Video-Assisted Septoplasty: The Future in Teaching Septal Surgery-A Technical Note.

Teaching and learning septoplasty is challenging due to the limited and intermittent visualization of the surgical site by the resident and the mentor. Our objective was to develop and test the surgical tools required to achieve optimal visualization of the surgical field during septal surgery without having to modify the way conventional septoplasty is performed. A flexible high-definition endoscope is mounted on a modified 50-mm nasal speculum. This allows real-time visualization of all steps of the surgery on the video monitor. The residents can follow all intranasal surgical steps on the monitor while the surgeon is operating. In the same way, the mentor can guide the resident through the surgery and provide more appropriate feedback. All steps of the septal surgery can be recorded for later educational use. Video-assisted septoplasty will help surgeons teach septal surgery more efficiently.

The role of computed tomography in the management of the neck after chemoradiotherapy in patients with head-and-neck cancer.

PURPOSE: The aim of this study was to describe the outcome in patients with head-and neck-squamous cell carcinoma (HNSCC) followed up without neck dissection (ND) after concomitant chemoradiotherapy (CRT) based on computed tomography (CT) response. The second objective was to establish CT characteristics that can predict which patients can safely avoid ND. METHODS AND MATERIALS: Between 1998 and 2007, 369 patients with node-positive HNSCC were treated with primary CRT at our institution. After a clinical and a radiologic evaluation based on CT done 6 to 8 weeks after CRT, patients were labeled with a complete neck response (CR) or with a partial neck response (PR). RESULTS: The median follow-up was 44 months. The number of patients presenting with N3, N2, or N1 disease were 54 (15%), 268 (72%), and 47 (13%), respectively. After CRT, 263 (71%) patients reached a CR, and 253 of them did not undergo ND. Ninety-six patients reached a PR and underwent ND. Of those, 34 (35%) had residual disease on pathologic evaluation. A regression of the diameter of ≥ 80% and a residual largest diameter of 15 mm of nodes had negative pathologic predictive values of 100% and 86%, respectively. The 3-year regional control and survival rates were not different between patients with CR who had no ND and patients with PR followed by ND. CONCLUSION: Node-positive patients presenting a CR as determined by CT evaluation 6 to 8 weeks after CRT had a low rate of regional recurrence without ND. This study also suggests that lymph node residual size and percentage of regression on CT after CRT may be useful criteria to guide clinical decisions regarding neck surgery. Those results can help diminish the number of ND procedures with negative results and their associated surgical complications.