# Head and Neck Surgery — GCMD Library living collection

Updated: n/a · 5 episodes · 44 cited statements

## Episodes
### Thyroid Surgery
- [Nerve monitoring and risk stratification in pediatric thyroid surgery](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844) — podcast · 6:20 · [machine version](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844.md)

### Branchial Cleft Anomalies
- [Branchial cleft cyst management: endoscopic cauterization versus open excision](https://library.globalcastmd.com/watch/branchial-cleft-cyst-management-endoscopic-cauterization-versus-open-excision-16843) — podcast · 2:35 · [machine version](https://library.globalcastmd.com/watch/branchial-cleft-cyst-management-endoscopic-cauterization-versus-open-excision-16843.md)

### Lymphatic Malformations
- [Differentiating Lymphatic Malformations from Ranulas in Pediatric Neck Masses](https://library.globalcastmd.com/watch/differentiating-lymphatic-malformations-from-ranulas-in-pediatric-neck-masses-16839) — podcast · 3:55 · [machine version](https://library.globalcastmd.com/watch/differentiating-lymphatic-malformations-from-ranulas-in-pediatric-neck-masses-16839.md)
- [Pediatric Surgery Literature Updates: Lymphatic Malformations, G-Tube Complications, and Cryptorchidism Timing](https://library.globalcastmd.com/watch/pediatric-surgery-literature-updates-lymphatic-malformations-g-tube-complication-16862) — podcast · 4:25 · [machine version](https://library.globalcastmd.com/watch/pediatric-surgery-literature-updates-lymphatic-malformations-g-tube-complication-16862.md)

### Craniofacial
- [Understanding craniosynostosis: skull sutures, growth patterns, and diagnosis in infants](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830) — podcast · 10:21 · [machine version](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830.md)

## Chapters
- [0:22](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830?t=22) Definition, epidemiology, and normal infant skull anatomy (Ep 5)
- [2:33](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830?t=153) The four major sutures and Virchow's law of compensatory growth (Ep 5)
- [5:14](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830?t=314) Timing of normal suture closure and clinical significance (Ep 5)
- [6:37](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830?t=397) Physical examination and differential diagnosis (Ep 5)
- [8:48](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830?t=528) Partial fusion, elevated intracranial pressure, and treatment principles (Ep 5)
- [0:00](https://library.globalcastmd.com/watch/differentiating-lymphatic-malformations-from-ranulas-in-pediatric-neck-masses-16839?t=0) Case Presentation and Initial Differential (Ep 3)
- [1:03](https://library.globalcastmd.com/watch/differentiating-lymphatic-malformations-from-ranulas-in-pediatric-neck-masses-16839?t=63) Diagnostic Challenges and Treatment Evolution (Ep 3)
- [2:06](https://library.globalcastmd.com/watch/differentiating-lymphatic-malformations-from-ranulas-in-pediatric-neck-masses-16839?t=126) Treatment Approaches for Ranulas (Ep 3)
- [2:43](https://library.globalcastmd.com/watch/differentiating-lymphatic-malformations-from-ranulas-in-pediatric-neck-masses-16839?t=163) Lymphatic Malformation Treatment Options (Ep 3)
- [3:28](https://library.globalcastmd.com/watch/differentiating-lymphatic-malformations-from-ranulas-in-pediatric-neck-masses-16839?t=208) Key Takeaways (Ep 3)
- [0:00](https://library.globalcastmd.com/watch/branchial-cleft-cyst-management-endoscopic-cauterization-versus-open-excision-16843?t=0) Introduction and case presentation setup (Ep 2)
- [0:30](https://library.globalcastmd.com/watch/branchial-cleft-cyst-management-endoscopic-cauterization-versus-open-excision-16843?t=30) Initial case presentation and imaging findings (Ep 2)
- [1:01](https://library.globalcastmd.com/watch/branchial-cleft-cyst-management-endoscopic-cauterization-versus-open-excision-16843?t=61) Management principles and endoscopic approach (Ep 2)
- [1:41](https://library.globalcastmd.com/watch/branchial-cleft-cyst-management-endoscopic-cauterization-versus-open-excision-16843?t=101) Comparative outcomes and clinical recommendations (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=0) Case presentation and initial management of indeterminate thyroid nodule (Ep 1)
