Tips and tricks for maximising access to the middle cranial fossa using the superior lateral orbital portal.

BACKGROUND: Transorbital endoscopic approaches are becoming increasingly popular for skull base pathologies; the superior lateral orbital portal is one such approach to the middle cranial fossa. This paper provides a technical description that maximises the surgical portal and minimises morbidity. TECHNICAL DESCRIPTION: A superior lid crease incision is made extending laterally and the orbital rim is exposed. A subperiosteal dissection of the lateral and superior orbit is performed, with elevation of periosteum off Whitnall's tubercle, ligation of the recurrent branch of the middle meningeal artery, and identification of the superior orbital fissure. The lacrimal keyhole is then drilled away. The middle cranial fossa is accessed by drilling posterior to the orbital rim to expose: the temporalis muscle anterior-laterally, the dura of the temporal lobe posterior-laterally, the anterior cranial fossa superiorly and the periorbita medially. CONCLUSION: These surgical steps can maximise the surgical portal and minimise morbidity, with avoidance of injury to surrounding structures.

Transorbital Endoscopic Surgery for Sphenoid Wing Meningioma: Long-Term Outcomes and Surgical Technique.

Sphenoid wing meningiomas are benign tumors that can result in proptosis, visual impairment, and pain. Traditional open surgical approaches are associated with significant morbidity. Transorbital endoscopic surgery has been developed as a minimally invasive approach to gain access to these tumors and address the main presenting symptoms. Case series reporting transorbital endoscopic resection of sphenoid wing meningiomas using combined endonasal, pre-caruncular, and extended superior eyelid approaches have demonstrated stable and/or improved short- and medium-term visual outcomes. Earlier medial optic nerve decompression appears to result in more favorable long-term visual outcomes. Transorbital endoscopic surgery therefore represents an emerging minimally invasive alternative to deal with these challenging lesions.

Pre-caruncular approach to the medial orbit and landmarks for anterior ethmoidal artery ligation: a cadaveric study.

OBJECTIVE: In epistaxis and skull base surgery, the anterior ethmoidal artery sometimes needs to be ligated. We describe a novel, quick and scar-free surgical technique to ligate this artery with salient landmarks allowing rapid identification. PATIENTS AND METHODS: Twenty medial orbital walls from 10 randomly selected fresh-frozen, non-formalinised cadaver heads were examined. Dissection was performed by a pre-caruncular external approach to expose the AEA in all cases. RESULTS: The Horner's muscle and nasion, two salient landmarks, have been identified for use during the pre-caruncular approach. DISCUSSION/CONCLUSION: The pre-caruncular approach is a novel combined open and endoscopic surgical approach to the anterior ethmoidal artery. It is a simple, quick and scar-free technique. The identification of the artery is easy when using the two anatomic landmarks we describe in our study, that is Horner's muscle and the nasion.

Endoscopic resection of skull base tumours utilising the ultrasonic dissector.

OBJECTIVE: We report the use and benefits of the ultrasonic dissector in the resection of difficult skull base lesions. METHOD: Five case reports are presented, and the utilisation of ultrasonic dissectors in otorhinolaryngology is reviewed. RESULTS: The ultrasonic dissector was found to be a useful tool during the endoscopic resection of poorly accessible skull base tumours. Safe dissection and complete removal of all five lesions were achieved without any vascular injury. To our knowledge, this is the first report of the use of the ultrasonic dissector for the resection of sinonasal and skull base tumours. CONCLUSION: The ultrasonic dissector was found to be particularly useful during the endoscopic transnasal approach to the petrous apex. During minimally invasive endonasal surgery, benefits include the length of the instrument, speed and precision of dissection, and low risk of vascular injury.

Peroral drainage of post-traumatic sialocoeles: report of three cases.

OBJECTIVE: To discuss the technique and outcome of this simple procedure and the management of post-traumatic parotid sialocoeles, and to review the literature regarding this condition. CASE REPORT: We report the successful surgical treatment, by peroral drainage, of three patients with post-traumatic parotid sialocoele resistant to conservative management. DISCUSSION: We discuss the method and outcome of the surgical procedure performed, along with the causes, presentation and management of parotid sialocoele. CONCLUSION: Correct initial management of a parotid duct injury may prevent the formation of a sialocoele. When conservative treatment of post-traumatic parotid sialocoele fails, we advocate the surgical technique described in this report as it is effective, simple and carries minimal risk to the patient.

Retained knife blades in the ear, nose and throat: three cases.

OBJECTIVE: To discuss the management and to review the literature regarding retained knife blades in the head and neck. CASE REPORT: We present three cases in which patients presented with retained knife blades in the head and neck region; in two of these, the diagnosis was delayed by more than eight weeks. In all patients, the retained knife blade was removed through the pathway of insertion, without significant sequelae. DISCUSSION: The methods of removal, appropriate radiological investigations and patient profiles are discussed. CONCLUSIONS: We propose that radiography be performed on all patients presenting with facial stab injuries which are anything more than superficial. We further suggest that the direct extraction of sharp objects through the pathway of insertion is safe if radiological studies show no risk of vascular injury.

Alcohol sclerotherapy of human immunodeficiency virus related parotid lymphoepithelial cysts.

OBJECTIVE: The aim of the study was to determine the effectiveness of alcohol sclerotherapy in patients with human immunodeficiency virus related salivary gland disease. STUDY DESIGN: Prospective study investigating the effectiveness of alcohol as a sclerosing agent. SETTING: Tertiary referral hospital. PATIENTS: Eleven human immunodeficiency virus positive patients with benign lymphoepithelial cysts were included in the study, from July 2005 to September 2006. INTERVENTIONS: Alcohol sclerotherapy was performed under local anaesthesia, with alcohol infiltrated into the benign lymphoepithelial cysts. RESULTS: Alcohol injection sclerotherapy proved to be an effective, simple, cheap, ambulatory procedure for patients who did not qualify for antiretroviral treatment.

Endoscopic transnasal removal of migrated dental implants.

We report a case of migration of a dental implant into the maxillary sinus and discuss the benefits of endoscopic transnasal removal of such implants. As the sole approach, this technique has rarely been described. The most commonly used technique for retrieval of dental implants is the Caldwell-Luc procedure. This, however, has certain morbidity associated with it and may compromise subsequent implant insertion.