Contributors: Marco P. Fisichella
65 year old man who underwent a laparoscopic Nissen fundoplication in August 2015. Preoperative manometry was normal and DeMeester score was 25. Two months later he began to experience difficulty of swallowing solid foods, then liquids. After 2 dilatations, dysphagia persisted.
Referred By: Jeffrey B. Matthews
In contrast to major thoracic operations, per oral endoscopic myotomy for Zenker’s diverticulum offers the possiblity to resect a symptomatic Zenker’s under monitored anesthesia care (MAC) for patients to ill to undergo general anesthesia. Patients have similar functional results when compared to small Zenker’s treated with traditional operative approaches.
Contributors: M. Nathan Nair and Timothy Deklotz
For patients with basilar invagination, an odontoidectomy may be necessary to decompress the brainstem, before further correction and stabilization of the craniocervical junction can be achieved. The open-mouth odontoidectomy procedure is associated with significant moribdity, and the endoscopic endonasal approach may be a better option. In this video, we provide a step-by-step demonstration of the endoscpic endonasal approach for odontoidectomy.
Contributors: Gresham Richter
Here we present endoscopic excision of a concha bullosa (a pneumatized middle turbinate) that was causing obstruction in the left nasal cavity. This particular patient failed medical management of his chronic sinusitis including antibiotic and steroid therapy. The concha bullosa was causing obstruction of the maxillary sinus ostium and deviation of the nasal septum. Resection of the concha bullosa was necessary in order to complete a functional endoscopic sinus surgery afterward and septoplasty (not shown).
DOI # 10.17797/pyzfxehca8
Author Recruited by: Gresham Ritcher
Contributors: Ehab Hanna and Peleg Horowitz
Anterior skull base sinonasal malignancy previously biopsied as esthesioneurobastoma. Tumor extension through the left cribiriform plate and left lamina papyracea.
Author Recruited By: Dr. Ehab Hanna
Contributors: Timothy R. DeKlotz
With the widespread use of the endoscope in pituitary surgery, many technical nuances have emerged. Some surgeons still use a sublabial incision and a speculum, despite using the endoscope for visualization, while others favor approaches that are purely endonasal. Some surgical teams, using an endoscope-holder, work sequentially and individually, while others prefers two surgeons working together simultaneously. In this video, we demonstrate an endoscopic endonasal approach, in which the tumor resection is performed with a 4-hand technique with both surgeons working simultaneously.
This video demonstrates the use of the endoscope in cartilage myringoplasty.
A 4 year-old boy presented to our tertiary center with acute left ethmoiditis and a subperiosteal orbital abscess. He presented with exophtalmia but had no visual impairment or limitation of ocular mobility.
CT-scan found a 8 mm large subperiosteal orbital abscess with no further complications.
Surgery was decided using a combined approach to drain the abscess and to obtain a bacterial sample: first external (incision in the inner canthus area) and then endonasal (functional endoscopic sinus surgery – FESS) to open the middle meatus and ethmoid.
External approach: 10 mm incision in the inner canthus region, elevation of the lamina papyracea periosteum until the abscess was reached. Rubber drain was put in place for irrigation.
Endonasal approach: after careful CT-scan examination, endonasal surgery was performed with a 30° rigid endoscope. The middle turbinate was medialised to expose the middle meatus, uncinectomy and antrostomy followed by anterior and posterior ethmoidectomy was performed.
Antibiotics were given intravenously for 5 days and saline irrigation on the drain was performed during 2 days. Patient was discharged after 5 days.