- [1:07](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=67) Surgical approach and surgeon selection for pediatric thyroid nodules (Ep 1)
- [2:07](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=127) Intraoperative nerve monitoring technique and evidence (Ep 1)
- [4:40](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=280) Modified TIRADS criteria for pediatric populations (Ep 1)
- [5:45](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=345) Summary of key recommendations (Ep 1)
- [0:16](https://library.globalcastmd.com/watch/pediatric-surgery-literature-updates-lymphatic-malformations-g-tube-complication-16862?t=16) Lymphatic Malformations Management and Outcomes (Ep 4)
- [1:49](https://library.globalcastmd.com/watch/pediatric-surgery-literature-updates-lymphatic-malformations-g-tube-complication-16862?t=109) G-Tube Complications and Quality Improvement Targets (Ep 4)
- [2:57](https://library.globalcastmd.com/watch/pediatric-surgery-literature-updates-lymphatic-malformations-g-tube-complication-16862?t=177) Timing of Orchiopexy and Testicular Volume Outcomes (Ep 4)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Dr. Jesse Skoch states that skull volume essentially doubles during the first year, representing an impressive change. — Jesse Skoch (clinical) [Ep 5 · 2:19](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830?t=139)
- According to Virchow's law, when a suture is fused, skull growth perpendicular to that suture will be arrested and growth will happen in the parallel direction. — Jesse Skoch (clinical) [Ep 5 · 3:57](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830?t=237)
- Dr. Skoch prefers a three-dimensional concept of Virchow's law, thinking of it as squeezing a balloon, which better predicts the resulting skull shape. — Jesse Skoch (opinion) [Ep 5 · 4:20](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830?t=260)
- Trigonocephaly is the triangular head shape seen in metopic craniosynostosis. — Jesse Skoch (clinical) [Ep 5 · 4:48](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830?t=288)
- The metopic suture is by far the earliest closing suture, typically closing between 3 to 9 months, while other sutures don't typically close until late adulthood. — Jesse Skoch (clinical) [Ep 5 · 5:24](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830?t=324)
- Dr. Skoch states that if a suture closes in the first year or two of life but isn't closed right at birth, patients can often do perfectly fine with very minimal deformity; prenatal closure is what truly warrants concern. — Jesse Skoch (clinical) [Ep 5 · 5:55](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830?t=355)
- Minor suture fusion usually does not cause significant deformity or risks to brain development. — Jesse Skoch (clinical) [Ep 5 · 6:27](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830?t=387)
- Head shape is more important than palpation findings (ridge, fontanelle size, prominent suture) in diagnosing craniosynostosis. — Jesse Skoch (clinical) [Ep 5 · 6:49](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830?t=409)
- Dr. Skoch states that with true lambdoid synostosis there is almost always a height differential of the ears with a lower-set ear on the affected side, whereas ear height is typically normal with positional plagiocephaly. — Jesse Skoch (clinical) [Ep 5 · 7:38](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830?t=458)
- Dr. Skoch states that CT is the gold standard but most of the time it's not necessary for diagnosis, and CTs should not be obtained on patients who don't really need them. — Jesse Skoch (guideline) [Ep 5 · 8:18](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830?t=498)
- Dr. Skoch states that partially fused sutures are the real deal and deserve all the attention of a fully fused suture, comparing them to a partially locked door—if it's stuck, it's stuck, regardless of how much. — Jesse Skoch (clinical) [Ep 5 · 8:56](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830?t=536)
- Dr. Skoch states that multi-suture, typically syndromic deformities are important to treat much earlier because of the significant risk of elevated intracranial pressure. — Jesse Skoch (guideline) [Ep 5 · 9:33](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830?t=573)
