DCR and Nasolacrimal System (Cadaver) Prithwijit Roychowdhury, BS1; C. Scott Brown, MD2; Matthew D. Ellison, MD2 1University of Massachusetts Medical School 2 Department of Otolaryngology, Duke University
Nasolacrimal duct obstruction (NDO) is the most common disorder of the lacrimal system that affects patients of every age and results in excessive tearing (epiphora) and if untreated, painful infection (dacryocystitis). When NDO symptoms progress and can no longer be managed with conservative measures, endoscopic dacryocystorhinostomy (DCR) is indicated.
In this case, DCR exploration of the nasolacrimal anatomy is performed on a cadaver. The typical presentation of NDO is epiphora but the presence of painful swelling of the medial canthus and mucoid or purulent discharge may indicate the presence of dacryocystitis. The approach presented here involves the creation of a mucosal flap and subsequent use of the DCR drill to expose the nasolacrimal duct anatomy.
Minimally invasive direct coronary artery bypass (MIDCAB) utilizes a small (4–5 cm) left anterior thoracotomy incision for direct visualization of the diseased coronary artery on the anterior wall of the left ventricle without the use of cardiopulmonary bypass (CPB).
This article describes the basics of the MIDCAB surgery, emphasizing both the left anterior thoracotomy for the harvest of LIMA and direct anastomosis on a beating heart without CPB. This procedure is done on a 72-year-old patient who had significant long LAD stenosis and presented with effort angina. Following a multidisciplinary “heart team” conference, he underwent a successful MIDCAB and was discharged home on postoperative day 4.
The application of minimally-invasive approaches in otologic surgery, including the management of middle ear tumors like glomus tympanicum tumors, represents a promising advancement in the field, potentially improving surgical outcomes and patient recovery. In this article, a patient with pulsatile tinnitus is found to have a glomus tympanicum tumor of the right ear. Calhoun Cunningham III, MD performs a transcanal resection of the mass using the KTP laser.
