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. http://www.optecoto.com/?rss=yesElsevier Inc.en © 2011 Published by Elsevier Inc. All rights reserved. Operative Techniques in Otolaryngology - Head and Neck Surgery1043-1810224December 2011 © 2011 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.optecoto.com/article/PIIS1043181011001163/abstract?rss=yesMasthead10.1016/S1043-1810(11)00116-3Operative Techniques in Otolaryngology - Head and Neck Surgery 22, 4 (2011)2011-12-01Operative Techniques in Otolaryngology - Head and Neck Surgery2011-12-01224S1043-1810(11)X0005-2IFCIFChttp://www.optecoto.com/article/PIIS1043181011001175/abstract?rss=yesEditorial Board10.1016/S1043-1810(11)00117-5Operative Techniques in Otolaryngology - Head and Neck Surgery 22, 4 (2011)2011-12-01Operative Techniques in Otolaryngology - Head and Neck Surgery2011-12-01224S1043-1810(11)X0005-2iihttp://www.optecoto.com/article/PIIS1043181011001187/abstract?rss=yesContents10.1016/S1043-1810(11)00118-7Operative Techniques in Otolaryngology - Head and Neck Surgery 22, 4 (2011)2011-12-01Operative Techniques in Otolaryngology - Head and Neck Surgery2011-12-01224S1043-1810(11)X0005-2iiiiihttp://www.optecoto.com/article/PIIS1043181011001199/abstract?rss=yesFuture and recent issues10.1016/S1043-1810(11)00119-9Operative Techniques in Otolaryngology - Head and Neck Surgery 22, 4 (2011)2011-12-01Operative Techniques in Otolaryngology - Head and Neck Surgery2011-12-01224S1043-1810(11)X0005-2ivivhttp://www.optecoto.com/article/PIIS1043181011001205/abstract?rss=yesInformation for authors10.1016/S1043-1810(11)00120-5Operative Techniques in Otolaryngology - Head and Neck Surgery 22, 4 (2011)2011-12-01Operative Techniques in Otolaryngology - Head and Neck Surgery2011-12-01224S1043-1810(11)X0005-2vvihttp://www.optecoto.com/article/PIIS104318101100114X/abstract?rss=yesIn this issue we focus on advanced techniques to address a wide variety of pathology that extend beyond the transsphenoidal corridor. The anterior cranial fossa, posterior cranial fossa, cavernous sinus and infratemporal fossa are all accessible by extended endoscopic approaches, which have been elaborated upon in the following manuscripts. Because both extracranial and intracranial pathology are amenable to these approaches, these topics are relevant to otolaryngologist–head and neck surgeons and neurosurgeons alike.Introduction: Extended Endoscopic Skull Base TechniquesVijay K. Anand, Theodore H. Schwartz, Edward D. McCoul10.1016/j.otot.2011.10.003Operative Techniques in Otolaryngology - Head and Neck Surgery 22, 4 (2011)2011-12-01Operative Techniques in Otolaryngology - Head and Neck Surgery2011-12-01224S1043-1810(11)X0005-2253253http://www.optecoto.com/article/PIIS1043181011000704/abstract?rss=yesMeningiomas of the anterior skull base have been traditionally approached through transcranial or combined craniofacial routes. While these approaches offer wide exposure and working space, brain retraction, neurovascular manipulation, sinus obliteration, wound healing, and cosmesis can be significant issues. With the evolution of endoscope-assisted surgery, transnasal endoscopic approaches have developed as useful alternatives. These approaches can provide visualization comparable to or better than microscope-assisted surgery, as the endoscope provides excellent resolution of anatomic and pathologic details down these narrow corridors. Moreover, the use of angled endoscopes and instruments enables the surgeon to visualize and remove structures around the corners and avoid brain retraction. Potential disadvantages include narrow working spaces and reduced degrees of freedom with the dissecting instruments. In addition, operating through the nose carries with it the theoretical risk of intracranial infection and CSF leak, given the challenge of reconstructing the dura and skull base from below. With these issues in mind, a balanced approach to the resection of these tumors can be used to maximize tumor removal while minimizing operative time, trauma to surrounding structures, and procedure-related complications. This review will discuss the indications and limitations, technical nuances, postoperative care, and potential complications associated with endonasal endoscopic treatment of anterior cranial fossa meningiomas.Endoscopic management of anterior cranial fossa meningiomasGraeme F. Woodworth, Edward D. McCoul, Vijay K. Anand, Jeffrey F. Greenfiled, Theodore H. Schwartz10.1016/j.otot.2011.08.006Operative