Sliding Osseous Genioplasty and Coronoidectomy in a Patient with Treacher-Collins Syndrome

Contributors: Andrew Weaver and Kumar Patel, PA-C

18 y.o. female with Treacher-Collins syndrome (patients have micrognathia, underdeveloped facial bones, particularly the cheek bones, and a very small jaw and chin. She is only able to open her mouth to 20mm due to the interference of her coronoid process with her zygoma/

DOI: http://dx.doi.org/10.17797/959yiezvoo

Reoperative Laparoscopic Anti-Reflux Surgery

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.

DOI#: http://dx.doi.org/10.17797/egw2097cpq

Referred By: Jeffrey B. Matthews

Novel use of a balloon for bronchial bead foreign body removal

Contributors: Josephine Czechowicz and Sanjay Parikh

Removal of a bronchial foreign body with a smooth surface can be challenging with standard optical forceps. The fogarty arterial embolectomy catheter is a suitable alternative, particularly in the setting of a bead or other hollow object.

DOI: http://dx.doi.org/10.17797/7gq2gil0v3

Editor Recruited by: Sanjay Parikh

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 Tympanoplasty

Transcanal endoscopic tympanoplasty is illustrated with steps explained. This is a “realistic” case with bleeding and middle ear adhesions; tips to overcome these hurdles are discussed.

DOI# http://dx.doi.org/10.17797/atpw43so2e

Editor Recruited by: Ravi N. Samy

Endoscopic endonasal approach for odontoidectomy

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.

DOI:http://dx.doi.org/10.17797/6mx9qe789f

Costochondral Graft Harvest for Laryngoplasty

Rib cartilage is the workhorse autogenic material for laryngeal airway expansion surgery.  Most usually one will use the right-sided 5th or 6th rib as the donor site.  A 2.5 cm incision is made directly over the rib, in the inframammary crease from the lateral aspect of the nipple to the sternal xyphoid process.  Subcutaneous fat is removed.  The overlying intercostal muscles are dissected up away from the rib, divided, and retracted– effectively exposing the rib.  Perichondrium is sharply incised on the superior and inferior borders of the rib.  A posterior tunnel is elevated in asub-perichondrial plane using blunt instruments, just medial to the osseocartilagenous (OC) junction.  A Doyen elevator is inserted into the tunnel and the rib is transected right at the OC junction.  The rib is then elevated from lateral to medial in the subperichondrial plane.

Such a manuever ensures that the plueral space will not be entered, protecting the pleural membrane from injury.

Once the rib has been elevated to the sternal attachment, it is completely released.  The pleura is inspected directly to confirm it has not been injured.  The wound is filled with normal saline and 30 cm of water pressure valsalva is applied by the anesthesiologist for 30 seconds, to ensure no air is escaping the lung.  The wound is closed in layers over a rubber band drain placed in a dependent position.

One should be able to harvest 2.5-3 cm of cartilage. Post-operatively a chest radiograph is obtained to rule out pneumothorax

DOI: http://dx.doi.org/10.17797/2jra6vjlud

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