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Otolaryngologic Clinics of North America

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https://www.readbyqxmd.com/read/28392038/the-emerging-role-of-3-dimensional-printing-in%C3%A2-rhinology
#1
REVIEW
Janalee K Stokken, John F Pallanch
Nasal septal perforations, particularly those that are large and irregular in shape, often present as challenging surgical dilemmas. New technology has allowed us to develop techniques using computed tomography imaging and 3-dimensional (3D) printers to design custom polymeric silicone septal buttons. These buttons offer patients an option that avoids a surgical intervention when standard buttons do not fit well or are not tolerated. Preliminary data suggest that buttons designed by 3D printer technology provide more comfort than standard commercially available or hand-carved buttons with equivalent reduction of symptoms...
April 6, 2017: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/28392037/next-generation-surgical-navigation-systems-in-sinus-and-skull-base-surgery
#2
REVIEW
Martin J Citardi, William Yao, Amber Luong
Over the past 25 years, rhinologists have adopted surgical navigation technology for endoscopic sinus and skull base procedures. Navigation systems often produce a wide target registration error (TRE). Ideally, next-generation systems will include a leap in target registration error reduce TRE through innovative hardware and software. Incorporation of microsensors will be another important innovation. Future systems are likely to include augmented reality, which can project overlays of critical anatomy on real-world endoscopic images...
April 6, 2017: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/28389019/evolution-in-visualization-for-sinus-and-skull-base-surgery-from-headlight-to-endoscope
#3
REVIEW
Omar H Ahmed, Sonya Marcus, Richard A Lebowitz, Joseph B Jacobs
Rhinoscopy became a formal field of study in the mid-nineteenth century as improvements in nasal specula were made and the potent vasoconstrictive effects of cocaine on the intranasal tissues were discovered. Since then, a multitude of advances in visualization and illumination have been made. The advent of the Storz-Hopkins endoscope in the mid-twentieth century represents a culmination of efforts spanning nearly 2 centuries, and illumination has evolved concomitantly. The future of endoscopic sinus surgery may integrate developing technologies, such as 3-dimensional endoscopy, augmented reality navigation systems, and robotic endoscope holders...
April 4, 2017: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/28389018/topical-drug-therapies-for-chronic-rhinosinusitis
#4
REVIEW
Lauren J Luk, John M DelGaudio
Chronic rhinosinusitis is recognized as an inflammatory syndrome involving the nose and paranasal sinuses of multifactorial etiology. Research has demonstrated a complex interplay between host factors, microbiota, environmental exposures, and epigenetics resulting in chronic mucosal inflammation. The mainstay of medical therapy addresses this inflammation. In previously operated sinuses this includes topical saline and corticosteroids, reserving antibiotics for culture-directed acute exacerbations. Topical antiinflammatory therapies allow increased local concentration of drugs while minimizing side effects...
April 4, 2017: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/28372815/application-of-ultrasonic-aspirators-in-rhinology-and-skull-base-surgery
#5
REVIEW
Dominic Vernon, Brian C Lobo, Jonathan Y Ting
Ultrasonic aspirators (UAs) are increasingly being used in rhinology and skull base surgery. The use of ultrasonic vibration for the removal of bony tissue transfers minimal heat to surrounding tissues and is relatively atraumatic to nearby soft tissue structures. This article details the development and application of this technology in septoturbinoplasty, endoscopic dacryocystorhinostomy (DCR), and skull base surgery. The benefits and limitations of UAs compared with conventionally powered instruments are discussed...
March 31, 2017: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/28372814/endoscopic-skull-base-reconstruction-an-evolution-of-materials-and-methods
#6
REVIEW
Aaron C Sigler, Brian D'Anza, Brian C Lobo, Troy Woodard, Pablo F Recinos, Raj Sindwani
Endoscopic skull base surgery has developed rapidly over the last decade, in large part because of the expanding armamentarium of endoscopic repair techniques. This article reviews the available technologies and techniques, including vascularized and nonvascularized flaps, synthetic grafts, sealants and glues, and multilayer reconstruction. Understanding which of these repair methods is appropriate and under what circumstances is paramount to achieving success in this challenging but rewarding field. A graduated approach to skull base reconstruction is presented to provide a systematic framework to guide selection of repair technique to ensure a successful outcome while minimizing morbidity for the patient...
March 31, 2017: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/28372813/innovations-in-balloon-catheter-technology-in-rhinology
#7
REVIEW
Brian D'Anza, Raj Sindwani, Troy D Woodard
Since being introduced more than 10 years ago, balloon catheter technology (BCT) has undergone several generations of innovations. From construction to utilization, there has been a myriad of advancements in balloon technology. The ergonomics of the balloon dilation systems have improved with a focus on limiting the extra assembly. "Hybrid" BCT procedures have shown promise in mucosal preservation, including treating isolated complex frontal disease. Multiple randomized clinical trials report improved long-term outcomes in stand-alone BCT, including in-office use...
