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Atlas of Operative Otorhinolaryngology and Head & Neck Surgery (2 Volumes)
Bachi T Hathiram, Vicky S Khattar
SECTION 1: OTOLOGY AND LATERAL SKULL BASE
CHAPTER 1:
The Surgical Technique of Otoplasty
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
1. Perioperative Routine
2. Skin Incision
3. Creation of the Antihelical Fold
4. Correction of the Conchal Bowl
5. Lobule and Helical Rim Positioning
6. Dressing and Postoperative Care
NEW TECHNIQUES IN THE SURGERY
The Négrevergne Otoplasty Technique
COMPLICATIONS
OTHER TREATMENT OPTIONS AVAILABLE FOR THE SAME CONDITION
SUMMARY
ACKNOWLEDGEMENT
CHAPTER 2:
Single Stage Pinna Reconstruction
INTRODUCTION
INDICATIONS
SPECIFIC PREOPERATIVE EVALUATIONS—EVALUATION OF DEGREE OF MICROTIA
Aguilar and Jahrsdoerfer Classification
Four Stages: By Brent Technique
First Stage: Auricular Framework Fabrication with Contralateral Rib Cartilage
Second Stage: Lobule Transposition
Third Stage: Auricular Framework Elevation
Fourth Stage: Tragus Construction
Nagata Technique
Stage I: Fabrication of Auricular Framework, Tragus Reconstruction and Lobule Transposition
Stage II: Framework Elevation
COMPLICATIONS
Ear Reconstruction Site
Cartilage Donor Site
SURGICAL STEPS FOR SINGLE STAGE PINNA RECONSTRUCTION
Preoperation and Preparation
Local Anesthesia
Implant Preparation
Harvesting the Abdominal, Chest Wall or Inguinal Skin Grafts
Elevation Scalp Flaps, Elevating Temporoparietal Fascia Flaps, Lobule Transposition14
Implant Placement
Suture Skin Grafts
Dressing
POSTOPERATION
CHAPTER 3:
Treatment of Earlobe Keloids
INTRODUCTION
PATHOLOGY
TREATMENT
CHAPTER 4:
Preauricular Sinus
INTRODUCTION
INDICATIONS FOR SURGERY
PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS (FIGS 1 TO 6)
COMPLICATIONS AND THEIR MANAGEMENT
Intraoperative Complications
Postoperative Complications
ACKNOWLEDGMENTS
CHAPTER 5:
External Auditory Canal Obliteration
STEPS OF SURGERY
CHAPTER 6:
Meatoplasty
DEFINITION
INDICATIONS
SPECIFIC PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
SURGERY
Principle of Surgery
Steps of the Surgical Procedure
OTHER TECHNIQUES OF MEATOPLASTY
Meatoplasty Using a Koerner's Flap
Siebenmann's Meatoplasty
Portmann's Technique of Conchomeatoplasty4
POINTS TO REMEMBER
THE SURGICAL TECHNIQUE OF REVISION MEATOPLASTY
CONCLUSION
CHAPTER 7:
Intratympanic Injection
INTRODUCTION
INDICATIONS
PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
DOSAGES
FREQUENCY
NEWER TECHNIQUES AND MODIFICATION8
COMPLICATIONS AND their MANAGEMENT
CHAPTER 8:
Surgical Approaches to the Middle Ear Cleft and Their Indications
INFILTRATION
BASIC INCISIONS
Rosen's Endomeatal Incision
Indications
Lempert's Endaural Incision
Indications
Wilde's Postaural Incision
Indications
ACKNOWLEDGMENTS
CHAPTER 9:
Tympanoplasty (Author's Technique)
INTRODUCTION
INDICATIONS FOR THE SURGERY
PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
Method of Local Infiltration
STEPS OF SURGERY
Dry and Clean the Ear
The Posterior Incision
Raising the Posterior Tympanomeatal Flap
Inspection of the Middle Ear
Strip the Malleus
The Anterior Incision
Raising the Anterior Tympanomeatal Flap
Harvest of the Fascia Lata
Preparation of a Graft
Placement of the Graft in the Middle Ear
Canal Packing
POSTOPERATIVE EVALUATION
MODIFICATIONS SUGGESTED
COMPLICATIONS
SPECIAL INSTRUMENTS USED FOR THE SURGERY
ADVANTAGES OF AUTHOR’S TYMPANOPLASTY
CHAPTER 10:
Ossiculoplasty
INTRODUCTION
AUSTIN’S CLASSIFICATION OF OSSICULAR CHAIN DEFECTS
PATIENT SELECTION (INDICATIONS) FOR OSSICULOPLASTY
PREOPERATIVE EVALUATION
ANESTHESIA
GRAFT MATERIALS USED FOR OSSICULOPLASTY
Autografts
Homografts
Alloplastic Prosthesis
SURGICAL STEPS OF INCUS INTERPOSITION OSSICULOPLASTY
Approach
Posterior Canal Wall Incision and Tympanomeatal Flap Elevation
Clearance of Middle Ear Disease
Refashioning the Incus
Detachment of Incus
Drilling the Incus
Repositioning the Incus
Alloplastic Prosthesis
Outcome Measures
COMPLICATIONS
SPECIAL INSTRUMENTS USED FOR THE SURGERY (Figs 7A to D)
CHAPTER 11:
The Vibrant Soundbridge
INTRODUCTION
Vibrating Ossicular Prosthesis Template
Crimping Forceps
HISTORICAL REVIEW
THE DEVICE
COMPARISON WITH A HEARING AID
TECHNIQUES
SENSORINEURAL HEARING LOSS (Fig. 10)
CONDUCTIVE AND MIXED HEARING LOSS (Fig. 11)
SURGICAL PROCEDURE
Incision
The “Facial Recess” Route
The “Device-seat” and “Tie-down” Holes
Routes to the Middle Ear
The Facial Recess Route (Fig. 13)
The Transmeatal Route (Fig. 14)
Fixation of Demodulator
Floating Mass Transducer Placement in Incus Vibroplasty
Opening the FMT Clip with a Straight Needle (Fig. 16)
SUMMARY
ACKNOWLEDGMENT
CHAPTER 12:
Totally Implantable Middle Ear Device Esteem®
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
NEW TECHNIQUES IN THE SURGERY
COMPLICATIONS
SPECIAL INSTRUMENTS USED FOR THE SURGERY
OTHER TREATMENT OPTIONS AVAILABLE FOR THE SAME CONDITION
CHAPTER 13:
The Surgical Management of Cholesteatoma
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
The Simple Mastoidectomy
Intact Canal Wall or Canal Wall Up Mastoidectomy
Canal Wall Down Mastoidectomy
Radical Mastoidectomy
Atticotomy/Limited Mastoidectomy
Surgical Incision/Approach
Postauricular Incision
Endaural Incision
Surgical Methods
Introduction
Simple Mastoidectomy
Intact Canal Wall Up Mastoidectomy—Posterior Tympanotomy—Combined Approach
Canal Wall Down Mastoidectomy
Radical Mastoidectomy
Canal Wall Down Versus Canal Wall Up/The Controversy
Atticotomy—Limited Mastoidectomy—The Third Way in Cholesteatoma Surgery
Postoperative Care
COMPLICATIONS
Facial Nerve Injury
Hearing Loss
Infection
Vertigo
Intracranial Injury
Bleeding
Chronic Aural Discharge
SPECIAL INSTRUMENTS USED FOR THE MIDDLE EAR SURGERY
CONCLUSION
CHAPTER 14:
Transposed Canal Wall Tympanomastoidectomy
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
Features
COMPLICATIONS
SPECIAL INSTRUMENTS USED FOR THE SURGERY
OTHER TREATMENT OPTIONS AVAILABLE FOR THE SAME CONDITION
CHAPTER 15:
Inside-Out Mastoidectomy
PHILOSOPHY OF INSIDE-OUT MASTOIDECTOMY
INDICATIONS FOR INSIDE-OUT SURGERY
PREOPERATIVE EVALUATION AND ANESTHETIC CONSIDERATIONS ARE THE SAME AS FOR ANY ROUTINE EAR SURGERY
SURGICAL STEPS
Incision
Musculoperiosteal Incision
Atticotomy
Canal Wall Down
Facial Nerve
Ossiculoplasty
Partial Obliteration of Cavity
Management of Exposed Dura
Meatoplasty
Closure
ADVANTAGES OF INSIDE-OUT TECHNIQUE
CHAPTER 16:
The Surgical Management of Congenital Cholesteatoma
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
Presentation
Surgical Assessment
ANESTHETIC CONSIDERATIONS
SURGICAL APPROACHES AND STEPS
Transcanal
Surgical Steps
Endaural
Surgical Steps
Extended Tympanotomy
Surgical Steps
Intact Canal Wall
Surgical Steps
Canal Wall Down
Surgical Steps
Postoperative Considerations
COMPLICATIONS
SPECIAL INSTRUMENTS USED FOR THE SURGERY
NEW TECHNIQUES
OTHER TREATMENT OPTIONS
CHAPTER 17:
The Technique of Otoendoscopy for Cholesteatoma Surgery
INTRODUCTION
PREOPERATIVE EVALUATION
INSTRUMENTATION AND SURGICAL TECHNIQUE
Detailed Description of the Endoscopic Ear Surgery Setup: Whether Exclusive Endoscopic or Endoscope Assisted Ear Surgery
SURGICAL TECHNIQUES
CONCLUSIONS
CHAPTER 18:
Endoscopic Management of Cholesteatoma
APPLIED ENDOSCOPIC ANATOMY FOR CLEARANCE OF CHOLESTEATOMA
Anatomy of Posterior Mesotympanum— The Retrotympanic Recesses (Fig. 1)
Anatomical Bony Landmarks in the Posterior Mesotympanum
Anatomy of Attic1,2
Boundaries
Attic Classification1
Applied Anatomy
CHOLESTEATOMA CONCEPTS, APPROACHES AND CLASSIFICATION
Traditional Microscopic Approaches for Cholesteatoma
Role of Endoscope in Management of Cholesteatoma
Endoscope-Assisted Combined Approach Tympanoplasty
Endoscopic Permeatal Tympanoplasty for Cholesteatoma
Endoscopic Second Look
Author's Approach to Cholesteatoma
Preparation
Preoperative Evaluation
Aim of Preoperative Evaluation
Intraoperative Evaluation
Why the Mesotympanic Work First in all Cases?
