Residency: Specialties
Residency | Specialties | Research | Global Health | Application | Handbook PDF |
The residency core curriculum can be found in the following pdf file:
Click Here
The following is a description of departmental specialties
where residents receive exposure and experience.
Our 2009-2010 Chief Residents
| HEAD AND NECK SURGERY |
Residents have an active role in the evaluation and management of head and neck cancers. The bulk of this experience occurs at the Stanford campus, and Palo Alto Veterans’ Administration Hospital where there are several hundred new head and neck cancer patient visits per year. In addition to formal grand rounds and teaching rounds relating to head and neck cancer, there is a multidisciplinary Tumor Board, consisting of surgeons, radiation therapists, oncologists, maxillofacial surgeons, speech therapists, neuroradiologists and pathologists which meet to discuss all new head and neck cancer patients. Besides allowing for careful clinical diagnosis and treatment planning, this Tumor Board affords an excellent opportunity for didactic teaching. Active involvement by medical students, residents, and faculty is solicited.
| FACIAL PLASTICS AND RECONSTRUCTIVE SURGERY |
Under the guidance of three facial plastic surgeons, residents learn techniques of facial reanimation, scar revision, and facial reconstruction following trauma and cancer excision. There is also exposure to patients desiring facial rejuvenation, and residents learn the latest techniques of facial cosmetic surgervides significant exposure to patients with congenital and acquirey.
Special emphasis is placed on functional and aesthetic nasal analysis for rhinoplasty patients. In addition to the regular Facial Plastic Surgery Conferences, there are two weekly clinics at Stanford dedicated solely to these services. A yearly Facial Plastic Surgery Course is held each Fall.
Facilities include computer facial imaging, and a procedure room for aesthetic facial surgery, including state-of-the-art laser and IPL treatments. Additional reconstructive experience is gained at the Santa Clara Valley Medical Center and Veterans Affairs-Palo Alto.
| LARYNGOLOGY |
The full spectrum of disease that impacts voice and swallowing are seen and treated in our division, accounting for over 2000 patient visits and 300 surgeries per year. Surgical techniques emphasized include laryngeal framework surgery (thyroplasty, arytenoid adduction); injection laryngoplasty; operative microlaryngoscopy; endoscopic and open partial laryngectomy; and endoscopic and open airway reconstruction, including tracheal and cricotracheal resection. Residents gain early exposure and expertise in the evaluation of voice and swallowing disorders, videostroboscopy and interpretation, and office based procedures including injection of the vocal fold and transnasal esophagoscopy. Rotation on the laryngeal surgical service begins in the R2 year and progresses through the chief year, with increasing levels of responsibility afforded accordingly. The Division of Laryngeal surgery has an active research arm with emphasis on the development of new technologies to aid diagnosis and therapy. This includes high resolution MRI imaging to detect early invasive laryngeal cancer, real time MRI imaging of the larynx and pharynx to better characterize voice and swallowing disorders, and the application of robotic systems to aid laryngeal surgery. Instruction in advanced laryngeal concepts and the management of challenging laryngeal problems is emphasized in our monthly Laryngology Conference. There is considerable opportunity to publish and to present at national meetings, with strong emphasis placed on helping our residents establish a strong academic track record and gain exposure to national leaders in the field of laryngeal surgery.
| OTOLOGY, NEUROTOLOGY AND SKULL BASE SURGERY |
The centerpiece of the otology education program is at the Stanford campus. Residents are trained in the care of patients with otologic, neurotologic, vestibular, and skull base disorders, actively participating with teams of neurotologists, otologists, and audiologists in patient care. In addition to a programmed reading course, there are several educational conferences: Otology Grand Rounds, Weekly Chart Discussion, Journal Club, Audiology Rounds, Skull Base Grand Rounds, and Neuroradiology Grand Rounds.Surgical skills are further honed through a comprehensive Temporal Bone Surgical Dissection Course. Additional otologic surgical experience is afforded at the Santa Clara Valley Medical Center and Kaiser Permanente.
