Operative Techniques in Otolaryngology - Head and Neck Surgery RSS feed: Current Issue. This large-size, atlas-format journal presents detailed illustrations of new surgical procedures and techniques in otology, rhinology, laryngology, reconstructive head and neck surgery, and facial plastic surgery. Feature articles in each issue are related to a central theme by anatomic area or disease process. The journal will also often contain articles on complications, diagnosis, treatment or rehabilitation. New techniques that are non-operative are also featured. 2008 Topics , Volume 19 March Minimally invasive surgery June Facial Trauma Sept Endoscopic surgery of the orbit and Lacrimial system December Salivary Glands and Tumors http://www.optecoto.com/?rss=yesElsevier Inc.en © 2010 Published by Elsevier Inc. All rights reserved. Operative Techniques in Otolaryngology - Head and Neck Surgery1043-1810211March 2010 © 2010 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.optecoto.com/article/PIIS1043181010000217/abstract?rss=yesMasthead10.1016/S1043-1810(10)00021-7Operative Techniques in Otolaryngology - Head and Neck Surgery 21, 1 (2010)2010-03-01Operative Techniques in Otolaryngology - Head and Neck Surgery2010-03-01211S1043-1810(10)X0002-1IFCIFChttp://www.optecoto.com/article/PIIS1043181010000229/abstract?rss=yesEditorial Board10.1016/S1043-1810(10)00022-9Operative Techniques in Otolaryngology - Head and Neck Surgery 21, 1 (2010)2010-03-01Operative Techniques in Otolaryngology - Head and Neck Surgery2010-03-01211S1043-1810(10)X0002-1iihttp://www.optecoto.com/article/PIIS1043181010000230/abstract?rss=yesContents10.1016/S1043-1810(10)00023-0Operative Techniques in Otolaryngology - Head and Neck Surgery 21, 1 (2010)2010-03-01Operative Techniques in Otolaryngology - Head and Neck Surgery2010-03-01211S1043-1810(10)X0002-1iiiiihttp://www.optecoto.com/article/PIIS1043181010000242/abstract?rss=yesFuture and recent issues10.1016/S1043-1810(10)00024-2Operative Techniques in Otolaryngology - Head and Neck Surgery 21, 1 (2010)2010-03-01Operative Techniques in Otolaryngology - Head and Neck Surgery2010-03-01211S1043-1810(10)X0002-1ivivhttp://www.optecoto.com/article/PIIS1043181010000254/abstract?rss=yesInformation for authors10.1016/S1043-1810(10)00025-4Operative Techniques in Otolaryngology - Head and Neck Surgery 21, 1 (2010)2010-03-01Operative Techniques in Otolaryngology - Head and Neck Surgery2010-03-01211S1043-1810(10)X0002-1vvihttp://www.optecoto.com/article/PIIS1043181009000815/abstract?rss=yesThis issue is dedicated to “surgical approaches to the anterior skull base.” Over the past several years, there have been tremendous advances in techniques for accessing and resecting benign and malignant lesions of the anterior skull base. In this issue, we have assembled an outstanding group of authors with many years of surgical experience in this complex anatomical location. Topics covered range from the most traditional open surgical approaches to the newer and minimally invasive endoscopic/computer-assisted techniques. It is imperative that any surgeon operating in this delicate and complex region is familiar with the most recent minimally invasive techniques and can also comprehend the well-established open approaches. A thorough knowledge of both will provide the safest and best possible surgical outcomes for accessing, resecting, and reconstructing tumors in this very delicate and complex anatomical location. It is my hope that this issue of Operative Techniques provides an excellent update and review for your surgical armamentarium.IntroductionTerry Y. Shibuya10.1016/j.otot.2009.10.013Operative Techniques in Otolaryngology - Head and Neck Surgery 21, 1 (2010)2010-03-01Operative Techniques in Otolaryngology - Head and Neck Surgery2010-03-01211S1043-1810(10)X0002-111http://www.optecoto.com/article/PIIS1043181009000451/abstract?rss=yesTumors of the sinonasal region and anterior skull base present diagnostic and surgical challenges. Access to and exposure of the tumor tends to be difficult because of the delicate neurovascular structures that occupy this area, including the brain and the orbital contents. The diagnosis and treatment of tumors in this region have improved with advances in diagnostic imaging, anesthesia, surgical navigation, and regional and free-tissue reconstruction. Unfortunately, due