Management as per the Staged Extent of Cholesteatoma
Instruments
Instrumentation
Troubleshooting
Anesthesia
ENDOSCOPIC PERMEATAL TYMPANOPLASTY FOR CHOLESTEATOMA
Surgical Steps
Incision, Tympanomeatal Flap and Exposure
Clearance of Cholesteatoma from the Hidden Areas—Endoscopic Vision is a Boon
Hypotympanum
Sinus Tympani
Ossicular Area
Protympanum
Attic
Aditus
Reconstruction of Middle Ear
Ossicular Reconstruction
Attic and Tympanic Membrane Reconstruction
Postoperative Problems
Residual Cholesteatoma
Retraction
Middle Ear Ventilation
Perforations
ENDOSCOPE-ASSISTED COMBINED APPROACH TYMPANOPLASTY
RELOOK
The Need
Indications
Contraindications
Methods
Second Look Surgical Procedural Steps
Second Look Mastoidoscopy
Second Look Lateral Tympanotomy
Conclusion
CONCLUSION
ACKNOWLEDGMENTS
CHAPTER 19:
Surgical Management of Complications of Chronic Suppurative Otitis Media
INTRODUCTION
MODE OF SPREAD OF INFECTION
SPECIFIC INVESTIGATIONS
ANESTHETIC CONSIDERATIONS
CONTRAINDICATIONS
STEPS OF SURGERY
ACKNOWLEDGMENTS
CHAPTER 20:
Tympanosclerosis: Surgery and Hearing Results
INTRODUCTION
SURGICAL TREATMENT
POSTOPERATIVE RESULTS
CHAPTER 21:
Stapedotomy
INTRODUCTION
INDICATION
CONTRAINDICATIONS
SPECIFIC INVESTIGATION
ANESTHETIC CONSIDERATIONS
STEPS OF SURGERY (Figs 1 to 10)
Steps for “Reverse Stapedotomy”
SPECIAL CONSIDERATIONS
COMPLICATIONS
POSTOPERATIVE CONSIDERATIONS
RECENT ADVANCES
ACKNOWLEDGMENTS
CHAPTER 22:
Total Decompression of the Facial Nerve—Superior Prelabyrinthine Cell Tracts Approach
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
NEW TECHNIQUES IN THE SURGERY
COMPLICATIONS
SURGICAL STEPS
SPECIAL INSTRUMENTS USED FOR THE SURGERY
OTHER TREATMENT OPTIONS AVAILABLE FOR THE SAME CONDITION
CHAPTER 23:
Zygomatic Root Approach
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
Features
COMPLICATIONS
SPECIAL INSTRUMENTS USED FOR THE SURGERY
OTHER TREATMENT OPTIONS AVAILABLE FOR THE SAME CONDITION
CHAPTER 24:
Decompression of the Facial Nerve Following Traumatic Palsy
INTRODUCTION
INDICATIONS FOR DECOMPRESSION OF THE NERVE
EVALUATION OF FACIAL NERVE FUNCTION
SPECIFIC INVESTIGATIONS
ANESTHETIC CONSIDERATIONS
STEPS OF SURGERY
Traumatic Facial Nerve Paralysis
Slitting the Nerve Sheath
Coexistent Post-traumatic Cerebrospinal Fluid Otorrhea and Facial Palsy
Important Landmarks
Trauma at the Stylomastoid Foramen
Iatrogenic Facial Nerve Paralysis
CONTRAINDICATIONS TO SURGICAL DECOMPRESSION
CHAPTER 25:
Bone Conduction Implants
INTRODUCTION
INDICATIONS
AUDIOLOGICAL INVESTIGATIONS
RADIOLOGICAL INVESTIGATIONS
SURGICAL INSTRUMENTS
Cochlear Baha® Instrument Organizer
Abutment Inserter
Implant Inserter
Widening Drill
SURGICAL TECHNIQUE SELECTION
FAST or single-stage surgery in:
Two-Stage Surgery in:
SURGICAL STEPS
Mark the Site with Template
Linear Incision
Exposure of Cortical Bone
Drilling Fixture
Widening Drill
Fixture with Abutment Installation in FAST or Single-Stage Surgery
Soft Tissue Reduction in FAST Procedure
FAST Surgery: Wound Closure and Abutment Exposed
Fixture with Mount Installation
Second-Stage of Two-Stage
Second-Stage of Two-Stage: Removal of Cover Screw
Second-Stage of Two-Stage: Abutment Insertion
Bringing Abutment Out/Healing Cap
COMPLICATIONS
Intraoperative
Perioperative
Postoperative
SOUND PROCESSOR FITTING
ACKNOWLEDGMENTS
CHAPTER 26:
Minimally Invasive Cochlear Implantation with Mastoidal Three-Layer Flap
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
Features
COMPLICATIONS
SPECIAL INSTRUMENTS USED FOR THE SURGERY
OTHER TREATMENT OPTIONS AVAILABLE FOR THE SAME CONDITION
CHAPTER 27:
Cochlear Implants
INDICATIONS FOR THE SURGERY
CONTRAINDICATIONS
SPECIFIC PREOPERATIVE EVALUATION
Audiological Evaluation
Imaging
Pediatric Evaluation
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
COMPLICATIONS
SPECIAL INSTRUMENTS USED FOR THE SURGERY
CHAPTER 28:
Cochlear Implantation
BACKGROUND
INDICATIONS FOR THE SURGERY
Candidacy Criteria
SPECIFIC PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
NEW TECHNIQUES IN THE SURGERY
Modifications in Technique
POSTOPERATIVE CARE
COMPLICATIONS
SPECIAL INSTRUMENTS USED FOR THE SURGERY
Other Treatment OptioNS
ACKNOWLEDGMENTS
CHAPTER 29:
Cochlear Implants
COMPONENTS OF A COCHLEAR IMPLANT SYSTEM
TYPES OF COCHLEAR IMPLANTS2
SPEECH PROCESSING STRATEGIES2
INDICATIONS FOR COCHLEAR IMPLANTATION3
CONTRAINDICATIONS FOR COCHLEAR IMPLANTATION3
PREOPERATIVE ASSESSMENT
COCHLEAR IMPLANTATION SURGERY
POSTOPERATIVE MANAGEMENT
COMPLICATIONS OF COCHLEAR IMPLANTATION
SWITCH-ON and MAPPING OF COCHLEAR IMPLANT
MEASURING LEVEL OF PERFORMANCE
OUTCOMES OF COCHLEAR IMPLANTATION
DIFFICULT SCENARIOS IN COCHLEAR IMPLANTATION
Cochlear Implantation in Labyrinthitis Ossificans
Cochlear Implantation in Mondini's Deformity/Large Vestibular Aqueduct Syndrome
Auditory Neuropathy/Auditory Dys-synchrony Spectrum Disorder
Cochlear Implantation in Multihandicapped Individuals
Minimally Invasive Cochlear Implantation4
Cochlear Endoscopy
Perimodiolar and Midscalar Cochlear Implantation
Bilateral Cochlear Implantation
FUTURE DIRECTIONS IN COCHLEAR IMPLANTATION
CHAPTER 30:
Totally Implantable Hearing Devices
INCLUSION CRITERIA FOR TOTALLY IMPLANTABLE HEARING DEVICES
OPERATIVE PROCEDURE FOR TOTALLY IMPLANTABLE HEARING DEVICE
SUMMARY
CHAPTER 31:
Auditory Brainstem Implants
INDICATIONS FOR AUDITORY BRAINSTEM IMPLANTATION
CLINICAL ASSESSMENT FOR AUDITORY BRAINSTEM IMPLANTATION
OPERATIVE PROCEDURE FOR AUDITORY BRAINSTEM IMPLANTATION
HABILITATION AFTER AUDITORY BRAINSTEM IMPLANTATION
OUTCOMES OF AUDITORY BRAINSTEM IMPLANTATION
DISCUSSION
SUMMARY
CHAPTER 32:
Direct Acoustical Cochlear Stimulator
INDICATIONS FOR DIRECT ACOUSTICAL COCHLEAR STIMULATOR
CHAPTER 33:
Electro-Acoustic Stimulation/Hybrid Implants
INDICATIONS
COMPONENTS OF HYBRID IMPLANT
BENEFITS OF HYBRID HEARING
SUMMARY
CHAPTER 34:
Auditory Midbrain Implants
INDICATIONS FOR AUDITORY MIDBRAIN IMPLANT
OPERATIVE PROCEDURE FOR AUDITORY MIDBRAIN IMPLANT
SUMMARY
CHAPTER 35:
Endolymphatic Sac Surgery for Meniere's Disease
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
NEW TECHNIQUES IN THE SURGERY
COMPLICATIONS
SPECIAL INSTRUMENTS USED FOR THE SURGERY
OTHER TREATMENT OPTIONS AVAILABLE FOR THE SAME CONDITION
CHAPTER 36:
Transmastoid Repair of Temporal Meningoencephaloceles and Cerebrospinal Fluid Otorrhea
INTRODUCTION
TEMPORAL BONE DEFECTS, CEREBROSPINAL FLUID LEAKS AND MENINGOENCEPHALOCELES
Congenital Defects
Chronic Otitis Media and Iatrogenic Lesions
Post-Traumatic Defects
SURGICAL APPROACHES
The Subtemporal Approach
The Transmastoid Approach
Combined Approach
MATERIALS FOR RECONSTRUCTION
ORGANIC TISSUES
Alloplastic Materials
CONCLUSION
SUMMARY
CHAPTER 37:
The Surgical Management of Cerebrospinal Fluid Otorrhea
INTRODUCTION
SPECIFIC INVESTIGATIONS
SPECIAL CONSIDERATIONS
Principles in the Management of CSF Leaks of the Temporal Bone
Materials Used to Repair and Reinforce the Defect
Techniques of the Multilayered Closure of the Defect17
STEPS OF SURGERY
Transmastoid Repair of CSF Otorrhea
ACKNOWLEDGMENTS
CHAPTER 38:
Decision-Making in Lateral Skull Base Surgery
INTRODUCTION
DECISION-MAKING IN VESTIBULAR SCHWANNOMA SURGERY
DECISION-MAKING IN GLOMUS TUMORS
DECISION-MAKING IN PETROUS AND PETROCLIVAL LESIONS
SUMMARY
CHAPTER 39:
Middle Fossa Approach
INTRODUCTION
INDICATIONS
SPECIFIC PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
General Procedure
Specific Considerations for Two Different Indications
Resurfacing Technique for Superior Semicircular Canal Dehiscence Syndrome (Figs 4 and 5)
Internal Auditory Canal Decompression for Skull Base Bone Dysplasias
ANY NEWER TECHNIQUE/MODIFICATION IN THE SURGERY
COMPLICATIONS
General Complications
Resurfacing Superior Semicircular Canal
SPECIAL INSTRUMENTS USED FOR THE SURGERY
CHAPTER 40:
Surgical Approach to Jugular Foramen Tumors (Infratemporal Fossa Type A)
INTRODUCTION
SURGICAL STEPS
CHAPTER 41:
Enlarged Translabyrinthine Approach
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
SURGICAL PROCEDURE
Incision
Extended Cortical Mastoidectomy
Labyrinthectomy
Exposure of Internal Auditory Meatus
Dural Incision and Draining of Cerebrospinal Fluid
Tumor Removal with Preservation of Facial Nerve
Closure
FACIAL NERVE FUNCTION (AUTHORS’ RESULTS)
ANESTHETIC CONSIDERATIONS
SPECIAL EQUIPMENT
COMPLICATIONS
CHAPTER 42:
Management of Vestibular Schwannoma: Dependence on Stakeholder's View for Small and Medium-Sized Tumors
INTRODUCTION
SIZE AND GROWTH RATE OF THE TUMOR
Localization
Age and General Medical Condition
Facial Nerve Function
Hearing and Hearing Deterioration Rate
Balance and Vestibular Function
Trigeminal Nerve Function
RISK OF MALIGNANT TRANSFORMATION AND RADIATION-INDUCED TUMORS
HEALTH-RELATED QUALITY OF LIFE MEASURES
PATIENT’S AND SURGEON’S PREFERENCE
COST-EFFECTIVENESS
DECISION ANALYSIS
SUMMARY
CHAPTER 43:
Gamma Knife Radiosurgery for Vestibular Schwannomas
INTRODUCTION
INDICATIONS FOR GAMMA KNIFE RADIOSURGERY
RESULTS OF GAMMA KNIFE RADIOSURGERY
COMPLICATIONS OF RADIOSURGERY
Risk of Facial Nerve Palsy
Risk of Hearing Deterioration
Risk of Trigeminal Nerve Neuropathy
Tumor Volume Increase after Radiosurgery
Hyporesorptive Hydrocephalus
Secondary Malignant Tumors
STEREOTACTIC FRACTIONATED RADIOTHERAPY
CONSERVATIVE APPROACH—NATURAL COURSE OF THE DISEASE
SUMMARY
CHAPTER 44:
Jugular Glomus: Literature Review and Surgical Technique
INTRODUCTION
SPECIFIC PREOPERATIVE EVALUATION
Epidemiology
Diagnosis
Clinical Aspects
Surgical Anatomy
Management of Glomus Tumors
Embolization
Radiation
Surgery
ANESTHETIC CONSIDERATIONS
SURGICAL TECHNIQUE
Position
Surgical Steps
Cranial Region Dissection
Cervical Dissection
Five Crucial Points in the Management of Glomus Tumors
Types A, B, C and D Approaches
CONCLUSION
GLOMUS JUGULAR TIPS
SECTION 2: RHINOLOGY AND ANTERIOR SKULL BASE
CHAPTER 45:
Septoplasty
HISTORY OF SEPTOPLASTY
ANATOMY
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
SPECIAL INSTRUMENTS
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
NEW TECHNIQUES IN THE SURGERY
COMPLICATIONS
CHAPTER 46:
Endoscopic Septoplasty
INTRODUCTION
INDICATIONS OF ENDOSCOPIC SEPTOPLASTY
Advantages over the Conventional Septoplasty
STEPS OF SURGERY
COMPLICATIONS
ACKNOWLEDGMENTS
CHAPTER 47:
Management of Septal Perforations
INDICATIONS FOR THE SURGERY
PREOPERATIVE CONSIDERATIONS
NONSURGICAL TREATMENT
SPECIFIC PREOPERATIVE EVALUATION
SURGICAL TECHNIQUES AND APPROACHES
NEW TECHNIQUES IN THE SURGERY
Closure of Septal Perforation with PDS Flexible Plate
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
POSTOPERATIVE CARE
SUMMARY
CHAPTER 48:
Septal Reconstructions
INDICATIONS FOR THE SURGERY
Septal Reconstruction with PDS Flexible Plate as Solution for the Difficult Septum
SPECIFIC PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
Further Applications of the Compound Graft
Combining Septum and Auricular Conchal Cartilage
Complete Septum Reconstruction with Bilateral Auricular Cartilage
SUMMARY
CHAPTER 49:
Nasal Fractures
INTRODUCTION
INDICATIONS FOR SURGERY
PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
OPEN REDUCTION
MODIFICATIONS IN SURGERY
COMPLICATIONS AND ITS MANAGEMENT
SPECIAL INSTRUMENTS FOR SURGERY
ACKNOWLEDGMENTS
CHAPTER 50:
Carbon Dioxide Laser Treatment of Rhinophyma
INTRODUCTION
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
Post-Treatment Care and Follow-Up
COMPLICATIONS
SPECIAL INSTRUMENTS USED FOR THE SURGERY
OTHER TREATMENT OPTIONS AVAILABLE FOR THE SAME CONDITION
CHAPTER 51:
Surgical Management of Oroantral Fistulae
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
Selection of Treatment Modalities
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
Modified Caldwell-Luc Surgery for Treatment of Odontogenic Sinusitis with Oroantral Fistulae
Functional Endoscopic Sinus Surgery for Treatment of Odontogenic Sinusitis with Oroantral Fistulae
Surgical Closure of Oroantral Fistula
Buccal Advancement Flap
Buccal Fat Pad
Palatal Rotation Flap
COMPLICATIONS
CHAPTER 52:
The Surgical Closure of an Oroantral Fistula
INTRODUCTION
INDICATIONS
SPECIFIC INVESTIGATIONS
STEPS OF SURGICAL CLOSURE
Buccal Flap
Palatal Flap
Buccal Pad of Fat Flap
STEPS OF SURGERY
RECENT ADVANCES
CHAPTER 53:
Atrophic Rhinitis—An Alternative Surgical Concept
INTRODUCTION
