Endoscopic Repair of Internal Carotid Artery Injury with a Lateral Tongue Muscle Patch Graft: Novel Technique and Literature Review.

 Iatrogenic injury to the internal carotid artery (ICA) is one of the most catastrophic complications of endoscopic sinus and skull base surgery. Previous research has shown that packing with a crushed muscle graft at the injury site can be an effective management technique to control bleeding and prevent the need for ICA sacrifice. Here, we describe a novel and readily available repair donor site-an autologous lateral tongue muscle patch.

Balloon Sinuplasty and Stenting in the Management of Complex Frontal Sinus Outflow Tract Fractures.

Objective: Classical management of complex fractures involving the frontal sinus outflow tract (FSOT) favors obliteration or cranialization to avoid delayed complications. We aim to exhibit success with a novel application of balloon sinuplasty and frontal stenting in the management of complex injuries disrupting the FSOT, which might have otherwise required more invasive interventions.

Study Design: Retrospective review.

Septal Perfoplasty for Management of Symptomatic Nasal Septal Perforation: An Alternative to Surgical Closure.

Symptomatic septal perforations are often difficult to manage and can have a significant impact on patient quality of life. Available surgical techniques for repair have demonstrated a varying rate of success, presenting a need for reliable interventions targeting symptom control. To describe the modified surgical technique here termed septal perfoplasty.

A multi-subject accuracy study on granular jamming for non-invasive attachment of fiducial markers to patients.

Purpose: This short communication describes experimental evaluation of a new granular jamming cap (GJC) recently introduced in Wellborn et al. (Int J Comput Assist Radiol Surg 12(6):1069-1077, 2017). The contributions beyond [8] are (1) to evaluate accuracy across multiple human subjects, and (2) to determine how much of the accuracy improvement is attributable to improved fiducial marker arrangement alone, and how much is due to granular jamming.

Orbital apex syndrome caused by species: A novel invasive fungus and new treatment paradigm.

Orbital apex syndrome as a result of invasive fungal sinusitis is a disease entity most commonly found in immunocompromised patients. Infectious invasion affecting the orbital apex can have devastating visual and life-threatening consequences. and species are the most common causes of such infections.

Risk Factors for Intraoperative and Postoperative Cerebrospinal Fluid Leaks in Endoscopic Transsphenoidal Sellar Surgery.

Objective To determine the factors associated with intra- and postoperative cerebrospinal fluid (CSF) leaks in setting of endoscopic transsphenoidal sellar surgery. Study Design Retrospective cohort. Setting Tertiary referral center.

Through the Eustachian Tube and Beyond: A New Miniature Robotic Endoscope to See Into The Middle Ear.

This paper presents a novel miniature robotic endoscope that is small enough to pass through the Eustachian tube and provide visualization of the middle ear (ME). The device features a miniature bending tip previously conceived of as a small-scale robotic wrist that has been adapted to carry and aim a small chip-tip camera and fiber optic light sources. The motivation for trans-Eustachian tube ME inspection is to provide a natural-orifice-based route to the ME that does not require cutting or lifting the eardrum, as is currently required.

The relationship between social determinants of health and utilization of tertiary rhinology care.

Background: Chronic rhinosinusitis (CRS) has a high prevalence and significant cost and quality of life implications. Many types of practitioners care for patients with rhinosinusitis; however, patients with chronic or complicated conditions are often referred for tertiary rhinology services. It is unclear how social determinants of health affect access and utilization of these services.

Coffee: the key to safer image-guided surgery-a granular jamming cap for non-invasive, rigid fixation of fiducial markers to the patient.

Purpose: Accurate image guidance requires a rigid connection between tracked fiducial markers and the patient, which cannot be guaranteed by current non-invasive attachment techniques. We propose a new granular jamming approach to firmly, yet non-invasively, connect fiducials to the patient.

Methods: Our granular jamming cap surrounds the head and conforms to the contours of the patient's skull.

Outcomes of endoscopic repair of cerebrospinal fluid rhinorrhea without lumbar drains.

Objective: Lumbar drains (LD) are commonly used during endoscopic repair of cerebrospinal fluid (CSF) rhinorrhea, either to facilitate graft healing or to monitor CSF fluid dynamics. However, the indications and necessity of LD placement remains controversial. The current study sought to evaluate endoscopic CSF leak repair outcomes in the setting of limited LD use.

Outcomes of outpatient endoscopic repair of cerebrospinal fluid rhinorrhea.

Background: Endoscopic repair of anterior skull-base defects has become the gold standard for management of cerebrospinal fluid (CSF) rhinorrhea. Both improved techniques and adjuvant therapies have led to accepted success rates of greater than 90%. As management has evolved, shorter hospitalizations have been required and the goal of this study is to analyze the outcomes of patients repaired on an outpatient basis vs those managed as inpatients postoperatively.

Endonasal Skull Base Tumor Removal Using Concentric Tube Continuum Robots: A Phantom Study.

Objectives The purpose of this study is to experimentally evaluate the use of concentric tube continuum robots in endonasal skull base tumor removal. This new type of surgical robot offers many advantages over existing straight and rigid surgical tools including added dexterity, the ability to scale movements, and the ability to rotate the end effector while leaving the robot fixed in space. In this study, a concentric tube continuum robot was used to remove simulated pituitary tumors from a skull phantom.

Risk of post-operative pneumocephalus in patients with obstructive sleep apnea undergoing transsphenoidal surgery.

