[An atypical medial canthal mass: a case of lacrimal sac inverted papilloma with literature review]. / Atypische Schwellung des medialen Augenwinkels: Fallbericht von einem invertierten Papillom des Tränenapparats und Literaturrecherche.

BACKGROUND: Lacrimal sac localization of an Inverted Papilloma is extremely rare and no risk factors are reported in literature. HISTORY: A chemical trauma was followed by a painless, growing mass in the medial canthal area associated with epiphora. FINDINGS: Rhinoendoscopy, Computed Tomography and Magnetic Resonance showed a well-defined mass in left lacrimal fossa extended to the nasolacrimal duct. TREATMENT: An endoscopic resection and a dacryocystorhinostomy were performed. CONCLUSION: The aim of the present study is to show an atypical presentation of a well-known tumor along with a suspicious risk factor and to lead otolaryngologists to consider an inverted papilloma of the lacrimal system among lesions causing lateral nasal swelling.

Endoscopic Findings on Facial Nerve Anatomy During Exclusive Endoscopic Stapedotomy: Clinical Considerations and Impact on Surgical Results.

BACKGROUND: Variations along the facial nerve (FN) course present considerable challenges in the surgical treatment of otosclerosis, often complicating the procedure. Existing knowledge of its tympanic tract and its implications primarily comes from microscopical procedures. This study aims to assess endoscopic findings of FN anatomy in a healthy tympanic cavity and its impact on the stapedotomy procedure, focusing on the risk of complications and functional hearing outcomes. METHODS: A retrospective study on exclusive endoscopic stapedotoplasties between October 2014 and October 2021 at our Otorhinolaryngology University Department was carried out. An evaluation of intraoperative endoscopic findings reviewed in surgical descriptive and/or video records was conducted to assess their potential negative impact on the surgery. Demographic data, preoperative and postoperative hearing thresholds, as well as intraoperative and postoperative complications were analyzed. RESULTS: One hundred fifty-seven subjects were included. A FN partially overhanging the oval window was observed in 7.3% (n=12): 10 prolapsing with bony canal dehiscence and 2 without any detected dehiscence. Each procedure was successfully completed without any issues related to the anomalous anatomy, and in no case, switching to the microscope for the handling of the prosthesis near the dehiscent nerve was required. No facial paralysis occurred, with an early- or long-term postoperative House-Brackman grade of 1 (n=157, 100%). Only 3/157 patients (1.9%) showed a sensorineural threshold reduction of ≥20 dB HL, but a significant air-bone gap improvement was observed (mean closure of 18.36 dB HL, P -lt; .0001). CONCLUSION: The endoscope promotes a concrete description of tympanic FN anatomy, and endoscopic stapes surgery appears to be a safe and viable option when dehiscent or prolapsed FNs reduce the footplate's exposure.

Operative technique: Tracheal resection and anastomosis in a revision surgery.

Tracheal stenosis is an uncommon pathological condition in which the lumen of the trachea is reduced. Within its management an adequate preoperative workup is crucial to determine the most appropriate procedure for each patient. In this scenario tracheal resection and anastomosis is a viable approach, as a procedure in which part of the trachea is removed and then restored with a tension-free anastomosis. It is usually indicated for extensive and high-grade lesions or when previous endoscopic procedures had failed. The patient here presented had already undergone a balloon dilatation twice and a tracheal resection and referred to our clinic with a residual tracheal stenosis graded Myer-Cotton 3 involving three tracheal rings. We here illustrate step-by-step the surgical procedure and highlight a peculiar way to perform the anastomosis, especially in a revision surgery.

Endoscopic stapler-assisted Zenker's diverticulotomy: The surgical technique with video.

OBJECTIVE: The aim of the present article is to describe step by step the endoscopic stapler-assisted Zenker's diverticulotomy (ESD) and to show in details pre- and post-operative management. STUDY DESIGN: Case study with instructional video. SETTING: Department Of Otolaryngology, San Bortolo Hospital of Vicenza. BACKGROUND: Several comparable surgical approaches have been proposed for the treatment of hypopharyngeal Zenker's diverticulum, however determining the best operative facility in terms of safety, outcomes and hospital stay is still a matter of debate. In this scenario the endoscopic treatment of Zenker's diverticulum using the stapler device permits simultaneous sectioning and suturing of the septum between the pouch and esophagus, creating a more functional common cavity. METHODS: We here present a step by step description of an endoscopic treatment of Zenker's diverticulum using the stapler device. Common referral symptoms are persistent hoarseness and globus sensation associated with transient dysphagia. An endoscopic dynamic examination of upper airway may reveal the presence of a hypopharyngeal pouch, which should be confirmed by a fluoroscopic barium esophageal radiography. If a Zenker's diverticulum is diagnosed, an endoscopic single or multiple diverticulotomy with a stapler device is indicated. The patient may be discharged after 24-48 h without any dietary restrictions, once a post-operative esophageal radiography rules out any sort of perforation. CONCLUSION: It is of relevance to precisely know the Endoscopic Stapler-assisted Zenker's Diverticulotomy as it represents a safe and efficient procedure and ensures good outcomes with the benefit of being performed even on a planned 24-hour-stay basis.