Optico-carotid recess and anterior clinoid process pneumatization â€" proposal for a novel classiï¬cation and uniï¬ed terminology: an anatomic and radiologic study.

BACKGROUND: The aims of this study were to propose a novel and uniï¬ed classiï¬cation system of the optico-carotid recess (OCR) and anterior clinoid process (ACP) pneumatization, determine their frequency in a Caucasian population and measure the size of the OCR. METHODOLOGY: A total of 200 specimen (400 sphenoid sinuses) were evaluated in a separate anatomic cadaveric study (n=100) and radiologic study (n=100) by using sphenoidal sinus cast and computed tomography (CT) scan. OCR was divided according to its location to the optic nerve into sub-optical and latero-optical OCR grade I-III. RESULTS: An OCR was found in 39% of the samples (78/200) and in 19% (38/200) it occurred bilaterally. Both, sub-optical and latero-optical OCR were identiï¬ed in 14% of the sides (58/400), with a mean length and depth of 6.9 mm; 7.7 mm and 2.3 mm, 7.1 mm, respectively. We determined the pneumatized ACP frequency with 23% (46/200) and deï¬ned 3 uniï¬ed different types of pneumatization. CONCLUSIONS: The OCR is a reliable landmark to identify the optico-carotid region in endoscopic sphenoid sinus surgery, and can even be visualized by CT. Hence, preoperative investigation of the sphenoid region is mandatory. In our opinion, the classiï¬cation presented in this study can be useful in order to avoid surgical complications.

Exploring stimulation patterns for electrical stimulation of the larynx using surface electrodes.

PURPOSE: Functional electrical stimulation (FES) is considered an upcoming treatment modality for a number of laryngeal diseases. However, sound data are scarce when it comes to surface FES to treat voice disorders. Aim of the present study was to identify and differentiate suitable surface FES patterns to activate internal laryngeal muscles. METHODS: Non-invasive FES was performed in a cohort of 17 elderly woman. Our user-customized electrical stimulation setup allowed us to deliver ten different stimulation patterns (rectangular and sawtooth shaped) with variation of frequency and amplitude. Stimulation outcome, i.e., vocal fold (VF) reaction, was continuously verified by transnasal endoscopy. RESULTS: Responses to FES using ten different stimulation patterns varied inter-individually. None of the stimulation parameter sets could elicit a VF reaction in all participants. CONCLUSION: Based on our findings we conclude that individual fitting is necessary when defining surface stimulation parameters. To overcome limitations of previous studies, devices with freely programmable patterns are required as shown here. Endoscopic control of VF reaction is absolutely essential to ensure effectiveness of the delivered patterns.

The unsolved chapter of vocal fold scars and how tissue engineering could help us solve the problem.

Vocal fold scarring is a relatively small field in scar research with prerequisites found nowhere else. The deterioration of the delicate tri-layered micro-structure of the epithelium of the vocal folds leads to impaired vibration characteristics resulting in a permanent hoarse and breathy voice. Tissue engineering approaches could help to restore the pre-injury status. Despite a considerable progress in this field during the last years, routine clinical applications are not available so far. One reason might be that vocal fold fibroblasts, as the responsible cell type for fibrogenesis, have very particular properties that are only poorly characterized. Moreover, in vivo trials are costly and time consuming and a representative in vitro model does not exist so far. These particular circumstances lead to innovative in vitro strategies and concepts such as macro-molecular crowding that can also be applied in adjacent fields.

A transthyroidal method for arytenoid adduction: a basic anatomical study.

