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Message from the Chairman

It is a great honor or me to assume the position o Interim Chair o the

Department o Otolaryngology-Head and Neck Surgery at the University o

Caliornia, San Francisco. However, it is humbling to ollow in the ootsteps o

my riend and mentor, David W. Eisele. We have seen so much positive change

in our department throughout Dave’s tenure, such as: doubling the size o the

clinical aculty with outstanding physician recruitments; increasing the scope o

our research with new basic scientists; and expanding the size o our residency

program. Our department now covers every clinical aspect o Otolaryngology-

Head and Neck Surgery including: robotic surgery; endoscopic skull basesurgery; microvascular ree ap reconstruction; endocrine surgery o the head

and neck; sleep apnea surgery; ultrasound diagnostic capability; and, o course,

cochlear implantation. We are extremely well positioned to provide high quality

service to our community and to our university.

Nina and Barney Cohen each camerom very dierent backgrounds.

Barney grew up in an orthodoxJewish household in a steel town inIndiana, while Nina was raised by non-religious parents in Massachusetts. Yet,throughout their 69 years together theyhave always shared the same values.Married in 1943, they moved to Caliorniarom the East Coast at the end o WorldWar II. “We didn’t want to upset eithero our amilies by living closer to one orthe other o them,” says Nina. “So wedecided to move across country.”

In her teen years, Nina noticed shewas having a problem with her hearing.She was diagnosed with Otosclerosis,which causes an abnormal bone growthin the middle ear. Just beore she andBarney let or Caliornia, Nina had earsurgery at Massachusetts GeneralHospital, where surgeons were experi-menting with a new kind o procedureor patients with her condition. Thesurgery did improve Nina’s hearingthough she suered an inection ormore than a year aterward.

Couple Supporting the Future o

Otolaryngology – Head and Neck Surgery

Barney and Nina Cohen have generouslyincluded the Department o Otolaryngology–Head and Neck Surgery in their estate plans.

“We are so grateul or the

Cohens’ generosity. Support

like theirs will help the

Department to maintain its

position as one o the best in

the country or clinical care,

research and educational

programs.” – Dr. Andrew H. Murr

Heads Up! Summer 2012 1

UNIVERSIT Y OF CALIFORNIA, SAN FRANCISCO SUMMER 2012 | VOL. 9, ISSUE

News rom the UCSF Department o Otolaryngology –

Head and Neck Surgery

Message rom the Chairman 1

Donor Highlight 1

Minimally-Invasive Surgery 3

Pediatric Otolaryngology 4

Plastic & Reconstructive Surgery 5

Honoring Michael M. Merzenich, PhD 5

Education Program Update 6

Upcoming Events 6

General Otolaryngology

Pediatric Otolaryngology–HNS

Otology, Neurotology and Skull Base Surgery

Rhinology and Sinus Surgery

Sleep Surgery

415/353-2757

Cochlear Implant Center 415/353-2464

Facial Plastic and Aesthetic Surgery Practice

UCSF Medical Center

415/353-9500

HNS–Facial Plastic and Post-OncologicReconstructive Surgery, UCSF Helen Diller

Family Comprehensive Cancer Center

415/885-7528

Head and Neck Surgery and Oncology

Head and Neck Endocrine Surgery

Salivary Gland Center

415/885-7528

Balance and Falls Center 415/353-2101

Voice and Swallowing Center 415/885-7700

Audiology 415/353-2101

To support the Department o

Otolaryngology – Head and Neck Surgery,please contact Development Director

Justin Marsh at 415/476-5885

or [email protected].

In This Issue:

Contact Us:



Continued from page 1

At age 30, Nina enrolled as areshman at UC Berkeley to studynutritional biochemistry. She wenton to get a Masters in Biostatisticsrom the UC Berkeley School oPublic Health and later on a PhD.

Nina remembers some o thecommercial hearing aids she worewhile she was at Berkeley; one shehad to attach to her glasses whichmeant she could only hear peoplebehind her. Eventually she hadone custom made, which made abig dierence.

