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Otolaryngologic Clinics of North America Feb 2017Refractory chronic rhinosinusitis can be challenging to treat. Initial treatment focuses on medical and nonsurgical treatments. If these treatments fail, revision... (Review)
Review
Refractory chronic rhinosinusitis can be challenging to treat. Initial treatment focuses on medical and nonsurgical treatments. If these treatments fail, revision endoscopic sinus surgery is an option. A plan for revision surgery must address anatomic factors contributing to recurrence. Preoperative imaging and sinonasal endoscopy are systematically reviewed; areas of disease and "danger" zones are identified. Traditional anatomic landmarks are often obscured or absent; thus, a set of consistent landmarks (unchanged despite prior surgery) are used to navigate the revision endoscopic sinus surgery. Wide sinusotomies permit visualization and access to disease intraoperatively. Large sinus openings also facilitate post-operative debridements in clinic, endoscopic disease monitoring, and topical sinus therapy.
Topics: Chronic Disease; Humans; Natural Orifice Endoscopic Surgery; Paranasal Sinuses; Recurrence; Reoperation; Rhinitis; Sinusitis; Tomography, X-Ray Computed
PubMed: 27888911
DOI: 10.1016/j.otc.2016.08.012 -
The American Journal of Cardiology Jan 1988What is double-orifice mitral valve anatomically and embryologically? In 27 postmortem cases, an anomaly of the tensor apparatus was always found. These malformations... (Review)
Review
What is double-orifice mitral valve anatomically and embryologically? In 27 postmortem cases, an anomaly of the tensor apparatus was always found. These malformations may be summarized as: (1) chordal ring; (2) accessory papillary muscle or muscles; (3) subdividing muscular ridge; (4) fused papillary muscles (parachute mitral valve); (5) crossing chordae tendineae; and (6) central fibrous subdivision. More than 1 of these anomalies often coexisted per case. Double-orifice mitral valve almost always consisted of abnormal holes in essentially normal leaflets, rather than of abnormal fibrous bridges or adhesions between normal leaflets. Since these fibrous "bridges" between the smaller accessory orifice and the larger main orifice are composed of mitral leaflet tissue and chordae, not fibrous adhesions, these bridges should not be transected surgically, to avoid iatrogenic mitral regurgitation. The accessory (smaller) orifice was at the anterolateral commissure in 11 cases (41%), at the posteromedial commissure in 12 (44%) and there was a central fibrous subdivision with approximately equal-sized orifices in 4 (15%). The atrioventricular (AV) canal was normally divided in 12 cases (44%) and a common AV canal was present in 15 (56%). When the accessory orifice was at the anterolateral commissure, the AV canal usually was normally divided (8 of 11, 73%). But when the accessory orifice was at the posteromedial commissure, a common AV canal almost always was present (11 of 12, 92%). Functionally, the mitral valve was normal in 13 (48%), regurgitated in 7 (26%) and stenotic in 7 (26%). The key to the diagnostic and surgical understanding of the double-orifice mitral valve is the underlying tensor apparatus.
Topics: Humans; Mitral Valve; Mitral Valve Insufficiency
PubMed: 3276118
DOI: 10.1016/0002-9149(88)91322-7 -
Clinical Anatomy (New York, N.Y.) Jul 2009Success in surgical procedures relies on the surgeon's understanding of anatomy and the ways in which the internal organs relate to one another. Recently, a new surgical...
Success in surgical procedures relies on the surgeon's understanding of anatomy and the ways in which the internal organs relate to one another. Recently, a new surgical technique has been introduced. Natural orifice translumenal endoscopic surgery (NOTES) uses the body's natural orifices (mouth, anus, urethra, or vagina) as entrance points to the peritoneal cavities (through the stomach, rectum, bladder, or posterior vaginal fornix). NOTES techniques have proven feasible in both animal and early human trials. While it remains to be seen what advantages NOTES possesses over traditional surgical approaches, a clear understanding of human anatomy will be critical for successful, safe NOTES procedures. This article summarizes the development and the basic techniques of NOTES and reviews those anatomical considerations specific to NOTES.
Topics: Endoscopy; Female; Humans; Male; Minimally Invasive Surgical Procedures; Peritoneal Cavity; Rectum; Stomach; Urinary Bladder; Vagina
PubMed: 19544299
DOI: 10.1002/ca.20816 -
Journal of Feline Medicine and Surgery Jan 2023Stenosis is a postoperative complication reported in 12-17% of male cats that undergo perineal urethrostomy (PU). This study compared two different revision techniques...
OBJECTIVES
Stenosis is a postoperative complication reported in 12-17% of male cats that undergo perineal urethrostomy (PU). This study compared two different revision techniques for failed perineal urethrostomies. The first objective was to evaluate the feasibility of performing a transpelvic urethrostomy (TPU) after a previous, correctly performed PU in male cats. The second objective was to determine the residual urethral length, orifice diameter, and the position of the orifice relative to the pubic brim and anus after PU, TPU and subpubic urethrostomy (SPU).
