S123 – New Approaches to Infratemporal Fossa Foreign Body Removal

Objectives 1) To understand indications for removal of foreign bodies (FB) from the head and neck. 2) To be able to describe the use of new surgical technologies for FB removal from the head and neck region. 3) To understand the clinical applications of a novel, minimally-invasive technique for removal of FB from the infratemporal fossa. Methods A retrospective review of 2 cases of infratemporal fossa foreign bodies, which were referred to a tertiary care facility for management utilizing a novel transoral, endoscopic, image-guided approach. Results Both patients presented with pain and trismus following failed attempts to retrieve foreign bodies–1 broken hypodermic needle and 1 torn cottonoid sponge-through open explorations. Use of endoscopic equipment for visualization and image-guidance system for precise localization enabled both objects to be removed through a transoral approach. Surgical removal resulted in improvement in pain and trismus in both patients who were discharged within 24 hours. Conclusions A new approach is now available for the minimally-invasive retrieval of radio-opaque foreign bodies in the infratemporal fossa, which avoids the need for extensive surgical dissection or an external incision.

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Ultrasound-guided removal of soft tissue foreign bodies in companion animals: A case series

Veterinární Medicína ◽

10.17221/18/2019-vetmed ◽

2020 ◽

Vol 65 (No. 2) ◽

pp. 49-55

Author(s):

S Manfredi ◽

G Covi ◽

M Bonazzi ◽

G Gnudi ◽

M Fumeo ◽

...

Keyword(s):

Soft Tissue ◽

Minimally Invasive ◽

Foreign Bodies ◽

Soft Tissues ◽

Companion Animals ◽

Case Series ◽

Invasive Technique ◽

Surgical Removal ◽

Small Animals ◽

Ultrasound Guided

Foreign bodies (FBs) retained in the subcutaneous tissues are a common reason for medical consultation. In small animals, FBs usually consist of vegetal materials, especially grass awns. Failure to remove the FBs is likely to give rise to acute or late complications. The surgical removal of the FBs can be invasive, costly and technically challenging. Ultrasound has become a mainstay in the detection of FBs and it can be used to guide the extraction of the FBs with a minimally invasive technique. This study describes the detection and extraction of soft-tissue FBs in small animals. One hundred-sixty-two patients, presenting at two veterinary clinics with suspected FBs retained in the soft tissues of various body districts, were considered. Once an ultrasound diagnosis was established, the ultrasound-guided removal of the FB was performed. A high-frequency linear transducer, a skin disinfection, sedation or anaesthesia was used when needed and a scalpel and some Hartmann forceps were also used. One hundred-eighty-two FBs were successfully removed in all the patients. In six cases, the FB was identified during a second ultrasonographic examination, after recurrence of the fistula. No complications were reported after the procedure. The extraction of the FB was performed in an echographic suite in 138 cases and in a surgery room with surgical intervention in 24 cases. In the latter situation, the surgical minimally invasive dissection of tissues under ultrasound guidance was performed before the removal of the FB. In conclusion, the ultrasound-guided removal of the FBs retained in the superficial soft tissue can be considered a good alternative to surgery. However, failure to remove a FB does not preclude the removal by traditional surgery.

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Improving accuracy and reducing radiation exposure in minimally invasive lumbar interbody fusion

Journal of Neurosurgery Spine ◽

10.3171/2009.11.spine09270 ◽

2010 ◽

Vol 12 (5) ◽

pp. 533-539 ◽

Cited By ~ 33

Author(s):

Martin James Wood ◽

Richard John Mannion

Keyword(s):

