Surgery

Contralateral hearing loss after vestibular schwannoma excision: A rare complication of neurotologic surgery

January 19, 2015     Robert H. Deeb, MD; Jack P. Rock, MD; Michael D. Seidman, MD, FACS
article

Abstract

We report a rare case of contralateral hearing loss after vestibular schwannoma excision in a 48-year-old man who underwent surgery via a suboccipital approach for removal of a nearly 2-cm lesion involving the right cerebellopontine angle. Postoperatively, the patient awoke with bilateral deafness, confirmed by both audiometry and spontaneous otoacoustic emissions. The patient was treated aggressively with high-dose intravenous steroids, vitamins E and C, and oxygen. Over the next several months he had gradual recovery of most of the hearing in his left (unoperated) ear. Contralateral hearing loss may develop after vestibular schwannoma excision; multiple pathophysiologic mechanisms for this occurrence have been proposed.

Cerebrospinal fluid leaks following septoplasty

December 19, 2014     Naren N. Venkatesan, MD; Douglas E. Mattox, MD; John M. Del Gaudio, MD
article

We conducted a retrospective review to identify the characteristics of cerebrospinal fluid (CSF) leak in patients who had undergone septoplasty and in selected patients who had experienced a spontaneous CSF leak. CSF leak is a known but infrequently reported complication of septoplasty; to the best of our knowledge, only 4 cases have been previously published in the literature. A review of our institution's database revealed 3 cases of postseptoplasty CSF leak. We reviewed all the available data to look for any commonalities among these 7 cases. In addition, we reviewed 6 cases of spontaneous CSF leak selected from our database for the same purpose. For all patients, we noted the side of the cribriform plate defect, its size and, for the postseptoplasty cases, the interval between the septoplasty and the leak repair. Overall, we found that leaks were much more common on the right side than on the left. The sizes of the leaks in the 2 postseptoplasty groups were comparable (mean: 14.0 x 6.4 mm). The interval between septoplasty and leak repair ranged from 2.5 to 20 years in our cases and from 3 days to 22 weeks in the previously published cases. All 3 of the postseptoplasty patients in our database presented with clear rhinorrhea. Two of the 3 patients had meningitis; 1 of these 2 also had pneumocephalus. Of the 6 cases of spontaneous CSF leaks, 4 occurred on the right and 2 on the left; the average size of the defect was 5.8 mm in the greatest dimension. The finding that cribriform plate defects after septoplasty were typically right-sided likely reflects the prevalence of left-sided surgical approaches. Also, the fact that the defects were larger in the postseptoplasty cases than in the spontaneous cases is likely attributable to the torque effect toward the thin skull base that occurs when the perpendicular plate is twisted during septoplasty.

Sinus transillumination, then and now

December 19, 2014     Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS
article

In recent years, a new use has been found for transillumination in sinus surgical procedures involving balloon dilation. In these procedures, it is used to identify a sinus and to confirm that the balloon has entered the sinus correctly.

Iatrogenic fracture of the superomedial orbital rim during frontal trephine irrigation

December 19, 2014     Douglas Angel, MD; Rebecca Zener, MD; Brian W. Rotenberg, MD, MPH, FRCSC
article

Frontal sinus trephination (FST) has numerous applications in the treatment of acute and chronic sinus disease. This procedure involves making an incision at the medial aspect of the supraorbital rim and then drilling the sinus's anterior table. Placement of a frontal trephine allows for irrigation of the frontal recess in order to evacuate the frontal sinus in a minimally invasive manner. Orbital injury is a rare complication of FST. We present a case of previously unreported orbital compartment syndrome secondary to iatrogenic fracture of the superomedial orbital rim as a complication of frontal trephine irrigation. We also review the literature on the applications of FST and its associated complications, and we discuss orbital compartment syndrome as a complication of sinus surgery.

Distal nasolacrimal duct showing the valve of Hasner

October 17, 2014     Joseph P. Mirante, MD, FACS; Dewey A. Christmas, MD; Eiji Yanagisawa, MD, FACS
article

Recognition of the location of the nasolacrimal duct opening is important to prevent its damage while performing an intranasal inferior meatal antrostomy or creating a window transantrally in the inferior meatal wall during a Caldwell-Luc procedure.

A transoral surgical approach to a parapharyngeal-space pleomorphic adenoma

October 17, 2014     Christopher Schutt, MD; Joehassin Cordero, MD, FACS
article

Abstract

It is relatively difficult to gain surgical access to pleomorphic adenomas of the parapharyngeal space. Since the lateral border is the mandible, gaining access to them can put several important neurovascular structures at risk. A number of surgical approaches have been developed to overcome this difficulty, and each has its advantages and disadvantages. We report the case of a 59-year-old woman with a parapharyngeal-space pleomorphic adenoma that was accessed via a transoral approach. Transoral approaches are controversial and rarely used. However, we feel that for a selected group of tumors, this approach provides clear benefits by decreasing cosmetic and functional disability while providing good surgical access to the tumor.