- The 16-year-old presented with right submandibular swelling that was soft and painless. — Douglas von Allmen (clinical) [Ep 3 · 0:30](https://library.globalcastmd.com/watch/differentiating-lymphatic-malformations-from-ranulas-in-pediatric-neck-masses-16839?t=30)
- CT scan showed a cystic mass heading up underneath the mandible that abuts the submandibular gland on the right side. — Douglas von Allmen (clinical) [Ep 3 · 0:34](https://library.globalcastmd.com/watch/differentiating-lymphatic-malformations-from-ranulas-in-pediatric-neck-masses-16839?t=34)
- It can be really hard to differentiate a giant ranula from a lymphatic malformation. — Douglas von Allmen (clinical) [Ep 3 · 1:14](https://library.globalcastmd.com/watch/differentiating-lymphatic-malformations-from-ranulas-in-pediatric-neck-masses-16839?t=74)
- The lab tends to have trouble running thick fluid from aspirated neck masses. — Douglas von Allmen (clinical) [Ep 3 · 1:25](https://library.globalcastmd.com/watch/differentiating-lymphatic-malformations-from-ranulas-in-pediatric-neck-masses-16839?t=85)
- Lymphatic malformations near glandular tissue can have leaching of saliva into them, resulting in a false positive amylase test. — Douglas von Allmen (clinical) [Ep 3 · 1:28](https://library.globalcastmd.com/watch/differentiating-lymphatic-malformations-from-ranulas-in-pediatric-neck-masses-16839?t=88)
- Ultrasound suggested the mass was a lymphatic malformation. — Douglas von Allmen (clinical) [Ep 3 · 1:50](https://library.globalcastmd.com/watch/differentiating-lymphatic-malformations-from-ranulas-in-pediatric-neck-masses-16839?t=110)
- Removal of all sublingual glandular tissue made Dr. Van Alman confident the mass was a lymphatic malformation rather than a ranula. — Douglas von Allmen (clinical) [Ep 3 · 1:50](https://library.globalcastmd.com/watch/differentiating-lymphatic-malformations-from-ranulas-in-pediatric-neck-masses-16839?t=110)
- From a ranula perspective, removal of the sublingual gland has been the best practice. — Douglas von Allmen (clinical) [Ep 3 · 2:10](https://library.globalcastmd.com/watch/differentiating-lymphatic-malformations-from-ranulas-in-pediatric-neck-masses-16839?t=130)
- When a ranula has a cervical component, you can aspirate that, and as long as you remove the sublingual gland, it should go away. — Douglas von Allmen (clinical) [Ep 3 · 2:16](https://library.globalcastmd.com/watch/differentiating-lymphatic-malformations-from-ranulas-in-pediatric-neck-masses-16839?t=136)
- Micromarsupialization is a new technique to treat ranula: if you can identify an intraoral component, you throw silk sutures through the cyst, let it sit for 30 days to develop a fistula, then cut the sutures out and it will spontaneously drain into the mouth. — Douglas von Allmen (clinical) [Ep 3 · 2:25](https://library.globalcastmd.com/watch/differentiating-lymphatic-malformations-from-ranulas-in-pediatric-neck-masses-16839?t=145)
- Gene panels now guide medical therapy for lymphatic malformations, particularly PIK3CA mutations, which suggest that alpelisib (a PI3K alpha inhibitor) can be useful. — Douglas von Allmen (clinical) [Ep 3 · 2:53](https://library.globalcastmd.com/watch/differentiating-lymphatic-malformations-from-ranulas-in-pediatric-neck-masses-16839?t=173)
- For congenital developmental neck masses, you have to not just excise the mass but deal with the embryological component and etiology to prevent recurrence. — Douglas von Allmen (clinical) [Ep 3 · 3:15](https://library.globalcastmd.com/watch/differentiating-lymphatic-malformations-from-ranulas-in-pediatric-neck-masses-16839?t=195)
- Interventions on branchial cleft cysts should be avoided until ready to resolve the issue definitively. — Douglas von Allmen (opinion) [Ep 2 · 1:01](https://library.globalcastmd.com/watch/branchial-cleft-cyst-management-endoscopic-cauterization-versus-open-excision-16843?t=61)
- Incision and drainage can make future definitive surgery more challenging for branchial cleft cysts. — Douglas von Allmen (clinical) [Ep 2 · 1:08](https://library.globalcastmd.com/watch/branchial-cleft-cyst-management-endoscopic-cauterization-versus-open-excision-16843?t=68)