INTRODUCTION: Arytenoid adduction is a very effective procedure for medializing the posterior part of the vocal fold in vocal fold paralysis. Major drawback of the method is the technically sometimes-difficult access to the arytenoid with increased postoperative morbidity. Aim of this study was to provide basic anatomical data regarding the accessibility of the arytenoid cartilage through a thyroplasty window. Furthermore, to investigate the feasibility of an arytenoid adduction by fixation of a surgical screw to the arytenoid cartilage by using this approach. MATERIALS AND METHODS: 10 cadaver larynges, six female and four male, were dissected and measured for our points of interest. A standard manufacture-made surgical screw attached to a suture was anchored to the fovea oblonga of the arytenoid cartilage. RESULTS: Our anatomical measurements proved a mean distance from the posterior edge of the thyroid window to the arytenoid of about 8-9 mm in male larynges and 7-8 mm in female larynges. The distances did not differ significantly between the sexes. Pulling the anchored surgical screw medializes the posterior part of the vocal fold. DISCUSSION: Our data showed that there is a very constant morphometric relation between the thyroplasty window and the arytenoid cartilage. It is known that gender-related differences result in a veritable laryngeal dimorphism in nearly all absolute laryngeal dimensions. These differences appear to a much lesser extend in the distances from the surface to the depth, as was confirmed in our series. Using these findings led us to identification of the fovea oblonga near the muscular process as the most favorable point for fixation of a surgical screw through a conventional thyroplasty window. Pulling the attached suture medializes the arytenoid cartilage.

Endoscopic resection of odontoid process in Arnold Chiari malformation type II.

INTRODUCTION: Arnold Chiari Malformation Type II can be associated with basilar invagination through an elongated retroflexed odontoid process (dens axis). Traditionally, decompression surgery has been performed transorally under microscopic vision or via transcutaneous latero-cervical/posterior approaches. Endoscopic approaches were introduced a few years ago. CASE REPORT: We report of an eleven-year-old girl with Arnold Chiari Malformation Type II who had undergone surgery eight years ago for posterior cranial fossa decompression at the department of neurosurgery. At that time, an external transcutaneous median approach was performed to resect the posterior arch of the atlas. The patient now presented with the initial symptoms of brainstem compression as a result of an elongated retroflexed odontoid process and craniocervical instability. SURGICAL TECHNIQUE: An endoscopic transoral/transnasal approach was chosen for the resection of the dens. CONCLUSION: Endoscopic surgery was successful and the complete resection of the dens was achieved without any complications. In a second intervention, orthopaedic surgeons performed cranio-cervical arthrodesis.

Ethmoid roof CSF-leak following frontal sinus balloon sinuplasty.

INTRODUCTION: Though clear indications for its clinical application are not established yet, balloon sinuplasty technology per se is considered safe and very few severe complications have been mentioned in literature as of today. CASE REPORT: We report the case of a 36-year-old female patient who presented with right sided rhinorrhea from a CSF-leak in the ethmoidal roof after balloon sinuplasty, aimed at her right frontal sinus. Apparently, the surgeon was unaware of having penetrated the skull base through the lateral lamella of the cribriform plate intraoperatively. CSF rhinorrhea became evident 3 weeks postoperatively only when fever, headaches and moderate nausea developed. Upon revision, diameter, size and shape of the bony defect exactly matched with the tip of a standard sinus balloon catheter device, as could be demonstrated and documented. A small posttraumatic encephalocele had intermittently blocked the leak. Endoscopic surgery and duraplasty were performed under intrathecal fluorescein control, applying CT image-guided navigation. Since two-layer fascia lata closure of the defect, the patient has remained free of symptoms without any evidence of CSF leakage. CONCLUSION: Balloon sinuplasty per se is considered a safe technique, though in inexperienced hands or wrongly applied, complications may occur, as with any surgical tool rigid enough to breach through skull base.

[First clinical experience with a moderately bent laryngoscope for endolaryngeal surgery]. / Erste klinische Erfahrungen mit einem gebogenen Laryngoskopierohr für die endolaryngeale Chirurgie.

INTRODUCTION: In this article we describe the successful use of a moderately bent laryngoscope in two different patient cases. MATERIALS: We developed a prototype of a 20 degrees bent laryngoscope. The moderate curvature allows insertion of the laryngoscope without using any optical device. The operation is performed via a laterally attached 30 degrees nasal endoscope and a monitor, with slightly bent instruments. Previous work by our group showed that when a bent laryngoscope was used, the forces on the oropharyngeal tissues were significantly reduced. Furthermore, the use of these laryngoscopes significantly improves the exposure of the endolarynx. RESULTS: We present two cases in which insertion of a conventional straight laryngoscope was not possible due to anatomical reasons. However, the operations could be performed successfully with the bent laryngoscope.