In the early 1970s, Barney retiredrom Bechtel Corporation where heworked or much o his career, andthe couple headed out to Perth,

Australia. Nina was hired by theWestern Australian Institute oTechnology (now Curtin University)

to start two new courses: one innutritional biochemistry and one indietetics. In Perth, Nina had anothesurgical procedure on her middleear, a stapedectomy, which helpedimprove her hearing even more.

Ater our years, the couple decideto return home and did so the longway, spending nine months travelinthrough nine dierent countries.

Support to UCSF

Because o Nina’s challenges with

Otosclerosis and her desire tosupport the work o the UCSFDepartment o Otolaryngology, sheand Barney recently established acharitable git annuity or which,in addition to receiving an incometax deduction, they will also beentitled to receive income or lie.

The Cohens have also gener-ously included the Department oOtolaryngology–Head and NeckSurgery in their estate plans.The use o their annuity and theirbequest is unrestricted because,

as Nina says, “I preer to allow theDepartment to spend our git in away that makes sense at the time.”

“We are so grateul or theCohens’ generosity,” says AndrewH. Murr, MD, Associate Proessoro Clinical Otolaryngology at UCSF“Support like theirs will help theDepartment to maintain its positionas one o the best in the countryor clinical care, research andeducational programs.” n

In my role as Interim Chair, DeanHawgood empowered me to continueto improve and develop ourdepartment. I will devote mysel toulflling this directive through actionssuch as the ollowing:

n Active recruitments, including:

a head and neck endocrinesurgeon to partner with Dr. Orlo;a vestibular otologist to partnerwith Dr. Lustig’s group; a newDirector o Audiology to fll in orDr. Sweetow now that he is retired;and, continued increase o ourresident complement.

n Making use o cutting edge

technologies and acilities,such as: participation in the frstwave o development or our newcancer hospital and in thedevelopment o the UCSF BenioChildren’s Hospital (which arebeing constructed on scheduleand on budget); and, being parto the opening o the brand newSan Francisco General Hospital –which is arising beore our eyeson the ormer ront lawn o theSFGH campus.

I am so proud o our outstandingresidents who display an amazingesprit de corps. Our residents

are extremely accomplished andproessional, and I will commitmysel to continuing to ocus ourresources on creating the bestOtolaryngology-Head and NeckSurgery residency program in thecountry. This year, our phenomenalchie residents are pursuing diversecareers: Dr. Kangelaris will be joiningthe Schindler/Johnson/Yeung/Kimpractice here in San Francisco,Dr. Huoh will be matriculating inthe pediatric ellowship at Lucille

Packard Hospital, and Dr. Changwill be joining our own academicpractice here at UCSF.

From a clinical services standpoint:our Chie o Facial Plastic andReconstructive Surgery Dr. Dan Knottis extremely busy with aesthetic andreconstructive surgery; Dr. MarikaRussell has seamlessly integrated intothe San Francisco General Hospitalpractice; Dr. Will Ryan is an extremelybusy head and neck oncologic

Continued from page 1

surgeon; and, Dr. Matt Russell isblazing a trail as the OtolaryngologyHospitalist at the Parnassus site.

As a gauge o the excellence o ourclinical enterprise, our Head andNeck practice just received thehighest patient generated score orrecommending the practice to otherpatients in the entire University o

Caliornia, San Francisco, a trulyspectacular achievement!

From a research standpoint: wewelcome Dr. Andrea Hasenstaub, aKlingenstein Fellowship neuroscienceresearcher, who joins the Keck Centerand who will collaborate closelywith Dr. Christoph Schreiner. Ourrhinology team o Andrew Goldbergand Steven Pletcher has hiredEmily Cope, PhD as a postdoctoralscholar to pursue an initiative devotedto understanding the human biome

as it relates to sinus disease.Finally, we have just completed a

series o amazingly successul CMEcourses including the UCSF VoiceConerence run by Dr. Courey, theUCSF Otolaryngology Update, theUCSF–Penn Sleep Medicine andSurgery Course with Drs. Goldbergand Kezirian, and multiple UltrasoundCourses organized by Dr. Orlo.