- Type 3 and type 4 branchial cleft cysts typically have a tract going up to the pyriform sinus. — Douglas von Allmen (clinical) [Ep 2 · 1:24](https://library.globalcastmd.com/watch/branchial-cleft-cyst-management-endoscopic-cauterization-versus-open-excision-16843?t=84)
- A study comparing endoscopic approach versus open excision for branchial cleft cysts showed equivalent recurrence outcomes. — Douglas von Allmen (clinical) [Ep 2 · 1:45](https://library.globalcastmd.com/watch/branchial-cleft-cyst-management-endoscopic-cauterization-versus-open-excision-16843?t=105)
- For Bethesda 3 thyroid nodules in pediatrics, lobectomy is recommended rather than molecular testing or repeat FNA because there is a higher rate of malignancy in those populations compared to adults — Ben Hamm (guideline) [Ep 1 · 0:52](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=52)
- For an intermediate-risk thyroid nodule with approximately 30% cancer risk, hemithyroidectomy rather than total thyroidectomy is recommended — Ben Hamm (clinical) [Ep 1 · 1:10](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=70)
- The 2015 pediatric guidelines recommend thyroid surgery be performed by a high volume thyroid surgeon — Ben Hamm (guideline) [Ep 1 · 1:28](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=88)
- One recent study showed the rate of recurrent laryngeal nerve injury decreasing from 8% to 1.5% with nerve monitoring — Ben Hamm (epidemiological) [Ep 1 · 2:27](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=147)
- Studies in adults have shown nerve monitoring helps identify the nerve more, but maybe doesn't change injury rates — Ben Hamm (clinical) [Ep 1 · 2:50](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=170)
- There are no studies in pediatrics showing significant decrease in injury rates with nerve monitoring, but several show absolute decrease — Ben Hamm (clinical) [Ep 1 · 2:57](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=177)
- The recurrent laryngeal nerve is smaller in children and may be harder to identify — Ben Hamm (clinical) [Ep 1 · 3:22](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=202)
- The rate of recurrent laryngeal nerve injury in children is 9% versus about 6% in adults — Ben Hamm (epidemiological) [Ep 1 · 3:25](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=205)
- If injury is detected on one side with nerve monitoring, waiting to see if it's transient and can recover later may be appropriate — Ben Hamm (clinical) [Ep 1 · 3:38](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=218)
- Expense is one consideration as a downside to nerve monitoring — Ben Hamm (opinion) [Ep 1 · 3:47](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=227)
- Some have questioned why use nerve monitoring if it doesn't change injury rates or outcomes — Ben Hamm (opinion) [Ep 1 · 3:52](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=232)
- Recent endotracheal tube electrode publications report use in patients down to age 0 — Ben Hamm (clinical) [Ep 1 · 4:13](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=253)
- Nerve monitoring is most beneficial when doing a total thyroidectomy where the contralateral cord is at risk, to help decrease the risk of tracheotomy with bilateral paralysis — Ben Hamm (clinical) [Ep 1 · 4:28](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=268)
- If a child is too small for standard electrodes, electrodes can be placed directly into the vocalis muscle via direct laryngoscopy for monitoring (clinical) [Ep 1 · 4:40](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=280)
- A recent paper suggested that if size criteria are adjusted, TIRADS actually performs better than the 2015 pediatric guidelines — Ben Hamm (clinical) [Ep 1 · 5:00](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=300)
- The PES-TIRADS (modified version) recommends biopsy for every TIRADS 3 nodule over 1 cm or TIRADS 4/5 over 0.5 cm (guideline) [Ep 1 · 5:13](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=313)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- Craniosynostosis occurs in roughly 1 in 2500 births. — The host summarizes what Dr. Jesse Skoch said [Ep 5 · 0:22](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830?t=22)
