Trans-nasal endoscopic and intra-oral combined approach for odontogenic cysts

Maxillary cysts are a common finding in maxillofacial surgery, dentistry and otolaryngology. Treatment is surgical; a traditional approach includes Caldwell-Luc and other intra-oral approaches. In this article, we analyse the outcomes of 9 patients operated on using a combined intra-oral and trans-nasal approach to the aforementioned disease. Although the number of patients is small, the good results of this study suggest that the combined approach might be a reliable treatment option

Exclusive surgical treatment for vestibular schwannoma regrowth or recurrence: A meta-analysis of the literature

Vestibular schwannomas can be treated in different ways, but for symptomatic or growing tumors, the gold standard is surgical removal of the lesion. In order to preserve neurovascular structures, partial removal is often performed, leaving a residual that may grow in subsequent years. To date, there is no consensus with regard to surgical treatment of vestibular schwannoma residuals, and so this review focuses on this topic. A structured search was performed on PubMed searching for all articles discussing vestibular schwannoma residuals and recurrences. Only articles discussing surgical treatment were included, focusing on studies which also examined facial nerve outcomes. A total of 51 articles were eligible for review and these included 375 patients. Statistical analysis was performed by correlating the following parameters: patients' gender and age at first surgery, surgical approach adopted at first and subsequent surgeries, tumor and residual size, and extent of resection (gross total, near total, subtotal or others) at first and subsequent surgical procedures. Facial nerve function was also analyzed focusing on its performance when correlated with the different surgical approaches. The data were analyzed by linear regression but there were no correlations between any of the parameters chosen. There was a statistically significant difference between the first approach used (mainly the retrosigmoid route) compared with subsequent approaches (mainly the translabyrinthine route). In total, 8.5 % of patients needed further treatment due to residual regrowth. Facial nerve outcome was independent of the parameters chosen. Exclusive surgical treatment for vestibular schwannoma residuals had a very low failure rate in terms of requiring further treatment. The approach usually chosen for second surgery was the translabyrinthine technique, and this may be explained by the location of the residual, rather than its size. The choice of a particular surgical approach rather than another had no influence on facial nerve function. Complications rates are comparable to Gamma Knife Radiosurgery's as reported in the literature

Role of endoscopy in lateral skull base approaches to the petrous apex

Objective: The aim of this article is to study the role and advantages of combined microscopic/endoscopic procedures or exclusive endoscopic approaches in the treatment of petrous apex pathologies. Methods: The study was designed as a retrospective case series analysis. We included patients affected by pathologies of the petrous apex, who underwent microscopic/endoscopic-assisted or exclusive endoscopic procedures. Patient and pathology characteristics and surgical data (focusing on the involvement of the internal carotid artery (ICA) and facial nerve by the disease) were collected. Residual disease, detected through the endoscopic check, and the feasibility of endoscopic residual tumor removal were also evaluated. Finally, facial nerve and hearing functions were assessed pre- and postoperatively. Results: The records of 75 patients undergoing lateral skull base surgery for petrous apex lesions, from May 2009 to March 2019, were collected. In 17 out of 75 patients, an exclusive endoscopic procedure was possible. The remaining 58 patients underwent a combined microscopic/endoscopic approach. In 15 cases, residual disease was found and removed endoscopically at the end of the microscopic procedure; in eight cases, the residual disease was medial and/or inferior to the horizontal segment of the ICA, while in two cases, it was located in the fundus of the internal auditory canal. In five cases, it involved the labyrinthine segment of the facial nerve. Conclusion: Petrous apex surgery remains a traditional microscopic-based surgery, but the recent advent of endoscopic surgery has permitted an improvement in radicality minimizing the manipulation of neurovascular structures

To hear or not to hear: Sound Availability Modulates Sensory-Motor Integration

When we walk in place with our eyes closed after a few minutes of walking on a treadmill, we experience an unintentional forward body displacement (drift), called the sensory-motor aftereffect. Initially, this effect was thought to be due to the mismatch experienced during treadmill walking between the visual (absence of optic flow signaling body steadiness) and proprioceptive (muscle spindles firing signaling body displacement) information. Recently, the persistence of this effect has been shown even in the absence of vision, suggesting that other information, such as the sound of steps, could play a role. To test this hypothesis, six cochlear-implanted individuals were recruited and their forward drift was measured before (Control phase) and after (Post Exercise phase) walking on a treadmill while having their cochlear system turned on and turned off. The relevance in testing cochlear-implanted individuals was that when their system is turned off, they perceive total silence, even eliminating the sounds normally obtained from bone conduction. Results showed the absence of the aftereffect when the system was turned off, underlining the fundamental role played by sounds in the control of action and breaking new ground in the use of interactive sound feedback in motor learning and motor development