AN ENDOSCOPIC PICTURE OF ATROPHIC RHINITIS (Figs 1A AND B)
CT SCAN OF ATROPHIC RHINITIS OF NOSE—NASAL CAVITY AND PARANASAL SINUSES (FIGS 2A TO C)
HISTOLOGY OF ATROPHIC RHINITIS (FIGS 3A AND B)
MANAGEMENT MODALITIES
INDICATIONS, CONSIDERATIONS AND PREREQUISITES
ANESTHETIC CONSIDERATIONS
PROCEDURE AND SURGICAL STEPS (FIGS 4 TO 7)
THE SAC CREATION (FIGS 8A AND B)
PROCEDURE—INVERSION BOLGERIZATION NEOTURBINATE (FIG. 9)
ENDOSCOPIC VIEW—NASAL CAVITY INVERTED SAC (FIGS 10A TO C)
HEALTHY MUCOSA ORGANIZED BOLGERIZED NEOTURBINATE (FIG. 11)
CT SCAN—BOLGERIzED BILATERAL—NEOTURBINATE (FIGS 12 AND 13)
POSTOPERATIVE CARE
BOLGERIZED CONDITION OF NEOTURBINATE (TABLE 1)
COMPARATIVE STUDY WITH OTHER BOLGERIZED CASES (TABLE 2)
CONCLUSION
CHAPTER 54:
Combined Subciliary and Endoscopic Dacryocystorhinostomy
INTRODUCTION
INDICATIONS OF COMBINED SUBCILIARY AND ENDOSCOPIC DACRYOCYSTORHINOSTOMY
ADVANTAGES
Advantages Over External Dacryocystorhinostomy
Advantages Over Endonasal Dacryocystorhinostomy
PREOPERATIVE EVALUATION
Preoperative Anesthesia Evaluation
SURGICAL STEPS
Positions
Decongestion
Infiltration
Incision
Flap Elevation
Osteotomy
Exposure of Sac
Subciliary Incision
Dissection
Soft Tissue Anastomosis
Wound Closure
Nasal Packing
MODIFICATIONS SUGGESTED
COMPLICATIONS
SPECIAL INSTRUMENTS
OTHER TREATMENTS AVAILABLE
CHAPTER 55:
Endoscopic Dacryocystorhinostomy
INTRODUCTION
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
STEPS OF SURGERY
Use of Mitomycin-C
COMPLICATIONS (Figs 18 to 21)
SPECIAL INSTRUMENTS USED FOR THE SURGERY
Use of a Diode LASER
Use of a Microdebrider to Create a Large Rhinostomy
ADVANTAGES OF ENDOSCOPIC DACRYOCYSTORHINOSTOMY
ACKNOWLEDGMENTS
CHAPTER 56:
Endonasal Endoscopic Marsupialization of a Nasolabial Cyst
INTRODUCTION
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATION
SURGICAL STEPS (Figs 5A and B)
OTHER SURGICAL TECHNIQUE OR INSTRUMENTS
COMPLICATIONS
SPECIAL INSTRUMENTATION
OTHER TREATMENT OPTIONS AVAILABLE FOR THE SAME CONDITION
CHAPTER 57:
Endoscopic Sinus Surgery
INDICATIONS FOR THE SURGERY
EXTENDED APPLICATIONS
SPECIFIC PREOPERATIVE EVALUATION
History
Anterior Rhinoscopy
Nasal Endoscopy
IMAGING
Computed Tomography Scan of the Paranasal Sinuses
Magnetic Resonance Imaging of Paranasal Sinuses
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
Uncinectomy (Figs 1 to 3)
Maxillary Ostium Widening (Figs 4 and 5)
Approach to the Frontal Recess and Frontal Sinus (Figs 6 to 9)
Anterior Ethmoid Clearance (Fig. 10)
Posterior Ethmoid Clearance (Figs 11 and 12)
Approaching the Sphenoid Sinus (Figs 13 to 15)
Steps of Endoscopic Sinus Surgery
COMPLICATIONS
Intraoperative Complications
Bleeding
Orbital Injury
Cerebrospinal Fluid Leak
Optic Nerve Lesion
Postoperative Complications
Infections
Epistaxis
Adhesions
Epiphora
Anosmia
SPECIAL INSTRUMENTS USED FOR THE SURGERY
OTHER TREATMENT OPTIONS AVAILABLE FOR THE SAME CONDITION
CHAPTER 58:
The Technique of Functional Endoscopic Sinus Surgery
INTRODUCTION
SURGICAL ANATOMY
Roof
Lateral Wall (Figs 1A to C)
Frontal Cell Types (Bent and Kuhn)
Turbinates
Key Points
ANATOMICAL VARIATIONS
SURGICAL PRINCIPLES
Indications for the Surgery
Extended Indications
SETUP
Endoscopes
Key Point
Technical Skills
Suction
Forceps
Other Instruments
Video System
Powered Tools (Fig. 9A)
Endoscope Holding Techniques (Fig. 10A)
Chopstick Technique
Step 1
Step 2
Step 3
Positioning
Anesthetic Considerations
Preparation
Radiology
Uses
Coronal and Axial Views (Figs 12A to K and 13A to P)
Skull Base Level (Figs 13Q to T)
Radio-Pathology Images (Figs 16A to O)
TECHNIQUES
Septoplasty
Technique
Uncinectomy
Technique
Middle Meatal Antrostomy
Indications
Technique
Complications
Anterior Ethmoidectomy
Technique
Posterior Ethmoidectomy
Sphenoidotomy
Anteroposterior Approach
Posteroanterior Approach
Frontal Sinus Surgery
Key Points
Concha Bullosa Reduction
Technique
Balloon Sinuplasty
Technique and Principles
Turbinoplasty (Figs 25A to L)
Technique
Endoscopic Sphenopalatine Artery Ligation
Technique
Dacryocystorhinostomy
Technique
Medial Maxillectomy
Technique
Fungal Sinusitis (Fig 30A to F)
Frontal Mucocele (Figs 31A to G)
SKULL BASE SURGERY
Transnasal Endoscopic Pituitary Surgery
Technique
Cerebrospinal Fluid Repair
Technique
Complications
Preventive measures
Endoscopic Postoperative Care
ACKNOWLEDGMENTS
CHAPTER 59:
Revision Endoscopic Sinus Surgery: When, Why and How?
INTRODUCTION
WHEN?
WHY?
HOW?
EXAMPLE A: MISSED OSTIUM SEQUENCE
Description
EXAMPLE B: KUHN TYPE 3 CELL
Description
EXAMPLE C: FRONTAL BULLA CELL
Description
CHAPTER 60:
Endoscopic Management of Paranasal Sinus Mucopyoceles
INTRODUCTION
INDICATIONS
CONTRAINDICATIONS9
Absolute
Relative
SPECIFIC INVESTIGATIONS
STEPS OF SURGERY
Ethmoidal Mucopyocele
Supraorbital Mucopyocele
Maxillary Mucocele
ADVANTAGES OF THE ENDOSCOPIC APPROACH
RECENT ADVANCES
Maxillary Mucocele (Figs 27 to 35)
ACKNOWLEDGMENTS
CHAPTER 61:
Sphenopalatine Artery Ligation
INTRODUCTION
INDICATIONS FOR SURGERY
SPECIFIC PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
SPECIAL INSTRUMENTS USED FOR THE SURGERY
OTHER TREATMENT OPTIONS AVAILABLE FOR THE SAME CONDITION
CHAPTER 62:
Endonasal Endoscopic Repair of Choanal Atresia
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS (Figs 1 to 18)
NEW TECHNIQUES IN THE SURGERY
COMPLICATIONS
OTHER TREATMENT OPTIONS AVAILABLE FOR THE SAME CONDITION
CONCLUSION
CHAPTER 63:
The Surgical Technique of Adenoidectomy
INTRODUCTION
Function
INDICATIONS FOR THE SURGERY
Surgical Indications for Adenoidectomy
Contraindications
Diagnostic Assessment of Adenoids
SPECIFIC PREOPERATIVE EVALUATION
SURGICAL STEPS
Operating Techniques
New techniques in the surgery
Postoperative Care
COMPLICATIONS
ALTERNATIVE TREATMENT TO ADENOIDECTOMY
CHAPTER 64:
Adenoidectomy
INDICATIONS FOR THE SURGERY
SURGICAL STEPS
Adenoidectomy Techniques
Positioning and Preparations for Surgery and Anesthesia
Curette Adenoidectomy
Postoperative Care
OTHER TECHNIQUES IN THE SURGERY
Suction Electrocautery
Power Assisted Microdebridement
COMPLICATIONS
SPECIAL INSTRUMENTS USED FOR THE SURGERY AND POSITION
CHAPTER 65:
Overcoming Challenges in the Endoscopic Management of Sinonasal Tumors
INTRODUCTION
MATERIALS AND METHODS
DISCUSSION
Challenges
Infratemporal Fossa Involvement
Orbital Conservation
Piecemeal Versus En Bloc Resection
Wide Margins
Palliation Versus Cure
Preoperative Versus Postoperative Radiotherapy
The Role of Chemotherapy
RESULTS
CONCLUSION
SUMMARY
ACKNOWLEDGMENTS
CHAPTER 66:
Endonasal Endoscopic Orbital Decompression in Graves’ Disease
INTRODUCTION
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATION
SURGICAL STEPS (Figs 1 to 3)
COMPLICATIONS
SPECIAL INSTRUMENTS USED FOR THE SURGERY
OTHER TREATMENT OPTIONS AVAILABLE FOR THE SAME CONDITION
CONCLUSION
CHAPTER 67:
Endonasal Endoscopic Orbital Decompression
INTRODUCTION
INDICATIONS FOR THE SURGERY
ANESTHETIC CONSIDERATIONS
SPECIFIC INVESTIGATIONS
SURGERY OF ORBITAL DECOMPRESSION
Other Approaches Used for Orbital Decompression
Steps of Endoscopic Orbital Decompression
ADVANTAGES
CONTRAINDICATIONS
COMPLICATIONS
ACKNOWLEDGMENTS
CHAPTER 68:
Endoscopic Endonasal Reduction Surgery for Isolated Inferior Blowout Fracture
BACKGROUND AND THE MODIFIED TECHNIQUES FOR THE SURGERY
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
Supplementary Procedures
Reduction Surgery
Intraoperative Eye Traction Test and Incomplete Cases
Reconstruction of the Inferior Orbital Wall (Orbital Floor) and Nasal Packing
COMPLICATIONS
POSTOPERATIVE MANAGEMENT AND EVALUATION
OTHER TREATMENT OPTIONS AVAILABLE FOR THE SAME CONDITION
NEW TECHNIQUES IN THE SURGERY
CHAPTER 69:
Endoscopic Optic Nerve Sheath Fenestration for Idiopathic Intracranial Hypertension
DEFINITION OF IDIOPATHIC INTRACRANIAL HYPERTENSION
DIAGNOSTIC CRITERIA
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
NEWER MODIFICATION IN THE TECHNIQUE
COMPLICATIONS
INSTRUMENTS
OTHER TREATMENT OPTIONS
CHAPTER 70:
Endoscopic Optic Nerve Decompression
INTRODUCTION
ANATOMICAL AND PATHOPHYSIOLOGICAL CONSIDERATIONS
INDICATIONS FOR ENDOSCOPIC DECOMPRESSION
SPECIFIC INVESTIGATIONS FOR ASSESSMENT
SURGERY
Approaches in the Past
Steps of Surgery
CONTRAINDICATIONS
COMPLICATIONS
ADVANTAGES
ACKNOWLEDGMENTS
CHAPTER 71:
Endonasal Resection of an Angiofibroma
INTRODUCTION
DIAGNOSIS
INDICATIONS FOR SURGERY
PREOPERATIVE EVALUATION
EMBOLIZATION
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS OF ENDONASAL RESECTION OF AN ANGIOFIBROMA (FIGS 3 TO 21)
Special Equipments
Surgical Principles
Nasal Preparation
Nasal Access
Tumor Mobilization and Resection
COMPLICATIONS
ALTERNATIVE TREATMENT OPTIONS
CHAPTER 72:
Endoscopic Embolization and Resection of Juvenile Nasopharyngeal Angiofibromas
CHAPTER 73:
Endoscopic Excision of Angiofibroma: Operative Technique and Applied Anatomy
APPLIED ANATOMY
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
Imaging
Hematological Evaluation
General Systemic Evaluation
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
Steps
Conclusion
NEWER TECHNIQUE AND MODIFICATIONS IN THE SURGERY
COMPLICATIONS
OTHER TREATMENT OPTIONS AVAILABLE FOR THE SURGERY
CHAPTER 74:
Endoscopic Management of Juvenile Nasopharyngeal Angiofibroma
INTRODUCTION
Points to Remember
INDICATIONS FOR THE SURGERY
PREOPERATIVE EMBOLIZATION
STEPS OF SURGERY
Tricky Situations
Situation 1: Lack of working space (Figs 28 to 32)
Situation 2: Extensive Infratemporal fossa involvement (Figs 33 to 37)
Situation 3: Intraorbital and intracranial extension with sudden onset blindness (Figs 38 to 52)
Situation 4: Extensive intracranial involvement (Figs 58 to 61)
CONCLUSION
ACKNOWLEDGMENTS
CHAPTER 75:
The Surgical Management of Skullbase Tumors Extending to the Infratemporal Fossa
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
SURGICAL STEPS
Positioning
Skin Incision
Reflection of Cutaneous Flap and Temporalis Muscle
Zygomatic Osteotomy
Orbitozygomatic Osteotomy
Temporal Base Drilling and Skeletonization of Foramen Ovale and Rotundum (Figs 6 to 8)
Tumor Exposure by Opening Pseudocapsule and Subcapsular Tumor Resection (Figs 9 to 12)
NEW TECHNIQUES IN THE SURGERY
COMPLICATIONS
CHAPTER 76:
Cerebrospinal Fluid Leakage Diagnosis
TRAUMATIC CEREBROSPINAL FLUID LEAKS
NONTRAUMATIC CEREBROSPINAL FLUID LEAKS
ILLUSTRATIVE CASE
SODIUM FLUORESCEIN
SODIUM FLUORESCEIN PRODUCTION
CHAPTER 77:
Endoscopic Repair of CSF Rhinorrhea
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
Imaging
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
Cribriform Plate Defects
Sphenoid Sinus Defects
Roof of Ethmoid
COMPLICATIONS
SPECIAL INSTRUMENTS USED FOR THE SURGERY
OTHER TREATMENT OPTIONS AVAILABLE FOR THE SAME CONDITION
CHAPTER 78:
Endonasal Endoscopic Management of CSF Rhinorrhea
INTRODUCTION
INDICATIONS
SPECIFIC INVESTIGATIONS
MATERIALS/TISSUES USED FOR CLOSURE OF THE LEAK
ANESTHETIC CONSIDERATIONS
INTRAOPERATIVE IDENTIFICATION OF THE SITE OF THE CSF LEAK
STEPS OF SURGERY (FOR SPONTANEOUS LEAKS)
STEPS OF SURGERY FOR A CASE OF SPONTANEOUS CSF RHINORRHEA ARISING FROM THE LATERAL RECESS OF THE RIGHT SPHENOID SINUS
CEREBROSPINAL FLUID LEAK CLOSURE FOR SMALL POST-TRAUMATIC LEAKS
SPECIAL POSTOPERATIVE CONSIDERATIONS
COMPARISION WITH INTRACRANIAL REPAIR OF CSF LEAKS
RECENT ADVANCES
ACKNOWLEDGMENTS
CHAPTER 79:
Endoscopic Pituitary Surgery
INTRODUCTION
INDICATIONS
Adenomas
Rathke's Pouch Cyst
Craniopharyngiomas
Chordomas
Other Lesions
SPECIFIC PREOPERATIVE EVALUATION
Hormonal Assay
Radiological Evaluation
Ophthalmological Evaluation
Neurosurgical Evaluation
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
COMPLICATIONS
Intraoperative
Hemorrhage
CSF Leak
Postoperative
SPECIAL INSTRUMENTS REQUIRED
OTHER TREATMENT OPTIONS AVAILABLE
Medical Management
Radiotherapy
Gamma Knife Surgery
Other Surgical Approaches
CHAPTER 80:
Anterior Craniofacial Resection
INTRODUCTION
Background
HISTORY
ANATOMY OF ANTERIOR SKULL BASE
PROCEDURE
Facial Approach
Craniotomy
RECONSTRUCTION
Reconstruction Options Following Anterior Skull Base Tumor Resection
IMAGING STUDIES
COMPLICATIONS OF ANTERIOR CRANIOFACIAL RESECTION (Table 2)
OUTCOME
CONTRAINDICATIONS
FUTURE ASPECTS
CONCLUSION
CHAPTER 81:
Endoscopic-Assisted Craniofacial Resection
INTRODUCTION
TRADITIONAL CRANIOFACIAL RESECTION
CONCEPT
Why Endonasal Approach?
