Operative Techniques in Otolaryngology - Head and Neck Surgery最新文献

Surgical approaches to the oropharynx have trended over the years from more invasive to more minimally invasive procedures, with the advent of transoral laser microsurgery and transoral robotic surgery. With less invasive procedure, visualization of critical structures may be more limited, necessitating a robust understanding and working knowledge of the underlying anatomy to avoid surgical complications and errors. Herein, we review pertinent anatomical structures in the oropharynx through use of a sagittally split cadaveric model in 2D and 3D imaging, with a focus on surgical relevance.

Odontogenic descending necrotizing mediastinitis (DNM) is a rare but sometimes fatal complication of tooth infections. The mortality rate remains high, up to 40%, and there is no consensus on optimal workup and management currently. This review aims to summarize cases of odontogenic DNM in the literature to optimize management strategies and aid physicians in its early recognition. A systematic review of the Ovid Medline, EMBASE Classic and Pubmed databases was conducted using PRISMA guidelines. Original research studies reporting an odontogenic etiology of DNM were included. Our search identified 226 articles. Final inclusion consisted of 60 studies describing 204 cases. Most patients were male (80.4%) with a mean age of 47.64 ± 15.96 years old. Patients primarily presented with edema (57.7%), fever (42.3%), trismus (37.2%), dyspnea, (26.9%), dysphagia (26.9%). Common radiologic findings were abscesses or fluid collection in the mediastinum (53.1%), air in the soft tissues (50.0%), pleural effusion or empyema (37.5%), mediastinal widening (32.8%), and pericardial effusion (7.8%). Patients were treated with intravenous antibiotics and a variety of surgical techniques such as cervicotomy only (51.2%), thoracotomy only (15.9%), cervicotomy and chest tube (3.5%). The mortality rate was 14.2% with a mean length of hospital stay of 30.1 ± 20.2 days. This systematic review reports and analyzes epidemiological, clinical and treatment-related data regarding patients with odontogenic DNM. Effective disease recognition and patient-specific targeted treatment are needed to ensure treatment success. Further research is needed to promote implementation of such data into clinical practice, with potential to reduce the associated mortality rate.

Epiglottopexy is an uncommon, but effective procedure for pediatric patients with obstructive sleep apnea. It is important to establish retroflexion and collapse of the epiglottis at the base of tongue prior to surgery. Preoperative polysomnogram, flexible fiberoptic laryngoscopy, and sometimes drug induced sleep endoscopy are critical components of the workup as many patients who benefit from epiglottopexy have already failed primary adenotonsillectomy. The surgery involves demucosalizing the base of tongue and lingual surface of the epiglottis and securing the 2 structures to one another. Patients tolerate the procedure well and can often be discharged home the following day.

Surgical treatment of obstructive sleep apnea in children who fail tonsillectomy and adenoidectomy, or in those children with small nonobstructing tonsils is performed infrequently. Further evaluation including drug induced sleep endoscopy may uncover residual upper airway obstruction at the tongue base. When this finding is identified, targeted treatment of tongue base obstruction can be performed. A straight forward easy to perform tongue reduction procedure with minimal complications and good clinical outcomes when part of a multi-level approach is described.

Otolaryngologists play a central role in diagnosing and treating facial pain syndromes and headache disorders. Although sphenopalatine ganglion block is a recognized treatment option, literature on transnasal injection techniques is limited. This study's objective is to refine anatomic landmarks and optimize a technique for in-office transnasal sphenopalatine ganglion blocks. Eight cadaveric head specimens were dissected to record 16 measurements of critical anatomic landmarks and surgical instruments for sphenopalatine ganglion block. On average, the sphenopalatine foramen center was 5.94 mm (±1.65 mm) superior to the inferior border of the middle turbinate's basal lamella attachment to the lateral nasal wall. We describe the reliability of using a 20G spinal needle bent at 70-degree to perform a transnasal injection technique for sphenopalatine ganglion block. The inferior border of the middle turbinate basal lamella attachment to the lateral nasal wall may be used as an intranasal landmark in transnasal injection of the sphenopalatine ganglion. Further testing in the clinical setting is required to assess efficacy.

Over the last 40 years, dental implants have become popular. Despite being a safe procedure with few reported complications, dental implants may become displaced into the maxillary sinus. We analyzed the outcomes of endoscopic inferior meatal antrostomy (EIMA) for implant removal. Medical records of all patients who had EIMA for dislocated dental implants at our institution during 2016-2021 were retrospectively reviewed. Ten patients were included in the analysis; most of them were asymptomatic at presentation. Implants, displaced into the lower, central, or upper parts of the maxillary sinus, were removed by EIMA, which provided excellent access and view. The ostiomeatal complex remained untouched. The average operation time (including administration of general anesthesia) was 42 minutes. No intraoperative or postoperative complications occurred. Recirculation was not detected. All patients healed without requiring further interventions. EIMA should be considered for removal of dislocated dental implants from the maxillary sinus, since it provides better access and view, while maintaining the integrity of the ostiomeatal complex.

Temporal bone cerebral spinal fluid (CSF) leak is a condition characterized by continuous CSF leakage from the intracranial cavity into the middle ear space. Prompt surgical management is warranted as temporal bone CSF leaks may lead to serious infections such as meningitis and encephalitis. There are several methods and materials utilized to repair tegmen defects that cause CSF leaks. Herein, we describe a novel technique to repair the tegmen in patients with temporal bone CSF leak utilizing a tragal cartilage butterfly graft. Cartilage is a readily available, generously biocompatible, resistant to deformation and an inherently pliable graft material. Butterflied cartilage grafts provide unique benefit allowing both intracranial and extracranial support to seal tegmen defects with the placement of a single piece of graft material.

The objective of this chapter is to describe lingual tonsillectomy (LT) as a treatment strategy for children with persistent obstructive sleep apnea after adenotonsillectomy. Drug-induced sleep endoscopy is a useful tool that enables physicians to identify sites of obstruction resulting from dynamic airway collapse and direct surgical interventions accordingly. Lingual tonsil hypertrophy is graded according to the degree of effacement of the vallecula and the posterior displacement of the epiglottis. The surgical technique for microscopic- and endoscopic-assisted coblation LT is described along with postoperative care and complications. LT is an important and efficacious technique for the treatment of pediatric obstructive sleep apnea in patients with base of tongue obstruction.

Nasal obstruction is one of the more common complaints seen in children, which can exacerbate symptoms of sleep disordered breathing. Sites of obstruction within the nasal passage are due to inferior turbinate hypertrophy and septal deviation. The inferior nasal turbinates, due to internal nasal valve positioning, can be surgically addressed following a trial of medication. This article will focus on the 2 most frequently utilized surgical techniques today for inferior turbinate reduction in children: microdebridement and coblation technology.