I am very excited about our teamand our uture. We will continue toinnovate and collaborate. I will strive

to expand the oundation o successthat has enabled the continualadvancement o our department.

Sincerely,

Andrew H. Murr, MDInterim ChairmanProfessor of Clinical Otolaryngology–Head and Neck Surgery Roger Boles, MD Endowed Chair inOtolaryngology EducationDepartment of Otolaryngology–Head andNeck Surgery

Dr. Andrew H. Murr

2 Heads Up! Summer 2012

Donor HighlightChair’s Message



Over the past decade, surgeons

have utilized the da Vinci

surgical robot (Intuitive,

Sunnyvale, CA) or more precise,saer, minimally-invasive surgeries,

particularly in the areas o urology,

gynecology, and laproscopic

abdominal surgery.

Recently, a robotic-assisted

surgical technique or the treatment o

head and neck cancer was approved

by the FDA. The technique, called

Trans-Oral Robotic Surgery or TORS,

involves the use o the da Vinci

surgical robot to remove benign

and malignant tumors o the throat.

TORS is a minimally-invasivetechnique where a surgical robot,

consisting o a three-dimensional high

defnition video camera and robotic

arms with miniaturized instruments

da Vinci Surgical Robot for Head and Neck Cancers

under the ull control o the surgeon,

is used to completely remove tumors

o the pharynx and larynx through the

mouth without external incisions.In January o 2011, a surgical

team including Dr. Steven Wang,

Dr. Ted Leem, and Dr. William Ryan

perormed the frst TORS procedure

at the UCSF Helen Diller Family

Comprehensive Cancer Center.

During the past year and a hal,

UCSF surgeons have saely

perormed TORS procedures on

patients with tonsil, base o tongue,

and palate tumors.

Improved Visualization

According to Dr. Wang, the most

common candidates or the TORS

procedure include patients with small

to medium-sized tumors o the tonsil,

sot palate, base o tongue, and

larynx. In the past, the conventional

surgical approach to these tumors

would typically require a large incision

through the lip and jawbone in a

lengthy operation requently lasting

10 to 12 hours. These conventionally-

treated patients oten would remain

hospitalized with eeding tubes or upto 2 weeks ollowing surgery.

Using the da Vinci robot or TORS,

these same tumors can be removed

more precisely and with less blood

loss, due to improved visualization

and the fne motion control o the

robotic instruments. TORS patients

can requently resume an oral diet

and go home rom the hospital within

1 or 2 days.

Analyzing Patient Outcomes

Dr. Wang states that, “O course themost important measure o any new

cancer treatment is how eective it is

in curing the cancer.” Early reports

rom other major hospitals around the

country indicate that TORS patients

have equivalent cancer control rates

compared to both conventional

surgery and radiation-based

treatments and may have quicker

recovery and improved swallowing

unction. “However,” says Dr. Wang,

“like any new cancer treatment

technique, it is important to continue

to study the outcomes o patients in

order to validate the fndings o these

early reports.” UCSF, in collaboration

with other centers around the

country, is actively accruing

inormation on their own patients

who have undergone TORS in order

to analyze the efcacy, outcomes,

and costs associated with this new

tool or the treatment o head and

neck cancer.

Notwithstanding the initial success

o the new UCSF Trans-Oral Robotic

Surgery program, Dr. Wang believes

that robotic surgery is an approach

that must be selected appropriately.

Not all head and neck cancer

patients should be treated with TORS

or even with surgery. Some patients

are still best served by traditional

open procedures (through the jaw

and/or neck). All new head and neck

cancer patients at UCSF receiveevaluation by a multidisciplinary team

that includes head and neck cancer

specialists rom otolaryngology-head

and neck surgery, radiation oncology,

medical oncology, and others, so

that every patient is able to make an

inormed treatment choice. For those

patients who will beneft rom TORS,

Dr. Wang and Dr. Ryan are pleased

to be able to provide this exciting

new treatment option. n

For those patients who will

beneft rom TORS, Dr. Wang

and Dr. Ryan are pleased to

be able to provide this exciting

new treatment option.