CASE SELECTION
STEPS
Endonasal Endoscopic Access
Transcranial Access
Skull Base Repair
POSTOPERATIVE PERIOD
ADVANTAGES OVER TRADITIONAL CRANIOFACIAL RESECTION
RESULTS
CONCLUSION
SUMMARY
CHAPTER 82:
Expanded Endonasal Approaches to the Anterior Skull Base
INTRODUCTION
PATIENT SELECTION
SURGICAL TRAJECTORY PLANNING
TECHNIQUES OF INSTRUMENTATION
RECONSTRUCTION
COMPLICATIONS
Vascular Complications
Intraoperative Nerve Injury
Cerebrospinal Fluid Leak
Infectious Complications
Other Complications
CASE ILLUSTRATION AND SURGICAL TECHNIQUE
CONCLUSION
SUMMARY
CHAPTER 83:
The Surgical Approach to Clival Lesions
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
Magnetic Resonance Imaging
Computed Tomography
Digital Subtraction Angiography
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
Midline Approach to the Clivus
Transnasal Expanded Endoscopic Approach
Complications
Lateral Approach to the Clivus
Infratentorial/Supratentorial Retrosigmoid Approach
Complications
CHAPTER 84:
The Endoscopic Surgical Approaches to the Clivus
INTRODUCTION
SURGICAL INDICATIONS
PREOPERATIVE EVALUATION
Clinical Presentation
Radiology
Tumor Grading
SURGICAL TREATMENT
Anatomic Considerations
SURGICAL STEPS
Phase 1: Nasal Phase
Phase 2: Sphenoidal Phase
Phase 3: Sellar and Upper Clival Phase
Phase 4: Middle and Lower Clival Phase
Phase 5: Closure and Reconstruction
COMPLICATIONS
OTHER TREATMENT OPTIONS
ACKNOWLEDGMENTS
CHAPTER 85:
The Surgical Technique of Endonasal Endoscopic Approach to the Craniovertebral Junction
INTRODUCTION
ANATOMIC CONSIDERATIONS
SPECIFIC PREOPERATIVE EVALUATION AND SURGICAL INDICATIONS
Diseases of the Craniovertebral Junction
Clinical Presentation
Radiology
Surgical Indications
Treatment
SURGICAL STEPS
Anesthetic Considerations
COMPLICATIONS
ACKNOWLEDGMENTS
CHAPTER 86:
Endoscopic Endonasal Skull Base Approaches to the Midline and to the Cavernous Sinus
INTRODUCTION
MATERIAL AND METHODS
SKULL BASE ENDOSCOPIC ENDONASAL APPROACHES TO THE MIDLINE: PRELIMINARY STEPS
ANTERIOR SKULL BASE APPROACHES
CHAPTER 87:
Expanded Endoscopic Endonasal Approach for Anterior Skull-Base Lesions: Technical Nuances and Description of Indications and Limitations
INTRODUCTION
INDICATIONS FOR THE USE OF EXPANDED ENDOSCOPIC ENDONASAL APPROACH IN ANTERIOR SKULL-BASE LESIONS
SPECIFIC PREOPERATIVE EVALUATION
Endocrinological Assessment
Ophthalmologic Assessment
SURGICAL STEPS
Follow-Up
Case Illustration—Tuberculum Sellae Meningioma
COMPLICATIONS
CONCLUSION
CHAPTER 88:
Skull-Base Reconstruction after Endoscopic Expanded Approaches
INTRODUCTION
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
Overview of Pedicled Flaps
Hadad-Bassagaisteguy Flap
Posterior Pedicle Inferior Turbinate Flap
Posterior Pedicle Middle Turbinate Flap
Transpterygoid Transposition of Temporoparietal Fascia Flap
Transfrontal Pericranial Flap
Oliver Pedicled Palatal Flap
New Techniques/Modifications in the Surgery
COMPLICATIONS
SPECIAL INSTRUMENTS USED FOR THE SURGERY
OTHER TREATMENT OPTIONS
POSTOPERATIVE CARE
CONCLUSION
SECTION 3: FACIAL PLASTICS, COSMETICS AND RECONSTRUCTIVE SURGERY
CHAPTER 89:
Chemical Peels
DEFINITION
HISTORY
Historical Timeline
PRINCIPLE
HISTOLOGY
Actinic Changes3
Peel Skin Histology4,5 (Figs 2 to 5)
Other Changes
CLASSIFICATION1,2
Classification According to Depth of Peel
Very Superficial Peel
Superficial Peel
Medium Depth Peel
Medium-Deep Depth Peel
Deep Peel
MECHANISM OF ACTION6
INDICATIONS OF PEELS
CONTRAINDICATIONS
IMPROVEMENT IN PHOTOAGING (Figs 6A and B)
PATIENT SELECTION
Fitzpatrick Classification (Table 1)
Glogau Classification (Table 2)
EXAMINATION PRIOR TO PEELS
ADVANTAGES OF PRIMING
PREPEEL PROCEDURES8
Counseling
Preparation of Skin
Before Peel
During Peel
Precautions
TRICHLOROACETIC ACID PEEL8
Preparation of Solution
Depth and Concentration
Advantages
Trichloroacetic Acid in Combination
Application Protocol
Postpeel Events
Postpeel Care
ALPHA-HYDROXY ACID PEEL1,2
Preparation and Formulation
Application Protocol
Postpeel Care
Postpeel Events
Peels Timetable (Table 3)
Advantages
SALICYLIC ACID PEEL1 (Fig. 8)
Advantages
Formulations
Procedure
Advantages
Postpeel Events and Care
Intervals
PHYTIC ACID PEELS6
Indications
Application
Postpeel Care
TRETINOIN PEELS6
Product and Procedure
Postpeel Care
Peels in Combination
Peel with Dermabrasion
Peel with LASER9
Peel with Manual Dermasanding
Complications of Peels
Toxicity
Resorcinol Toxicity6
Salicylism
SEQUELAE
COMPLICATIONS
CONCLUSION
CHAPTER 90:
Head and Neck Tissue Expansion
INTRODUCTION AND BIOLOGY OF TISSUE EXPANSION
TYPES OF IMPLANTS
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
OPERATIVE TECHNIQUE
SURGICAL STEPS
Insertion of Tissue Expanders
Removal of Tissue Expanders
Head and Neck Reconstruction
Scalp
Face
Neck
COMPLICATIONS
Infection
Implant Exposure
Expander Deflation
CHAPTER 91:
The Surgical Technique of LASER Skin Resurfacing
INDICATIONS FOR LASER RESURFACING
Other Indications
SPECIFIC PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
Ablative LASER Resurfacing
Carbon Dioxide LASER
Erbium: YAG LASER
Plasma Skin Resurfacing
Nonablative Resurfacing
Fractional Resurfacing
Practical Tips for Treatment of LASER Resurfacing
COMPLICATIONS OF LASER SKIN RESURFACING
Prolonged Erythema
Infection
Acne and Milia
Dermatitis
Pigmentary Alteration
Scarring
Ectropion Formation
Eruptive Keratoacanthomas
Recall Phenomenon
CHAPTER 92:
Hair Transplantation
INDICATIONS
Primary Alopecia
Secondary or Traumatic Alopecia
ANDROGENETIC ALOPECIA
CLASSIFICATION
PATIENT EVALUATION FOR SURGERY
FOLLICULAR UNIT HAIR TRANSPLANTATION
Six Steps for Hair Transplantation
1. Patient Preparation
2. Anesthesia (Figs 10A and B)
3. Donor Strip Harvest
4. Donor Strip Dissection
5. Recipient Site (Figs 14A to E)
6. Postoperative Care
COMPLICATION5,23,24
Donor Area
Recipient Area
ACKNOWLEDGMENTS
CHAPTER 93:
Surgery for Alopecia
INTRODUCTION
SYNTHETIC HAIR GRAFTINGS
Requirements for Synthetic Hair
Advantages
Disadvantages
HAIR TRANSPLANT
Indications for Hair Transplant
Contraindications
Preoperative Evaluation
Anesthesia
Steps of Surgery
Preparation of Donor Site and Harvesting of Strip
Graft Preparation
Recipient Site Preparation
Complications
Donor site
Recipient site
Special Instruments
SCALP REDUCTION SURGERY
Indications
Advantage
Disadvantages
SCALP FLAPS
Types
Advantages
Disadvantages
EXPANDED HAIR BEARING FLAPS
CHAPTER 94:
Upper and Lower Lid Blepharoplasty
HISTORICAL PERSPECTIVE
SPECIFIC PREOPERATIVE EVALUATION
Preoperative Assessment
Physical Examination
Photography Documentation
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
Upper Eyelid Blepharoplasty
Preoperative Marking
Surgical Technique
Postoperative Care
Complications
Lower Eyelid Blepharoplasty
Transcutaneous Lower Eyelid Surgery
Preoperative Marking
Anesthesia
Operative Technique
Transconjunctival Lower Eyelid Blepharoplasty
Lower Eyelid Fat Repositioning
Postoperative Care
Complications
General Complications
Early Complications
Late Complications
REOPERATIONS
CONCLUSION
CHAPTER 95:
SMAS Rhytidectomy: Preoperative Evaluation, Surgical Techniques and Pitfalls
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
Categories of Subcutaneous SMAS Facelifting
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
SPECIAL INSTRUMENTS USED FOR THE SURGERY
Operative Technique
Special Considerations
COMPLICATIONS
Hematoma
Infection
Skin Slough/Flap Loss
Great Auricular Nerve Injury
Facial Nerve Injury
Pixie Ear Deformity
Unhappy Patient
OTHER TREATMENT OPTIONS AVAILABLE FOR THE SAME CONDITION
Chemical Peels
Dermabrasion
LASER Resurfacing
Fillers
CHAPTER 96:
Planning and Facial Analysis before Rhinoplasty
INDICATIONS FOR THE SURGERY
Facial Analysis
SPECIFIC PREOPERATIVE EVALUATION
Clinical Evaluation
Photographic Study
Complementary Exams
CT Scans
Computer Imaging
3D Radiologic Viewer in the Office
SURGICAL STEPS
Surgical Planning
Reduction Rhinoplasty
Augmentation Rhinoplasty
CHAPTER 97:
A Color Atlas of Septorhinoplasty
PREOPERATIVE PLANNING
Patient Selection
Clinical Examination
Inspection of the Frontal View
Inspection of the Lateral View
Inspection of the Basal View
Assessment of the Skin
Clinical Photographs
Consent
SETUP OF THE OPERATING THEATeR
General Theater Layout
Instruments (Figs 8 and 9)
Mounting Clinical Photographs
Theater Lighting
Position of the Patient and Surgeon
Patient Preparation (Fig. 16)
SURGICAL STEPS
Local Anesthetic
Vibrissae Trimming
Septoplasty
Rhinoplasty: Endonasal versus External Exposure
Endonasal Approach
External Approach
Skin Marking
Hump Reduction
Osteotomies: Medial and Lateral
Medial Osteotomy
Lateral Osteotomy (Fig. 59)
Tip Surgery
The Tripod Concept
TIP MODIFICATION
Changing Tip Projection
Increasing Projection
Decreasing Projection
Altering Tip Rotation
Decreasing the Distance between the Tip-Defining Points
Reducing Tip Fullness
Creating a Supra-Tip Break
Altering the Alar-Columellar Relationship
SPECIALIST TECHNIQUES
Spreader Grafts
Alar Batten, Alar Strut and Rim Grafts
Dorsal Augmentation
Closure and Dressings
POSTOPERATIVE CARE
CHAPTER 98:
Augmentation Rhinoplasty
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
Analyzing and Making Reference of the Preoperative Photographs of the Patient
Length of the Nose
Hump
The Relationship to the Chin
Verifying Physiological or Anatomical Problems within the Nasal Cavity
Considering the Occupation and the Circumstances Surrounding the Patients
ANESTHETIC CONSIDERATIONS
The Condition of the Patient
Familiarity of the Anesthesia to the Surgeon
SURGICAL STEPS
Autologous Tissue
Septal Cartilage
Conchal Cartilage
Costal Cartilage
Autologous Fascia
Dermofat
Homologous Tissue or Tissue Allograft
Homologous Costal Cartilage
Tutoplast Processed Fascia Lata
Silicone
Trimming the Silicone
Method of Inserting the Silicone
Gore-Tex
Method of Trimming and Inserting Gore-Tex According to Each Individual Type
NEW TECHNIQUES IN THE SURGERY
Crushed Cartilage-TPFL Grafting
Silicone Sheeting
COMPLICATIONS
Autologous Cartilage
Homologous Costal Cartilage
Homologous Fascia
Silicone
Gore-Tex
SPECIAL INSTRUMENTS USED FOR THE SURGERY
CHAPTER 99:
The Surgical Management of the Crooked Nose
INTRODUCTION
OPERATIVE TECHNIQUE
Indications
Preoperative Planning
Patients
Case Presentation for Technique
Step 1
Step 2
Step 3
Step 4
Postoperative Care
Results
Alternative Bone Graft Sources for L-Strut Frame
Discussion
Surgical Tips
CHAPTER 100:
Surgical Techniques in Open Rhinoplasty Procedures
HISTORY
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATIONS
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
Surgical Technique
INSTRUCTIONS
GENERAL INFORMATION
ALTERNATIVE TREATMENT
RISKS OF RHINOPLASTY SURGERY
Bleeding
Infection
Scarring