to the insidious onset and progression of vague symptoms, patients usually present with advanced disease. Craniofacial approaches are designed to improve tumor exposure permitting complete resection of large tumors that would otherwise be very difficult to resect from an isolated approach. The aim of this article is to describe both the surgical approaches and methods of resection for tumor of the anterior skull base.Traditional craniofacial resectionLucio Pereira, Michael A. Carron, Robert H. Mathog10.1016/j.otot.2009.06.004Operative Techniques in Otolaryngology - Head and Neck Surgery 21, 1 (2010)2010-03-01Operative Techniques in Otolaryngology - Head and Neck Surgery2010-03-01211S1043-1810(10)X0002-128http://www.optecoto.com/article/PIIS1043181009000475/abstract?rss=yesThe subfrontal approach represents a versatile technique allowing for broad exposure of the base of the anterior cranial fossa with minimal functional and aesthetic sequelae. A number of surgical manouvers will optimize the outcomes. These will be reviewed in detail in the article.The subfrontal approach to the anterior skull baseYadranko Ducic, Caetano Coimbra10.1016/j.otot.2009.06.006Operative Techniques in Otolaryngology - Head and Neck Surgery 21, 1 (2010)2010-03-01Operative Techniques in Otolaryngology - Head and Neck Surgery2010-03-01211S1043-1810(10)X0002-1918http://www.optecoto.com/article/PIIS1043181010000102/abstract?rss=yesMidfacial degloving is a useful approach for sinonasal and skull base lesions. This technique provides wide exposure for a variety of pathologies without needing facial incisions. The midfacial degloving technique, described in detail, can also be combined with other approaches to manage extensive lesions.Midface degloving approach to the skull baseVincent Y. Chen, Terry Y. Shibuya, Young S. Oh10.1016/j.otot.2010.03.008Operative Techniques in Otolaryngology - Head and Neck Surgery 21, 1 (2010)2010-03-01Operative Techniques in Otolaryngology - Head and Neck Surgery2010-03-01211S1043-1810(10)X0002-11921http://www.optecoto.com/article/PIIS1043181009000487/abstract?rss=yesAnterior skull base neoplasms require a multispecialty approach for adequate resection and reconstruction. Otolaryngologists are often consulted to help provide access to middle cranial fossa tumors or treat anterior cranial base pathology that arises from the nasal cavity or paranasal sinuses. The LeFort I osteotomy with downfracture of the maxilla is one of many well-described osteoplastic anterior transfacial approaches to access these areas of the skull base. The approach greatly improves visualization of not only the central skull base, but also the infratemporal fossa when the posterior wall of the antrum and the pterygoid plates are removed. We will review proper patient selection, the anatomy, and surgical exposure with modifications of the LeFort I osteotomy, operative procedure, and complications. This approach should be included in the skull base surgeon's repertoire as an intermediate alternative to limited access transnasal, transantral, and endoscopic approaches and wide exposure face-splitting procedures.LeFort I osteotomy approach to the anterior skull baseDavud Sirjani, Neal Futran10.1016/j.otot.2009.06.007Operative Techniques in Otolaryngology - Head and Neck Surgery 21, 1 (2010)2010-03-01Operative Techniques in Otolaryngology - Head and Neck Surgery2010-03-01211S1043-1810(10)X0002-12225http://www.optecoto.com/article/PIIS1043181009000529/abstract?rss=yesSurgical resection of the nasopharynx has evolved over the years. Because of its central location, anatomic complexity, and proximity to vital structures of the head and neck, radical surgery in this region of the head and neck was once considered imprudent and fraught with major complications, including death to the patient. Because of significant advancements in the areas of skull-base surgery, lighting, and instrumentation, surgical resection of the nasopharynx is no longer considered as daunting a task for those surgeons with the prerequisite training and experience. In this presentation, the current literature is reviewed with respect to surgical resection of the nasopharynx, and the various techniques are elucidated for outcomes. There are several approaches to surgically resecting the nasopharynx. This article emphasizes the transpalatal/transmaxillary/transcervical