The da Vinci surgical robot consists o a three-dimensional high defnition video camera androbotic arms with miniaturized instruments

under the ull control o the surgeon.

Dr. Stephen Wang (let) and Dr. WilliamRyan at the UCSF Helen Diller FamilyComprehensive Cancer Center

3

Minimally-Invasive Surgery



Most parents o children with

complex medical conditions

agree that they preer a

multidisciplinary approach. Having

multiple experts come together toexamine a child, review pertinent

studies and discuss a comprehen-

sive treatment plan is preerable

or amilies rather than having to

schedule multiple individual

appointments.

The UCSF Birthmark and

Vascular Anomalies Center (BVAC)

has been seeing patients since 1991

and is the second oldest in North

America. Pediatric Otolaryngology

has been a part o the Center

since 2002 when Dr. Kristina Rosbearrived – which is ftting since over

50% o vascular anomalies occur in

the head and neck.

“I participated in Boston Children’s

Hospital’s Vascular Anomalies

Clinics when I was a ellow and

knew this was something I wanted

to continue throughout my career,”

says Dr. Rosbe, Proessor o

Otolaryngology and Pediatrics and

Director o Pediatric Otolaryngology

at UCSF. “It is a privilege to be able

to work alongside Dr. Ilona Frieden,”the ounder o the Center and

Director o Pediatric Dermatology

at UCSF who has contributed

Comprehensive Care at Birthmarkand Vascular Anomalies Center

Pediatric Otolaryngology

signifcantly throughout her career,

to understanding o inantile

hemangiomas and other vascular

anomalies. Patients at the Center

also have access to Dr. ChristopherDowd, one o the most experienced

interventional radiologists in

the techniques o sclerotherapy in

the world.

Monthly Clinics with

Experienced Specialists

Patients are reerred rom all over

Caliornia, the United States and

even other countries. The Center

holds clinic once a month. All the

specialists see each patient and

reconvene in a conerence roomto review pertinent imaging and

other studies. A comprehensive

treatment plan is ormulated and

communicated to the amily at the

end o the session.

Many patients and amilies who

are reerred are anxious. Their

primary care provider has not been

able to give them an accurate

diagnosis. The uncertainty o the

diagnosis causes stress and even

concern or malignancy. One o the

main goals o the UCSF BVAC is toeducate patients and amilies about

the natural history o the birthmark or

malormation. Some diagnoses do

not necessarily require intervention

and will be ollowed until resolution.

Other malormations may require

intervention by multiple specialists.

State-o-the-art Treatment

and Research

The Center prides itsel on being

able to oer state-o-the-art

treatments such as radiorequency

ablation o oral lymphatic malorma-

tions or propranolol or airway

hemangiomas. The UCSF BVAC

was one o the frst centers to start

using propranolol or treatment o

hemangiomas and has now treated

over 100 patients.The UCSF BVAC is involved in

several multi-institutional studies o

hemangiomas and vascular

anomalies, examining both saety and

efcacy o treatments.

The Center has also recently

published one o the largest series o

PHACE patients, a constellation o

complex medical conditions

including (P)osterior ossa brain

anomalies, large segmental

(H)emangiomas, (A)rterial anomalies

such as coarctation o the aortaor other (C)ardiac anomalies, and

E)ye anomalies. PHACE was frst

described by Dr. Ilona Frieden here

at UCSF.

UCSF Pediatric Otolaryngology is

proud to be part o this unique

opportunity or patients and their

amilies to access experienced

specialists oering comprehensive

state-o-the art care backed by the

most up to date research. n

Dr. Anna Meyer and Dr. Kristina Rosbeat UCSF Children’s Hospital

One o the main

goals o the

UCSF BVAC is to

educate patients

and amilies about

the natural historyo the birthmark

or malormation.