Damage to Deeper Structures
Change in Skin Sensation
Asymmetry
Skin Discoloration/Swelling
Seroma
Pain
Allergic Reactions
Delayed Healing
Skin Sensitivity
Nasal Septal Perforation
Nasal Airway Alterations
Surgical Anesthesia
Substance Abuse Disorders
Skin Contour Irregularities
Sutures
Unsatisfactory Result
Shock
Cardiac and Pulmonary Complications
ADDITIONAL ADVISORIES
Skin Disorders/Skin Cancer
Long-Term Results
Female Patient Information
Intimate Relations after Surgery
Smoking, Second-Hand Smoke Exposure, Nicotine Products (Patch, Gum, Nasal Spray)
Mental Health Disorders and Elective Surgery
Medications
PATIENT COMPLIANCE
HEALTH INSURANCE
FINANCIAL RESPONSIBILITIES
ADDITIONAL SURGERY NECESSARY
DISCLAIMER
CONSENT FOR SURGERY/PROCEDURE OR TREATMENT
CHAPTER 101:
Rhinoplasty for Cleft Nasal Deformity
INTRODUCTION
UNILATERAL CLEFT LIP NASAL DEFORMITY
Etiology
Components
Pathologic Anatomy
BILATERAL CLEFT LIP NASAL DEFORMITY
Etiology: Several Hypotheses
Pathologic Anatomy
MANAGEMENT
SURGICAL CORRECTION
Timing of the Surgery
Primary Cheilorhinoplasty—Open Approach
Advantages
SURGICAL TECHNIQUE
Primary Rhinoplasty by Open Approach with Repair of Unilateral Complete Cleft Lip
Surgical Technique—Unilateral Complete Cleft Lip
Primary Rhinoplasty by Open Approach with Repair of Bilateral Complete Cleft Lip
Surgical Technique—Bilateral Complete Cleft Lip
NOSTRIL CONFORMERS (FIGS 19 TO 21)
PREOPERATIVE AND POSTOPERATIVE PHOTOGRAPHS OF CONSECUTIVE PATIENTS WITH LONG-TERM FOLLOW-UP
Unilateral Complete Cleft Lip (Figs 22A to G)
Directions for Figures
Bilateral Complete Cleft Lip (Figs 23A to G)
Directions for Figures
SECONDARY RHINOPLASTY
Soft Tissue Corrections
Cartilage Corrections
Skeletal Corrections
SECONDaRY SEPTORHINOPLASTY IN CLEFT LIP AND PALATE (FIGS 24 TO 29)
Clinical Photographs
CHAPTER 102:
Revision Rhinoplasty: The Lost Tip Support
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
SURGICAL STEPS
Premaxillary Augmentation
Caudal Septum Replacement Graft
Graft Harvest
Graft Placement and Fixation
TECHNICAL CONSIDERATIONS IN THE SURGERY
COMPLICATIONS
OTHER TREATMENT OPTIONS AVAILABLE FOR THE SAME CONDITION
Premaxillary Deficiency
Caudal Septum Deficiency
CHAPTER 103:
Alar Struts in Rhinoplasty
INDICATIONS FOR THE SURGERY
PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
SURGICAL PROCEDURE
COMPLICATIONS
SPECIAL INSTRUMENTATION
CHAPTER 104:
Augmentation Rhinoplasty
INTRODUCTION
Causes for Saddle Nose
SPECIFIC PREOPERATIVE EVALUATION
Esthetics
ANESTHETIC CONSIDERATION
CHOICE OF GRAFT MATERIAL
Graft Harvesting
Allograft
SURGICAL STEPS
Step 1: Painting and Draping
Step 2: Incision
Step 3: Elevation of Dorsal Skin Flap
Step 4: Preparation of Recipient Site
Step 5: Supporting Graft
Step 6: Diced Cartilage in Facial Tube
Step 7: Positioning the Graft in Place
Graft Placement
Step 8
Step 9
POSTOPERATIVE DETAILS
COMPLICATIONS
DIFFICULTIES AND SOLUTIONS
Partial or Complete Absorption of Graft Material
Graft Visibility
Dorsal Irregularities
Soft Tissue Deficiency
Septum
GRAFT MATERIAL
Choice of Graft Material
CHAPTER 105:
Alar Base Reduction
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
Excessive Width of the Lower Third of the Nose
Increased Collumellar-Alar Base Distance and Large or Asymmetric Nostril
Excessive Alar Flaring
Excessive Alar Hooding
Algorithm
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
Alar Base Reduction
External Alar Base Reduction
Internal Alar Base Reduction
Combination
Alar Flare Reduction
Alar Hooding Reduction
COMPLICATIONS
SPECIAL INSTRUMENTS USED FOR THE SURGERY
A MENTION OF OTHER TREATMENT OPTIONS AVAILABLE FOR THE SAME CONDITION
CHAPTER 106:
Esthetic Rhinoplasty—Ailed and Ailing Noses
INTRODUCTION
AILED ASSOCIATED NOSES
Congenital Deformities (Figs 1 to 7)
Congenital Deformities (Figs 1 to 7)
Developmental Deformities (Figs 8 to 12)
Traumatic Deformities (Figs 13 to 17)
Iatrogenic Deformities (Figs 18 to 22)
Skin Conditions (Figs 23 to 25)
Chronic Diseases (Figs 26 and 27)
Associated Deformities
AILING ASSOCIATED NOSES
Infections (Figs 29 to 36)
ASSOCIATION-EVALUATION (FIGS 42 TO 47)3,6,8,13,16
HOW TO RECTIFY2,3,6,8,9,11,14,15,18
SOME OF THE EXAMPLES OF AILED AND AILING NOSES BEFORE AND AFTER ESTHETIC SURGERY
CHAPTER 107:
Cleft Lip and Palate
OVERVIEW
EMBRYOLOGY
FUNCTIONAL ANATOMY
CLASSIFICATION
Classification of the International Confederation of Plastic and Reconstructive Surgery
Classification of Kernahan and Stark
PRENATAL DIAGNOSIS
PRESURGICAL ORTHOPEDICS
Unilateral Cleft Lip and Palate
Bilateral Cleft Lip and Palate
SURGICAL TREATMENT
Cheilorhinoplasty of a Unilateral Cleft in Two Steps
Cheilorhinoplasty of a Unilateral Cleft with an “All in One” Technique
Cheilorhinoplasty of a Bilateral Cleft in Two Steps
SURGICAL OUTCOMES
Nasal Fistulae
Velopharyngeal Insufficiency
Maxillary Hypoplasia
Nasolabial Outcomes
CHAPTER 108:
Lip Reconstruction
INTRODUCTION
ANATOMY
RECONSTRUCTION OF LIP DEFECTS
Reconstruction of Vermilion Defect: Vermilion Advancement
RECONSTRUCTION OF LIP DEFECTS: LESS THAN ONE-THIRD OF LIP DEFECT
RECONSTRUCTION OF LIP DEFECTS: ONE-HALF TO TWO-THIRDS OF LOWER LIP
ABBE CROSS-LIP FLAP
Flap Design
Surgical Steps
Postoperative Care
Advantage
Disadvantages
THE ESTLANDER FLAP
Karapandzic Flap
Flap Design (Figs 7A to C)
Advantages
Disadvantage
Reconstruction of Total Lip Defect
Bilateral Nasolabial Flap
Flap Design
Surgical Steps
Reconstruction of Upper Lip Forehead Visor Flap
Flap Design
Procedure
Advantages
Disadvantages
RECONSTRUCTION OF LIP COMPOSITE DEFECT
Reconstruction of Lip Composite Defect with Pectoralis Major Myocutaneous Flap11
Positioning, Prepping and Draping
Surface Markings of the Vascular Pedicle
Flap Design (Fig. 10)
Procedure
Closure of Donor Site Defect
CHAPTER 109:
Operative Techniques in Mandible Fractures
INTRODUCTION
REDUCTION
IMMOBILIZATION
TYPES OF REDUCTION
INDICATIONS FOR THE SURGERY
Closed Reduction
Open Reduction
SPECIFIC PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
Preoperative
Perioperative
Postoperative
SURGICAL STEPS
Closed Reduction and Immobilization
General Considerations
Open Reduction and Immobilization
Extraoral Approach
Intraoral Approach
The Use of Existing Lacerations
Steps After Exposure of Fracture Fragment
Reduction of Fracture Fragment
Fixation
Champy's Lines of Osteosynthesis
Technique
Principle
Fracture of Angle and Ramus
Complex Symphysis and Parasymphysis Fracture
Complex Angle and Body Fracture
Condylar Fracture
Open Reduction
Fracture of Coronoid Process
Alternative Surgical Approaches
Transparotid Approach
Retroparotid Approach
The Various Modification of Preauricular Incision
Endaural Approach
Submental Approach
Retromandibular Approaches
Alternative Method of Intermaxillary Fixation
Alternative Way of Fixing Arch Bar
SPECIAL INSTRUMENTS USED FOR THE SURGERY
Instruments for Gaining Surgical Access
Instruments for Reflection of Mucoperiosteum Flap
Instruments for Retraction
Instrument for Drilling Holes
Implants for Mandible and Instruments that Need to Fix Them
Mini Hole Plates
Reconstruction Plates
Screw Driver and Screws
Instrument Used for Intermaxillary Fixation
COMPLICATIONS
Early Complications
Infection
Late Complications
Fixation Failure
Limitation of Opening of Mouth
Scar
CHAPTER 110:
Faciomaxillary Fractures
INTRODUCTION
INDICATIONS
PREOPERATIVE EVALUATION
Clinical Examination (Figs 1 and 2)
External Examination (Fig. 3)
Specific Investigations
CLASSIFICATION OF MANDIBLE FRACTURES
Classification on the Basis of Region
Classification on the Basis of Other Associated Injuries to
SPECIFIC ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
Arch Bar Insertion (Figs 6A and B)
Maxillary Mandibular Fixation (Figs 7A to D)
Other Methods of the Maxillary Mandibular Fixation
Approach
Exposure (Figs 9A to D)
Reduction (Fig. 10)
Selection of Implants
Symphysis and Parasymphysis (Fig. 11)
Body
Angle and Ramus
Condylar Process and Head
Comminuted Fractures
Plate Contouring and Placement
Drilling of Hole and Screw Placement (Figs 12A to C)
Confirmation of Reduction and Occlusion (Fig. 12D)
Closure (Fig. 12E)
MODIFICATIONS
Transbuccal Approach
Endoscopic Approach
COMPLICATIONS
Early
Late
SPECIAL INSTRUMENTS (Figs 13A to D)
OTHER FIXATION TECHNIQUES
CHAPTER 111:
Orbital Floor Fracture
INTRODUCTION
ENDOSCOPIC REPAIR OF ORBITAL FLOOR FRACTURE
Advantages
INDICATIONS FOR ORBITAL FLOOR REPAIR
Indications for Endoscopic Repair of Orbital Floor Fracture
Limitations
PREOPERATIVE EVALUATION
SURGICAL STEPS
Hinge Fracture
Medial Blowout Fracture
Precautions
Subciliary Approach
Skin Incision
Dissection
Periosteal Incision over the Infraorbital Rim
Subperiosteal Dissection of Orbit
Closure
Transconjunctival Approach
Advantages
Disadvantages
Surgical Steps
Infiltration and Incision
Wound Closure
Postoperative Positioning
Nose-blowing
Wound Care
Clinical Follow-Up
MODIFICATIONS / SUGGESTIONS
Titanium Meshes/Implant
Advantages
Disadvantages
COMPLICATIONS
SPECIAL INSTRUMENTS (FIG. 12)
OTHER TREATMENTS AVAILABLE
SECTION 4: VOICE AND LARYNGOTRACHEAL SURGERY
CHAPTER 112:
Principles of Phonomicrosurgery
INTRODUCTION
EXPOSURE
SUBEPITHELIAL INFILTRATION
INCISION
ELEVATION OF THE MICROFLAP
PRESERVATION OF THE MEDIAL VIBRATING EDGE OF THE VOCAL FOLD
PRESERVATION OF THE LAMINA PROPRIA
ANTERIOR COMMISSURE LESIONS
HEMOSTASIS
ACKNOWLEDGMENTS
CHAPTER 113:
Leukoplakia of the Vocal Folds
INTRODUCTION
Indications for Surgery
SPECIFIC PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
NEW TECHNIQUES IN THE SURGERY
Recent Advances
Other reatment options and newer techniques
COMPLICATIONS
SPECIAL INSTRUMENTS USED FOR THE SURGERY
CHAPTER 114:
Premalignant Lesions of the Larynx and their Management
INTRODUCTION
MANAGEMENT
CONSERVATIVE MEASURES
CHEMOPREVENTION
MODALITY OF SURGICAL TREATMENT
FOLLOW-UP
PERSISTENT OR RECURRENT PRECANCEROUS LESIONS
SUMMARY
CHAPTER 115:
Photodynamic Therapy for Laryngeal Cancers
INTRODUCTION
PRINCIPLES OF PHOTODYNAMIC THERAPY
PHOTOSENSITIZERS UNDER EVALUATION FOR HEAD AND NECK CANCER
TUMOR ILLUMINATION
LARYNGEAL PHOTODYNAMIC THERAPY—TECHNIQUE
PUBLISHED EXPERIENCE WITH LARYNGEAL PHOTODYNAMIC THERAPY
CONCLUSION
SUMMARY
CHAPTER 116:
Transoral Microlaryngoscopic LASER Surgery for Cancer of Larynx and Hypopharynx
INTRODUCTION
INDICATIONS
LIMITATIONS
OPERATION THEATER SETUP
SAFETY MEASURES
ANESTHETIC CONSIDERATION
TECHNICAL CONSIDERATIONS
PROCEDURE
Glottic Carcinoma In Situ
T1/T2 Glottic Cancer
Supraglottic Cancer with Mobile Vocal Cords T1/T2/ Early T3
Hypopharyngeal Cancers
COMPLICATIONS
ACKNOWLEDGMENT
CHAPTER 117:
Injection Laryngoplasty: Indications, Techniques, Injectables and Results
INTRODUCTION
INDICATIONS FOR INJECTION LARYNGOPLASTY
WHEN TO INJECT A PARALYTIC VOCAL FOLD?