- Most craniosynostosis cases involve a single suture with no underlying syndrome, and the sagittal suture is most often affected. — The host summarizes what Dr. Jesse Skoch said [Ep 5 · 0:31](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830?t=31)
- A minority of craniosynostosis cases are syndromic (Apert, Crouzon, Muenke, and others) and tend to involve more than one suture. — The host summarizes what Dr. Jesse Skoch said [Ep 5 · 0:39](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830?t=39)
- Infant skull bone does not expand from the middle but gets laid down at the edges, at the sutures, as the brain pushes outward. — The host summarizes what Dr. Jesse Skoch said [Ep 5 · 1:21](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830?t=81)
- The dura mater signals the bone-forming edges of each suture, and the brain's growth is the trigger for skull expansion. — The host summarizes what Dr. Jesse Skoch said [Ep 5 · 1:29](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830?t=89)
- The posterior fontanelle closes by around 2 to 3 months of age. — The host summarizes what Dr. Jesse Skoch said [Ep 5 · 1:45](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830?t=105)
- The anterior fontanelle stays open until somewhere between 9 and 18 months. — The host summarizes what Dr. Jesse Skoch said [Ep 5 · 1:53](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830?t=113)
- The fastest skull growth is over by 12 months of age. — The host summarizes what Dr. Jesse Skoch said [Ep 5 · 2:26](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830?t=146)
- The metopic suture runs down the midline of the forehead from the anterior fontanelle to the root of the nose and allows the forehead to widen. — The host summarizes what Dr. Jesse Skoch said [Ep 5 · 2:51](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830?t=171)
- The coronal sutures run transversely, one on each side, separating the frontal bone from the parietal bones and allow the forehead and orbital rim to advance. — The host summarizes what Dr. Jesse Skoch said [Ep 5 · 3:09](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830?t=189)
- The sagittal suture runs front to back down the midline between the two parietal bones and allows the skull to widen. — The host summarizes what Dr. Jesse Skoch said [Ep 5 · 3:20](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830?t=200)
- The lambdoid sutures angle back from the midline, separating the parietals from the occipital bone, and allow the posterior skull to grow. — The host summarizes what Dr. Jesse Skoch said [Ep 5 · 3:27](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830?t=207)
- Virchow published his law in the 1850s and it remains the current framework for understanding craniosynostosis. — The host summarizes what Dr. Jesse Skoch said [Ep 5 · 4:56](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830?t=296)
- Positional plagiocephaly is far more common than any fused suture and is caused by a baby lying the same way for long stretches, with all sutures remaining open. — The host summarizes what Dr. Jesse Skoch said [Ep 5 · 7:07](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830?t=427)
- Positional molding produces a parallelogram shape from above, while lambdoid synostosis produces a trapezoid shape. — The host summarizes what Dr. Jesse Skoch said [Ep 5 · 7:29](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830?t=449)
- In positional molding, the ear shifts forward but the two ears stay level. — The host summarizes what Dr. Jesse Skoch said [Ep 5 · 7:55](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830?t=475)
- CT with three-dimensional reconstruction is the confirmatory study for craniosynostosis, showing the sutures directly. — The host summarizes what Dr. Jesse Skoch said [Ep 5 · 8:02](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830?t=482)
- Ionizing radiation from CT in infants is associated with increased cancer risk in the future with large doses. — The host summarizes what Dr. Jesse Skoch said [Ep 5 · 8:32](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830?t=512)
