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Background: Endoscopic septoplasty provides several advantages over traditional headlight septoplasty in terms of better visualization. However, surgeons may experience frequent soiling of the endoscope lens by blood from the incision site and awkwardness in finding adequate space for the endoscope and dissectors in narrow septal mucosal tunnels. Here, we propose a simple and safe modification for endoscopic septoplasty., Methods: A total of 21 patients underwent endoscopic septoplasty using a new modification. Briefly, a posterosuperior extension incision was made along the dorsal septum at the superior end of the caudal septal incision, and a posteroinferior-based septal mucosal flap was developed and placed laterally over the inferior turbinate during surgery., Results: The new modification reported here provided clear endoscopic visualization and a comfortable working space from making the incision to closing the wound. In addition, no significant complications related to this modification, such as increased operation time, intraoperative or postoperative bleeding, delayed wound healing, synechia, nasal septal perforation, and reduced olfaction, were observed., Conclusion: Adding a posterosuperior extension incision to the caudal septal incision might be a safe and efficient modification for endoscopic septoplasty., (© 2015 ARS-AAOA, LLC.)

Objectives/hypothesis: Since the introduction of an endonasal endoscopic approach in transsphenoidal pituitary surgery, reports of perioperative olfactory changes have presented conflicting results. We examined the incidence of olfactory loss in cases of endoscopic transsphenoidal pituitary surgery with skull base repair using the nasoseptal flap (NSF) and the effects of monopolar electrocautery commonly used in designing the NSF., Study Design: Case-control study., Methods: Fifteen patients who underwent endoscopic transsphenoidal pituitary surgery with skull base reconstruction using the NSF were divided into cold knife (n = 8) and electrocautery (n = 7) groups according to the device used in the superior incision of the NSF. Patients were followed regularly to monitor the need for dressing or adhesiolysis around the olfactory cleft. All subjects received olfactory tests before and 6 months after surgery. Septal mucosa specimens obtained during posterior septectomy were incised with different devices, and the degree of mucosal damage was evaluated., Results: One patient in the electrocautery group demonstrated olfactory dysfunction postoperatively, but the other 14 patients showed no decrease in olfaction. In histologic analyses, 55.8% and 76.9% of the mucosal surface showed total epithelial loss when the mucosa was cut with cutting- and coagulation-mode electrocautery, respectively. In contrast, only 20% of the mucosal surface exhibited total epithelial loss when the mucosa was cut with a cold knife (P < .01)., Conclusions: Olfactory impairment is not common after use of the NSF. Use of the cold knife in making superior incision may reduce tissue damage with better olfactory outcomes., (Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.)

Background: Surgical removal of a dermoid cyst is usually accomplished through an external neck incision. However, this procedure inevitably results in a neck scar., Methods: We report the case of a 17-year-old woman with a submental mass. We implemented a modified approach to dermoid cyst removal through the floor of the mouth using an endoscope system., Results: The patient received a modified approach to dermoid cyst removal and remains free of disease 6 months after excision., Conclusion: Resection of the submental type dermoid cyst can be performed by an intraoral endoscope-assisted approach through the floor of the mouth. We describe the procedure of the endoscope-assisted intraoral resection., (Copyright © 2010 Wiley Periodicals, Inc.)

Background: Postoperative treatment after functional endoscopic sinus surgery (FESS) aims to modulate the wound healing process. Systemic or topically applied corticosteroids have been reported to be beneficial for improving nasal wound healing after FESS. However, few studies have investigated the effects of postoperative systemic steroids on nasal wound healing with regard to histological changes. The aim of this study was to evaluate the effect of systemic dexamethasone on nasal wound healing after mechanical injury in the rat., Methods: A unilateral wound in the nasal cavity was induced using the brushing technique in 4-week-old, Sprague-Dawley rats (n = 70). Dexamethasone (0.15 mg/kg daily for 7 days) and normal saline were administered i.p. to the experimental and control groups (n = 35 for each) after the injury. The rats (n = 7 for each) were killed on days 2, 5, 14, 28, and 42 after the injury. Histological changes in the nasal mucosa were examined and compared using hematoxylin and eosin and Masson's trichrome staining., Results: The experimental group showed less subepithelial edema formation and epithelial disarray at the early phase of the wound healing period. There were statistically significant differences in the subepithelial thickness and epithelial thickness indices between the experimental and control groups (p < 0.05). Ciliary and goblet cell indices were lower in the experimental group, which means that ciliary and goblet cell regeneration may be delayed by dexamethasone (p < 0.05). There were no differences in the subepithelial fibrosis index between the two groups. Adhesion formation between the nasal septum and turbinate were found only in the control group., Conclusion: Systemic dexamethasone after mucosal injury may lessen subepithelial edema, goblet cell hyperplasia, and adhesion formation; however, it may cause delayed mucosal ciliary regeneration.