Properties of the Perfect Injectable
INJECTION TECHNIQUES
Operating Room versus Office Injections
Types of Injectables
How to Control the Effectiveness of the Injection?
ADVANTAGES OF INJECTION LARYNGOPLASTY
COMPLICATIONS
RESULTS REPORTED IN THE LITERATURE
Short Term Results
Long Term Results
INJECTABLES OF THE FUTURE
CONCLUSION
CHAPTER 118:
Surgical Management of Sulcus Vocalis
DEFINITION
INDICATIONS FOR THE SURGERY
Surgical Management of Sulcus Vocalis
SPECIFIC PREOPERATIVE EVALUATION
Diagnosis
SURGICAL STEPS (FIGS 1 TO 10)
Medialization Thyroplasty (Type 1)
Medialization Thyroplasty (type 1) with Relaxation Thyroplasty (type 3)
Vocal Fold Augmentation Techniques (Injection Laryngoplasty)
Collagen Injection
Fat Injection
Hyaluronic Acid Injection
Cold Instrument Excision
Slicing Technique
Fascia Implant (Superficial or Deep)
POSTOPERATIVE DETAILS AND FOLLOW-UP
CONCLUSION
CHAPTER 119:
Anterior Glottic Web Management
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
Step I
Step II
Step III
Step IV
NEW TECHNIQUES IN THE SURGERY
Complications
SPECIAL INSTRUMENTS USED FOR THE SURGERY
OTHER TREATMENT OPTIONS AVAILABLE FOR THE SAME CONDITION
CHAPTER 120:
Diagnostic Laryngo-Tracheo-Bronchoscopy
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
SURGICAL PROCEDURE
COMPLICATIONS
CHAPTER 121:
Bronchoscopyd
PREOPERATIVE PREPARATION
INDICATIONS FOR BRONCHOSCOPY
Positive History of Foreign Body Aspiration
Suspicion of Foreign Body in the Airway
Symptoms
Signs
Radiological Signs
PREOPERATIVE ASSESSMENT
GENERAL ANESTHESIA CONSIDERATIONS
Monitoring the Child during Bronchoscopy
Anesthesia in a Stable Child
In a Child with Respiratory Distress and Hypoxia
In a Child with Respiratory Distress and Full Stomach
INTRAOPERATIVE MONITORING
SURGICAL STEPS
Introduction of Bronchoscope
Holding the Bronchoscope
Entering Main Bronchi
TIPS FOR EASY REMOVAL
COMPLICATIONS
OTHER SURGICAL OPTIONS
POSTOPERATIVE CARE
NEWER TECHNIQUES AND SPECIAL INSTRUMENTS
CHAPTER 122:
The Use of the KTP Laser for Treatment of Laryngeal Papillomatosis
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
NEW TECHNIQUES IN THE SURGERY
COMPLICATIONS
SPECIAL INSTRUMENTS USED FOR THE SURGERY
OTHER AVAILABLE TREATMENT OPTIONS FOR THE SAME CONDITION
CHAPTER 123:
Surgical Management of Laryngeal Papillomatosis Using Microdebrider
INTRODUCTION
INDICATIONS
SYMPTOMS AND SIGNS
PREOPERATIVE CONSIDERATIONS
ANESTHESIA CONSIDERATIONS
SURGICAL STEPS
Carbon Dioxide LASER
Microdebrider
Microlaryngeal Techniques
SPECIAL CONSIDERATIONS
NEWER TECHNIQUE OR MODIFICATION
Medical Therapy
Interferon
Photodynamic Therapy
Indole-3-Carbinol
Ribavirin
Acyclovir
Cidofovir
Vaccines and Immunostimulant Drugs
COMPLICATIONS
FOLLOW-UP AND PROGNOSIS
STEPS OF SURGERY
ACKNOWLEDGMENTS
CHAPTER 124:
Aryepiglottoplasty
INDICATIONS FOR THE SURGERY
ANESTHETIC CONSIDERATIONS
SURGICAL PROCEDURE
COMPLICATIONS
CHAPTER 125:
Surgical Management of Posterior Glottic Stenosis
INTRODUCTION
STEPS OF SURGERY
FOLLOW-UP
ACKNOWLEDGMENTS
CHAPTER 126:
Dilatation of a Tracheal Web Using a Laser
INTRODUCTION
STEPS OF SURGERY
ACKNOWLEDGMENTS
CHAPTER 127:
Laser Arytenoidectomy
STEPS OF SURGERY
ACKNOWLEDGMENTS
CHAPTER 128:
Laterofixation of the Vocal Folds in Acute Bilateral Vocal Fold Paralysis
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
SURGICAL PROCEDURE
COMPLICATIONS
SPECIAL INSTRUMENTS USED FOR THE SURGERY
OTHER TREATMENT OPTIONS AVAILABLE FOR THE SAME CONDITION
CHAPTER 129:
Pediatric Tracheostomy
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
SURGICAL PROCEDURE
COMPLICATIONS
Early Complications
Late Complications
CHAPTER 130:
Cricoid Split
INDICATIONS FOR THE SURGERY
SURGICAL PROCEDURE
NEW TECHNIQUES IN THE SURGERY
COMPLICATIONS
CHAPTER 131:
Voice Restoration after Cordectomies: Type III Thyroplasty for Voice Reconstruction after Laryngofissure Cordectomy
INTRODUCTION
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
OTHER TREATMENT OPTIONS AVAILABLE FOR THE SAME CONDITION
POSTOPERATIVE DETAILS AND FOLLOW-UP
CONCLUSION
CHAPTER 132:
Botulinum Toxin for Laryngeal Dystonias
INRODUCTION
ANATOMIC CONSIDERATIONS
TECHNIQUES FOR ADDUCTOR SPASMODIC DYSPHONIA
Injection through the Cricothyroid Membrane
Injections through the Thyrohyoid Space
Injections from Above
TECHNIQUES FOR ABDUCTOR SPASMODIC DYSPHONIA
Posterior-lateral Approach to the Posterior Cricoarytenoid Muscle
Injection through the Cricoid Cartilage
CHAPTER 133:
Selective Laryngeal Adductor Denervation-Reinnervation Surgery for Adductor Spasmodic Dysphonia
INTRODUCTION
INDICATIONS FOR THE SURGERY
PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
COMPLICATIONS
SPECIAL INSTRUMENTS USED FOR THE SURGERY
OTHER TREATMENT OPTIONS
CHAPTER 134:
Medialization Laryngoplasty (Thyroplasty)
INTRODUCTION
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
Setup
Surgical Technique
SPECIAL INSTRUMENTS USED FOR THE SURGERY
CHAPTER 135:
Silastic Medialization Laryngoplasty (Type 1 Thyroplasty)
INTRODUCTION
INDICATIONS FOR THE SURGERY
Contraindications
Relative Contraindications
SPECIFIC PREOPERATIVE EVALUATION
Patient Selection
Timing of Surgery
ANESTHETIC CONSIDERATIONS
SURGICAL APPROACH
Level of Vocal Fold
Size and Position of the Thyroplasty Window
Implant Design
Implant Placement
Perioperative Care
Postoperative Advice
Future Operations
COMPLICATIONS
SPECIAL INSTRUMENTS USED FOR THE SURGERY
OTHER TREATMENT OPTIONS AVAILABLE
ACKNOWLEDGMENT
CHAPTER 136:
Arytenoid Rotation
INDICATIONS
SURGICAL TECHNIQUES
CHAPTER 137:
Type I Thyroplasty
INDICATIONS FOR TYPE I SURGERY
OTHER PREOPERATIVE CONSIDERATIONS
CONTRAINDICATIONS OF THYROPLASTY
ANESTHESIA FOR THYROPLASTY
POSITION
SURGICAL TECHNIQUES
COMPLICATIONS OF THYROPLASTY SURGERIES
CHAPTER 138:
Type II Thyroplasty
INDICATIONS FOR TYPE II SURGERY
OTHER PREOPERATIVE CONSIDERATIONS
CONTRAINDICATIONS OF THYROPLASTY
ANESTHESIA FOR THYROPLASTY
POSITION
SURGICAL TECHNIQUES
COMPLICATIONS OF THYROPLASTY SURGERIES
CHAPTER 139:
Type III Thyroplasty
INDICATIONS FOR TYPE III SURGERY
OTHER PREOPERATIVE CONSIDERATIONS
CONTRAINDICATIONS OF THYROPLASTY
ANESTHESIA FOR THYROPLASTY
POSITION
SURGICAL TECHNIQUE (FIGS 1 TO 15)
COMPLICATIONS OF THYROPLASTY SURGERIES
CHAPTER 140:
Type IV Thyroplasty
INDICATIONS FOR TYPE IV SURGERY
OTHER PREOPERATIVE CONSIDERATIONS
CONTRAINDICATIONS OF THYROPLASTY
ANESTHESIA FOR THYROPLASTY
POSITION
SURGICAL TECHNIQUES
COMPLICATIONS OF THYROPLASTY SURGERIES
CHAPTER 141:
Expertise of Voice Feminization Surgery to 270 Diverse International Patients
INTRODUCTION
METHODS
Patients
Video-Stroboscopy
SURGICAL TECHNIQUE
Cricothyroid Approximation
Post Surgery
Voice Pitch Evaluation
RESULT
Objective Evaluations
Follow-Ups
Stroboscopic Evaluation
Subjective Evaluations
DISCUSSION
CONCLUSION
CHAPTER 142:
Decision-Making in Laryngotracheal Stenosis
INTRODUCTION
HISTORY
Neonates/Children
External Trauma
Prolonged Intubation
Duration of Intubation
Peri-intubational Circumstances
Size of Tube
Type of Endotracheal Tube
Tracheostomy
The Site of a Tracheostomy Tube
The Number of Tracheal Rings Cut
Cuff
Material of Tube
Infection
Site of Tracheostomy
Revision Procedures
Comorbidities
Coexistent Medical Conditions
Syndromic Association
GENERAL PHYSICAL EVALUATION
PREOPERATIVE EVALUATION
Awake Fiberoptic Endoscopic Evaluation
Rigid Hopkins Telescopic Evaluation (Direct Laryngotracheoscopy)
INDICATIONS FOR SURGERY AND OPERATIVE DECISIONS
Bilateral Vocal Fold Immobility
Options Available
Open Procedures
Endoscopic Procedures
Posterior Glottic Stenosis
PRESURGICAL PLANNING
PREOPERATIVE MEDICATIONS
SURGICAL TIMING
CHAPTER 143:
The Surgical Management of Tracheal Stenosis
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
Preferred Examination
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS1–4
Operative Technique Tracheal Resection for Stenosis and Reanastomosis
Postoperative Care
NEW TECHNIQUES IN THE SURGERY
Reconstruction of Partial Tracheal Stenosis with Cervical Fascia
Operative Technique
COMPLICATIONS
SPECIAL INSTRUMENTS USED FOR THE SURGERY
OTHER TREATMENT OPTIONS AVAILABLE FOR THE SAME CONDITION
CHAPTER 144:
The Surgical Management of Tracheal Stenosis
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
Resection and Reconstruction
Concomitant Tracheoesophageal Fistula
Tracheal Augmentation
Autologous Costal Cartilage Graft Procedure
Autologous Pericardial Patch Grafting Procedure
Slide Tracheoplasty Technique
Comments
Carinal Reconstruction
Concepts (Principles)
Carinal Resection
Approach
NEW TECHNIQUES IN THE SURGERY
COMPLICATIONS
Tracheal Release (Mobilization)
OTHER TREATMENT OPTIONS AVAILABLE FOR THE SAME CONDITION
Final Consideration
CHAPTER 145:
Tracheal Resection and Anastomosis
INTRODUCTION
INDICATIONS FOR SURGERY
PREOPERATIVE EVALUATION AND ANESTHETIC CONSIDERATIONS
STEPS OF SURGERY
COMPLICATIONS AND THEIR PREVENTION
ACKNOWLEDGMENTS
CHAPTER 146:
Laryngotracheal Reconstruction
INTRODUCTION
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
