1,720,987 research outputs found
Endoscopic Middle Ear Anatomy
No full textThe anatomy of the middle ear is very complex. The otologist must have a good knowledge of the structures comprising the tympanic cavity; a clear view of all the subsites of this region is essential to ensure the complete removal of all pathology. The development of endoscopic techniques to access the middle ear has offered the possibility to “look around corners” and explore hidden recesses the microscope cannot reach. Moreover, by leading to a better understanding of the different ventilation pathways of the tympanic cavity, alterations of which may cause pathologies such as cholesteatoma, endoscopy represents a surgical approach aimed toward restoring normal physiology as well as eradicating disease. In this article, we discuss the state of the art of middle ear endoscopic anatomy, describing the different subsites of this small but challenging region
Atypical mycobacteriosis involving parotid and para-retropharyngeal spaces
No full textThe incidence of retro-parapharyngeal localization of cervical adenitis due to non-tuberculous mycobacteria is very rare. We present a case of an 18-months-old child with an involvement of parapharyngeal and retropharyngeal areas, right parotid and submandibular regions by atypical mycobacteriosis in the CT and MRI scan. The masses were surgically removed and the frozen-section histological exam upheld their atypical mycobacterial origin
Limits in endoscopic ear surgery
No full textBackground In recent decades, endoscopic ear surgery (EES) has been rapidly evolving, expanding its boundaries from the middle ear to the lateral skull base. Nonetheless, the advantages of the endoscopic technique are associated with a number of intrinsic limitations. Methods and objective A narrative review was conducted to investigate the current limits of EES, analyzing the different otologic and skull base surgery procedures. Results Limitations of EES can be divided into general and procedure-related. General limitations have been extensively described in the literature and are related to the bidimensional image provided by the endoscope, as well as the one-handed surgical technique and its implications in the management of bleeding. Procedure-related limits are continuously evolving and are also discussed in the present review. Conclusion Although endoscope use is intrinsically associated with general limitations, these have been systematically overcome by the refinement of the surgical technique as a consequence of the increasing surgical experience gained over the last 20 years. The main limits of EES are currently associated with specific procedure- and disease-related situations. This review describes the general limitations and their management, as well as the current limits in the endoscopic management of various otologic diseases, from the external ear to the lateral skull base
Novel Dissection Station for Endolaryngeal Microsurgery and Laser Surgery: Development and Dissection Course Experience.
No full textOBJECTIVE
We aimed to develop and validate an ex vivo dissection station for endolaryngeal surgery suitable for different kinds of laryngeal specimen and any type of operating technique (CO2 laser, cold instruments by endoscopic or microscopic techniques).
STUDY DESIGN
Experimental construction and validation of a highly specialized dissection station.
SETTING
Laboratory and international dissection course.
METHODS
We designed a lightweight dissection station made of polycarbonate resin approved for use with a CO2 laser. The cylindrical box hosts an articulated laryngeal support. The laryngoscope is positioned on an articulated arm, which is fixed on the construction's footplate. Validation of the larynx box was performed during an international dissection course on laryngeal surgery held in January 2016.
RESULTS
We assessed the suitability of our novel dissection station among specialized laryngologists with a mean experience of 14 years. Feedback from the participants was very positive, with a mean general impression of 9.5 (out of 10 points) and a recommendation score of 9.6 for further use. Its utility in transforming the taught surgical steps into daily practice has been highly recognized, with a score of 9.5.
CONCLUSION
The lightweight and transparent larynx box is suitable for any kind of laryngeal specimen, and any surgical intervention can be taught at reasonable cost. It is safe and suitable for use with CO2 lasers. Validation among experienced surgeons revealed its suitability in the teaching of endolaryngeal microsurgery and laser surgery
An Ovine Model for Exclusive Endoscopic Ear Surgery.
Full text linkImportance
With the international spread of exclusive transcanal endoscopic ear surgery, the need for a suitable and affordable surgical training model has grown during the past years.
Objective
To develop and validate an ex vivo animal model for exclusive endoscopic ear surgery.
Design, Setting, and Animal Models
In an experimental study, we compared ovine and human middle ear anatomy in 4 specimens and assessed the lamb as a model for endoscopic ear surgery. After confirming its suitability, we developed a surgical training program for canaloplasty, myringoplasty, and ossiculoplasty. From March 1 to May 31, 2016, the ex vivo model was tested, assessing the time needed for dissection and complications. Each experience was subjectively validated on a scale from 1 (very poor) to 10 (excellent).
Main Outcomes and Measures
Suitability of the lamb model for training in exclusive endoscopic ear surgery.
