Contributors: Bruce E. Mickey and J. Walter Kutz
This video highlights key steps to the translabyrinthine approach for vestibular schwannoma resection. It emphases identification of the facial nerve and the benefit of facial nerve monitoring in lateral skull base surgery.
DOI#: https://doi.org/10.17797/4w83z6uxam
This video demonstrates the use of the endoscope in cartilage myringoplasty.
DOI# http://dx.doi.org/10.17797/gz02921q1s
Contributors: Amy M. Moore, and Brandon Isaacson
CHARGE syndrome is associated with a variety of temporal bone anomalies and deafness. The lack of surgical landmarks and facial nerve irregularities make cochlear implantation in this population a challenging endeavor. This video describes a safe and efficacious transcanal approach for cochlear implantation that obviates the need to perform a mastoidectomy and facial recess.
Tympanoplasty with tragal cartilage graft, postauricular approach
Blake Hollowoa, Michael Kubala, Gresham Richter.
Introduction
Tympanic membrane (TM) perforations arise from multiple conditions including acute otitis media, barotrauma, chronic eustachian tube dysfunction, or as a complication of pressure equalization (PE) tube insertion. Most perforations heal spontaneously or with conservative measures such as ototopical drops and dry ear precautions. Perforations that do not heal can lead to conductive hearing loss, chronic infection, or cholesteatoma. A 6-year-old patient with a persistent TM perforation presented with otalgia and otorrhea. A tympanoplasty with a tragal cartilage graft was performed to repair the patient’s TM perforation.
Methods
The patient was intubated and the operation carried out under general anesthesia. Facial electrodes were inserted for facial nerve monitoring. The patient was prepped and draped in sterile fashion. The external canal was suctioned and irrigated. A tragal incision was then made to harvest a 1 cm piece of cartilage for the TM graft. The tragal incision was closed with monocryl suture. A postauricular incision was made in the natural skin crease to expose the posterior canal. Canal incisions were made to enter the external canal. A tympanomeatal flap was elevated until the middle ear was entered. The previously harvested tragal cartilage graft was inserted medial to the native TM perforation. Gel-Foam was inserted medial to the graft for support. Tragal perichondrium was inserted lateral to the tragal cartilage graft. Gel-Foam was then inserted lateral to the graft for support. The periosteum and postauricular incision were closed with vicryl suture. The external canal was inspected, then antibiotic ointment and an ear wick was inserted. The patient was dressed using a Glasscock dressing.
Results
The patient was discharged the same day and seen in clinic two weeks from his surgery. The incisions were healing well with no indications of infection or wound dehiscence. His pain was resolved and an appointment for formal audiology was scheduled for a 3-month follow-up visit.
Conclusion
Tympanoplasty with a tragal cartilage graft using a postauricular approach is a successful method to surgically correct persistent tympanic membrane perforations.
This video demonstrates total facial nerve decompression via combined Middle Fossa-Transmastoid approach.
Gavriel D. Kohlberg, MD,1 Noga Lipschitz, MD,1 Charles B. Poff, BS,2 MD, Ravi N. Samy, MD, FACS1,3
1 Department of Otolaryngology – Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
2 College of Medicine, Medical University of South Carolina, Charleston, SC, USA
3 Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
This video demonstrates the operative setup and surgical steps of a middle fossa approach for the resection of vestibular schwannoma (acoustic neuroma).
Authors:
Cameron C. Wick, MD (cameron.wick@wustl.edu) 1
Samuel L. Barnett, MD (sam.barnett@utsouthwestern.edu) 2
J. Walter Kutz Jr., MD (walter.kutz@utsouthwestern.edu) 3
Brandon Isaacson, MD (brandon.isaacson@utsouthwestern.edu) 3
1 – Department of Otolaryngology – Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO
2 – Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX
3- Department of Otolaryngology – Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX
This video demonstrates the use of CO2 flexible fiber laser for the lyses of middle ear adhesions in a patient s/p canal wall down mastoidectomy.
This video illustrates an endoscopic ossiculoplasty using a total ossicular replacement prosthesis (TORP) in a patient with a mixed hearing loss and a large conductive component. The video highlights the middle ear anatomy including a dehiscent and prolapsed facial nerve partially obstructing the oval window. Technical pearls for the ossiculoplasty are also highlighted.
Cameron C. Wick, MD
Department of Otolaryngology – Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
cameron.wick@wustl.edu
J. Walter Kutz Jr., MD
Department of Otolaryngology – Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
walter.kutz@utsouthwestern.edu
N/A
Endoscopic ear surgery is an emerging technique championed for its improved visualization within the middle ear space. Stapes surgery presents a unique endoscopic challenge in that it offers a different type of depth perception compared to the binocular microscopic view. This video highlights the surgical steps for an endoscopic stapedotomy using a CO2 laser and Eclipse nitinol piston. The stapes footplate and stapedotomy are well visualized with the endoscope. Just like in endoscopic sinus surgery, depth perception is achieved through muscle-memory and camera movement.
Author: Cameron C. Wick, MD
Institution: Department of Otolaryngology – Head and Neck, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
Email: cameron.wick@wustl.edu
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