Nasal Encephalocele: Endoscopic Surgery

Contributors: Vincent Couloigner

We describe the excision of a nasal encephalocele obstructing the left nasal fossa with an anterior subcutaneous portion deforming the nasal pyramid in a four-year-old girl using endoscopic surgery combined to a Rethi approach. The anterior skull base defect was reconstructed using autologous conchal cartilage and temporal fascia.

Editor Recruited By: Sanjay Parikh, MD, FACS

DOI: http://dx.doi.org/10.17797/udewjr2ge7

Endoscopic Endonasal Approach for Pituitary Tumor Resection

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.

DOI#: http://dx.doi.org/10.17797//bdxmmtst16

Endoscopic Resection of Concha Bullosa

Concha bullosa represents a benign entity that can present problems for the endoscopic sinus surgeon by limiting access and visualization to the middle meatus.  Additionally, this may be a significant contributor to a patient’s nasal obstruction, or the leading factor for osteomeatal complex obstruction. Endoscopic removal provides a quick, safe, and reliable means to deal with this issue and provide the appropriate surgery for the patient.

Combined drainage of subperiosteal orbital abscess complicating ethmoiditis

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.

Internal Nasal Valve Stabilization

Dynamic internal nasal valve collapse is common form of nasal valve collapse that can be difficult to address surgically. There have been many surgical techniques described to stabilize and improve the function of the internal nasal valve. Our presented technique is a simple and reproducible surgical technique that has proved reliable in treatment of dynamic internal nasal valve collapse. This video clearly describes and demonstrates our internal nasal valve stabilization technique.

Endoscopic Sphenopalatine Artery Ligation

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.

Contributors:

Mathew Geltzeiler and Eric Wang

Reconstruction of Transcribriform Skull Base Defects

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.

Contributors:

Paul A. Gardner, MD, Eric W. Wang, MD, Juan C. Fernandez-Miranda, MD, and Carl H. Snyderman, MD, MBA

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