Results
We assessed the suitability of our novel lamb model on 20 ovine middle ears. All interventions could be performed in a satisfactory manner. The mean (SD) time required to perform canaloplasty was 29.7 (13.2) minutes, for middle ear dissection was 7.7 (2.6) minutes, for myringoplasty was 7.7 (4.3) minutes, and for ossiculoplasty was 10.4 (2.7) minutes. The time required for canaloplasty and tympano-meatal flap elevation during dissection decreased from 46.4 minutes in the first 5 cases to 16.2 minutes in the last 5 cases, representing an absolute difference of 30.2 minutes (95% CI, 22.28-38.12). Subjective ratings revealed excellent values for tissue quality (8.9 points of 10), overall satisfaction (8.3 points), and the learning experience (8.8 points).
Conclusions and Relevance
The ovine model is suitable for endoscopic ear surgery. We describe a novel, exclusively endoscopic approach in an ex vivo animal model for middle ear surgery. The proposed surgical program leads the trainee step by step through the main otologic procedures and is able to enhance his or her surgical skills
Novel Surgical and Radiologic Classification of the Subtympanic Sinus: Implications for Endoscopic Ear Surgery
Full text linkObjective: The aim of this study is to describe the endoscopic anatomy of the subtympanic sinus (STS), establish a classification according to its extension regarding the level of the facial nerve (FN), and assess the feasibility of the transcanal endoscopic approach to the STS. Study Design: Experimental anatomic research. Setting: Temporal bone laboratory. Methods: We performed endoscopic dissection of 34 human whole head and ear block specimens. Of those, 29 underwent high-resolution computed tomography. The STS was classified according to its extension regarding the level of the FN: type A, no extension medial to the FN; type B, extension to the medial limit of the FN; type C, extension of the sinus medially and posteriorly from the FN into the mastoid cavity. Results: The majority of cases (n = 21, 72%) showed a shallow type A STS. We observed a deep type B configuration in 6 cases (21%) and a type C in 2 cases (7%). The STS was completely exposable with a 0° endoscope in 44% of the specimens. Using a 45° endoscope, we gained complete insight in 79%. However, in 21% of the cases, the posteromedial extension of the STS was too deep to be completely explored by an endoscopic transcanal approach. Conclusion: The majority of the STS is shallow and does not extend medially from the FN. This morphologic variant allows complete transcanal endoscopic visualization. In more excavated STS, a complete endoscopic exploration is not achievable, and a retrofacial approach may be adopted to completely access the STS
An Integrated (Microscopic/Endoscopic) Dissection Ear Surgery Course
No full textTraditionally, otologic surgical training consisted of microscopic cadaveric dissections. However, during the last decades the endoscope has significantly changed the surgical perspective in the otologic field. Thus, the modern ear and lateral skull base surgeon should master the entire spectrum of endoscopic and microscopic approaches, with the aim of tailoring the procedure and guaranteeing the best possible functional outcome. This work proposes a step-by-step guided and illustrated dissection course, including indications for the setup of the cadaver lab and the integration of the microscope and endoscope to enhance the use of both instruments. The alternation of the endoscope and microscope allows the novice to train the correct handling of the instruments in the surgical field under both optical views. This aspect is of utmost importance since it is not advisable to start off a technique without practicing the other one, as both are important and complementary in the modern otologic surgery setting
Facial sinus endoscopic evaluation, radiologic assessment, and classification
Full text linkObjectives: To describe facial sinus anatomy from an endoscopic perspective and present a radiologic classification. Methods: Facial sinus was studied by endoscopy and high-resolution computed tomography (HRCT) scan in 39 temporal bones that underwent exclusive transcanal endoscopic approach. A radiomorphologic classification based on the relationship between the facial sinus and the mastoid portion of the facial nerve is created as follows. In type A facial sinus, the pneumatization of the facial sinus did not extend medially or posteriorly to the mastoid portion of the facial nerve. In type B facial sinus, the pneumatization extended posteriorly to the mastoid portion of the facial nerve. In type C facial sinus, the pneumatization extended posteriorly and medially to the mastoid portion of the facial nerve. Results: In all the specimens that underwent HRCT (n = 31), facial sinus could be identified, and its depth classified, in relation to the facial nerve. In this group, 58% type A, 29% type B, and 13% type C facial sinuses were identified. In all the specimens (n = 39), the facial sinus could be assessed by means of an exclusive endoscopic transcanal approach, and anatomical variants of the chordiculus, previously known as chordal ridge, could be described: ridge (39%), bridge (18%), incomplete (15%), and absent (28%). Conclusion: Endoscopic exploration of the retrotympanum guarantees a very good exposure of the facial sinus, allowing detailed anatomic descriptions of its conformation and relationships with other structures. Improvement in our knowledge of its anatomy might decrease the possibility of residual disease during cholesteatoma surgery. Angled endoscopes (e.g. 45 °, 70 °) can guarantee a better view of the facial sinus. Level of Evidence: NA. Laryngoscope, 128:2397–2402, 2018
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