METHODS
Twenty male cat cadavers were randomly divided into two groups: TPU and SPU. In group TPU, PU was followed by TPU; in group SPU, PU was followed by SPU. After each procedure, the urethral orifice cross-section size was estimated by inserting the largest possible urinary catheter without resistance. Residual urethral length was measured both on contrast radiographs and after anatomical dissection.
RESULTS
In all cats, TPU could be performed following a technically correct PU. The TPU resulted in a 1.5-times longer residual urethral length than SPU, based on contrast radiographs ( = 0.001) and confirmed by anatomical dissection ( <0.001). Relative to the initial urethral length, PU, TPU and SPU resulted in a reduction of 24%, 36% and 56%, respectively. The urethral orifice diameter after TPU did not differ from SPU ( = 1.000), and it was not statistically significantly different between TPU and PU ( = 0.317) or between SPU and PU ( = 0.655). The urethral orifice was located further away from the pubis ( <0.001) and closer to the anus ( <0.001) after TPU than after SPU.
CONCLUSIONS AND RELEVANCE
Both TPU and SPU are possible revision surgeries following PU. As TPU preserves a significantly longer urethral length and requires less tissue dissection, the risk of urinary tract infections, urinary dermatitis and urinary incontinence might be less following TPU than SPU.
Topics: Cats; Male; Animals; Urethra; Urologic Surgical Procedures; Urinary Tract Infections; Postoperative Complications; Constriction, Pathologic; Urethral Obstruction; Cat Diseases
PubMed: 36638151
DOI: 10.1177/1098612X221137076 -
Laryngo- Rhino- Otologie May 2024Endoscopic endonasal skull base surgery has gained acceptance worldwide. Comparative analysis has demonstrated that endoscopic skull base surgery may have advantages for... (Review)
Review
OBJECTIVE
Endoscopic endonasal skull base surgery has gained acceptance worldwide. Comparative analysis has demonstrated that endoscopic skull base surgery may have advantages for many pathologies of the anterior skull base, e. g., sinonasal malignant tumors; pathologies of the central skull base, e. g., pituitary adenomas, craniopharyngiomas; well-selected cases of planum sphenoidale and tuberculum sellae meningiomas; or for clival lesions, e. g., chordomas, chondrosarcomas, or selected meningiomas. Over the past three decades, interdisciplinary surgical teams, consisting of otolaryngologists and neurosurgeons, have provided detailed anatomical knowledge, suggested new approaches or modifications of established surgical techniques, and offered continued surgical education.
METHOD
A review of pertinent literature was conducted with an emphasis on interdisciplinary endoscopic surgery of skull base lesions.
RESULTS
Based on the authors̓ surgical experience in two different interdisciplinary endoscopic skull base centers, the authors classify approaches for endoscopic endonasal skull base surgery, describe indications, and key anatomic landmarks for common pathologies, and highlight surgical techniques to avoid complications.
CONCLUSION
Interdisciplinary endonasal endoscopic surgery combines surgical expertise, improves resection rates for many pathologies, and minimizes morbidity by reducing the incidence of surgical complications.
Topics: Skull Base Neoplasms; Humans; Endoscopy; Patient Care Team; Skull Base; Natural Orifice Endoscopic Surgery; Interdisciplinary Communication
PubMed: 38697142
DOI: 10.1055/a-2196-8984 -
Turkish Thoracic Journal Mar 2021There are various anatomic variations in the tracheobronchial system. The frequency in studies with bronchoscopy was contradictory. This study aimed to investigate the...
OBJECTIVES
There are various anatomic variations in the tracheobronchial system. The frequency in studies with bronchoscopy was contradictory. This study aimed to investigate the tracheobronchial tree of the deceased patients with anatomical dissection.
MATERIAL AND METHODS
We made anatomical dissections on 204 cases in the Council of Forensic Medicine, Ministry of Justice. The deceased patients who were older than 12 years of age and of Turkish origin were included in this study consecutively.
RESULTS
Of the 204 cases, 161 (78.9%) were males and 43 (21.1%) were females. The mean age was 44.15±19.23 years. Anatomical variations were found to be present in 200 cases (98% of total). The highest degree of variation of the right upper lobe was noted to be 16.6% (34/204). An anomalous arrangement (with three segments or different placement) of the middle lobe was noted in 16.1% of cases. For the basal lower lobe, b8+(b9+b10) pattern and basal orifice with four segments were noted to be the most frequent anatomical variant in the right and left lungs, respectively. The most frequent tracheobronchial variations were as follows: apical basal lobe with two subsegments in the right and left (39.7%), left lower lobe basal orifice with four segments (34.8%), left upper lobe with three segments (25.5%), and right lower lobe basal orifice with three main segmental bronchi (21.1%).
