶ Ep 4 · 6:03
clinical Involvement of speech language pathologists and pulmonary colleagues is important to help manage the sequelae of aspiration ↗
▶ Ep 4 · 6:11
clinical 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 ↗
▶ Ep 4 · 6:15
quote There is some suggestion that these patients can be at increased risk for malignancy down the road and surveillance for neoplasm development is helpful. ↗
Douglas's statements about Esophageal Atresia 12 statements

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Update Course Rewind 2025: The Recurrent TEF Problem

▶ Ep 76 · 0:34
quote This was a 7-year-old who came to us, had a history of TEF EA, had a repair, and was having chronic cough as well as food impaction. ↗
▶ Ep 76 · 0:34
clinical A 7-year-old patient with history of TEF-EA repair presented with chronic cough and food impaction. ↗
▶ Ep 76 · 0:43
clinical The patient was referred for esophageal diverticulum and airway evaluation was performed. ↗
▶ Ep 76 · 0:43
quote She was referred for the esophageal diverticulum, but we were involved to evaluate the airway as well. ↗
▶ Ep 76 · 0:53
clinical Esophagoscopy showed a ledge formation at the esophageal anastomosis with a dilated upper pouch. ↗
▶ Ep 76 · 1:06
opinion Second fistulas or H-type fistulas can be very difficult to manage endoscopically. ↗
▶ Ep 76 · 1:06
quote Second fistulas or H-type fistulas can be really hard to deal with endoscopically sometimes. ↗
▶ Ep 76 · 1:30
clinical The transtracheal technique involves performing a distal tracheotomy, using bronchoscopy to localize the fistula level, then making a tracheotomy over the fistula and working through it to divide the esophageal layers. ↗
▶ Ep 76 · 1:49
epidemiological Recurrent laryngeal nerve injury is underreported. ↗
▶ Ep 76 · 1:49
quote Recurrent laryngeal nerve injury is underreported. ↗
▶ Ep 76 · 1:52
quote If it is a true paralysis over time, that muscle atrophies, they have long term voice problems and potentially have issues with aspiration. ↗
▶ Ep 76 · 1:52
clinical True recurrent laryngeal nerve paralysis leads to muscle atrophy over time, resulting in long-term voice problems and potential aspiration issues. ↗
Douglas's statements about Lymphatic Malformation 13 statements

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Update Course Rewind 2025: Neck Pathologies - The Diagnostic Challenge

▶ Ep 5 · 1:14
quote It can be really hard to differentiate a giant granula from a lymphatic malformation. ↗
▶ Ep 5 · 1:14
clinical It can be really hard to differentiate a giant ranula from a lymphatic malformation. ↗
▶ Ep 5 · 1:24
clinical The lab tends to have trouble running thick fluid from aspirated neck masses. ↗
▶ Ep 5 · 1:24
quote The lab tends to have trouble running this thick fluid. ↗
▶ Ep 5 · 1:28
clinical Lymphatic malformations near glandular tissue can have leaching of saliva into them, resulting in false positive amylase testing. ↗
▶ Ep 5 · 1:28
quote And you can also have lymphatic malformations near glandular tissue that have leaching of the saliva into it and you get a false positive. ↗
▶ Ep 5 · 2:10
guideline Removal of the sublingual gland has been the best practice for ranula treatment. ↗
▶ Ep 5 · 2:10
quote So from a granular perspective, removal of the sublingual gland has been the best practice. ↗
▶ Ep 5 · 2:16
quote When you have a cervical component, you can aspirate that and as long as you remove the sublingual gland, it should go away. ↗
▶ Ep 5 · 2:16
clinical When a ranula has a cervical component, you can aspirate that and as long as you remove the sublingual gland, it should go away. ↗
▶ Ep 5 · 2:25
clinical 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. ↗
▶ Ep 5 · 2:53
clinical Gene panels now guide medical therapy for lymphatic malformations, particularly PIK3CA mutations which suggest that alpelisib (a PI3K alpha inhibitor) can be useful. ↗
▶ Ep 5 · 3:15
clinical For congenital developmental neck masses, you have to deal with the embryological component and etiology to prevent recurrence, not just excise the mass. ↗
Douglas's statements about Tracheoesophageal Fistula 12 statements

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Update Course Rewind 2025: The Recurrent TEF Problem

▶ Ep 32 · 0:34
quote This was a 7-year-old who came to us, had a history of TEF EA, had a repair, and was having chronic cough as well as food impaction. ↗
▶ Ep 32 · 0:34
clinical A 7-year-old patient with history of TEF-EA repair presented with chronic cough and food impaction. ↗
▶ Ep 32 · 0:43
quote She was referred for the esophageal diverticulum, but we were involved to evaluate the airway as well. ↗
▶ Ep 32 · 0:43
clinical The patient was referred for esophageal diverticulum and airway evaluation was performed. ↗
▶ Ep 32 · 0:53
clinical Esophagoscopy showed a ledge formation at the esophageal anastomosis with a dilated upper pouch. ↗
▶ Ep 32 · 1:06
quote Second fistulas or H-type fistulas can be really hard to deal with endoscopically sometimes. ↗
▶ Ep 32 · 1:06
opinion Second fistulas or H-type fistulas can be very difficult to manage endoscopically. ↗
▶ Ep 32 · 1:30
clinical The transtracheal technique involves performing a distal tracheotomy, using bronchoscopy to localize the fistula level, then making a tracheotomy over the fistula and working through it to divide the esophageal layers. ↗
▶ Ep 32 · 1:49
quote Recurrent laryngeal nerve injury is underreported. ↗
▶ Ep 32 · 1:49
epidemiological Recurrent laryngeal nerve injury is underreported. ↗
▶ Ep 32 · 1:52
clinical True recurrent laryngeal nerve paralysis leads to muscle atrophy over time, resulting in long-term voice problems and potential aspiration issues. ↗
▶ Ep 32 · 1:52
quote If it is a true paralysis over time, that muscle atrophies, they have long term voice problems and potentially have issues with aspiration. ↗