Endoscopic-assisted Cochlear Implantation in Children with malformed ears

Objective: Complex middle and inner ear malformations are considered an important limitation for cochlear implant (CI) with traditional microscopic techniques. The aim of the present study is to describe the results of the endoscopic-assisted CI procedure in children with malformed ears. Study design: Case series with chart review of consecutive patients. Setting: Two tertiary referral centers: University Hospital of Verona and University Hospital of Modena, Italy. Subjects and methods: In total, 25 children underwent endoscopic-assisted cochlear implantation between January 2013 and January 2018. The audiologic and neuroradiologic assessment showed profound hearing loss and malformation of the middle and inner ear in all children. A complete review of anatomic features, surgical results, and audiologic outcomes was performed. The surgical technique is described step-by-step, and the outcomes are detailed. Results: All patients (mean age, 3.6 years; range, 2.8-9 years) underwent a transattical/endoscopic-assisted CI procedure. All children showed varying degrees of auditory benefit, as measured by routine audiometry, speech perception tests, and Categories of Auditory Performance scores (mean, 6). No immediate or late postoperative complications were noted. Conclusion: The endoscopic-assisted approach proved to be successful in cochlear implantation. The direct visualization and magnification allow (1) exploration of the tympanic cavity; (2) confirmation of all anatomic features, with strict control of the course of the facial nerve, round window area, and inner ear; and (3) performance of the cochleostomy with adequate insertion of the array

Endoscopic stapedotomy: safety and audiological results in 150 patients

Objective: The most widely accepted treatment for otosclerosis is currently microscopic stapes surgery under either local or general anesthesia. The aim of the study is to describe the surgical steps in endoscopic stapes surgery and to evaluate the audiologic and surgical outcomes. Materials and methods: All patients who underwent exclusive endoscopic stapes surgery or revision surgery for previous stapedotomy between November 2014 and September 2018 were enrolled in this study. Demographic data, surgical information, preoperative and postoperative pure tone averages and air bone gaps, intraoperative and postoperative complications and follow-up data were summarized and gathered in a database for further consideration and analysis. Results: In the period examined, 181 stapes surgical procedures were performed and out of these 150 met the inclusion criteria. There were no cases of major intraoperative complications. Sensorineural hearing loss was observed in one case. In one patient a gusher effect occurred during surgery. The postoperative air-bone gap improved significantly compared to the preoperative gap (8 vs 29 dB HL, respectively), and the mean air-bone gap closure was 20 dB HL. In 78.7% of cases, the observed postoperative air-bone gap was less than 10 dB HL and in 14% it was between 11 dB HL and 20 dB HL. An ABG closure lower than 20 dB HL was achieved in a total of 92.7% of patients. Conclusions: Endoscopic stapes surgery is a safe procedure with a low risk of peri- or postoperative complications and is a possible alternative to the traditional microscopic surgical procedure in the treatment of otosclerosis

Congenital Pyriform Sinus Fistula: Systematic Review and Proposal for Treatment Using a Novel Endoscopic Approach

The pyriform sinus fistula (PSF) is a congenital developmental defect of the third or fourth branchial pouch. It presents as acute inflammatory swelling of the neck with recurrent deep neck abscesses, recurrent neck cystic lesions or suppurative thyroiditis. The literature reports various surgical approaches to treat this condition in children. A systematic review of the literature related to management protocols for PSF was conducted and we report a case exemplifying treatment in our department. Traditionally, treatment for PSF has been open surgery; however, in the last few decades, the minimally invasive transoral endoscopic approach has gained in importance, demonstrating long-term outcomes comparable to open surgery and with lower morbidity, and it has now become the first-choice treatment. We further describe a case of PSF treated by a transoral endoscopic approach with electric cauterization, fibrin glue obliteration of the fistula and Polydimethylsiloxane (Vox-Implants®, Bioplasty, Geleen, The Netherlands) submucosal injection. According to the authors, application of Vox-Implants® injection, in addition to standard techniques, may be helpful to reduce fistula recurrence rate after surgery

Discovering middle ear anatomy by transcanal endoscopic ear surgery: A dissection manual

The middle ear is located in the center of the temporal bone and bears a highly complex anatomy. The recently introduced exclusively endoscopic transcanal approach to the middle ear is a minimally invasive technique sparing the bone and mucosa of the mastoid bone, since the middle ear is accessed through the external auditory canal. This emerging method has several advantages over the traditional (microscopic) approaches to the middle ear such as the panoramic wide-angle views of the anatomy, the possibility to approach and magnify tiny structures, and the possibility of looking around the corner using angled endoscopes. The cadaveric dissection method presented here consists of an overview on the technical requirements and a precise description of a step-by-step protocol to discover the anatomy of the middle ear. Each step and anatomical structure is carefully described in order to provide a comprehensive guide to endoscopic ear anatomy. In our opinion, this is particularly important to any novice in endoscopic ear surgery as it provides thorough anatomical knowledge and may improve surgical skills

Expanded Endoscopic Approach for Anterior Skull Base Tumors: Experience of a Multidisciplinary Skull Base Team

Abstract: The aim of this study is to describe the experience of a multidisciplinary skull base team with transnasal endoscopic surgery for anterior cranial base tumors. A retrospective chart review was conducted on patients who underwent an exclusive expanded transnasal approach to the anterior skull base in the period from December 2014 to November 2015. Data on patient demographics, tumor characteristics, surgical information, imaging, and postoperative complications were collected and analyzed. From a total of 120 patients with skull base diseases managed by the skull base team, 36 were admitted to this study. The overall complication rate in this series was 16.7%, gross total resection was achieved in 32 cases (88.9%) and postoperative CSF leakage occurred in 5 cases (13.9%). Our preliminary results confirm that an exclusive endoscopic transnasal approach to the anterior cranial base