CONCLUSION
The tracheobronchial tree exhibits highly individualistic features. The knowledge of the frequency of different variations obtained in different studies and normal anatomic variants in return makes doing therapeutic or diagnostic interventions easier and more accurate.
PubMed: 33871335
DOI: 10.5152/TurkThoracJ.2021.18111 -
Ophthalmic Plastic and Reconstructive... 2019
Topics: Anatomic Landmarks; Humans; Natural Orifice Endoscopic Surgery; Nose; Ophthalmologic Surgical Procedures; Optic Chiasm; Sphenoid Bone; Terminology as Topic
PubMed: 31283690
DOI: 10.1097/IOP.0000000000001394 -
Laboratory Animals Oct 2022The objective of this work was to anatomically locate the urethral orifice in female minipigs and describe the use of video laryngoscopes in urethral catheterization.
OBJECTIVE
The objective of this work was to anatomically locate the urethral orifice in female minipigs and describe the use of video laryngoscopes in urethral catheterization.
METHODS
Urethral catheterization guided by a video laryngoscope was attempted in 16 adult female Bama minipigs. The anatomical location of urethral orifices, operating time and complications (mucosal edema and bleeding in the vaginal vestibule, and the numbers of red blood cells (RBCs) and white blood cells (WBCs) in mid-stream urine samples) were recorded.
RESULTS
The anatomical location of the urethral orifice: the depth of the urethral orifice in female Bama minipigs was 4.2 ± 1.2 cm; all the urethral orifices were covered by mucosal folds of the vaginal vestibule. In the supine position, the orifice of the urethra at 9-12 and 1-3 o'clock accounted for 6.25%, 6.25%, 18.75%, 50%, 12.5%, 6.25% and 6.25%, respectively. All animals were successfully catheterized and the operating time was 9.0 (6.0-12.8) min. Complications: no bleeding in the vaginal vestibule was observed; the incidence of mucosal edema was 12.5%, all of which were mild; of urine samples collected 1 h after catheterization, 12.5% were found to contain RBCs and no RBCs were detected 6 h after catheterization; no WBCs were detected 1 h or 6 h after catheterization.
CONCLUSIONS
The urethral orifice of female minipigs was located deep in the vagina at variable clock directions and was unexceptionally covered by mucosal folds. Applying a video laryngoscope in urethral catheterization allowed quick and accurate exposure of the urethral orifice and minimal operational injury in female minipigs.
Topics: Swine; Female; Animals; Urinary Catheterization; Laryngoscopes; Swine, Miniature; Urethra; Vagina
PubMed: 35535457
DOI: 10.1177/00236772221092933 -
Otolaryngologic Clinics of North America Dec 2020Robotic-assisted surgery embodies the latest in technological advancement and is being applied to operative management of patients. The current concept of robotic... (Review)
Review
Robotic-assisted surgery embodies the latest in technological advancement and is being applied to operative management of patients. The current concept of robotic surgery involves performance of surgical procedures by using small wristed instruments attached to a robotic arm. Its extension to otolaryngology is only natural, because it allows for precise surgery through anatomic orifices, often allowing for preservation of critical anatomic structures and functions. Transoral robotic surgery is an effective and safe tool for head and neck surgeons. Its speed of recent growth and the imminent addition of innovative technology could signal the advent of a new era in surgery.
Topics: Disease Management; History, 20th Century; History, 21st Century; Humans; Otolaryngology; Robotic Surgical Procedures; Robotics; Treatment Outcome
PubMed: 32838968
DOI: 10.1016/j.otc.2020.07.005 -
Clinical Gastroenterology and... Feb 2014Choledochoceles are cystic dilatations of the intraduodenal portion of the common bile duct. Although often classified as Type III biliary cysts, choledochoceles have... (Review)
Review
Choledochoceles are cystic dilatations of the intraduodenal portion of the common bile duct. Although often classified as Type III biliary cysts, choledochoceles have distinctive demographic and anatomic features and a lower risk of malignancy than other types of choledochal cysts. Type A choledochoceles are cystic dilatations of a segment of the intra-ampullary bile duct and are located proximal to the ampullary orifice. Type B choledochoceles are diverticula of the intra-ampullary common channel and are located distal to the ampullary orifice; they can be distinguished from duodenal duplication cysts both anatomically and histologically. Both types of choledochocele may present with pancreatitis, biliary obstruction, or nonspecific gastrointestinal symptoms. Cross-sectional imaging, endoscopic ultrasound, and endoscopic retrograde cholangiopancreatography are useful for diagnosis. Choledochoceles may be drained or resected endoscopically. Surveillance for dysplasia should be considered for lesions that are not resected.
Topics: Cholangiopancreatography, Endoscopic Retrograde; Choledochal Cyst; Duodenum; Endosonography; Humans; Magnetic Resonance Imaging; Prognosis; Tomography, X-Ray Computed
PubMed: 23660418
DOI: 10.1016/j.cgh.2013.04.037