approach, which has demonstrated reasonable outcomes with acceptable complication rates.Surgical resection of the nasopharynxJimmy J. Brown, Willard E. Fee10.1016/j.otot.2009.08.001Operative Techniques in Otolaryngology - Head and Neck Surgery 21, 1 (2010)2010-03-01Operative Techniques in Otolaryngology - Head and Neck Surgery2010-03-01211S1043-1810(10)X0002-12634http://www.optecoto.com/article/PIIS104318101000014X/abstract?rss=yesThe retromaxillary-infratemporal fossa dissection with preauricular incision is a versatile approach that can be used effectively for treating tumors involving the anterior and lateral skull base. This approach, which originally was described for accessing the temporomandibular joint, lateral orbit, and zygomatic arch, has been expanded for the treatment of tumors extending or originating within the infratemporal fossa. We have used this approach alone or in combination with a facial degloving approach, subfrontal approach, or submandibular/cervical exposure for the past decade. Because of its excellent exposure, ease of access and low rate of morbidity, we believe the retromaxillary-infratemporal fossa dissection is an important surgical technique that should be in the armamentarium of any surgeon operating in the anterior/lateral skull base.Retromaxillary-infratemporal fossa dissection for tumors of the anterior and anterior/lateral skull basePaul Schalch, Timothy D. Doerr, Kenneth Krantz, Marc Vanefsky, Terry Y. Shibuya10.1016/j.otot.2010.04.001Operative Techniques in Otolaryngology - Head and Neck Surgery 21, 1 (2010)2010-03-01Operative Techniques in Otolaryngology - Head and Neck Surgery2010-03-01211S1043-1810(10)X0002-13538http://www.optecoto.com/article/PIIS1043181010000096/abstract?rss=yesSurgical exposure for massive tumor of the anterior skull base can be difficult. We have combined two surgical approaches, the subfrontal/subcranial approach and the Le Fort I osteotomy approach, to provide panoramic accesses to the anterior skull base. Via this combination of exposures, we have easily accessed and resected tumors extending from the cribiform plate all the way down to the level of the upper cervical spine. Additionally, we have used the nasal endoscope and microscope to assist in our resection. This approach has several advantages, which include ease of post-resection skull base reconstruction and excellent cosmetic results by avoiding anterior facial incisions. We believe this approach should be in the armamentarium of any surgeon resecting massive anterior skull base tumor.A panoramic approach to the anterior skull base—The combined subfrontal/subcranial and Le Fort I approachTerry Y. Shibuya, Randall Schoeman, Sooho Choi10.1016/j.otot.2010.03.007Operative Techniques in Otolaryngology - Head and Neck Surgery 21, 1 (2010)2010-03-01Operative Techniques in Otolaryngology - Head and Neck Surgery2010-03-01211S1043-1810(10)X0002-13943http://www.optecoto.com/article/PIIS104318100900044X/abstract?rss=yesThe use of surgical navigation has grown tremendously in endonasal endoscopic surgery. The technology has been used as an adjunct during endoscopic surgery of the skull base. Although not requisite, the benefits of navigation during endoscopic skull base surgery may lie in its ability to enhance a surgeon's approach to complex anatomic structures. The use of navigation during endoscopic skull base surgery does not completely parallel its use during surgery for inflammatory sinus disease, and those differences can be critical. For example, in endoscopic skull base surgery, soft tissue structures play a more prominent role during the dissection than in a typical surgery for inflammatory disease. Preoperatively, there are some particular issues that a navigated case will require above and beyond a non-navigated surgery, including obtaining appropriate radiographic studies, performing the appropriate preoperative software-based planning, and discussions with the patient. Intraoperatively, the set up of the navigation system in the operating room should augment the surgeon's operative field and maximize the utility of the navigation system. Specific indications where navigation may be useful include the endoscopic approach to sellar and parasellar lesions, benign anterior skull base tumors, encephaloceles, CSF leaks, and the like. The endoscopic