Multiportal Retrograde Endoscopy to Enhance Surgical Target Visualization: A Pilot Study.

Objective Current transnasal endoscopic techniques for sinus and skull base surgery use a single endoscope to provide visualization from one perspective curtailing depth perception and compromising visualization of the instrument-target interface. The view can be blocked by instruments, and collisions between instruments often occur. The objective of this study was to investigate the use of multiportal retrograde endoscopy to provide more accurate manipulation of the surgical target. Design Maxillary antrostomy and frontal sinusotomy were performed on three different cadavers by three different surgeons. A zero-degree rigid endoscope was introduced through the nose for the standard transnasal approach. A flexible endoscope was introduced transorally, directed past the palate superiorly, and then flexed 180 degrees for the retrograde view. Videos of the standard transnasal view from the rigid endoscope and retrograde view from the flexible endoscope were recorded simultaneously. Results All surgeries were able to be performed with dual-screen viewing of the standard and retrograde view. The surgeons noted that they utilized the retrograde view to adjust the location of ends/tips of their instruments. Four surgeons reviewed the videos and individually agreed that the visualization achieved provided a perspective otherwise not attainable with rigid transnasal endoscopy alone. Conclusion High-quality visualization of surgical targets such as the frontal or maxillary ostia can be challenging with rigid endoscopes alone. Multiportal retrograde endoscopy provides proof of concept that additional views of a surgical target can be achieved. Additional work is needed to further develop indications, techniques, and generalizability to targets beyond those investigated here.

Endoscopic Posterior Costochondral Graft with Cricoid Sutures for a Recurrent Type 3 Laryngeal Cleft.

A patient with a recurrent connection between their trachea and esophagus underwent an endoscopic repair (through the mouth with no incisions) with a graft secured via sutures, which is the first description of fully endoscopic graft placement for this pathology. Laryngoscope, 133:269-272, 2023.

Prenatal Imaging Findings Predict Obstructive Fetal Airways Requiring EXIT.

OBJECTIVE: Detection of fetal airway compromise through imaging raises the possible need for ex utero intrapartum treatment (EXIT) procedures. Despite EXIT procedures involving massive resource utilization and posing increased risk to the mother, decisions for EXIT are usually based on anecdotal experience. Our objectives were to analyze prenatal consultations with potential fetal airway obstruction for imaging and obstetric findings used to determine management strategy. METHODS: Retrospective chart review was performed for prenatal abnormal fetal airway consults between 2004-2019 at a quaternary pediatric facility. Data collected included demographics, imaging characteristics, delivery information, and airway management. Our primary outcome was EXIT performance and the secondary outcome was postnatal airway management. Fisher's exact test was used to compare management decisions, outcomes, and imaging findings. RESULTS: Thirty-seven patients met inclusion criteria. The most common diagnoses observed were lymphatic malformation, teratoma, and micrognathia. Of the imaging findings collected, only midline neck mass location was associated with EXIT procedure performance. Factors associated with invasive airway support at birth were mass-induced in-utero neck extension and neck vessel compression, polyhydramnios, and micrognathia. CONCLUSIONS: Multidisciplinary input and interpretation of prenatal imaging can guide management of fetal airway-related pathology. EXIT is an overall safe procedure and can decrease risk due to airway obstruction at birth. We identified in-utero neck extension, neck vessel compression, micrognathia, and polyhydramnios as better indicators of a need for invasive airways measures at birth and suggest use of these criteria in combination with clinical judgement when recommending EXIT. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E1357-E1362, 2021.