The submandibular approach, also known as the Risdon approach, is a well-established extraoral surgical technique employed for the treatment of complex mandibular fractures and pathologies. Despite the increasing popularity of intraoral approaches for open reduction and internal fixation, the submandibular approach remains a valuable option in the arsenal of maxillofacial surgeons. This approach offers several advantages, including superior access and visualization of the mandibular body and angle, facilitating better manipulation and reduction of fracture fragments. Furthermore, the submandibular approach enables direct access to the submandibular gland, facilitating its management in cases of pathology or injury. By providing a comprehensive understanding of this technique through cadaveric exploration, this video aims to contribute to the training and education of maxillofacial surgeons, ultimately enhancing patient care and outcomes.
Bilateral axillo-breast approach (BABA) is a contemporary technique for remote-access thyroidectomy. BABA robotic thyroidectomy (RT) offers a number of benefits over other remote-access thyroidectomy techniques, such as provision of a three-dimensional symmetric view of bilateral thyroid lobes and optimal visualization of important anatomical landmarks, including the recurrent laryngeal nerve (RLN), thyroidal vessels, parathyroid glands, and the trachea.
This educational video is a thorough demonstration of BABA RT performed on a young female patient diagnosed with a left-sided thyroid nodule in her early thirties. The thyroid fine needle aspiration biopsy of the 4-cm nodule was indeterminate. Additional molecular testing of the specimen had revealed one of the mutations associated with thyroid cancer. Therefore, a diagnostic thyroid lobectomy was planned. The patient had expressed a strong desire to avoid an obvious neck scar, and therefore, the BABA RT was offered.
The middle fossa approach is indicated for procedures requiring access to the internal auditory canal, structures within the temporal bone, and adjacent structures. This is one of the three main approaches for the surgical repair of tegmental defects causing cerebrospinal fluid (CSF) leak. The middle fossa approach allows for an optimal view of the middle fossa floor for larger or multiple defects, ease of graft placement, and avoidance of the removal of ossicle to access the tegmen.
Surgical intervention for CSF leak is indicated when conservative management fails or when spontaneous closure of a defect is unlikely. In this case, a middle fossa approach is used to surgically close a tegmen defect causing CSF otorrhea refractory to conservative management. This case highlights the step-by-step surgical techniques involved in this procedure including the surgical approach to expose the tegmen defect, repair of the tegmen defect using temporalis fascia and a bone graft, and craniotomy repair and closure.
Knot tying is a fundamental skill in the surgical field, essential for securing sutures, ligating vessels, and creating secure anastomoses. The art of knot tying requires precision, dexterity, and a thorough understanding of suture materials and techniques. This video article aims to provide a comprehensive overview of surgical knot tying for beginners.
Sphenoid wing meningiomas are typically benign, slow-growing tumors that may be identified incidentally on imaging or due to a symptomatic presentation from compression of a nearby structure. Located along the sphenoid wing, these tumors may infiltrate or compress the optic nerve, oculomotor nerve, cavernous sinus, or internal carotid artery, causing neurologic deficits such as visual disturbances, headache, paresis, and diplopia.
Surgical resection is considered the first-line treatment for a symptomatic meningioma, but is often challenging due to tumor proximity to these critical neurovascular structures. The most important prognostic factor for recurrence is the completeness of the surgical removal of the tumor, but this goal must be adapted to preserve neurologic function based on individual tumor location and invasion. Here we present a case of a 43-year-old patient diagnosed with a sphenoid wing meningioma after presenting with episodic difficulty speaking and aura-like symptoms who underwent total neurosurgical resection of the tumor via craniotomy.
Stapedotomy (Endaural) David M. Kaylie, MD, MS1; Trey A. Thompson2; C. Scott Brown, MD1 1Duke University Medical Center 2University of Washington School of Medicine
Otosclerosis is a condition characterized by abnormal bone growth that inhibits the movement of the stapes, leading to a gradual conductive hearing loss. The treatment options encompass observation, the use of hearing aids, and surgical intervention. If the patient opts for surgery, either a stapedotomy or a stapedectomy can be executed to liberate the stapes from the sclerotic bone.
In the case of a stapedotomy performed with an endaural approach, access to the middle ear is gained through a minor incision extending from the anterior ear canal to the incisura, also known as the intertragal notch. The surgeon then proceeds to remove the superstructure of the stapes, create an opening in the footplate of the stapes, and subsequently place a prosthesis into the opening, which is then connected to the incus. The outcomes of this procedure are generally positive, with 90–95% of patients experiencing an improvement in hearing.
Minor lower extremity amputations typically involve either toe or ray resections. The first ray is an essential component in the normal anatomy and biomechanics of the foot. By definition, the first ray consists of the hallux and the first metatarsal. The surgical procedure discussed in this educational video is a left first toe ray amputation on a cadaver. Toe amputation is a significant predictor of future limb loss. Ray amputation appears to be preferred over finger amputation in selected cases. However, the literature does not provide precise indications on when to consider a ray over a toe amputation. The choice is therefore left to the operating surgeon, based on their clinical expertise and the patient’s conditions and expectations, taking into account the underlying pathology.
Open Proctocolectomy for Hirschsprung’s Disease Mudassir Shah Akhter, MD1; Marcus Lester R. Suntay, MD, FPCS, FPSPS, FPALES2 1Oregon Health and Science University 2Philippine Children’s Medical Center
Hirschsprung’s disease is the main genetic cause of functional intestinal obstruction. Most cases are diagnosed in the first few months of life given classical presentation and ease of testing with rectal suction biopsy. The disease is due to the absence of enteric ganglion cells in the distal colon that results in functional constipation. Resection of the affected segment and bringing the normal bowel close to the anus has been the mainstay of treatment. Due to advances in surgical treatment over the past decades, a significant reduction in morbidity and mortality has been observed, and the previously multistage procedure can now be completed in one stage, as presented here.