Techniques in Otolaryngology - Head and Neck Surgery 22, 4 (2011)2011-12-01Operative Techniques in Otolaryngology - Head and Neck Surgery2011-12-01224S1043-1810(11)X0005-2254262http://www.optecoto.com/article/PIIS1043181011000819/abstract?rss=yesSkull base tumors that involve the cavernous sinus (CS) present a challenge to the endoscopic surgeon. Most such lesions arise from sellar pathology that involves the medial wall of the CS, which can be accessed by a transsphenoidal transsellar approach. Tumors that arise primarily in the medial CS may be accessed via a transethmoidal transsphenoidal parasellar approach, which avoids the dissection of sellar contents but requires the removal of bone overlying the carotid artery. Involvement of the tumor in the lateral CS may be accessed by a transmaxillary transpterygoid approach in patients who wish to avoid a craniotomy and in whom radiosurgery is not an option. These tumors are associated with a greater risk of cranial nerve injury, including extraocular palsy. Important adjuncts to the endoscopic approach include angled instrumentation, neuronavigation, intraoperative Doppler and intrathecal fluorescein injection. Tumor extirpation from the CS and cytoreduction are realistic goals for the endoscopic surgeon in well-selected cases.Endoscopic approaches to the cavernous sinusEdward D. McCoul, Vijay K. Anand, Theodore H. Schwartz10.1016/j.otot.2011.08.017Operative Techniques in Otolaryngology - Head and Neck Surgery 22, 4 (2011)2011-12-01Operative Techniques in Otolaryngology - Head and Neck Surgery2011-12-01224S1043-1810(11)X0005-2263268http://www.optecoto.com/article/PIIS1043181011000728/abstract?rss=yesArguably one of the most inaccessible regions because of its anatomical location, the petrous apex poses a significant challenge for access to its pathology. In the last 10 years we have seen an impressive evolution of endoscopic techniques, with key advances allowing us to push the limits of endoscopy. Anatomical understanding, instrumentation, and image guidance have greatly contributed to this expansion. These extended endoscopic techniques allow a more direct corridor to the petrous apex without the morbidity posed by lateral or transcranial open approaches. Patients experience a greatly reduced hospital stay, a quicker recovery, and minimal sequelae. Herein we describe the endoscopic approach to the petrous apex.Endoscopic approaches to the petrous apexMadeleine R. Schaberg, James J. Evans, Marc R. Rosen10.1016/j.otot.2011.08.008Operative Techniques in Otolaryngology - Head and Neck Surgery 22, 4 (2011)2011-12-01Operative Techniques in Otolaryngology - Head and Neck Surgery2011-12-01224S1043-1810(11)X0005-2269273http://www.optecoto.com/article/PIIS1043181011000790/abstract?rss=yesClival chordomas are rare tumors that become symptomatic by slow growth and local invasion of adjacent cranial nerves, typically abducens (CN VI), and brainstem structures. These tumors have been treated with extensive resections, with or without radiotherapy. Due to their location in the ventral midline skull base, the transnasal endoscopic approach to the clivus avoids cerebral retraction, reduces the incidence of injury to the lower cranial nerves, avoids external scars, is relatively quick, helps preserve the anatomical structures and appears to have good surgical outcomes. This article describes the “endoscopic binostril (transeptal/transeptal) approach” to resection of clival chordomas.Endonasal endoscopic approach to clival and posterior fossa chordomasAldo C. Stamm, Leonardo Balsalobre, Diego Hermann, Edward Chisholm10.1016/j.otot.2011.08.015Operative Techniques in Otolaryngology - Head and Neck Surgery 22, 4 (2011)2011-12-01Operative Techniques in Otolaryngology - Head and Neck Surgery2011-12-01224S1043-1810(11)X0005-2274280http://www.optecoto.com/article/PIIS1043181011000662/abstract?rss=yesThe origin of juvenile angiofibroma is usually around the region of the sphenopalatine artery, and the surgical management of large tumors can be challenging. Traditional approaches to advanced tumors involved open transfacial or transcranial microscope-assisted surgery. Advances in image guidance and endonasal endoscopic techniques have made endonasal endoscopic approaches to the pterygopalatine and infratemporal possible. Endoscopes allow for greater magnification and visualization of complex anatomy, and endoscopic approaches allow the surgeon to avoid manipulation