Minimally Invasive ◽

Radiation Exposure ◽

Interbody Fusion ◽

Case Series ◽

Guidance System ◽

Screw Placement ◽

Invasive Technique ◽

Computer Assisted ◽

Lumbar Interbody Fusion ◽

Screw Misplacement

Object The authors assessed the accuracy of placement of lumbar transpedicular screws by using a computer-assisted, imaged-guided, minimally invasive technique with continuous electromyography (EMG) monitoring. Methods This was a consecutive case series with prospective assessment of procedural accuracy. Forty-seven consecutive patients underwent minimally invasive lumbar interbody fusion and placement of pedicle screws (PSs). A computer-assisted image guidance system involving CT-based images was used to guide screw placement, while EMG continuously monitored the lumbar nerve roots at the operated levels with a 5-mA stimulus applied through the pedicle access needle. All patients underwent CT scanning to determine accuracy of PS placement. All episodes of adjusted screw trajectory based on positive EMG responses were recorded. Pedicle screw misplacement was defined as breach of the pedicle cortex by the screw of more than 2 mm. Results Two hundred twelve PSs were inserted in 47 patients. The screw misplacement rate was 4.7%. One patient experienced new postoperative radiculopathy resulting from a sacral screw that was too long, with lumbosacral trunk impingement. The trajectory of the pedicle access needle was altered intraoperatively on 20 occasions (9.4% of the PSs) based on positive EMG responses, suggesting that nerve root impingement may have resulted from these screws had the EMG monitoring not been used. Conclusions The combination of computer-assisted navigation combined with continuous EMG monitoring during pedicle cannulation results in a low rate of PS misplacement, with avoidance of screw positions that might cause neural injury. Furthermore, this technique allows reduction of the radiation exposure for the surgical team without compromising the accuracy of screw placement.

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Impact of the Novel Coronavirus 2019 (COVID-19) Pandemic on Head and Neck Cancer Care

Otolaryngology ◽

10.1177/01945998211004544 ◽

2021 ◽

pp. 019459982110045

Author(s):

Joshua Adam Thompson ◽

Joshua E. Lubek ◽

Neha Amin ◽

Reju Joy ◽

Donita Dyalram ◽

...

Keyword(s):

Head And Neck ◽

Tertiary Care ◽

Care Facility ◽

Cross Sectional Study ◽

Tumor Board ◽

Secondary Outcome ◽

Cross Sectional ◽

Tertiary Care Facility ◽

Procedural Volume ◽

The Impact

Objective The study aimed to assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on head and neck oncologic care at a tertiary care facility. Study Design This was a cross-sectional study conducted between March 18, 2020, and May 20, 2020. The primary planned outcome was the rate of treatment modifications during the study period. Secondary outcome measures were tumor conference volume, operative volume, and outpatient patient procedure and clinic volumes. Setting This single-center study was conducted at a tertiary care academic hospital in a large metropolitan area. Methods The study included a consecutive sample of adult subjects who were presented at a head and neck interdepartmental tumor conference during the study period. Patients were compared to historical controls based on review of operative data, outpatient procedures, and clinic volumes. Results In total, 117 patients were presented during the review period in 2020, compared to 69 in 2019. There was an 8.4% treatment modification rate among cases presented at the tumor conference. There was a 61.3% (347 from 898) reduction in outpatient clinic visits and a 63.4% (84 from 230) reduction in procedural volume compared to the prior year. Similarly, the operative volume decreased by 27.0% (224 from 307) compared to the previous year. Conclusion Restrictions related to the COVID-19 pandemic resulted in limited treatment modifications. Transition to virtual tumor board format observed an increase in case presentations. While there were reductions in operative volume, there was a larger proportion of surgical cases for malignancy, reflecting the prioritization of oncologic care during the pandemic.

