Choanal Atresia Repair

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

Bilateral Dacryocystoceles Resection

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

Laparoscopic Transgastric Pancreatic Necrosectomy and Cystgastrostomy

Contributors: Michael Nussbaum

Pancreatic necrosectomy is a necessary operation for necrotizing pancreatitis. The traditional open approach has been associated with difficult access and significant negative outcomes including wound complications, pancreatic fistula and prolonged hospital stay. A 57-y-old female patient presented with mild abdominal pain and epigastric fullness.She had a history of multiple episodes of acute pancreatitis and pseudocyst formation. Abdominal computed tomography (CT )scan showed a large pseudocyst of 12×15 cm size compressing the posterior wall of the stomach. Following cystgastrostomy, a large amount of necrotic pancreatic tissue is found and so necrosectomty step was added to the operation.This video demonstrates the technical details during a minimally invasive necrosectomy of the pancreas with an expedited recovery. 

DOI: http://dx.doi.org/10.17797/1ms9xzjz24

Editor Recruited By: Jeffrey B. Matthews, MD

Endoscopic Posterior Cricoid Split with Rib Grafting for Posterior Glottic Stenosis

Endoscopic posterior cricoid split with rib grafting can be used in children with Bilateral Vocal Fold Immobility due to bilateral vocal fold paralysis or cricoarytenoid joint fixation with posterior glottic stenosis. It is preferred to open laryngotracheal reconstruction because it does not disrupt the anteior cricoid ring therby preserving the “spring” of the cricoid.

DOI#: http://dx.doi.org/10.17797/5w4hsqmgnq

Translabyrinthine Approach for Vestibular Schwannoma (Acoustic Neuroma) Resection

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

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