of the osseous midfacial structures that may result in craniofacial abnormalities in this adolescent population.Endoscopic management of juvenile nasopharyngeal angiofibromasDara Liotta, Ashutosh Kacker, Theodore H. Schwartz, Vijay K. Anand10.1016/j.otot.2011.08.002Operative Techniques in Otolaryngology - Head and Neck Surgery 22, 4 (2011)2011-12-01Operative Techniques in Otolaryngology - Head and Neck Surgery2011-12-01224S1043-1810(11)X0005-2281284http://www.optecoto.com/article/PIIS1043181011000753/abstract?rss=yesThe infratemporal fossa is a deeply situated region that can give rise to a range of benign and malignant tumors. The endoscopic endonasal approach provides an alternative to open surgical approaches and may obviate the need for facial nerve transposition, middle ear obliteration, and brain retraction. A transmaxillary corridor with transpterygoid dissection is used to expose the pterygopalatine fossa. Further removal of the posterior wall of the maxillary sinus transgresses the pterygomaxillary fossa to provide access to the infratemporal fossa. The extradural nature of most pathology is associated with low rates of cerebrospinal fluid leakage. Understanding of the complex neurovascular anatomy of this region is essential to achieving successful resection and preventing complications.Endoscopic approach to the infratemporal fossaEdward D. McCoul, Theodore H. Schwartz, Vijay K. Anand10.1016/j.otot.2011.08.011Operative Techniques in Otolaryngology - Head and Neck Surgery 22, 4 (2011)2011-12-01Operative Techniques in Otolaryngology - Head and Neck Surgery2011-12-01224S1043-1810(11)X0005-2285290http://www.optecoto.com/article/PIIS1043181011000881/abstract?rss=yesExpanded endoscopic techniques often are used for benign diseases of the sinonasal cavity. Malignancy has traditionally been relegated to open approaches. Recent advances in instrumentation and technique have revolutionized endoscopic surgery. We believe that often endoscopic techniques achieve equivalent, if not improved, tumor resection and will likely prove to be comparable with or superior to open approaches as the use of these approaches continues. The axiom remains that if the approach is limiting the tumor resection, then a conversion to an open procedure is necessary. This article describes our approach to endoscopic resection of sinonasal malignancy.The endoscopic approach to sinonasal malignancyMarc R. Rosen, Madeleine R. Schaberg, Michael Lynn, James J. Evans10.1016/j.otot.2011.09.001Operative Techniques in Otolaryngology - Head and Neck Surgery 22, 4 (2011)2011-12-01Operative Techniques in Otolaryngology - Head and Neck Surgery2011-12-01224S1043-1810(11)X0005-2291296http://www.optecoto.com/article/PIIS1043181011000686/abstract?rss=yesAlthough en-bloc resection is the traditional teaching in oncological surgery, with recent technologic advancements and literature to support both safety and efficacy, there has been a growing acceptance of alternative techniques for the surgical management of paranasal sinus and anterior skull base malignancies. The endoscopic-assisted external approach affords many of the benefits of endoscopic resection while allowing for the management of lesions with marked intracranial extension that would otherwise require anterior craniofacial resection. Here we describe our endoscopic technique for resection of the anterior skull base and its role when combined with anterior craniotomy.Combined endoscopic and open approach to resection of the anterior skull baseLori A. Lemonnier, Roy R. Casiano10.1016/j.otot.2011.08.004Operative Techniques in Otolaryngology - Head and Neck Surgery 22, 4 (2011)2011-12-01Operative Techniques in Otolaryngology - Head and Neck Surgery2011-12-01224S1043-1810(11)X0005-2297301http://www.optecoto.com/article/PIIS1043181011000674/abstract?rss=yesThe surgical approach to the skull base has traditionally been transcranial, often involving extensive bone drilling, brain retraction, and nerve manipulation to expose pathology. The endoscopic endonasal approach represents a minimal access, maximally aggressive alternative that provides a direct route to the area of interest. Few data exist that can be used to compare these 2 surgical strategies. We conducted a systematic review of case series and case reports in hope of furthering our understanding of the role of endoscopy in the management of difficult cranial base lesions. We found that the endonasal endoscopic technique generates