surgeon who is performing skull base procedures should consider computer assisted navigation to be a helpful tool in his/her armamentareum.Use of surgical navigation during endoscopic skull base surgeryDavid Keschner, Jivianne Lee10.1016/j.otot.2009.06.003Operative Techniques in Otolaryngology - Head and Neck Surgery 21, 1 (2010)2010-03-01Operative Techniques in Otolaryngology - Head and Neck Surgery2010-03-01211S1043-1810(10)X0002-14450http://www.optecoto.com/article/PIIS1043181009000438/abstract?rss=yesEndoscopic transsphenoidal approaches to the pituitary developed with advances in endoscopic technology. Historically, transsphenoidal approaches to the pituitary transitioned from transcranial to transnasal. Each transnasal approach is associated with distinct advantages, limitations, and complications. The standard endoscopic paraseptal approach is discussed. Modifications of the paraseptal approach balance improved visualization with limited dissection. Endoscopes offer angled visualization of the sellar contents not possible with the binocular microscope. Reconstruction options range from minimal to pedical rotational flaps based on the anatomy of the defect and presence of cerebrospinal fluid (CSF).Endoscopic transsphenoidal approaches to the sellaMicah Hill, Rakesh K. Chandra, Andrew J. Fishman, Robert C. Kern10.1016/j.otot.2009.06.002Operative Techniques in Otolaryngology - Head and Neck Surgery 21, 1 (2010)2010-03-01Operative Techniques in Otolaryngology - Head and Neck Surgery2010-03-01211S1043-1810(10)X0002-15155http://www.optecoto.com/article/PIIS1043181010000126/abstract?rss=yesJuvenile nasopharyngeal angiofibromas (JNAs) are rare, benign, but locally invasive vascular lesions that have traditionally been resected using open surgical approaches. However, with the wider availability of superselective intra-arterial embolization, the advent of improved endoscopic, transnasal techniques, and advances in instrumentation, recent years have witnessed a shift toward the use of less invasive, strictly endoscopic methods for the management of such lesions. The purpose of this article is to describe the surgical techniques used in the endoscopic resection of JNAs and to discuss the indications, trends, and current limitations of this approach. As technological advancements and surgical expertise continue to develop, the spectrum of applicability for such endoscopic procedures will undoubtedly broaden to encompass progressively larger, more extensive lesions in the future.Endoscopic resection of juvenile nasopharyngeal angiofibromaJivianne T. Lee, David B. Keschner, David W. Kennedy10.1016/j.otot.2010.03.010Operative Techniques in Otolaryngology - Head and Neck Surgery 21, 1 (2010)2010-03-01Operative Techniques in Otolaryngology - Head and Neck Surgery2010-03-01211S1043-1810(10)X0002-15665http://www.optecoto.com/article/PIIS1043181009000700/abstract?rss=yesTraditional approaches for the resection of tumors that involve the anterior cranial base used facial and scalp incisions, a craniotomy, and facial osteotomies. These approaches required frontal lobe retraction and sometimes resulted in cosmetic and functional deficits. With the advances in optics, surgical instrumentation, and image-guided surgery, the expanded endonasal approach (EEA) has provided a less intrusive corridor to the anterior skull base without compromising the goals of oncological resection. Our extensive experience with this approach has enabled us to perform a “craniofacial resection” for anterior skull base tumors without resorting to external incisions or a craniotomy. This report details the operative technique for a completely endoscopic endonasal resection of the anterior skull base that may be used for the resection of both benign and malignant tumors.The expanded endonasal approach for the treatment of anterior skull base tumorsAmol M. Bhatki, Harshita Pant, Carl H. Snyderman, Ricardo L. Carrau, Paul Gardner, Daniel M. Prevedello, Amin B. Kassam10.1016/j.otot.2009.10.002Operative Techniques in Otolaryngology - Head and Neck Surgery 21, 1 (2010)2010-03-01Operative Techniques in Otolaryngology - Head and Neck Surgery2010-03-01211S1043-1810(10)X0002-16673http://www.optecoto.com/article/PIIS1043181009000712/abstract?rss=yesAdvances in endoscopic techniques and technology have substantially increased the scope of