- In practice, the specialist orders CT once the exam has raised the question, usually to plan an operation rather than to make the diagnosis. — The host summarizes what Dr. Jesse Skoch said [Ep 5 · 8:40](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830?t=520)
- If the skull genuinely cannot keep up with the brain, intracranial pressure rises, which is what surgery exists to prevent. — The host summarizes what Dr. Jesse Skoch said [Ep 5 · 9:11](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830?t=551)
- With a single fused suture, elevated intracranial pressure happens to a minority of children. — The host summarizes what Dr. Jesse Skoch said [Ep 5 · 9:23](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830?t=563)
- When more than one suture is involved, the restriction is greater and the risk of elevated intracranial pressure is real. — The host summarizes what Dr. Jesse Skoch said [Ep 5 · 9:27](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830?t=567)
- Every operation for craniosynostosis is built around a specific suture, where it sits, what it was holding back, and how much growth is left to harness. — The host summarizes what Dr. Jesse Skoch said [Ep 5 · 9:44](https://library.globalcastmd.com/watch/understanding-craniosynostosis-skull-sutures-growth-patterns-and-diagnosis-in-in-16830?t=584)
- A ranula is a benign cyst that forms under the tongue caused by saliva leaking from a blocked sublingual gland. — Jill Knepprath summarizes what Dr. Douglas von Allmen said [Ep 3 · 0:50](https://library.globalcastmd.com/watch/differentiating-lymphatic-malformations-from-ranulas-in-pediatric-neck-masses-16839?t=50)
- Lymphatic malformations are clusters of lymph vessels that are often present at birth. — Jill Knepprath summarizes what Dr. Douglas von Allmen said [Ep 3 · 0:58](https://library.globalcastmd.com/watch/differentiating-lymphatic-malformations-from-ranulas-in-pediatric-neck-masses-16839?t=58)
- For lymphatic malformations, there are 3 procedural treatments including laser, sclerotherapy, and excision. — Jill Knepprath summarizes what Dr. Douglas von Allmen said [Ep 3 · 2:43](https://library.globalcastmd.com/watch/differentiating-lymphatic-malformations-from-ranulas-in-pediatric-neck-masses-16839?t=163)
- There are 3 medical therapies for lymphatic malformations that are still undergoing clinical trials. — Jill Knepprath summarizes what Dr. Douglas von Allmen said [Ep 3 · 2:49](https://library.globalcastmd.com/watch/differentiating-lymphatic-malformations-from-ranulas-in-pediatric-neck-masses-16839?t=169)
- A branchial cleft cyst is a congenital neck mass that forms when tissues fail to develop properly during embryonic growth. — Jill Knepprath summarizes what Dr. Douglas von Allmen said [Ep 2 · 0:48](https://library.globalcastmd.com/watch/branchial-cleft-cyst-management-endoscopic-cauterization-versus-open-excision-16843?t=48)
- If a branchial cleft cyst recurs after antibiotic treatment, it may require an excision. — Jill Knepprath summarizes what Dr. Douglas von Allmen said [Ep 2 · 0:56](https://library.globalcastmd.com/watch/branchial-cleft-cyst-management-endoscopic-cauterization-versus-open-excision-16843?t=56)
- Types 3 and 4 branchial cleft cysts that appear on the left side of the neck can have associated thyroiditis. — Jill Knepprath summarizes what Dr. Douglas von Allmen said [Ep 2 · 1:13](https://library.globalcastmd.com/watch/branchial-cleft-cyst-management-endoscopic-cauterization-versus-open-excision-16843?t=73)
- A hemithyroidectomy may occasionally be required to excise type 3 or 4 branchial cleft cysts on the left side. — Jill Knepprath summarizes what Dr. Douglas von Allmen said [Ep 2 · 1:13](https://library.globalcastmd.com/watch/branchial-cleft-cyst-management-endoscopic-cauterization-versus-open-excision-16843?t=73)
- A cautery probe can be used to cauterize the pyriform sinus tract, which resolves the lesion and prevents recurrence. — Jill Knepprath summarizes what Dr. Douglas von Allmen said [Ep 2 · 1:35](https://library.globalcastmd.com/watch/branchial-cleft-cyst-management-endoscopic-cauterization-versus-open-excision-16843?t=95)
- Endoscopic cauterization avoids the morbidity of undergoing open surgery for branchial cleft cysts. — Jill Knepprath summarizes what Dr. Douglas von Allmen said [Ep 2 · 1:52](https://library.globalcastmd.com/watch/branchial-cleft-cyst-management-endoscopic-cauterization-versus-open-excision-16843?t=112)