Why don’t we appreciate thingsuntil we’ve lost them? Whilethis is true when it applies to

material goods, it is even moreimportant when it applies to one’sown body. Smiling is something thatwe most literally take or granted.There are thousands o expressionsthat a ace can convey with inections

provided by a subtle lit o theeyebrow, a ared nostril, or atightening o the jaw. Quite suddenlyhowever, all o these expressions, aswell as the ability to close the eye,speak, swallow or even breaththrough the nose may be swept away.

The acial nerve is a single cord-like structure that exits the brain stemater passing next to the inner ear andenters the ace in the sot tissue deepto the earlobe. It then divides andpowers all o the muscles o acialmovement. When the acial nerve isdamaged, through inection, stroke,trauma, cancer or surgery, one isessentially let without hal o a ace.This critical window to the worldbecomes wooden and droopy. Whilesome patients recover unction ontheir own, many are aced with lie-long paralysis. Social interaction isshunned, jobs are lost and relation-ships may be terminally stressed.

Traditional operations to repairacial movement required multiplestages, waiting periods o up to a

year or nerve grats to “take,” anddeorming contour abnormalities.However, with new techniques thathe has helped develop, Dr. DanielKnott, director o acial plastic andreconstructive surgery at UCSF,is able to restore meaningul andexpressive movement with immediateresults. Droopy eyebrows are lited,platinum implants are placed belowthe skin o the upper eyelid, the lowereyelid is tightened and the smile may

be restored with a muscle transer.Progress in this area has beenastounding, but much work remains.There is no single “answer” or everypatient, and nerve regenerativemedicine is one area that needsincreased research.

Lost smiles are not the only ocuso Dr. Knott’s clinical research. He

has also worked extensively in headand neck transplantation, cartilagebioengineering and acial contourrestoration. For example, imaginelosing your jaw. This may be astrange concept, but this was theate o an unortunate 15-year-oldcheerleader. Faced with a benign,but locally destructive dental tumor,this teenager underwent removal oher upper jawbone at UCSF 2 yearsago. Surgery resulted in removal ohal o her hard palate, all o theupper teeth on one side o her mouth,the shel o bone that supports hereyeball and most o her cheekbone.While her operation was curative,this young lady now must wear aspecially modifed denture in orderto speak or eat. This is quite achallenge or a high school studentwhose classmates worry more aboutacne, frst dates and frst kisses.

Dr. Knott is one o only a handulo surgeons in the country that isable to use part o a patient’s lowerleg bone to rebuild the bone and

sot tissue o the upper jaw, usingminimally invasive incisions and sottissue tunneling and underminingtechniques. Once healed, this bonesupports dental implants, and canreturn patients to complete normalcy.Dental implants are however veryexpensive and are rarely covered byinsurance. This young woman and heramily are currently trying to save upmoney to pay or the dental implantsto help und her upcoming surgery. n

Giving Back Smiles

Honoring MichaelM. Merzenich, PhD

On March 1, 2012, the

Department o Otolaryngology

– Head and Neck Surgery

presented a special lecture and

dinner in honor o Michael M.

Merzenich, PhD. The lecture,

presented by Dr. Merzenich,

himsel, was titled, “Cultural

Neuroscience: How brains change

humans and societies and societie

change brains and humans.”

Ater the lecture, invited guests

rom our dierent continents

attended a dinner to honor

Dr. Merzenich’s achievements

which have aected lives around

the world. A list o over 20 speaker

– many o whom are now leadersin technology and health sciences

themselves – told about their

experiences studying under the

tutelage o Dr. Merzenich, being his

colleague, and being his amily.

Dr. Merzenich’s eorts at UCSF

have led to great advances in

patient care and discoveries that

will beneft us all. One o the

greatest innovations in medicine is

due to the work that Dr. Merzenich

developed alongside a ormer

chairman o Otolaryngology – Headand Neck Surgery, Dr. Robert

Schindler: the multi-channel

cochlear implant.

