Abordaje Transoral para la Extracción de un Diente Supernumerario Intranasal. Presentación de un Caso y Revisión de la Literatura

RESUMEN: El diente supernumerario de ubicación nasal es una patología de baja prevalencia en la población con diferentes formas y sintomatología clínica. Es importante establecer un diagnóstico respecto a sus características clínicas y radiológicas para realizar una planificación de tratamiento quirúrgica adecuada, con nula o escasas complicaciones post intervención. Presentación del caso: En el presente estudio se reporta el caso de un niño de 10 años de edad, sin antecedentes mórbidos, que recurre al servicio por presentar un diente supernumerario en la línea media hallado radiográficamente. El CBCT demuestra un mesiodens en el septum nasal, palatal inclinado e invertido, parcialmente erupcionado cubierto por mucosa nasal, con su corona en sentido a la cavidad nasal en relación a las fosas nasales. El diente fue extraído con anestesia general mediante un abordaje transoral a través de una vestibulotomía. El diente supernumerario nasal es una patología poco prevalente. Es importante conocer sus características clínicas y radiográficas ya que determinarán el tipo de abordaje a realizar. El grado de erupción, la distancia a la espina nasal anterior y su sintomatología asociada son fundamentales para determinar si el abordaje quirúrgico es intraoral o extraoral.

ABSTRACT: The supernumerary tooth of nasal location is a pathology of low prevalence in the population with different forms and clinical symptoms. It is important to establish a diagnosis regarding its clinical and radiological characteristics in order to carry out adequate surgical treatment planning, with few or no post-intervention complications. Case presentation: This study reports the case of a 10-year-old boy, with no morbid history, who presented a supernumerary tooth, found radiographically in the midline. CBCT showed a mesiodens in the nasal septum, tilted and inverted palatal, partially erupted covered by nasal mucosa, with its crown facing the nasal cavity in relation to the nostrils. The tooth was extracted under general anesthesia using a transoral approach through a vestibulotomy. The nasal supernumerary tooth is a rare pathology. It is important to know its clinical and radiographic characteristics since they will determine the type of approach to be used. The degree of eruption, the distance to the anterior nasal spine and its associated symptoms are essential to determine whether the surgical approach is intraoral or extraoral.

Craneofaringiomas: cirugía transnasal via endoscópica / Craniopharyngiomas: endoscopic transnasal surgery

Introducción: Debido a su ubicación anatómica, los craneofaringiomas son tumores complejos en su tratamiento. Una resección completa tiene riesgos elevados de morbimortalidad y si se opta por una resección parcial la tasa de recurrencia es alta. Según su extensión supraselar y su relación con el tallo hipofisario, pueden dividirse en preinfundibulares, transinfundibulares y retroinfundibulares. Objetivo: El objetivo de este video es describir la técnica vía endoscópica para la resección de un craneofaringioma preinfundibular. Materiales y Métodos: Se seleccionó un caso de un paciente con un craneofaringioma preinfundibular operado en el Servicio de Neurocirugía del Hospital Italiano de Buenos Aires, por vía endoscópica transnasal. Resultados: Se realizó una exéresis completa de la masa tumoral, sin evidenciar complicaciones tales como, diabetes insípida o fistula de líquido cefalorraquídeo y con recuperación completa del déficit campimétrico. Conclusión: El tratamiento quirúrgico de los craneofaringiomas requiere un conocimiento detallado de la anatomía de base de cráneo así como de las diferentes técnicas quirurgicas. El uso de la endoscopia ha permitido un mejor acceso a éste tipo de lesiones, disminuyendo las comorbilidades en el paciente y la estadía hospitalaria. Un resultado quirúrgico satisfactorio se obtiene con la resección completa y la menor morbilidad posible para el paciente

Introduction: Due to its anatomical location, craniopharyngiomas are difficult tumors to treat. Complete resection has high morbidity and mortality and if a partial resection is chosen, the recurrence is common. According to their suprasellar extension and its relationship with stalk, it can be classified into: preinfundibular, transinfundibular and retroinfundibular. Objetive: The aim of this video is to describe the surgical technique we use for preinfundibular craniopharyngioma. Methods: We review a preinfundibular craniopharyngioma operated on the Neurosurgery Department of the Hospital Italiano de Buenos Aires, through a transnasal endoscopic approach. Results: Total removal was achived, no acute complications were found such as diabetes insipidus or cerebrospinal fluid leak and improved their visual field. Conclusion: Craniopharyngioma surgery requires detailed knowledge of skull base anatomy and approaches. The use of endoscopy has allowed better access to this type of lesions, reducing comorbidities and patient hospital stay. Complete resection with low morbidity are the treatment of this tumors