Background: Preoperative inflammation of the olfactory cleft may cause not only the obstruction of this area, but also damage of the olfactory neuroepithelium, resulting in anosmia. Therefore, the evaluation of the affected olfactory cleft by computed tomography (CT) might help predict postoperative olfaction., Methods: Fifty-two patients who underwent functional endoscopic sinus surgery for chronic rhinosinusitis (CRS) with nasal polyps were examined preoperatively and at 6 months after surgery. OMU CT was obtained preoperatively and olfactory function tests such as the butanol threshold test, the cross-cultural smell identification test, and questionnaires were performed at the initial preoperative visit and at 6 months after surgery. The correlation between the status of the olfactory cleft on CT and the postoperative olfactory results were investigated., Results: The findings of olfactory cleft opacification and the CT scores had a negative correlation with preoperative olfactory results (p < 0.05). The olfactory cleft opacification showed a stronger correlation with the preoperative olfactory results than the CT score. The total olfactory cleft opacification score and anterior olfactory cleft opacification score (AOCS) were more significantly correlated with the postoperative olfactory results than the other parameters (p < 0.05). Among the CT findings, the AOCS was a significant prognostic factor of olfactory results after surgery; these findings were significant on multiple regression analysis (p < 0.05). The postoperative olfactory scores and the improvement of olfactory scores after surgery were increased more in the mild AOCS group than in the moderate and severe AOCS groups (p < 0.05). Recovery and normosmia rates were much better in the mild AOCS group in this study (p < 0.05)., Conclusion: Preoperative CT findings, especially the anterior portion of the olfactory cleft, had a statistically significant association with the postoperative olfactory results in patients with CRS with nasal polyps.

Conclusion: Endoscopic intranasal reduction of the orbital floor with a detachable temporary balloon, or of the medial orbital wall with a silastic sheet and Merocel packing, provided good functional results and definite advantages. We suggest that these techniques are another surgical alternative for isolated orbital floor or medial wall blowout fractures that do not accompany any associated fractures of the orbital rim., Objectives: Extended applications of endoscopic sinus surgery have reported endoscopic intranasal reduction or reconstruction of the orbital wall with good functional and cosmetic results. We present our experience with endoscopic intranasal reduction of the orbit in isolated orbital floor and/or medial wall blowout fractures, treated by reduction of the orbital floor with a detachable temporary balloon, or of the medial orbital wall with a silastic sheet and Merocel packing., Subjects and Methods: Floor reduction: After creating a wide middle meatal antrostomy, herniated orbital contents and fracture-displaced floor are mobilized and reduced. The orbital floor is supported by a saline filled balloon, which is connected with an infant feeding catheter and passed through the middle meatal antrostoma. After confirming the reduction of the orbital floor by postoperative CT, the catheter is ligated and cut in short to keep it in the nasal cavity. Medial wall reduction: After completing an intranasal ethmoidectomy, herniated orbital contents and fractured lamina papyracea are mobilized and reduced. The shape of the medial orbital wall is fixed by a silastic sheet and Merocel packing saturated with an antibiotic solution. Surgery was performed when the eye function could be accurately assessed, usually at 7 to 10 days following the injury. Temporary supporting of the orbital wall with a detachable temporary balloon, or a silastic sheet and Merocel packing was removed 4 weeks after surgery in the out-patient clinic., Results: We have experienced 40 cases of endoscopic intranasal reduction of the orbit in blowout fractures. CT scan confirmed isolated orbital floor fracture in 11 patients, isolated medial wall fracture in 17 patients, and combined fractures of the orbital floor and the medial wall in 12 patients. Twenty five patients had diplopia, 20 patients had limitation of eye movement, and 14 patients developed enophthalmos. Thirty three of the 40 patients recovered completely without any residual eye symptoms or complications.

Abstract: With the advancement of transnasal endoscopic technique, endoscopic repair of basal skull fractures has considerably substituted former external approaches. The endoscopically feasible pedicled flap, named nasoseptal flap has been extending its range of application, since it was introduced for the reconstruction of the defect after resection of skull base tumors. We introduce two patients with complicated basal skull fractures at different sites who were successfully treated by the transnasal endoscopic approach using nasoseptal flap. [Copyright &y& Elsevier]