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| Resident Peter Li, M.D. molding an ear during a resident education session. | The finished product. |
Inner Ear Fluorescence Microendoscopy
Collaborators:
Mark Schnitzer PhD | Gerald Popelka PhD | Jeurgen Jung MS | Ashkan Monfared MD
We are developing a method to visualize functional hair cells and other cellular elements of the inner ear within the intact mammalian cochlea using fluorescence microendoscopy. Our laboratory has begun work on this minimally invasive in vivo imaging technique to provide high-resolution images of deep tissues previously inaccessible in live subjects. Using microendoscopes as small as 0.3 mm in diameter, we have successfully imaged individual red blood cells flowing within capillaries inside the mammalian cochlea. We are extending this work by labeling functional neural elements with fluorescent dyes to concurrently reveal mechanotransduction and electrical stimulation, as well as microanatomy.An imaging technology to observe functional hair cells and dendrites within live mammalian subjects will provide considerable benefit, and enable progress in a broad range of previously intractable hearing science questions. The success of inner ear microendoscopy will provide a basis on which inner ear surgery can be established. The development of non-destructive imaging techniques will enable diagnostic and therapeutic manipulations, including the optimal placement of cochlear implant arrays, or the specific delivery of stem cells or growth factors to enable hearing restoration.
Surgical Simulation
Collaborators:
Kenneth Salisbury PhD | Federico Barbagli PhDWe have developed a virtual surgery environment for skull base surgery to augment surgical education and provide for preoperative rehearsal of procedures. In order to be safe and effective, the skull base surgeon must have a complete understanding of the intricate anatomy involved. Such an understanding is difficult to acquire from traditional two-dimensional media. Similarly, the surgical technique of working within this confined space in close proximity to vital neurovascular structures is difficult to convey within the setting of actual surgery. For these reasons, the application of an immersive computer simulation environment is a natural fit for providing education in this surgical subspecialty.In collaboration with the Biorobotics group, we now have a working system for virtual skull base dissection, incorporating anatomically accurate stereoscopic models, and a touch-feedback (haptic) interface. Innovative simulation techniques have been incorporated to maximize its realism and educational utility. Such features include systems for innovative high resolution volumetric graphic rendering, a custom-developed simulation environment and user interface, and the potential for networked haptics – allowing multiple user s to manipulate and “feel” the same anatomic simulation. The system also incorporates a scripting language through which an instructor can establish the expected flow of the surgical procedure. Through the application of empirically determined metrics that define safe and effective surgery, the user can receive timely feedback regarding performance. Currently, we are incorporating preoperative patient-specific data to allow for rehearsal of planned procedures
Mathematical Modeling of Cochlear Biomechanics
Collaborators:
Sunil Puria PhD | Charles Steele PhDWe are designing a computational model of inner ear mechanics to understand the mechanisms that support the highly sensitivity, dynamic, and non-linear properties of normal hearing. This understanding will allow the functional characterization of alterations arising from a variety of cochlear disorders and from therapeutic interventions. We will develop an anatomically based three-dimensional computational model for the cochlea that incorporates the details of the micro-mechanics of the hair cells, neurons, supporting structures, membranes, and surrounding fluid environment. The model is based on previous work by Dr. Steele.A systematic and comprehensive computational model of inner ear mechanics will provide the basis for addressing a number of clinically important issues. For example, we will be able to predict the mechanical effect of cochlear implant array placement, and how it may influence residual acoustic hearing in the implanted ear. Such data may help us to develop more effective acoustic-electric hybrid prostheses for individuals with high frequency hearing loss. Similarly, we will explore the mechanical sequellae of endolymphatic hydrops, and the degree to which this could contribute to hearing loss in Meniere’s disease. With the anticipated advent of micro-robotics, otologists will develop technology to manipulate the organ of Corti in an attempt to improve hearing. The benefit of this exciting future technology can only be fully realized if therapy is grounded a clear understanding of cochlear mechanics as will be provided by our project. Another important future technology for hearing restoration is the regeneration of cochlear sub structures through the introduction and differentiation of stem cells. The yet unknown mechanical consequences on hearing of these regenerative efforts can be explored in the proposed biomechanical framework.
| RHINOLOGY |
| ALLERGY |
Children's Clinic
| PEDIATRIC OTOLARYNGOLOGY |
The pediatric otolaryngology portion of the residency training is centered at Lucile Salter Packard Children's Hospital . A pediatric otolaryngology and audiology clinic is located at the children's hospital. In addition to learning about common pediatric otolaryngology problems such as ear infections, tonsillitis, and sinusitis, residents will learn how to evaluate children with voice disorders, airway obstruction, hearing loss, nasal and/or neck masses and other less common otolaryngology problems. In addition, residents will learn how to care for otolaryngology problems in children with multiple congenital anomalies, as well as those who have undergone organ transplants, and have inherited diseases such as cystic fibrosis.
Resident Amanda Munoz, M.D.
Eduardo Corrales, M.D., speaking, 2009.