Expanded Endoscopic Transnasal Approach to the Chordoid Glioma of the Third Ventricle : The First Case Ever Reported

Chordoid glioma of the third ventricle is a rare and challenging tumor to surgery because of its unique anatomical location and its close juxtaposition to the neurovascular structures and hypothalamus. The authors report a case of chordoid glioma of the third ventricle in a 43-year-old woman, who presented with headache and somnolence. The tumor was approached by endoscopic transnasal technique with a favorable result. Histopathologic examination disclosed a neoplastic tissue composed of eosinophilic epithelioid cells, mucinous, periodic acid Schiff-diastase positive, extracellular matrix, and scattered lymphoplasmacytic infiltrates. The best treatment option remains controversial. Customarily, the surgical route to remove chordoid glioma is transcranial; however, the undersurface of the optic chiasm and optic nerves preclude an adequate surgical visualization. In contrast, an expanded endoscopic transnasal approach provides a direct midline corridor to this region without any brain retraction.

Virtual imaging anatomy of transnasal approach to the clivus / 解放军医学杂志

Objective To observe the virtual anatomy via transnasal approach in a virtual-reality (VR) environment, and to establish a virtual anatomical model of clival region and explore the application value of the virtual-reality technology. Methods Twenty patients (males 11, females 9, aged from 25 to 70 years old with a mean of 43±0.3 years) with no pathological changes in the sellar area and clivus underwent CT angiography with Discovery Ultra 16 and 3.0T MRI thin-slice scan. The data were collected and inputted into the Dextroscope in the DICOM format. Virtual observation of anatomy via transnasal approach and three-dimensional reconstruction of clivus were carried out in the VR environment. Results Virtual reconstruction and measurements of clivus were successfully performed in the 20 patients. The simulation of transnasal approach was also carried out in the VR environment. The lateral side of clival bone removal through transnasal approach was limited by internal carotid artery, the superior limit was sellar floor and the lower clivus could not be revealed completely because of the restriction of the maxilla and hard palate. Conclusions Virtual reconstruction of the clivus and simulation of transnasal approach can be performed exactly by VR technology, which provides imaginal and anatomical basis in dealing with clivus lesions via transnasal approach.

Transcanalicular diode laser-assisted dacryocystorhinostomy.

Objective: We present a prospective, non-comparative case series study of 126 consecutive diode laser-assisted transcanalicular dacryocystorhinostomy (TCL-DCR) procedures on 122 patients. We analyzed success rate, procedure time and amount of laser energy needed for a 5 mm osteotomy. Materials and Methods: One hundred and twenty-two patients with nasolacrimal duct obstruction were included in the study. The procedure was performed under general anesthesia, and the nasal mucosa was anesthetized. An endoscope was used for examination of the lacrimal pathways. The site of osteotomy was determined with transillumination of the lateral nasal wall. We achieved osteotomy by applying laser energy via an optic fiber. We used a 980 nm diode laser with power of 10 Watts. We inserted a bicanalicular silicone stent as the last step. Success of procedure was absence of epiphora (subjective), or patency of the lacrimal drainage system on irrigation (objective). Results: We performed 126 successive endoscopic laser (EL-DCR) with bicanalicular intubation in 122 patients. The average procedure time was 12 min, and on average 245 Joules of laser energy was needed. The silicone stents were removed three to eight months after surgery. We observed absence of epiphora and a patent nasolacrimal duct on irrigation in 105 out of 126 treated eyes. Eighteen patients had epiphora despite a patent nasolacrimal duct on irrigation. This yields a success rate of 83.3%, with an average follow-up period of 12 months. Conclusions: The 980 nm EL-DCR with bicanalicular intubation is a new contribution to the field of lacrimal surgery. It is a minimally invasive quick procedure yielding a high success rate.

Isolated Sphenoid Sinus Mucocele Presenting as Third Nerve Palsy

A sphenoid mucocele often presents late due to its deep seated anatomical site. And it has varied presentation due to its loose relationship to the cavernous sinus and the base of the skull. We describe a case of large sphenoid sinus mucocele. A middle aged old man suddenly developed third cranial nerve palsy. Brain imaging study revealed an isolated sphenoid sinus mucocele, compressing right cavernous sinus. Endoscopic marsupialization of the mucocele via transnasal approach led to complete resolution of the third cranial nerve palsy. Involvement of the third cranial nerve in isolated mucocele is rare but important neurosurgical implications which must be excluded. In addition, proper and timely treatment must be performed to avoid permanent neurologic deficit.