- Endoscopic cauterization avoids recurrent laryngeal nerve injury as an added benefit compared to open surgery. — Jill Knepprath summarizes what Dr. Douglas von Allmen said [Ep 2 · 1:57](https://library.globalcastmd.com/watch/branchial-cleft-cyst-management-endoscopic-cauterization-versus-open-excision-16843?t=117)
- Incision and drainage can make definitive surgical excision of branchial cleft cysts more difficult, so it is best to wait until ready to treat the underlying tract. — Jill Knepprath summarizes what Dr. Douglas von Allmen said [Ep 2 · 2:03](https://library.globalcastmd.com/watch/branchial-cleft-cyst-management-endoscopic-cauterization-versus-open-excision-16843?t=123)
- Endoscopic cauterization is an effective alternative to open surgery for branchial cleft cysts. — Jill Knepprath summarizes what Dr. Douglas von Allmen said [Ep 2 · 2:15](https://library.globalcastmd.com/watch/branchial-cleft-cyst-management-endoscopic-cauterization-versus-open-excision-16843?t=135)
- Studies show endoscopic cauterization has similar recurrence rates to open surgery while reducing surgical morbidity and avoiding recurrent laryngeal nerve injury. — Jill Knepprath summarizes what Dr. Douglas von Allmen said [Ep 2 · 2:19](https://library.globalcastmd.com/watch/branchial-cleft-cyst-management-endoscopic-cauterization-versus-open-excision-16843?t=139)
- Thyroid nodules are more common in adults than in children, resulting in few centers with pediatric surgeons having high volume of these cases — Jill Knepprath summarizing the discussion [Ep 1 · 1:35](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=95)
- In a recent survey, 80% of pediatric thyroid surgeons use nerve monitoring — Jill Knepprath summarizing the discussion [Ep 1 · 2:36](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=156)
- Nerve monitoring detects injury early, allowing surgeons to stage the operation and avoid bilateral injury, paralysis, and subsequent tracheotomy — Jill Knepprath summarizing the discussion [Ep 1 · 3:29](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=209)
- Nerve monitoring devices were often too big for pediatric patients historically — Jill Knepprath summarizing the discussion [Ep 1 · 3:58](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=238)
- Adhesive electrodes can be applied to even a 3.0 endotracheal tube, allowing nerve monitoring in all pediatric thyroid surgeries — Jill Knepprath summarizing the discussion [Ep 1 · 4:18](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=258)
- Radiologists say TIRADS is not reliable for pediatrics since it was originally developed for adults — Jill Knepprath summarizing the discussion [Ep 1 · 4:50](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=290)
- When criteria was based on the size of the thyroid relative to the size of the patient, no malignancies were missed — Jill Knepprath summarizing the discussion [Ep 1 · 5:27](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=327)
- Dr. Aldrin's 2025 study showed that PES-TIRADS eliminated unnecessary biopsies while not missing a single thyroid malignancy compared to adult and 2015 pediatric guidelines — Jill Knepprath summarizing the discussion [Ep 1 · 5:33](https://library.globalcastmd.com/watch/nerve-monitoring-and-risk-stratification-in-pediatric-thyroid-surgery-16844?t=333)
- Texas Children's Hospital researchers performed a systematic review focusing on 200 articles published from 1990 to 2021 on pediatric lymphatic malformations. — Lizzy Lee summarizes what Dr. Alex Halpern said [Ep 4 · 1:02](https://library.globalcastmd.com/watch/pediatric-surgery-literature-updates-lymphatic-malformations-g-tube-complication-16862?t=62)
- Sclerotherapy had a success rate of over 90% for macrocystic lymphatic malformations. — Lizzy Lee summarizes what Dr. Alex Halpern said [Ep 4 · 1:11](https://library.globalcastmd.com/watch/pediatric-surgery-literature-updates-lymphatic-malformations-g-tube-complication-16862?t=71)
- Sirolimus is helpful for extensive lymphatic malformations that are refractory to surgery and/or sclerotherapy. — Lizzy Lee summarizes what Dr. Alex Halpern said [Ep 4 · 1:17](https://library.globalcastmd.com/watch/pediatric-surgery-literature-updates-lymphatic-malformations-g-tube-complication-16862?t=77)
