A 58-year-old female on Plavix presented to the ER with recurrent left-sided epistaxis after two prior endoscopic control of epistaxis at an outside hospital. The patient’s hemoglobin and hematocrit at presentation were 8.3 gm/dL and 25.4%. Given the unilateral presentation, antiplatelet therapy, and recently failed endoscopic control, the patient was taken to the operating room for transnasal endoscopic sphenopalatine artery ligation (TESPAL) with bipolar cautery.
Mathew Geltzeiler and Eric Wang
A 51 year-old male presented to an outside otolaryngologist with recurrent facial pain and congestion. He was found to have a left-sided nasal mass. A work-up was performed, complete with biopsy, which was diagnosed as non-intestinal type adenocarcinoma. He underwent resection via the endoscopic endonasal transcribriform approach. In this video publication, we present our preferred method of reconstruction for sinonasal malignancies treated by endoscopic transcribriform resection using a multilayered closure with the following: a subdural DuraGen inlay graft, a fascia lata onlay graft, and an extradural, extracranial onlay pericranial flap via nasionectomy. A lumbar drain was placed at the end of the case for CSF diversion until the fifth postoperative day.
Paul A. Gardner, MD, Eric W. Wang, MD, Juan C. Fernandez-Miranda, MD, and Carl H. Snyderman, MD, MBA