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Minimally invasive therapy of lymphatic malformations in patients treated in the Paediatric Teaching Clinical Hospital, University Clinical Centre of the Medical University of Warsaw (DSK UCK WUM)

New Medicine ◽

10.25121/newmed.2019.23.4.119 ◽

2019 ◽

Vol 23 (4) ◽

Author(s):

Agata Wasilewska ◽

Małgorzata Badełek-Izdebska ◽

Lidia Zawadzka-Głos ◽

Remigiusz Krysiak ◽

Jarosław Żyłkowski

Keyword(s):

Minimally Invasive ◽

Head And Neck ◽

Neck Region ◽

Abnormal Development ◽

Invasive Technique ◽

Lymphatic Malformations ◽

Head And Neck Region ◽

Drug Doses ◽

Medical University ◽

Fluoroscopy Guidance

Introduction. Lymphatic malformations (LMs) are benign lesions thought to be caused by the abnormal development of the lymphatic system in utero. Most commonly, LMs affect the head and neck. Because of LM morphology and location close to important vascular and nervous structures, surgical treatment is difficult, associated with a high risk of complications, and often incomplete. Aim. Bleomycin sclerotherapy is a recognised minimally invasive technique used in the treatment of LMs. We present the outcomes of bleomycin therapy of LMs located in the head and neck area in children receiving therapy in our centre. Material and methods. Between September 2017 and October 2019, treatment with bleomycin was provided to a total of 6 patients with LMs of the head and neck, aged from 3 weeks to 10 years. The procedures were performed under ultrasound and/or fluoroscopy guidance. The aspects analysed included the number of procedures applied in patients, drug doses, treatment response and complications. Results. In 4 patients, the LM was located on the neck, in 1 patient ? on the neck and in the mediastinum, and in 1 patient in the cheek region. Three patients underwent 2 procedures, 1 patient ? 3 procedures, and 2 patients ? 1 procedure. The treatment outcome was excellent and good in 4 patients and 1 patient, respectively. However, in 1 patient, the therapeutic effect was unsatisfactory, and a decision was made to administer another course of treatment. The maximum single dose of bleomycin was 10,000 IU; the dose of 700 IU/kg BW was not exceeded. No complications were observed after the procedures. Conclusions. Preliminary results suggest that bleomycin sclerotherapy of LMs in the head and neck region in children is an effective and safe treatment modality.

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Profile of parotid tumors visiting tertiary health care facility in North India

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20201671 ◽

2020 ◽

Vol 6 (5) ◽

pp. 835

Author(s):

Manish Munjal ◽

Nitika Tuli ◽

Porshia Rishi ◽

Harjinder Singh ◽

Shivam Talwar ◽

...

Keyword(s):

Facial Nerve ◽

Head And Neck ◽

Head And Neck Neoplasms ◽

Tertiary Care ◽

Care Facility ◽

Malignant Neoplasms ◽

Head And Neck Neoplasm ◽

Anatomical Landmarks ◽

Parotid Tumors ◽

Parotid Surgery

Background: Neoplastic lesions of head and neck presenting in a tertiary care facility were analyzed. This study is proposed to examine the epidemiological pattern of parotid tumors, histopathology correlations and relation of facial nerve with the parotid tumors.Methods: This is a retrospective study of patients with head and neck neoplasms who presented to the ENT tumour clinic of Dayanand Medical College and Hospital over a period of 2 years i.e., from January 2018 to December 2019. Patients’ demographic profile, histopathological reports and pre-operative fine needle aspiration cytology reports were studied. Results: Total number of cases of head and neck neoplasms were 273 over a period of 2 years. Parotid tumours constituted 9.1% of the total head and neck neoplasm. Predominant age group in case of benign parotid tumors was 40-50 years, whereas in case of malignant neoplasms was 50-60 years. Posterior belly of digastric along with tragal pointer are the most consistent and reliable landmarks for Identification of facial nerve.Conclusions: Identification of trunk of facial nerve using anatomical landmarks is the keystone for parotid surgery. Posterior belly of digastric along with tragal pointer are the most consistent and reliable landmarks for Identification of facial nerve.

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C-arm Guided Minimally Invasive Percutaneous Fixation Technique of Mandibular Angle and Ramus Fractures - a Prospective Clinical Study at a Tertiary Care Center of Odisha, India.

