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

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.

Management of a nasolabial cyst typically involves surgical excision via a sublabial approach but the thin plane of dissection may lead to a cyst rupture, or a breach of the nasal mucosa. Endoscopic endonasal marsupialization has been recently described, but there is a risk of fistula stenosis and cyst recurrence especially for small nasolabial cysts with small intranasal components. We describe a modification of the endoscopic endonasal marsupialization technique by incorporating an inferiorly based flap that acts as a spacer to prevent recurrence. The procedure is performed under general anesthesia. With endoscopic guidance, the intranasal cyst wall is incised from a posterior superior to anterior inferior direction. The medial cyst wall is left pedicled inferiorly, trimmed to size and is rolled into the cyst cavity to act as a spacer. This technique has been performed in 4 patients with cyst sizes ranging from 9 to 29 mm with no recurrences at least 6 months postoperatively. Previous reports have described recurrence at 6 months after endoscopic marsupialization, despite an intranasal cyst opening of 10 × 10 mm. This simple modification of the previously described endoscopic marsupialization technique has successfully prevented stenosis and recurrence even in patients with small nasolabial cysts.

Deltopectoral flap was discovered in early 90s and used for nasal and pharyngeal reconstructions, since then its use has diminished over the years. We have tried to use this historic flap with the robust pectoralis major flap to reconstruct large head and neck defects. Though the ideal flap for such defects would be a free flap, in developing nations due to resource intense settings free flap is not always feasible. Our aim is to review combined deltopectoral and pectoralis major flap for large head and neck reconstructions. A retrospective study of 30 patients was done in our institute. Patients included in the study were resectable head and neck cancers with extensive skin involvement. A combined deltopectoral and pectoralis major flap was used to reconstruct the defect. A combined use of deltopectoral and pectoralis major flaps can be an effective alternative to free flaps in developing nations due to lack of resources and large volume of cases.

Supraglottoplasty involves the reshaping or removal of obstructive tissue from the upper larynx. This procedure is commonly done for patients with laryngomalacia when the airway obstruction from laryngeal collapse is significant enough to cause obstructive sleep apnea (OSA). Supraglottoplasty may involve the epiglottis, the aryepiglottic folds and the postglottis. Supraglottoplasty can be done using cold steel, CO₂ laser, or coblation. Supraglottoplasty is considered an effective treatment for OSA in some children. The procedure has a high success rate, few complications, and often results in reduction of sleep and breathing symptoms. This article will discuss the indications, technique, and complications of supraglottoplasty.

Tonsillectomy is a common surgical procedure performed in children for recurrent tonsillitis and obstructive sleep apnea. Though tonsillectomy is a longstanding and well-known procedure, preferred techniques for delivering the most effective and safe care still vary amongst surgeons. In this review, we provide a comparison of intracapsular versus extracapsular tonsillectomy techniques and potential benefits of each.

This review describes the current state of the evaluation and diagnosis of pediatric sleep apnea. Sleep apnea in children differs in important ways from sleep apnea in adults and commonly presents with more subtle symptoms. While there can be snoring, noisy breathing, and sleepiness, not all children with sleep apnea snore. Early symptoms can be speech delay, nap refusal, nocturnal enuresis, headaches, and hyperactivity. Children with sleep apnea may have tonsil and/or adenoid hypertrophy, adenoid facies, mouth-breathing, hyponasality, or low-hanging soft palate on exam. While many screening tools exist, definitive diagnosis of sleep apnea in children requires polysomnography. Nocturnal oximetry and home studies are not conclusive but can serve as a screening tool where pediatric polysomnography is not available. In conclusion, pediatric obstructive sleep apnea presents differently than adults and can only be definitively diagnosed with an in-lab polysomnography.