- Sirolimus is used as an initial treatment for extensive lymphatic malformations that compromise the airway. — Lizzy Lee summarizes what Dr. Alex Halpern said [Ep 4 · 1:24](https://library.globalcastmd.com/watch/pediatric-surgery-literature-updates-lymphatic-malformations-g-tube-complication-16862?t=84)
- Small asymptomatic lymphatic malformation lesions can be observed. — Lizzy Lee summarizes what Dr. Alex Halpern said [Ep 4 · 1:33](https://library.globalcastmd.com/watch/pediatric-surgery-literature-updates-lymphatic-malformations-g-tube-complication-16862?t=93)
- Large symptomatic lymphatic malformation lesions need to be divided into macrocystic, microcystic, or mixed lesions for treatment planning. — Lizzy Lee summarizes what Dr. Alex Halpern said [Ep 4 · 1:33](https://library.globalcastmd.com/watch/pediatric-surgery-literature-updates-lymphatic-malformations-g-tube-complication-16862?t=93)
- For localized lymphatic malformations, surgery or sclerotherapy is effective. — Lizzy Lee summarizes what Dr. Alex Halpern said [Ep 4 · 1:41](https://library.globalcastmd.com/watch/pediatric-surgery-literature-updates-lymphatic-malformations-g-tube-complication-16862?t=101)
- G-tube placement made up 5.3% of all cases submitted to NSQIP pediatric in 2023. — Alex Halpern summarizing a resource [Ep 4 · 2:21](https://library.globalcastmd.com/watch/pediatric-surgery-literature-updates-lymphatic-malformations-g-tube-complication-16862?t=141)
- Upper GI studies were obtained in 45% of G-tube cases with significant inter-hospital variability. — Alex Halpern summarizing a resource [Ep 4 · 2:27](https://library.globalcastmd.com/watch/pediatric-surgery-literature-updates-lymphatic-malformations-g-tube-complication-16862?t=147)
- In the first 30 days postoperatively after G-tube placement, 14% of patients went to the ED. — Alex Halpern summarizing a resource [Ep 4 · 2:34](https://library.globalcastmd.com/watch/pediatric-surgery-literature-updates-lymphatic-malformations-g-tube-complication-16862?t=154)
- In the first 30 days postoperatively after G-tube placement, 5.2% of patients experienced G-tube dislodgement. — Alex Halpern summarizing a resource [Ep 4 · 2:34](https://library.globalcastmd.com/watch/pediatric-surgery-literature-updates-lymphatic-malformations-g-tube-complication-16862?t=154)
- There is high postoperative G-tube related morbidity as well as high variability in preoperative upper GI use, which can both serve as targets for future quality improvement projects. — Alex Halpern summarizing a resource [Ep 4 · 2:43](https://library.globalcastmd.com/watch/pediatric-surgery-literature-updates-lymphatic-malformations-g-tube-complication-16862?t=163)
- The Swedish cryptorchidism study included 22 patients with spontaneous descent, 37 with surgery at 9 months, and 48 with surgery at 3 years of age. — Cecilia Gigena summarizes what Dr. Alex Halpern said [Ep 4 · 3:33](https://library.globalcastmd.com/watch/pediatric-surgery-literature-updates-lymphatic-malformations-g-tube-complication-16862?t=213)
- Testicular volume at puberty was significantly higher in patients with spontaneous descent of undescended testes versus those who had surgery at 9 months. — Cecilia Gigena summarizes what Dr. Alex Halpern said [Ep 4 · 3:33](https://library.globalcastmd.com/watch/pediatric-surgery-literature-updates-lymphatic-malformations-g-tube-complication-16862?t=213)
- Testicular volume at puberty was significantly higher in patients who had orchiopexy at 9 months versus those who had surgery at 3 years of age. — Cecilia Gigena summarizes what Dr. Alex Halpern said [Ep 4 · 3:33](https://library.globalcastmd.com/watch/pediatric-surgery-literature-updates-lymphatic-malformations-g-tube-complication-16862?t=213)
- Earlier orchiopexy is better for testicular volume outcomes as long as patients are given enough time for spontaneous descent. — Cecilia Gigena summarizes what Dr. Alex Halpern said [Ep 4 · 3:58](https://library.globalcastmd.com/watch/pediatric-surgery-literature-updates-lymphatic-malformations-g-tube-complication-16862?t=238)

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