Port for Ventilation
Intermittent Apnea
Postoperative Period
SURGICAL STEPS
Exposure
Laryngofissure
Division of the Posterior Cricoid Lamina
Cricoarytenoid Joint Ankylosis
Sizing of the Cartilage Graft
Epiglottopexy
Closure
NEWER TECHNIQUE/MODIFICATION IN THE SURGERY
COMPLICATIONS AND PRECAUTIONS TO PREVENT THEM
SPECIAL INSTRUMENTS USED FOR THE SURGERY
ACKNOWLEDGMENTS
CHAPTER 147:
Partial Cricotracheal Resection
INTRODUCTION
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
STEPS OF SURGERY
COMPLICATIONS AND THEIR PREVENTION
ACKNOWLEDGMENTS
CHAPTER 148:
Extended Partial Cricotracheal Resection
INTRODUCTION
STEPS OF SURGERY
ACKNOWLEDGMENTS
SECTION 5: HEAD AND NECK SURGERY
CHAPTER 149:
The Surgical Technique of Otoplasty
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
NEWER MODIFICATION IN THE SURGERY
COMPLICATIONS
SPECIAL INSTRUMENTS USED FOR THE SURGERY
CHAPTER 150:
Surgery of Oral Submucous Fibrosis
INTRODUCTION
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
Tongue Flaps
Nasolabial Flaps
Palatal Flaps
Fat Flap
Mandibular Mucoperiosteal Flap
Platysma Myocutaneous Flap
COMPLICATIONS OF TRISMUS SURGERY
Pain
Recurrence of Trismus
SPECIAL INSTRUMENTS USED FOR THE SURGERY
NEW TECHNIQUES AND OTHER TREATMENT OPTIONS FOR THE SAME CONDITION
CHAPTER 151:
Excision of the Submandibular Salivary Gland
INTRODUCTION
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
COMPLICATIONS
CHAPTER 152:
The Surgical Technique of Transoral Robotic Surgery
INTRODUCTION
SPECIFIC PREOPERATIVE EVALUATION
Anatomy of Oropharynx
Lateral Oropharynx and Palatine Tonsils
Vessels and Nerves of the Tonsillar Fossae
Lymphatics of Tonsillar Fossa
Base of Tongue
Vessels and Nerves of the Base of Tongue
Lymphatics of the Base of Tongue
SURGICAL STEPS
Transoral Robotic Surgery for Oropharyngeal Cancer
Lateral Oropharyngectomy
Transoral Robotic Surgery for Base of the Tongue Cancer
Neck Dissection
CONCLUSION
CHAPTER 153:
Coblation-Assisted Procedures for Snoring and Sleep Apnea
INTRODUCTION
SURGICAL INDICATIONS1
CONTRAINDICATIONS FOR SURGERY1
PROBLEMS ASSOCIATED WITH SLEEP APNEA SURGERIES
ADVANTAGES OF COBLATION IN OBSTRUCTIVE SLEEP APNEA SURGERIES
COBLATION PROCEDURES
Coblation Tonsillectomy
Indications
Advantages
Operative Technique
Intracapsular Tonsillectomy (Tonsillotomy)
Indications
Advantages
Operative Technique
Coblation Adenoidectomy
Indications
Advantages
Operative Technique
Coblation-Assisted Upper Airway Procedure
Indications
Advantages
Operative Technique
Coblation of the Salpingopharyngeal Folds
Indications
Advantages
Operative Technique (Fig. 4)
Coblation Uvulopalatopharyngoplasty
Indications
Advantages
Operative Technique
Coblation Midline Glossectomy
Indications
Advantages
Operative Technique
Submucosal Midline Endoscopic Lingual Base Lysis
Indications
Advantages
Operative Technique (Fig. 5)
CHAPTER 154:
Sialendoscopy
INTRODUCTION
INDICATIONS
Diagnostic
Therapeutic
CONTRAINDICATIONS
PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
INSTRUMENTATION FOR SIALENDOSCOPY
Modular Sialendoscope (Fig. 4)
TECHNIQUE OF SIALENDOSCOPY
DIAGNOSTIC SIALENDOSCOPY
INTERVENTIONAL SIALENDOSCOPY
Dilatation of Stenoses and Strictures
SIALENDOSCOPIC MANAGEMENT OF CHRONIC SIALADENITIS AND RECURRENT JUVENILE PAROTITIS
COMPLICATIONS
LIMITATIONS OF SIALENDOSCOPY
CHAPTER 155:
The Endoscopic Intraoral Approach to the Submandibular Salivary Gland Resection
INTRODUCTION
INDICATION FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
SURGICAL TECHNIQUE
Anatomical Details
Operative Technique
SPECIAL INSTRUMENTS USED FOR THE SURGERY
COMPLICATIONS
CHAPTER 156:
Transoral LASER Microsurgery for Malignancies of the Upper Aerodigestive Tract
INTRODUCTION
History
Technique and Concepts
ONCOLOGIC OUTCOMES
Larynx
Glottis
Supraglottis
Hypopharynx
Oropharynx and Oral Cavity
Neck Management
Salvage Transoral LASER Microsurgery
FUNCTIONAL OUTCOMES
General Functional Advantages of Transoral LASER Microsurgery
Preoperative Planning
SITE-SPECIFIC FUNCTIONAL OUTCOMES AND THERAPEUTIC IMPLICATIONS
Overview
Oral Cavity
Oropharynx and Hypopharynx
Larynx
Glottis
Supraglottis
Summary of Functional Outcomes
COMPLICATIONS
CONCLUSION
SUMMARY
CHAPTER 157:
Endoscopic Management of Zenker's Diverticulum
INTRODUCTION
INDICATIONS FOR THE SURGERY
EVOLUTION OF SURGICAL MANAGEMENT
SURGICAL STEPS
CONCLUSION
CHAPTER 158:
Oncological Outcome of Transoral LASER Surgery in Laryngeal Carcinomas
INTRODUCTION
PATIENTS AND METHODS
RESULTS
DISCUSSION
SUMMARY
CHAPTER 159:
Tracheostomy in Head and Neck Cancers
HISTORICAL REVIEW
CLASSIFICATION
INDICATIONS
Indications of Tracheostomy
Indications due to Pathology of the Larynx (Intrinsic)
Extrinsic Indications
Other Indications
CONTRAINDICATIONS
Types of Tracheostomy Tubes
PROCEDURE
Preprocedure Preparation
POSTOPERATIVE CARE/TRACHEOSTOMY CARE
Decannulation
Sequelae
SPECIAL CONSIDERATIONS FOR PERFORMING A TRACHEOSTOMY IN A PATIENT WITH HEAD AND NECK MALIGNANCY
COMPLICATIONS
Immediate Complications
Delayed Complications
Pneumothorax and Pyopneumothorax
Late Complications
A FEW WORDS OF CAUTION WHEN PERFORMING A TRACHEOSTOMY IN INFANTS AND CHILDREN
PERCUTANEOUS TRACHEOSTOMY
CRICOTHYROIDOTOMY
SUMMARY
CHAPTER 160:
Endoscopic Cricopharyngeal Myotomy
INTRODUCTION
INDICATIONS FOR THE SURGERY
CONTRAINDICATIONS
SURGICAL STEPS
COMPLICATIONS
DISCUSSION
CONCLUSION
CHAPTER 161:
Superficial and Total Parotidectomy
INTRODUCTION
DEFINITIONS AND INDICATIONS
Superficial Parotidectomy
Deep Parotidectomy
Superficial Parotidectomy with Partial Deep Lobe Resection
Superficial Parotidectomy with Total Deep Lobe Resection
Isolated Deep Parotidectomy
Extended Total Parotidectomy
SURGICAL ANATOMY
Related Fascia
VASCULAR ANATOMY
LYMPHATIC ANATOMY
NEURAL ANATOMY
PAROTID DUCT
SURGICAL TECHNIQUE
Preparation
Incisions and Flap Elevation
Deeper Dissection
Facial Nerve Mobilization
Removal of the Superficial Gland
Deep Parotidectomy
Total Parotidectomy with Facial Nerve Sacrifice
Resection of Adjacent Structures and Reconstruction
Postoperative Care
KEY PEARLS
CHAPTER 162:
Surgery of Thyroid
INTRODUCTION
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
SURGICAL TECHNIQUES
Positioning and Draping
Skin Incision
Development of Skin Flaps
Exposure of Strap Muscles
Middle Thyroid Vein
Superior Thyroid Pole, Superior Thyroid Vessels and Superior Laryngeal Nerve
Inferior Dissection
Dissection of the Thyroid Lobe (Capsular Approach)
Identification and Preservation of Recurrent Laryngeal Nerve
NEW TECHNIQUES IN THE SURGERY
Recent Advances
COMPLICATIONS
SPECIAL INSTRUMENTS USED FOR THE SURGERY
CHAPTER 163:
The Surgical Technique of Thyroidectomy
GENERAL PRINCIPLES
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
Preoperative
Minimally Invasive Nonendoscopic Thyroidectomy
Minimally Invasive Video Assisted Thyroidectomy
Postoperative Care
NEW TECHNIQUES IN THE SURGERY
New Advances
SPECIAL INSTRUMENTS USED FOR THE SURGERY
CONCLUSION
CHAPTER 164:
The Surgical Management of Differentiated Thyroid Cancer
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
NEW TECHNIQUE/MODIFICATION IN THE SURGERY
COMPLICATIONS
SPECIAL INSTRUMENTS
OTHER TREATMENT OPTIONS
CHAPTER 165:
Parathyroidectomy
INDICATIONS FOR PARATHYROIDECTOMY
Primary Hyperparathyroidism
Pathology
Parathyroid Adenoma
Primary Parathyroid Hyperplasia
Parathyroid Carcinoma
Secondary Hyperparathyroidism
Tertiary Hyperparathyroidism
SPECIFIC PREOPERATIVE EVALUATION
Signs and Symptoms
Laboratory Tests
Localization Studies
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
Surgical Techniques for Parathyroidectomy
Patient Positioning
Bilateral Neck Exploration
Minimally-Invasive Targeted Parathyroidectomy
Inferior Parathyroids
Superior Parathyroids
Mediastinal Parathyroid Adenoma
Partial Sternotomy
Complete Median Sternotomy
Thoracic Approach
NEW TECHNIQUES IN THE SURGERY
Intraoperative Adjuvant Techniques Confirming Adequate Resection
Intraoperative Quick Parathyroid Hormone Assay
Intraoperative Nuclear Mapping
COMPLICATIONS
Postoperative Hypocalcemia
Recurrent Nerve Injury
Persistent Disease
Superior Laryngeal Nerve Injury
Hematoma and Wound Infection
SPECIAL INSTRUMENTS USED FOR THE SURGERY
OTHER TREATMENT OPTIONS AVAILABLE FOR THE SAME CONDITION
CHAPTER 166:
The Management of the Parathyroid Glands During Thyroid Surgery
HISTORY AND BACKGROUND
INDICATIONS FOR THE SURGERY
SURGICAL ANATOMY
EMBRYOLOGY AND LOCATION
COMPLICATIONS OF PARATHYROID GLAND SURGERY
SPECIFIC PREOPERATIVE EVALUATION AND CONSIDERATIONS
SURGICAL STEPS FOR TOTAL THYROIDECTOMY AND PARATHYROID GLAND PRESERVATION
Surgical Techniques for Parathyroid Gland Identification
Inadvertent Parathyroidectomy or Failure to Identify Normal Glands
Fine Points of the Surgery
Methods for Evaluating Parathyroid Gland Viability
Anesthetic Considerations
New Techniques
Parathyroid Gland Autotransplantation
MANAGEMENT OF POSTOPERATIVE COMPLICATIONS: HYPOPARATHYROIDISM AND HYPOCALCEMIA
CHAPTER 167:
Thyroglossal Duct Cyst
