With the onset of the COVID-19 pandemic, many novel presentations of known conditions are occurring. In the pediatric population, new instances of Kawasaki disease have recently been singled out as presenting in conjunction with or soon after diagnosis of COVID-19. This poses a novel situation, particularly for otolaryngologists, who may be the first to encounter these patients. Otolaryngologists should be cognizant of the coexistence of conditions to allow for timely recognition and optimal management.

Introduction:Functional endoscopic sinus surgery is a complex procedure used by otorhinolaryngologists to treat a host of nasal sinus pathologies. Due to the involved nasal anatomy and the nature of the procedure, teaching residents to use an endoscope is challenging. Simulation labs have been helpful but intraoperative instruction can still present difficulty in communication between resident and attending physicians during the teaching process. The purpose of this is to hypothesize a method of teaching intraoperatively that can be used supplemental to or independently of virtual reality teaching.Method:Literature review to determine current intraoperative verbal teaching methods used by surgeons was performed. Review was also performed on the effects of simulation techniques in preparing residents for the operating room. Although this was not a systematic review including statistical analysis, a gap was found in the literature on how residents can be efficiently taught intraoperatively to navigate an endoscope while maintaining patient safety. A novel and inexpensive method has been devised as a possible teaching method.Conclusions:Extensive literature is not available in intraoperative teaching techniques. It is therefore uncertain whether such a method has been used before. Further study, possibly in the form of surveys and intraoperative trials, must be done to determine the effectiveness of this mechanism.

Purpose of review Craniosynostosis, a condition of premature cranial suture fusion, can have significantly detrimental effects on development and growth due to sequelae of increased intracranial hypertension (ICP), exophthalmos, and upper airway obstruction. Evolving surgical treatments now include distraction osteogenesis (DO) due to its many benefits relative to standard cranial vault remodeling procedures. This article provides an overview and update of different surgical applications of DO for patients with craniosynostosis. Recent findings DO has been utilized successfully for single and multisuture craniosynostosis with or without midface hypoplasia to increase intracranial volume, decrease ICP and improve aesthetics. It has been applied in single suture synostosis, posterior vault DO, fronto-orbital advancement, monobloc DO and Le Fort III DO. DO has been applied through modification of traditional surgical procedures with success in maintaining goals of surgery while reducing risk. Summary DO is still a relatively new and evolving surgical technique for patients with syndromic and nonsyndromic craniosynostosis. With promising benefits, consideration for each procedure should be weighed until longer-term data is available.

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We would like to thank Dr Sert for the thoughtful response. We agree that early cardiac consultation and vigilant followup are necessary to provide appropriate management for pediatric patients diagnosed with Kawasaki disease. A diagnosis of coronavirus disease 2019 (COVID-19) complicates this disease process. For this reason, along with increasing awareness of pediatric systemic multisystem inflammatory syndrome, this area is continuously evolving. Therefore, there are expected to be continued advances in knowledge to give these patients the best possible prognosis.