March 31, 2017: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/28372812/advances-in-microdebrider-technology-improving-functionality-and-expanding-utility
#8
REVIEW
Dennis Tang, Brian C Lobo, Brian D'Anza, Troy Woodard, Raj Sindwani
Since its application in nasal surgery, the microdebrider has revolutionized the practice of endoscopic sinus surgery. As the demands and breadth of procedures performed endoscopically have increased, so has the need for improvement in the microdebrider and related technologies. This article addresses how use of the microdebrider has impacted endonasal surgery and discusses current advances, which include creation of specialty hand pieces and blades, increases in instrument rotational speed, incorporation of navigation and energy, adaptation for intracranial use, and disposable instrumentation designed for in office use...
March 31, 2017: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/28347482/robotics-in-sinus-and-skull-base-surgery
#9
REVIEW
Sanjeet Rangarajan, Ralph Abi Hachem, Enver Ozer, Andre Beer-Furlan, Daniel Prevedello, Ricardo L Carrau
Transoral robotic surgery (TORS) has been proven to be safe and to yield acceptable oncological and functional outcomes for surgery of the oropharynx, hypopharynx, supraglottis, and glottis. TORS has been successful at reducing morbidity, improving quality of life, and providing access to areas that previously required mandibulotomy or other more radical approaches in the past. This has changed the paradigm of management of tumors in these anatomic locations. In this article, the authors review the recent literature discussing the role of robotic surgery in managing sinonasal and skull base pathology and discuss its current advantages and limitations...
March 24, 2017: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/28325634/emerging-roles-of-coblation-in-rhinology-and-skull-base-surgery
#10
REVIEW
Garret W Choby, Peter H Hwang
Coblation is a technology that incorporates bipolar radiofrequency energy to ablate tissue at relatively low temperatures. Its use for sinonasal surgery is actively being investigated, including applications for turbinate reduction, sinus surgery, skull base surgery, and adenoidectomy. Potential benefits include reduction in blood loss, improved endoscopic surgical visualization, and reduction in postoperative pain. The main drawbacks are its relatively high cost, potential adverse effects on functional epithelium, and relative paucity of long-term outcomes...
March 18, 2017: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/28325633/trends-in-the-use-of-stents-and-drug-eluting-stents-in-sinus-surgery
#11
REVIEW
Leah J Hauser, Justin H Turner, Rakesh K Chandra
Stenting has long been used in the paranasal sinuses with the goals of maintaining a patent sinus cavity during the postoperative healing process and preventing restenosis from inflammation or scarring. More recently, drug-eluting stents have been introduced. Steroid-impregnated dressings and implants appear to be safe, although likely have increased systemic absorption compared with topical nasal steroid sprays and rinses. There is evidence to support the use of steroid-releasing implants in the ethmoid cavity in the postoperative period; however, more study is needed to truly define the role of these implants...
March 18, 2017: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/28318535/organism-and-microbiome-analysis-techniques-and-implications-for-chronic-rhinosinusitis
#12
REVIEW
Ashleigh A Halderman, Andrew P Lane
Modern advances in DNA sequencing have allowed for the development of culture-independent techniques with application to infectious and inflammatory conditions, such as rhinosinusitis. Although paradigm-changing discoveries have resulted from molecular microbiologic methods for a number of diseases, insights provided into the role of bacteria in chronic rhinosinusitis have yet to be fully understood to the point of impacting clinical diagnosis and management. As culture-independent techniques continue to evolve and become more refined, it is likely that a better understanding will emerge of how the microbiome influences chronic rhinosinusitis pathogenesis and response to therapy...
March 16, 2017: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/28284452/advances-in-absorbable-biomaterials-and-nasal-packing
#13
REVIEW
Conner J Massey, Ameet Singh
Nasal biomaterials have been developed to improve postoperative outcomes after functional endoscopic sinus surgery (FESS). These products have been designed to overcome certain common complications in FESS, and to maximize patient comfort. This article evaluates the performance of nonabsorbable and absorbable packing with respect to these outcomes. The collected trials suggest superior performance of bioabsorbable packs compared with absorbable packs with respect to patient comfort. For hemostasis and wound healing, variation in performance metrics makes interstudy comparison difficult...
