Endoscopic measurement of nasal septum perforations.

BACKGROUND: Nasal septum perforations (NSP) have many uncomfortable symptoms for the patient and a highly negative impact on quality of life. NSPs are closed using patient-specific implants or surgery. Implants are created either under anesthesia using silicone impressions or using 3D models from CT data. Disadvantages for patient safety are the increased risk of morbidity or radiation exposure. MATERIALS AND METHODS: In the context of otorhinolaryngologic surgery, we present a gentle approach to treating NSP with a new image-based, contactless, and radiation-free measurement method using a 3D endoscope. The method relies on image information only and makes use of real-time capable computer vision algorithms to compute 3D information. This endoscopic method can be repeated as often as desired in the clinical course and has already proven its accuracy and robustness for robotic-assisted surgery (RAS) and surgical microscopy. We expand our method for nasal surgery, as there are additional spatial and stereoperspective challenges. RESULTS: After measuring 3 relevant parameters (NSP extension: axial, coronal, and NSP circumference) of 6 patients and comparing the results of 2 stereoendoscopes with CT data, it was shown that the image-based measurements can achieve comparable accuracies to CT data. One patient could be only partially evaluated because the NSP was larger than the endoscopic field of view. CONCLUSION: Based on the very good measurements, we outline a therapeutic procedure which should enable the production of patient-specific NSP implants based on endoscopic data only.

[Endoscopic measurement of nasal septum perforations. German version]. / Endoskopische Vermessung von Nasenseptumdefekten.

BACKGROUND: Nasal septum perforations (NSP) have many uncomfortable symptoms for the patient and a highly negative impact on quality of life. NSPs are closed using patient-specific implants or surgery. Implants are created either under anesthesia using silicone impressions or using 3D models from CT data. Disadvantages for patient safety are the increased risk of morbidity or radiation exposure. MATERIALS AND METHODS: In the context of otorhinolaryngologic surgery, we present a gentle approach to treating NSP with a new image-based, contactless, and radiation-free measurement method using a 3D endoscope. The method relies on image information only and makes use of real-time capable computer vision algorithms to compute 3D information. This endoscopic method can be repeated as often as desired in the clinical course and has already proven its accuracy and robustness for robotic-assisted surgery (RAS) and surgical microscopy. We expand our method for nasal surgery, as there are additional spatial and stereoperspective challenges. RESULTS: After measuring 3 relevant parameters (NSP extension: axial, coronal, and NSP circumference) of 6 patients and comparing the results of 2 stereoendoscopes with CT data, it was shown that the image-based measurements can achieve comparable accuracies to CT data. One patient could be only partially evaluated because the NSP was larger than the endoscopic field of view. CONCLUSION: Based on the very good measurements, we outline a therapeutic procedure which should enable the production of patient-specific NSP implants based on endoscopic data only.

Presurgical Alignment of Bilateral Cleft Segments With 3D Simulation Under Special Consideration of the Vomer: A Technical Note.

BACKGROUND: The main goal of presurgical orthopedics (PSO) for patients with bilateral cleft lip and palate is to correct the protruded and/or twisted premaxilla. However, PSO is associated with the risk of uncontrolled development of the vomer, which has received little attention to date. SOLUTION: We present a removable orthodontic device that can be used to keep or align the vomer and the premaxilla in the midline during preoperative molding of cleft segments independently and 3 dimensionally.

Customized Pre-Epiglottic Baton Plate-A Practical Guide for Successful, Patient-Specific, Noninvasive Treatment of Neonates With Robin Sequence.

OBJECTIVE: Despite its efficiency and benefits in treating patients with Robin sequence (RS), the pre-epiglottic baton plate (PEBP) is not widely used. However, its acceptance might improve with specific defined parameters for indication and proper design of the velar extension. We present our 13-year, single-center experience in treating infants with RS using PEBP, focusing on the description and insertion of an endoscopically guided PEBP design along with its complications and limitations. DESIGN AND INNOVATION: We recommend PEBP as primary treatment for RS, suggesting a new approach of design adjustment based on endoscopic findings of multilevel upper airway obstruction. SETTING: Department of cleft lip and palate. PATIENTS: Infants with isolated or syndromic RS, period 2010 to 2019. INTERVENTIONS: Pre-epiglottic baton plate treatment, intravelar veloplasty, and hard palate closure after initial PEBP treatment. RESULTS: We treated 132 infants (isolated RS, 111; syndromic RS, 21) with PEBP. All infants with isolated RS were discharged within an average of 8 days of PEBP therapy. For them, no tracheotomy or tongue-lip adhesion procedures were needed. Only 4 of the 20 infants discharged with a nasogastric tube needed it for >2 weeks. Intravelar veloplasty and palate closure were performed after 3 and 6 months of initiating PEBP treatment, respectively. CONCLUSIONS: Application of an orthodontic device in RS therapy has not been accepted worldwide. We hope that our learning curve and recommendations about PEBP will help the implementation of this highly effective and nonsurgical treatment option.

Vomer Flaps Support Velopharyngeal Competency, Fistula Free Repair, and 3D Construction of Normal Anatomy in Patients with Cleft Palate.

Cleft palate repair comprises the surgical creation of a congenitally nonexistent normal anatomy, to establish physiological function by moving tissues into their normal anatomical positions. In patients with isolated incomplete (IICP) or submucous (SMCP) cleft palate, the vomer is usually not completely attached to the palatal plate in the midline. This condition, which is visible through surgical access radiologically or via endoscope, is often disregarded during hard palate repair. This can lead to "hypernasality" despite a well-functioning velopharyngeal mechanism. The general practice of hard palate repair by suturing merely the nasal layers together separates the oral and nasal cavities. However, without incorporation of the vomer, it is impossible to build two separate nasal floors on the left and right sides. We consider that achieving normal speech and separation of the nasal cavities are mutually dependent and have to be considered equally. METHODS: We described hard palate repair involving the vomer for construction of both nasal floors. We presented the occlusal relationship, hypernasality, and fistula rates in 37 patients operated on between January 1, 2017 and June 30, 2018. RESULTS: One child presented minimal hypernasality; all others had normal resonance/voice. Fistula rate was zero, and no cross bites were observed. CONCLUSIONS: The implicit connection between the inner nose, resonance/voice, and prevention of fistulae has not yet been acknowledged. The correct usage of vomer flaps in IICP and SMCP creating separate nasal floors supports the velopharyngeal competency, avoids fistula formation, and should be incorporated regularly, like in other cleft forms.