Europasian Journal of Medical Sciences ◽

10.46405/ejms.v2i2.53 ◽

2020 ◽

Vol 2 (2) ◽

pp. 10-16

Author(s):

Sourav Kumar Rout ◽

Subrat Kumar Jena

Keyword(s):

Minimally Invasive ◽

Internal Fixation ◽

Tertiary Care ◽

Distinct Advantage ◽

Invasive Technique ◽

Rigid Fixation ◽

Mandibular Angle ◽

Unique Challenge ◽

Nerve Paralysis ◽

Intraoral Approach

Background: Rigid internal fixation of displaced mandibular angle and ramus fractures often poses a unique challenge to oral and maxillofacial surgeons. Various methods have been published to provide a safe and secure gateway for these circumstances. Intra-oral approach supplemented by a limited percutaneous method of fixation offers a distinct advantage of rigid fixation, reducing the known morbidity of using the sole internal as well as external techniques. The objective was to describe a minimally invasive technique for the mandibular angle and ramus fractures using the combined intraoral and extra-oral approach.Methods: This study was conducted on ten patients with mandibular angle or ramus fractures. All patients underwent open reduction and internal fixation. The intra-oral incision was used for visualization and reduction of fractures, and supplemental percutaneous stab incision was utilized to create a path for insertion of the handheld battery-operated microdrill shaft and screwdriver to permit screws fixation perpendicular to the plates.Results: This combined technique depicted minimal or no soft tissue infections, wound dehiscence, occlusal disturbances, or seventh cranial nerve paralysis. The mean surgical duration was 41.5 minutes. No patient had an visible scar marks, which would require further intervention.Conclusion: The described minimally invasive combined percutaneous and intraoral approach for mandibular angle, and ramus fracture provides a satisfactory alternative which could be safely applied to provide rigid fixation of these fractures with minimal damage to vital structures.

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Disease Profiles of Head and Neck Lesions Diagnosed by Fine Needle Aspiration Cytology at a Tertiary Care Hospital in Bangladesh

Journal of Current and Advance Medical Research ◽

10.3329/jcamr.v8i1.52477 ◽

2021 ◽

Vol 8 (1) ◽

pp. 21-24

Author(s):

Kazi Md. Shahidur Rahman ◽

Md. Mahmudul Huda ◽

ASM Mahmud Hasan ◽

Md Shaheeduzzaman ◽

Gazi Manjurul Islam

Keyword(s):

Head And Neck ◽

Tertiary Care ◽

Cost Effective ◽

Needle Aspiration ◽

Cross Sectional Study ◽

Lymphoid Hyperplasia ◽

Invasive Technique ◽

Care Hospital ◽

Neck Swelling ◽

Cross Sectional

Background: Head & Neck lesions encompass a multitude of congenital, inflammatory or neoplastic lesions including several anatomic sites and originating in different tissues and organs. FNAC is a simple, quick, feasible, cost effective and repeatable outpatient procedure with minimum risk of complications. Objective: The purpose of the present study was to study the spectrum of head & neck lesions attending in outpatient. Methodology: This present cross-sectional study included the patients presented with palpable head & neck swelling from January 2018 to September 2019 in outpatient (mostly ENT & HNS OPD) department of Monno Medical College & Hospital, Monno City, Gilondo, Manikgonj. Aspirates were done using mostly 5ml syringe and 23-gauge needle. Smears were stained with Papanicolaou stain. Results: Out of 210 patients of head & neck lesions studied, Lymph node (50.47%) was the predominant site aspirated with chronic nonspecific lymphadenitis & lymphoid hyperplasia being the commonest lesion. Thyroid lesions constituted 31.90% cases followed by soft tissue (11.9%) and salivary gland (5.71%). Conclusion: In conclusion FNAC is simple, quick, inexpensive and minimally invasive technique to diagnose different types of head and neck swelling. It could differentiate the infective process from neoplastic one and avoid unnecessary surgeries. Journal of Current and Advance Medical Research, January 2021;8(1):21-24

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Robotic paravertebral schwannoma resection at extreme locations of the thoracic cavity

Neurosurgical FOCUS ◽

10.3171/2017.2.focus16551 ◽

2017 ◽

Vol 42 (5) ◽

pp. E17 ◽

Cited By ~ 9

Author(s):

Giacomo Pacchiarotti ◽

Michael Y. Wang ◽

John Paul G. Kolcun ◽

Ken Hsuan-kan Chang ◽

Motasem Al Maaieh ◽

...