endonasal skull base surgery. Large dural defects after expanded endonasal approaches (EEA) present a challenge for reconstruction and have revealed the limitations of conventional reconstructive methods. Initial reconstructive attempts using nonvascularized free tissue grafts resulted in unacceptably high rates of cerebrospinal fluid fistulae. The advent of vascularized, pedicled flaps has substantially improved these outcomes. These flaps also have the advantage of a large surface area and can be mobilized over a large arc of rotation. Vascularized tissue heals quickly and can tolerate postoperative radiation therapy. We have developed 3 nasal vascularized flaps that can be used for skull base reconstruction after EEA. The anatomy, technique, and reconstructive considerations for the nasoseptal flap, the inferior turbinate flap, and the middle turbinate flap will be reviewed in detail in the following report.Reconstruction of the cranial base after endonasal skull base surgery: Local tissue flapsAmol M. Bhatki, Harshita Pant, Carl H. Snyderman, Ricardo L. Carrau, Amin B. Kassam, Daniel M. Prevedello, Paul Gardner10.1016/j.otot.2009.10.003Operative Techniques in Otolaryngology - Head and Neck Surgery 21, 1 (2010)2010-03-01Operative Techniques in Otolaryngology - Head and Neck Surgery2010-03-01211S1043-1810(10)X0002-17482http://www.optecoto.com/article/PIIS1043181010000138/abstract?rss=yesAdvances in endoscopic techniques and technology have substantially increased the scope of expanded endonasal skull base surgery. Larger and more complex skull base defects pose a unique challenge for reconstruction. The pedicled nasoseptal flap has become the workhorse for reconstruction and, through its use, the virtues of a vascularized reconstruction are clearly apparent. When local mucosal flaps are unavailable or insufficient for reconstruction, regional flaps may be employed. In this paper, we describe the techniques for three regional vascularized flaps that have been modified for endonasal skull base reconstruction: the transpterygoid temporoparietal fascial flap, the endoscopic pericranial flap, and the modified palatal mucosal flap. These flaps offer a large surface area of tissue supplied by a vascular pedicle that has sufficient reach and arc of rotation to adequately reconstruct portions of the ventral skull base. The specific anatomy, techniques, and technical considerations are discussed in detail to provide a comprehensive approach for skull base reconstruction.Reconstruction of the cranial base following endonasal skull base surgery: Regional tissue flapsAmol M. Bhatki, Harshita Pant, Carl H. Snyderman, Ricardo L. Carrau, Amin B. Kassam, Daniel M. Prevedello, Paul Gardner10.1016/j.otot.2010.03.011Operative Techniques in Otolaryngology - Head and Neck Surgery 21, 1 (2010)2010-03-01Operative Techniques in Otolaryngology - Head and Neck Surgery2010-03-01211S1043-1810(10)X0002-18390http://www.optecoto.com/article/PIIS1043181009000463/abstract?rss=yesImprovements in skull base surgery techniques have allowed surgeons to expand the indications for resection and reconstruction of aggressive tumors. The increasingly complex defects following surgical extirpation are often reconstructed with microvascular free flaps. Techniques for free flap reconstruction of the anterior skull base are elaborated.Microvascular free flap reconstruction of anterior skull base defectsQuang Luu, D. Gregory Farwell10.1016/j.otot.2009.06.005Operative Techniques in Otolaryngology - Head and Neck Surgery 21, 1 (2010)2010-03-01Operative Techniques in Otolaryngology - Head and Neck Surgery2010-03-01211S1043-1810(10)X0002-19195http://www.optecoto.com/article/PIIS1043181009000499/abstract?rss=yesResection of skull base lesions and subsequent reconstruction is difficult due to the complex three-dimensional anatomy of this region. Rapid prototyping using stereolithographic or laser sinter techniques may help visualize the lesions, design access osteotomies, and create templates for reconstruction of the bony skeleton.Solid modeling in surgery of the anterior skull baseBeat Hammer, Christoph Zizelmann, Kai Scheufler10.1016/j.otot.2009.06.008Operative Techniques in Otolaryngology - Head and Neck Surgery 21, 1 (2010)2010-03-01Operative Techniques in Otolaryngology - Head and Neck Surgery2010-03-01211S1043-1810(10)X0002-19699