Management of soft palate agenesis in Nager syndrome with an elongated, superiorly based pharyngeal flap

October 17, 2014     Oneida A. Arosarena, MD; Troy Hemme, DO
article

Abstract

Nager syndrome, or preaxial acrofacial dysostosis, is associated with aberrant development of the first and second branchial arch structures, as well as abnormal development of the limb buds. It is a rare disorder, and its clinical manifestations have not been completely defined. Absence of the soft palate has been reported in patients with Nager syndrome. In this report we describe the use of an elongated, superiorly based pharyngeal flap for the treatment of severe velopharyngeal insufficiency in a patient with Nager syndrome and absence of the soft palate. We also describe the dysmorphisms associated with Nager syndrome and present a differential diagnosis for the condition.

Endoscopic view of an ostium in a concha bullosa of the superior turbinate

October 17, 2014     Eiji Yanagisawa, MD, FACS; Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS
article

A specific outflow tract or ostium of the superior turbinate, as was seen in this case, has been infrequently described or imaged.

Hypocalcemia after minimally invasive thyroidectomy

September 17, 2014     Doug Massick, MD; Matthew R. Garrett, MD
article

Abstract

We conducted a retrospective study to determine the incidence of postoperative hypocalcemia following minimally invasive thyroidectomy. During the 2-year study period, 74 patients-16 men and 58 women (mean age: 43.7)-underwent either total or hemithyroidectomy through a 3-cm incision. Postoperative hypocalcemia occurred in 14 of these patients (18.9%)-4 men and 10 women-all of whom underwent total rather than hemithyroidectomy. All these patients received supplementation with calcium and vitamin D for 2 weeks postoperatively in order to regain a normal calcium status, and all demonstrated normal serum calcium levels at 3 weeks. Despite their low calcium levels, none of the 14 patients exhibited any overt symptoms of hypocalcemia. We conclude that minimally invasive thyroidectomy is associated with a low rate of postoperative hypocalcemia that is comparable to the rates previously reported for standard thyroidectomy.

Comparative study of intranasal septal splints and nasal packs in patients undergoing nasal septal surgery

September 17, 2014     Raman Wadhera, MS; Naushad Zafar, MS; Sat Paul Gulati, MS; Vijay Kalra, MS; Anju Ghai, MD
article

Abstract

We conducted a prospective, comparative, interventional study to evaluate the role of intranasal septal splints and to compare the results of this type of support with those of conventional nasal packing. Our study population was made up of 60 patients, aged 18 to 50 years, who had undergone septoplasty for the treatment of a symptomatic deviation of the nasal septum at our tertiary care referral hospital. These patients were randomly divided into two groups according to the type of nasal support they would receive: 30 patients (25 men and 5 women, mean age: 23.3 yr) received bilateral intranasal septal splints and the other 30 (26 men and 4 women, mean age: 22.4 yr) underwent anterior nasal packing. Outcomes parameters included postoperative pain and a number of other variables. At 24 and 48 hours postoperatively, the splint group had significantly lower mean pain scores (p < 0.05). At 48 hours, the splint group experienced significantly fewer instances of nasal bleeding (p < 0.01), swelling over the face and nose (p < 0.01), watering of the eyes (p < 0.01), nasal discharge (p = 0.028), nasal obstruction (p < 0.001), and feeding difficulty (p = 0.028). Likewise, mean pain scores during splint or pack removal were significantly lower in the splint group (p < 0.01). At the 6-week follow-up, only 2 patients (6.7%) in the splint group exhibited a residual deformity, compared with 8 patients (26.7%) in the packing group (p = 0.038). Finally, no patient in the splint group had an intranasal adhesion at follow-up, while 4 (13.3%) in the packing group did (p < 0.05). We conclude that intranasal septal splints result in less postoperative pain without increasing postoperative complications, and thus they can be used as an effective alternative to nasal packing after septoplasty.

Transoral robotic surgery and oropharyngeal cancer: A literature review

August 27, 2014     Paraig O'Leary, MD; Thomas Kjaergaard, MD, PhD
article

Abstract

The incidence of head and neck squamous cell carcinoma has risen steadily over the past decade due to the increase in cancers associated with the human papillomavirus (HPV). The prognosis for the treatment of this type of cancer with radiotherapy and chemoradiotherapy is good. However, because these treatments can have detrimental effects on organ function and quality of life, researchers are looking into transoral robotic surgery (TORS) as a possible alternate therapy. TORS might have a positive effect on postoperative function and quality of life for cancer survivors. The aim of this review is to report on the current situation regarding the treatment of oropharyngeal cancer with TORS, with a focus on the long-term oncologic and functional outcomes of this strategy. The articles cited in this review were selected from the PubMed and MEDLINE database. They contain study results pertaining to TORS implementation, complications, oncologic and functional outcomes, and the implications of HPV-associated cancer. We found that while TORS has some clear advantages and strengths and almost certainly a permanent place in future treatment, further research is necessary to correctly evaluate the role it will play in the complete management of oropharyngeal cancer.

Balloon sinus dilation in the office setting

August 27, 2014     Joseph P. Mirante, MD, FACS; Michael A. Munier, MD, FACS; Dewey A. Christmas Jr., MD; Eiji Yanagisawa, MD, FACS
article

The ability to complete operative procedures in the office setting avoids the time and cost of working in a hospital or outpatient surgical center operating room.

PreviousPage
of 10Next