March 9, 2017: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/28162242/endoscopic-resection-of-pterygopalatine-fossa-and-infratemporal-fossa-malignancies
#14
REVIEW
Gretchen M Oakley, Richard J Harvey
The endoscopic resection of pterygopalatine and infratemporal fossa malignancies allows excellent visualization and manipulation of tissues in an anatomically complex area compared with open approaches. With less approach morbidity, endoscopic endonasal surgery allows an easier recovery and earlier transition to adjuvant radiotherapy. The endoscopic approach is minimal access but rarely minimally invasive. Surgeons should not hesitate to gain wide surgical exposure of the pterygopalatine, infratemporal fossa, and petrocavernous carotid artery to ensure comfortable maneuverability and easy visualization of the tumor and its normal tissue margins...
February 2, 2017: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/28162241/transfacial-and-craniofacial-approaches-for-resection-of-sinonasal-and-ventral-skull-base-malignancies
#15
REVIEW
Elizabeth L Perkins, Bryan M Brandon, Satyan B Sreenath, Dipan D Desai, Brian D Thorp, Charles S Ebert, Adam M Zanation
Malignancies of the paranasal sinuses and ventral skull base present unique challenges to physicians. A transfacial or craniofacial approach allows for wide, possibly en bloc resection and is ideal for tumors that involve surrounding soft tissue, the palate, the orbit, anterolateral frontal sinus, and lateral dura. Transfacial approaches include a lateral rhinotomy often combined with a medial, subtotal, or total maxillectomy. Reconstruction is most commonly performed with a pericranial flap to separate the intranasal and intracranial compartments...
February 2, 2017: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/28162240/endoscopic-resection-of-sinonasal-and-ventral-skull-base-malignancies
#16
REVIEW
Ghassan Alokby, Roy R Casiano
The transnasal endoscopic resection of ventral skull base lesions represents a safe and effective method for the surgical management of sinonasal and ventral skull base malignancies in carefully selected cases. The goal of surgery is complete removal of all tumor with negative resection margins while maintaining the key oncological principles. Careful selection of cases along with the presence of an experienced surgeon and a fully involved multidisciplinary skull base team trained in the management of ventral skull base neoplasm are essential for excellent outcomes...
February 2, 2017: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/28160998/overview-of-sinonasal-and-ventral-skull-base-malignancy-management
#17
REVIEW
Peter F Svider, Michael Setzen, Soly Baredes, James K Liu, Jean Anderson Eloy
Significant technological advances have fostered a movement toward minimally invasive surgical interventions for the management of ventral skull base malignancies. The care of patients with these lesions ideally involves an interdisciplinary skull base team that includes otolaryngologists, neurologic surgeons, radiation oncologists, and medical oncologists. This overview describes considerations essential for diagnosis, prognosis, and preoperative evaluation. Furthermore, surgical nuances, strategies for skull base reconstruction, and nonsurgical options are briefly discussed...
February 1, 2017: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/28160997/the-role-of-chemotherapy-in-the-management-of-sinonasal-and-ventral-skull-base-malignancies
#18
REVIEW
George A Scangas, Jean Anderson Eloy, Derrick T Lin
In most cases of advanced sinonasal and ventral skull base cancer, a multimodal treatment approach provides the best chance for improved outcomes. Depending on the tumor type and extent of disease, systemic chemotherapy has been shown to play an important role in neoadjuvant, concomitant, and adjuvant settings. The lack of randomized trials continues to limit its indications. Further high-quality studies are needed to understand ideal chemotherapeutic regimens and their role and sequential timing in sinonasal and ventral skull base cancer...
February 1, 2017: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/28160996/survival-morbidity-and-quality-of-life-outcomes-for-sinonasal-and-ventral-skull-base-malignancies
#19
REVIEW
Suat Kilic, Sarah S Kilic, Soly Baredes, James K Liu, Jean Anderson Eloy
Sinonasal and ventral skull base malignancies are a rare, heterogeneous group of cancers. Although prognosis usually depends on many factors, long-term survival rates remain low despite recent advances. Population-based databases are powerful resources for studying survival outcomes. However, institutional retrospective chart-review studies have been able to provide more insight on recurrence patterns, morbidity, and quality-of-life metrics, as well as more details of the treatment information that may affect outcomes...
February 1, 2017: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/28160995/the-making-of-a-skull-base-team-and-the-value-of-multidisciplinary-approach-in-the-management-of-sinonasal-and-ventral-skull-base-malignancies
#20
REVIEW
Carl H Snyderman, Eric W Wang, Juan C Fernandez-Miranda, Paul A Gardner
The management of sinonasal and ventral skull base malignancies is best performed by a team. Although the composition of the team may vary, it is important to have multidisciplinary representation. There are multiple obstacles, both individual and institutional, that must be overcome to develop a highly functioning team. Adequate training is an important part of team-building and can be fostered with surgical telementoring. A quality improvement program should be incorporated into the activities of a skull base team...
February 1, 2017: Otolaryngologic Clinics of North America
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