Endowed Lecture

I you would like to partner with us

in honoring Dr. Merzenich’s

achievements through establishing

the Michael M. Merzenich Endowe

Lecture, please contact Justin

Marsh at [email protected]

or by calling 415/476-5885. n

Dr. Michael M. Merzenich

Dr. Daniel Knott discusses reconstructive options with a patient

Plastic & Reconstructive Surgery

5 Heads Up! Summer 2012

Building on History



O

ur education program is

extremely strong and i

this year’s NRMP residentmatch is any indication then it

is obvious that the word has

spread throughout the nation.

Our program combines a unique

esprit de corps with unparalleled

clinical and research experience

to create an exciting and

nurturing learning environment.

Welcome New Residents

This year, we competed against the

most outstanding and competitiveOtolaryngology–Head and NeckSurgery training programs in thecounty and matched threespectacular young physicians.Nicholas Dewyer, MD, is joining usrom the University o Michigan andhis wie will be matriculating in theRadiation Oncology program atUCSF. Jonathan Overdevest, PhD,MD, will be arriving rom theUniversity o Virginia, and MatthewTemplan, MD, will return home romUCLA to comprise our incoming

PGY-1 class.Meanwhile, please welcome Dan

Faden, MD, Shethal Bearelly, MD,Jerey Markey, MD, and MeghaParekh, MD, to their PGY-2 year.They are a spectacular class and thefrst o our classes with our residentsper year in keeping with our ACGMEapproved complement increase.

We will certainly miss our belovedchie residents, but no one istraveling too ar. Kevin Huoh, MD, willbe a pediatric ellow at Stanord,

Gerald Kangelaris, MD, will be

practicing in San Francisco, andJolie Chang, MD, will be a ull-time

aculty member in the department.We are very confdent in the skillsand physicianship displayed by thisoutstanding crew.

Program Support

We have been very ortunate thisyear in receiving generous supportor our education program includingtravel grants rom the American

Academy o OtolaryngologyHead and Neck Surgery, rom theTriological Society, and rom manyindividuals. We owe a special debt

o gratitude to Dr. Robert and JanetSchindler and Dr. David and DianaSchindler who have contributedgenerously to support our Robert A.Schindler Surgical Skills Classroom.We run numerous courses through-out the year or the residents inthis acility and have also recentlyrun post graduate courses withcadaver dissections to ocus onskull base surgery.

Expanding Understanding

Finally, Anna Meyer, MD has been

successul in integrating severalotolaryngology-head and necksurgery lectures into the basicscience curriculum or all UCSFmedical students. Her lectures wereextremely successul based uponthe ormal eedback we havereceived. We know that Anna’seorts will increase the generalawareness o otolaryngology issueswithin the medical school and willlead to even more responsibilitywithin the undergraduate medical

education curriculum at UCSF. n

Department Interim Chairman and Editor in Chief: Andrew H. Murr, MD

Contributors: Matt Forbush, Jennifer Lo, Justin Marsh

Design: Laura Myers Design / Photography: Matt Forbush, Susan Merrell

© 2012 The Regents of the University of California

http://ohns.ucs.edu

SUMMER 2012 | VOL. 9, ISSUE 1

News rom the UCSF Department o Otolaryngology – Head and Neck Surgery

Program Excels with Talent and Support

Laryngeal Endostroboscopy:Perormance andInterpretation

September 20–21, 2012

San Francisco, Caliornia

American College oSurgeons Thyroid andParathyroid UltrasoundSkills-Oriented Course

November 8, 2012


Head and Neck EndocrineSurgery — with or withoutHead and Neck Cancer

November 9–10, 2012


Head and Neck CancerSurgery (Only)



Temporal Bone SurgicalDissection Course

December 7–8, 2012San Francisco, Caliornia

Pacifc Rim OtolaryngologyHead and Neck SurgeryUpdate Conerence

February 16–19, 2013

Honolulu, Hawaii

UCSF OtolaryngologyUpdate: 2013



20th Annual Advances inDiagnosis and Treatment oSleep Apnea and Snoring

February 14–15, 2014


For more inormation about

these and other continuing

education oerings, please

visit http://ohns.ucs.edu and

http://cme.ucs.edu.

Upcoming EventsEducation Program Update


headsup summer 2012

Documents