INTRODUCTION
EMBRYOLOGY AND CLINICAL FEATURS
Embryology
Common Presentations
INDICATIONS OF SURGERY
PREOPERATIVE EVALUATION
ANESTHESIA CONSIDERATIONS
STEPS OF SURGERY
Sistrunk's Operation
Thyroglossal Cyst Mimicking a Plunging Ranula
Recurrent Thyroglossal Cyst
COMPLICATIONS AND MANAGEMENT OF COMPLICATIONS
Perioperative
Late
ACKNOWLEDGMENTS
CHAPTER 168:
The Surgical Management of Branchial Cyst and Fistula
INTRODUCTION
SPECIFIC INVESTIGATIONS
INDICATIONS FOR SURGERY
PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATION
SURGICAL STEPS
Branchial Cyst (Figs 1 and 2)
Branchial Fistula (Figs 3 to 17)
Bilateral Branchial Fistulae (Figs 18 to 22)
OTHER MODALITIES OF TREATMENT
COMPLICATIONS AND MANAGEMENT OF COMPLICATIONS
Intraoperative Complications
Postoperative Complications
ACKNOWLEDGMENTS
CHAPTER 169:
Surgical Management of Thyroglossal Duct Malignancy
INTRODUCTION
EMBRYOLOGY
INDICATIONS OF SURGERY
PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATION
SURGICAL STEPS
Sistrunk's Operation
COMPLICATIONS AND MANAGEMENT OF COMPLICATIONS
Perioperative
Late
ACKNOWLEDGMENTS
CHAPTER 170:
Maxillectomy
INTRODUCTION
TYPES OF MAXILLECTOMY
INDICATIONs
CONTRAINDICATION
PREOPERATIVE PREPARATION
POSITION and ANESTHESIA
SURGICAL STEPS
Incision Planning
Gingival Incision
Facial Flap Elevation
Palatal Incision
Preserving Orbit
Bony Cuts
TOTAL MAXILLECTOMY WITH ORBITAL EXENTERATION
MANAGEMENT OF ORBITAL DEFECT
Management of Airway
RECONSTRUCTION OF DEFECT
Postoperative Complications
POSTOPERATIVE CARE FOLLOWING MAXILLECTOMY
CHAPTER 171:
The Surgical Technique of Mandibular Swing
INTRODUCTION
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS (FIGS 3 TO 6)
ANY NEWER TECHNIQUE/MODIFICATION IN THE SURGERY SUGGESTED
COMPLICATIONS
OTHER TREATMENT OPTIONS AVAILABLE FOR THE SAME CONDITION
CHAPTER 172:
The Surgical Technique of Maxillary Swing
INTRODUCTION
INDICATIONS FOR THE SURGERY (FIGS 1A TO E)
SPECIFIC PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
ANY NEWER TECHNIQUE/MODIFICATION IN THE SURGERY SUGGESTED
COMPLICATIONS
SPECIAL INSTRUMENTS USED FOR THE SURGERY
OTHER TREATMENT OPTIONS AVAILABLE FOR THE SAME CONDITION
CHAPTER 173:
Radical Neck Dissection
SURGICAL STEPS
Position
Incision
Pitfalls
Raising the Flaps
Dissection
Preserving the XI Nerve
Ligation of the Internal Jugular Vein
Lower End of Dissection
Drains
Closure
ACKNOWLEDGMENTS
CHAPTER 174:
Parapharyngeal Space Tumors
INTRODUCTION
ANATOMY
INDICATIONS FOR SURGERY
SPECIFIC PREOPERATIVE EVALUATION
SURGICAL STEPS
Using the Transoral Approach
COMPLICATIONS
OTHER TREATMENT OPTIONS AVAILABLE FOR THE SAME CONDITION
CHAPTER 175:
Parapharyngeal Space Tumors
INTRODUCTION
SPECIFIC PREOPERATIVE EVALUATION
Treatment
Preoperative Embolization
SURGICAL STEPS
Surgical Approaches
Transoral Approach
Transcervical Approach
Transparotid-Transcervical Approach
Transmandibular Approaches
Orbitozygomatic Middle Fossa Approach
Reconstructive Considerations
COMPLICATIONS
OTHER TREATMENT OPTIONS AVAILABLE FOR THE SAME CONDITION
CHAPTER 176:
Parapharyngeal Space Tumors
INTRODUCTION
SPECIFIC PREOPERATIVE EVALUATION
ANESTHETIC CONSIDERATION
SURGICAL STEPS
Pre-Styloid and Post-Styloid Neurogenic/Salivary Gland Tumors (Free from Tail of Parotid)
Carotid Body Tumors
Transcervical Approach
COMPLICATIONS
OTHER TREATMENT OPTIONS AVAILABLE FOR THE SAME CONDITION
CHAPTER 177:
Treatment Decision in the Management of Laryngeal Cancer: An Overview
INTRODUCTION
EARLY LARYNGEAL CANCER (T1/T2)
T1 Glottic Cancer
T2 Glottic Cancer
SUPRAGLOTTIC CANCER (T1/T2)
ADVANCED LARYNGEAL CANCER (T3/T4a)
CONCLUSION
SUMMARY
CHAPTER 178:
Transoral LASER Assisted Open Vertical Partial Laryngectomy
INTRODUCTION
VERTICAL PARTIAL lARYNGECTOMY
INDICATIONS
LIMITATIONS
SPECIAL INSTRUMENTS
PROCEDURE OF TRANSORAL LASER ASSISTED OPEN VERTICAL PARTIAL LARYNGECTOMY
RECONSTRUCTION
Reattachment of the Remnant Vocal Cord
The Mucosal Defect
Reconstruction of the Resected Arytenoid
PREVENTION OF WEB FORMATION
POSTOPERATIVE MANAGEMENT
COMPLICATIONS
Reactionary Hemorrhage
Laryngeal Stenosis and Delayed Decannulation
Aspiration
Cartilage Necrosis
Surgical Emphysema
Voice Quality Issues
ACKNOWLEDGMENTS
CHAPTER 179:
Supracricoid Partial Laryngectomy: The Second Coming
INTRODUCTION
HISTORY
THE CONCEPT
INDICATIONS
CONTRAINDICATIONS
PREREQUISITES/WORKUP
SURGICAL PROCEDURE
Key Surgical Points
COMMENTS
SUMMARY AND CONCLUSIONS
CHAPTER 180:
Near-Total Laryngectomy
INTRODUCTION
INDICATIONS
CONTRAINDICATIONS
SURGICAL STEPS
Neck Dissection
Near-Total Laryngectomy
Dividing the Infrahyoid Strap Muscles
Exposure of the Hyoid and Thyroid Cartilage
Airway Transfer and Laryngeal Entry
Inspection of the Midline Laryngopharyngeal Mucosa and Thyroid Cartilage Division
Mucosal Cuts Circumscribing the Disease
Cricoid Cartilage Division in Midline
Preparing the Cricotracheal Mucosa for the Shunt
Near-Total Shunt Creation
NEOPHARYNX
Maturing the Tracheostome
POSTOPERATIVE CARE
ORAL INTAKE AND VOICING
CONCLUSION
SUMMARY
ACKNOWLEDGMENTS
CHAPTER 181:
Total Laryngectomy
HISTORY
INDICATIONS FOR TOTAL LARYNGECTOMY
SURGICAL TECHNIQUE
COMPLICATIONS
POSTLARYNGECTOMY REHABILITATION
MANAGEMENT OF STOMA
RECURRENCE
OUTCOMES/SURVIVAL
POSTLARYNGECTOMY QUALITY OF LIFE
SUMMARY
CHAPTER 182:
Voice Rehabilitation after Laryngectomy
SUMMARY
INTRODUCTION
HISTORICAL BACKGROUND
PREOPERATIVE EVALUATION
SURGICAL TECHNIQUES
Secondary Tracheoesophageal Puncture
Primary Tracheoesophageal Puncture
POSTOPERATIVE REHABILITATION AND COMPLICATIONS
Voice-Limiting Pharyngoesophageal Spasm
Prosthesis Migration and Leakage
SUMMARY
CHAPTER 183:
Complications in Head and Neck Surgery
INTRODUCTION
DURING NECK DISSECTION
INCISION PLANNING AND SKIN FLAP NECROSIS
Nerve Trauma
Greater Auricular Nerve
Marginal Mandibular Nerve
Spinal Accessory Nerve
Vascular Complications
Intraoperative and Reactive Hemorrhage
Secondary Hemorrhage
THORACIC DUCT INJURY
DURING THYROIDECTOMY
Laryngeal Nerve Injury
Recurrent Laryngeal Nerve
External Branch of the Superior Laryngeal Nerve
Vascular Injury
Parathyroid Injury
DURING PAROTIDECTOMY
Facial Nerve Injury
FOLLOWING LARYNGECTOMY
Pharyngocutaneous Fistula
FLAP COMPLICATIONS
Pedicled Flaps
Free Flaps
SUMMARY
SUGGESTED READING
Books
Articles
Recurrent Laryngeal Nerve Injury
Facial Nerve Injury
Shoulder Dysfunction
Chyle Leak
Pharyngocutaneous Fistula
Flap Complications
CHAPTER 184:
Principles of Skull Base Reconstruction after Ablative Head and Neck Cancer Surgery
INTRODUCTION
PATIENT-BASED APPROACH TO RECONSTRUCTION
DEFECT-BASED APPROACH TO RECONSTRUCTION
Scalp and Forehead Defects
Calvarial and Dural Defects
Defects of the Anterior Skull Base
Defects of the Lateral Skull Base
Defects of the Midface
Defects of the Orbit
Defects of the Sinuses and Nasal Cavity
CONCLUSION
CHAPTER 185:
Oral Cavity and Oropharyngeal Reconstruction
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
SURGICAL STEPS (ORAL CAVITY RECONSTRUCTION)
Tongue
Buccal Mucosa
Floor of Mouth, Alveolar Ridge and Retromolar Trigon
Lip
Mandible
SURGICAL STEPS (OROPHARYNGEAL RECONSTRUCTION)
Lateral Oropharyngeal Wall, Soft Palate
Posterior Oropharyngeal Wall
Tongue Base/Vallecula
NEW TECHNIQUES IN THE SURGERY
CHAPTER 186:
Free Radial Forearm Flap
SPECIFIC PREOPERATIVE EVALUATION
SURGICAL STEPS (HARVESTING TECHNIQUE)
CHAPTER 187:
Rectus Abdominis Free Flap
SPECIFIC PREOPERATIVE EVALUATION
SURGICAL STEPS (HARVESTING TECHNIQUE)
CHAPTER 188:
Free Fibula Osteocutaneous Flap
SPECIFIC PREOPERATIVE EVALUATION
General Considerations
SURGICAL STEPS
Harvesting Technique
CHAPTER 189:
Free and Pedicled Latissimus Dorsi Flap
GENERAL CONSIDERATIONS
SPECIFIC PREOPERATIVE EVALUATION
SURGICAL TECHNIQUE
CHAPTER 190:
Infrahyoid Fascio-Myocutaneous Flap
SPECIFIC PREOPERATIVE EVALUATION
SURGICAL STEPS
Harvesting Technique
CHAPTER 191:
Temporal Myofascial Flap
SPECIFIC PREOPERATIVE EVALUATION
SURGICAL STEPS (HARVESTING TECHNIQUE)
CHAPTER 192:
Pectoralis Major Flap
SPECIFIC PREOPERATIVE EVALUATION
SURGICAL STEPS
Harvesting Technique
CHAPTER 193:
Facial Artery Musculomucosal Flap
SPECIFIC PREOPERATIVE EVALUATION
SURGICAL STEPS
Harvesting Technique
CHAPTER 194:
Transoral Robotic Surgery—Radical Tonsillectomy
INTRODUCTION
INDICATIONS FOR THE SURGERY
SPECIFIC PREOPERATIVE EVALUATION
Clinical Evaluation
Laboratory Studies
Imaging Studies
Technical Considerations
ANESTHETIC CONSIDERATIONS
SURGICAL STEPS
Step 1
Step 2
Step 3
Step 4
Step 5
Step 6
Step 7
COMPLICATIONS
SPECIAL INSTRUMENTS USED FOR THE SURGERY
OTHER TREATMENT OPTIONS AVAILABLE FOR THE SAME CONDITION
CHAPTER 195:
Transoral Robotic Surgery for Ranula Excision
INTRODUCTION
INDICATIONS FOR SURGERY
PREOPERATIVE EVALUATION
Clinical Evaluation
Imaging Studies
Technical Considerations
ANESTHESIA CONSIDERATIONS
SURGICAL STEPS
COMPLICATIONS
Lingual Nerve Paresis
Submandibular Duct Injury
SPECIALIZED INSTRUMENTATION
ALTERNATIVE TREATMENT OPTIONS
ACKNOWLEDGMENTS
INDEX
TOC
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