Keyword(s):

Minimally Invasive ◽

Thoracoscopic Surgery ◽

Posterior Mediastinum ◽

Surgical Approaches ◽

Invasive Technique ◽

Surgical Removal ◽

Thoracic Cavity ◽

Excellent Outcome ◽

Nerve Sheath Tumors ◽

Superior Sulcus

Solitary paravertebral schwannomas in the thoracic spine and lacking an intraspinal component are uncommon. These benign nerve sheath tumors are typically treated using complete resection with an excellent outcome. Resection of these tumors is achieved by an anterior approach via open thoracotomy or minimally invasive thoracoscopy, by a posterior approach via laminectomy, or by a combination of both approaches. These tumors most commonly occur in the midthoracic region, for which surgical removal is usually straightforward. The authors of this report describe 2 cases of paravertebral schwannoma at extreme locations of the posterior mediastinum, one at the superior sulcus and the other at the inferior sulcus of the thoracic cavity, for which the usual surgical approaches for safe resection can be challenging. The tumors were completely resected with robot-assisted thoracoscopic surgery. This report suggests that single-stage anterior surgery for this type of tumor in extreme locations is safe and effective with this novel minimally invasive technique.

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Minimally invasive technique for intrathecal administration of morphine in rats: practicality and antinociceptive properties

Laboratory Animals ◽

10.1177/0023677216682771 ◽

2016 ◽

Vol 51 (5) ◽

pp. 479-489

Author(s):

Aurelie Anic Thomas ◽

Johann Detilleux ◽

Charlotte Friederike Sandersen ◽

Paul Andrew Flecknell

Keyword(s):

Minimally Invasive ◽

Technical Difficulty ◽

Intrathecal Administration ◽

Minimally Invasive Technique ◽

Invasive Technique ◽

Hypodermic Needle ◽

Direct Puncture ◽

Anaesthetized Rats ◽

Potential Interactions ◽

To Receive

The intrathecal (IT) route of administration represents a means to reduce the dose of morphine administered for analgesia, potentially minimizing interactions between opioid effects and experimental outcomes. Perceived technical difficulty, and previously described invasive methods, may limit its use. This report describes a minimally invasive technique for IT administration of morphine by direct transcutaneous lumbosacral puncture in rats; and assesses antinociceptive properties of morphine in anaesthetized rats. Rats ( n = 28) anaesthetized with sevoflurane (inspired fraction of sevoflurane: FiSevo = 2.4%) were randomly allocated to receive: IT morphine (0.2 mg/kg); subcutaneous (SC) morphine (3 mg/kg); SC buprenorphine (0.05 mg/kg); or SC or IT sodium chloride (NaCl). After a wash-in period (40 min), thermal nociceptive stimuli were applied at nine locations corresponding to different rostrocaudal dermatomes of the rat. Nociceptive stimulation cycles were repeated at all locations after successive decrement of FiSevo by 15%. Presence or absence of gross purposeful movement (GPM) was recorded for each individual stimulation. IT injection of morphine by direct puncture with a 25 G hypodermic needle is easily performed (successful first attempt: 82%) without complications. IT morphine reduced the frequency of GPM following nociceptive thermal stimulation in a way comparable with SC buprenorphine or morphine. It was not possible to delimit any rostral spinal spread of morphine. This report describes a refined and effective technique of administering morphine IT in rats using readily available materials. IT doses being markedly smaller than the systemic equivalent, analgesia could be provided whilst minimizing the potential interactions of non-analgesic opioid effects with research protocols.

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