Contributor: Tyler McElwee
Choanal atresia describes the congenital narrowing of the back of the nasal cavity that causes difficulty breathing in neonate. Choanal atresia is often associated with CHARGE, Treacher Collins and Tessier Syndrome. It is a rare condition that occurs in 1:7000 live births, seen in females twice as often as males, and affects bilaterally in roughly 50% of cases. Bilateral choanal atresia is usually repaired in the newborn period. Unilateral CA repair is often deferred until age 2-3 years. Stent placement has become optional as stentless repair is gaining popularity because this technique decreases foreign body reaction in the nasopharynx which in term decreases granulation formation. Transnasal endoscopic choanal atresia repair is performed by opening the atresia bilaterally, drilling out pterygoid bone as needed, and removal of the posterior septum and vomer. Normal mucosa is preserved as much as possible by elevating a lateral based mucosal flap to prevent scarring and restenosis. Postoperatively, these patients are treated with antibiotic, reflux medications and steroid nasal drops; a second look procedure is planned 4-6 weeks postop for debridement and possible removal of granulation tissue & scar.
DOI: http://dx.doi.org/10.17797/9s5ty2f7yv
Editor Recruited By: Sanjay Parikh, MD, FACS
Contributor: Tyler McElwee
Congenital dacryocystocele describe the distended lacrimal sac in neonates with or without associated intranasal cyst. The prevalence is about 0.1% of infants with congenital nasolacrimal duct obstruction and a slight prevalence in female infants. It refers to cystic distention of the lacrimal sac as a consequence of the nasolacrimal drainage system obstruction. It typically presents as a bluish swelling inferomedial to the medial canthus in the neonates. Unilateral congenital dacryocystocele is more common but 12-25% of patients affected have bilateral lesions. Ultrasound, CT scan or MRI can be used for diagnosis. About half of the patient with acute dacryocystitis can be management with conservative management such as digital massage of lacrimal sac or in-office lacrimal duct probing. The other half of patients will require surgery under general anesthesia for removal of the dacryocystocele. Endoscopic excision of the intranasal cysts has been used successfully as a treatment option with Crawford stent placement. Post-operatively patients are treated empirically with antibiotics and nasal saline. No second look is usually planned unless patients develop significant nasal obstrctuion.
Editor Recruited By: Sanjay Parikh, MD, FACS
DOI: http://dx.doi.org/10.17797/16rnuq8n0y
Trans-oral endoscopic approach to exposure of a type IV branchial cleft anomaly sinus tract in the left piriform recess and closure using cauterization and tisseel application.
Co-author: Yi-Chun Carol Liu
Chronic tympanic membrane (TM) atelectasis is a difficult condition with many management challenges and currently has no acceptable gold standard treatment. TM atelectasis is the loss of the normal elasticity of the TM as a result of chronic negative pressure in the middle ear and can be associated with retraction pockets. The under-ventilation of the middle ear and TM retraction can cause ossicular erosion, hearing loss, or cholesteatoma formation. Atelectasis can be halted or reversed with placement of pressure equalization tube (PET). Cartilage tympanoplasty with or without PET has been reported as the preferred material likely due to its higher mechanical stability under negative pressure changes within the middle ear, in addition to its resistance to resorption. This video demonstrates the feasibility of a minimally invasive endoscopic approach of cartilage shield T-tube tympanoplasty as a treatment of chronic TM atelectasis.