Patients undergoing transsphenoidal surgery (TSS) have an anterior skull base defect that limits the use of positive pressure ventilation post-operatively. Obstructive sleep apnea (OSA) can be seen in these patients and is treated with continuous positive airway pressure (CPAP). In our study we documented the incidence of pre-existing OSA and reported the incidence of diagnosed pneumocephalus and its relationship to OSA.

REMODEL larger cohort with long-term outcomes and meta-analysis of standalone balloon dilation studies.

Objectives/hypothesis: To provide the final results from the REMODEL (randomized evaluation of maxillary antrostomy versus ostial dilation efficacy through long-term follow-up) full-study cohorts and perform meta-analyses of standalone balloon sinus dilation studies to explore long-term outcomes in a large patient sample.

Study Design: Randomized controlled trial and meta-analysis.

Methods: Final outcomes from the REMODEL randomized trial, including a larger cohort of 135 patients treated with functional endoscopic sinus surgery (FESS) or in-office balloon dilation, were evaluated.

Early Practice: External Sinus Surgery and Procedures and Complications.

External approaches to the paranasal sinuses are rarely used in the endoscopic era. However, their indications for use have not changed, and in every surgeon's career those indications may present themselves. For residents training in the endoscopic era, these procedures are also very rarely seen.

An experimental feasibility study on robotic endonasal telesurgery.

Background: Novel robots have recently been developed specifically for endonasal surgery. They can deliver several thin, tentacle-like surgical instruments through a single nostril. Among the many potential advantages of such a robotic system is the prospect of telesurgery over long distances.

Forces Applied at the Skull Base during Transnasal Endoscopic Transsphenoidal Pituitary Tumor Excision.

Objectives Our laboratory is developing a surgical robotic system to further improve dexterity and visualization that will allow for broader application of transnasal skull base surgery. To optimize this system, intraoperative force data are required. Using a modified curette, force data were recorded and analyzed during pituitary tumor excision.

Oral antibiotics and the management of chronic sinusitis: what do we know?

Purpose Of Review: Chronic rhinosinusitis affected 12.5% of the general population in the United States, making it one of the most common causes for patients to seek medical care. Despite a lack of compelling evidence, antibiotics are the most frequently prescribed class of medications for the treatment of chronic sinusitis, demonstrating a deeply rooted belief that bacteria are in some way responsible for the disease.

A Telerobotic System for Transnasal Surgery.

Mechanics-based models of concentric tube continuum robots have recently achieved a level of sophistication that makes it possible to begin to apply these robots to a variety of real-world clinical scenarios. Endonasal skull base surgery is one such application, where their small diameter and tentacle like dexterity are particularly advantageous. In this paper we provide the medical motivation for an endonasal surgical robot featuring concentric tube manipulators, and describe our model-based design and teleoperation methods, as well as a complete system incorporating image-guidance.

Robotic surgery for the sinuses and skull base: what are the possibilities and what are the obstacles?

Purpose Of Review: Robotic surgery in otolaryngology - head and neck surgery has become a valuable tool in certain anatomic approaches; however, its application in surgery of the paranasal sinuses and anterior skull base is still in an investigatory phase and requires further evaluation.

Recent Findings: Existing robotic surgical systems face particular limitations in their application at the skull base because of instrument size and lack of variability. Unfortunately, only one system is available commercially that is applicable in the head and neck region and FDA approved for use in patients.

Comparison of maxillary sinus specimens removed during Caldwell-Luc procedures and traditional maxillary sinus antrostomies.

The cases of 80 patients who underwent Caldwell-Luc surgery for the treatment of chronic rhinosinusitis between 2002 and 2007 at Vanderbilt University Medical Center's Department of Otolaryngology were reviewed. Data on demographics, comorbidities, details of surgery, surgical pathology, and histology were collected. These data were compared with those of 40 patients who underwent standard functional endoscopic sinus surgery in 2007.

Prevention and management of skull base injury.

Skull base defects and injuries are rare, but may occur during endoscopic sinus surgery, as a result of facial trauma, or as a result of tumors in the anterior cranial fossa. Injury to the skull base can lead to catastrophic outcomes such as meningitis, brain abscess, neurological deficits, brain hemorrhage, and death. The content presents ways in which a surgeon may work to prevent or minimize injury to the skull base and describes management of skull base injuries when they do occur, reviews the current literature, and describes various reconstruction techniques used in free tissue grafts and pedicled grafts.

Endoscopic endonasal repair of difficult-to-access cerebrospinal fluid leaks of the frontal sinus.

Background: Cerebrospinal fluid (CSF) leaks located within the frontal sinus can be difficult to repair effectively. Additional challenges arise from the need to simultaneously repair the leak or defect and to ensure the future patency of the sinus itself.

Methods: The cases of two patients who underwent surgical repair of CSF leaks and skull base defects located in difficult to access locations within their frontal sinuses were reviewed.

Balloon sinuplasty for the surgical management of immunocompromised and critically ill patients with acute rhinosinusitis.

Objective: The purpose of this study was to review use of balloon sinuplasty for surgical treatment in critically ill patients with acute sinusitis.

Study Design: Case series with chart review.

Subjects And Methods: Patients who underwent balloon sinuplasty between October 2007 and March 2008 were identified.

Revisiting the interpretation of positive sinus CT findings: a radiological and symptom-based review.

Objective: It is widely believed that a high percentage of normal, healthy patients without sinusitis symptoms have abnormal findings on sinus CT. Experiences of the authors of this study suggest otherwise.

Study Design: Cross-sectional survey.