equivalent or greater rates of gross total resection than open approaches for craniopharyngiomas, clivalchordomas, odontoid resection, and tuberculumsellaemeningiomas. The rate of cerebrospinal fluid (CSF) leaks is greater for patients undergoing endoscopic surgery for anterior skull base meningiomas and craniopharyngiomas. There was no difference in the rate of CSF leak between approaches for clival chordoma resection or after odontoidectomy. Despite the increased risk of CSF leak, the risk of postoperative meningitis does not appear to be increased. Our systematic review supports the endonasal endoscopic approach as a safe and effective alternative for the treatment of a wide variety of skull base pathology, particularly small midline tumors. Careful patient selection and meticulous multilayer closure are critical to obtaining maximal resection and acceptably low CSF leak rates.Endoscopic versus open approaches to the skull base: A comprehensive literature reviewDaniel M.S. Raper, Ricardo J. Komotar, Robert M. Starke, Vijay K. Anand, Theodore H. Schwartz10.1016/j.otot.2011.08.003Operative Techniques in Otolaryngology - Head and Neck Surgery 22, 4 (2011)2011-12-01Operative Techniques in Otolaryngology - Head and Neck Surgery2011-12-01224S1043-1810(11)X0005-2302307http://www.optecoto.com/article/PIIS1043181010001296/abstract?rss=yesMaintaining structural integrity during rhinoplasty often necessitates adding support to the nose. Autologous grafting material is the safest and most reliable source of this structural support. A variety of sources in the body can serve as donor sites for such grafts. The most common sites are septal cartilage, auricular conchal cartilage and rib cartilage. Less common sites include tragal cartilage, calvarial bone and iliac bone. This article reviews the surgical techniques for accessing, harvesting, and modifying these grafts for use in rhinoplasty.Bone and cartilage harvesting techniques in rhinoplastyKrista Rodriguez-Bruno, Dean M. Toriumi, David W. Kim10.1016/j.otot.2010.12.001Operative Techniques in Otolaryngology - Head and Neck Surgery 22, 4 (2011)2011-12-01Operative Techniques in Otolaryngology - Head and Neck Surgery2011-12-01224S1043-1810(11)X0005-2Original contribution308315http://www.optecoto.com/article/PIIS1043181011000911/abstract?rss=yesAs disclosed in the abstract and in the introduction section of the paper entitled “Caldwell-Luc procedure” by Kim and Duncavage, the aims of the publication were to provide the current indications for Caldwell-Luc procedure and to describe the surgical procedure. However, the surgical procedure here described by the authors significantly differs from the traditional Caldwell-Luc procedure because it consists of a surgical approach to the maxillary sinus by a canine fossa puncture, eventually followed by an inferior meatal antrostomy.Considerations concerning: “Caldwell-Luc procedure” by Kim and DuncavageSara Torretta, Lorenzo Pignataro10.1016/j.otot.2011.09.004Operative Techniques in Otolaryngology - Head and Neck Surgery 22, 4 (2011)2011-12-01Operative Techniques in Otolaryngology - Head and Neck Surgery2011-12-01224S1043-1810(11)X0005-2Letters to the Editor316316http://www.optecoto.com/article/PIIS1043181011000935/abstract?rss=yesThank you for your comments on our Caldwell Luc procedure in Operative Techniques in Otolaryngology. You state that once the maxillary ostium is enlarged to provide drainage and ventilation the dependent larger sinuses usually heal without being touched. In our description of the Caldwell Luc, we state that chronic maxillary sinus infection that persists after maxillary antrostomy despite the use of culture directed antibiotics and biofilm treatment can be very problematic. We always provide adequate antral ventilation as the first step in treatment of chronic maxillary sinusitis. As you state, the dependent larger sinus “usually heals.” The key word in your statement is “usually.” You imply that the maxillary sinus may not always return to a normal state. The purpose of our paper is to provide sinus surgeons another surgical option for the patient who has disease that does not respond to further medical management after failed antrostomy.ResponseJames A. Duncavage10.1016/j.otot.2011.09.006Operative Techniques in Otolaryngology - Head and Neck Surgery 22, 4 (2011)2011-12-01Operative Techniques in Otolaryngology - Head and Neck Surgery2011-12-01224S1043-1810(11)X0005-2Letters to the Editor316317