Rathke's cleft cyst and partial feet adactyly: an unusual association

A 53 year-old woman presented a recurrent bifrontal headache of 2 years duration and bilateral progressive visual disturbance. The clinical and neurological examination showed a bilateral feet adactyly and bitemporal hemianopsia. The brain MRI demonstrated a Rathke's cleft cyst. The patient was operated by a transnasal endoscopic approach. It seems that this unusual association has never been described before.

Mulher de 53 anos com história recorrente de cefaléia com duração de 2 anos bilateral e progressiva, acompanhada de distúrbios visuais. O exame clinico e neurológico mostrou uma adactilia dos pés e hemianopsia bitemporal. A ressonância nuclear magnética cerebral mostrou um cisto de Rathke. A paciente foi operada por via transnasal endoscópica. Aparentemente esta é a primeira vez que esta associação é descrita na literatura.

Combination Therapy with Endoscopic Removal and Ambisome for Rhinocerebral Aspergillosis Invading Frontal Lobe: Report of a Case / 대한이비인후과학회지

The rhinocerebral aspergillosis invading sinuses and CNS is known to be a fatal desease in immunocompromised patients. The management principle of rhinocerebral aspergillosis is often by extensive surgical removal through craniotomy combined with amphotericin B therapy, and endoscopic removal had not been reported until now. We report in this study a case of rhinocerebral aspergillosis invading the left frontal sinus and the left frontal lobe which were treated by the combination therapy of endoscopic removal and antifungal agents.

Endoscopic Transnasal Transsphenoidal Pituitary Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Transseptal transsphenoidal approach has been used for the surgical removal of pituitary tumor. However, it may have a chance of complications following septal surgery. Recently, endoscopic transnasal transsphenoidal approach was attempted with several advantages. MATERIAL AND METHODS: We retrospectively reviewed the medical records of 10 patients who had received endoscopic transnasal transsphenoidal pituitary surgery between December, 1994 and August, 1998. We evaluated the effectiveness of this technique by analyzing operative findings, operative techniques, symptoms improvement and complications after surgery. RESULTS: In most cases, tumor were over 10 mm in diameter. Four patients had received previous transseptal transsphenoidal hypophysectomy. This technigre reduced the postoperative morbidity and compli-cations of transseptal approach. Another advantage of this technique was to examine operative site directly in outpatient clinic. CONCLUSION: We may consider that this approach is safe and effective, especially in revision cases after previoustransseptal surgery.

Four Cases of Choanal Atresia Managed by Endoscopic Endonasal Repair / 대한이비인후과학회지

As a surgical treatment of congenital choanal atresia, transnasal approach has been more widely used with the development of endoscopic surgical techinque. We have experienced 4 cases of congenital choanal atresia, which were treated via transnasal endoscopic approach. Three cases were unilateral, and one case was bilateral. We have fenestrated the atretic plate under endoscopic guide using forceps, curette, and/or Nd-YAG laser. Silastic stents were inserted in two cases and left in place for 3 weeks. No restenosis developed in the two cases to which stents were applied, while restenosis developed in two cases without stents. Revision transpalatal approach was performed in one case with bilateral atresia. No complication such as palatal deformity was developed. Newly formed choanal opening had a tendency to decrease in size with the passage of time. So, the opening should be wider initially, and postoperive endoscopic follow-up is needed.

Sphenoid Sinus Mucocele Complicated With Spontaneous CSF Rhinorrhea: Case Report

Mucocele is commonly found in frontal sinus. Mucocele of sphenoid sinus is rare and only 100 cases have been reported since Burg's description in 1889. Their etiology is still conjectural. These lesions are potentially more serious and are often misdiagnosed as pituitary tumor. The author experienced a case of sphenoid sinus mucocele develped headache, fever and CSF rhinorrhea. Plain skull, cisternography brain CT scan help the diagnosis of sphenoid sinus mucocele. A transnasal approach is considered best for case with extensive sphenoid sinus mucocele with bone destruction in the floor of sella turcica. The headache, fever and CSF rhinorrhea improved after surgery.