Mastoidectomy David M. Kaylie, MD, MS1; Adam A. Karkoutli2; C. Scott Brown, MD1 1Duke University Medical Center 2Louisiana State University Health Sciences Center – New Orleans
Mastoidectomy involves the removal of bone and air cells contained within the mastoid portion of the temporal bone. Common indications for this procedure include acute mastoiditis, chronic mastoiditis, cholesteatoma, and the presence of tympanic retraction pockets. Mastoidectomy may also be performed as part of other otologic procedures (e.g. cochlear implantation, lateral skull base tumors, labyrinthectomy, etc.) in order to gain access to the middle ear cavity, petrous apex, and cerebellopontine angle.
The procedure involves dissecting within the confines of the mastoid cavity, which include the tegmen superiorly, the sigmoid sinus posteriorly, the bony ear canal anteriorly, and the labyrinth medially. Mastoidectomy is traditionally classified as: simple (cortical/Schwartze), radical, and modified radical/Bondy’s mastoidectomy. The procedure can also be classified based on the preservation of the posterior canal wall: canal wall up (CWU) or canal wall down (CWD).
Establishing a sterile field, opening and organizing equipment and supplies, and preparing the operating room (OR) for a case are the foundations for ensuring an environment conducive to a safe and efficient operation. Surgical donning of gown and gloves is an integral component of infection control in the OR. Healthcare professionals must adhere to strict protocols to protect both patient and healthcare worker safety. Proper training, vigilance, and attention to detail are crucial in maintaining a sterile environment before and during surgical procedures. This article explores key considerations for healthcare professionals as they open up surgical equipment, establish and maintain a sterile field, doff and don gowns and gloves, and prepare the OR for a surgical procedure.
Acute cholecystitis occurs when gallstones become impacted in the neck of the gallbladder or cystic duct in approximately 90–95% of cases. Symptoms may include acute right upper quadrant pain, fever, nausea, and emesis often associated with eating. Acute cholecystitis generally has imaging findings of gallbladder wall thickening, edema, gallbladder distension, pericholecystic fluid, and positive sonographic Murphy sign. However, acute cholecystitis is largely a clinical diagnosis of persistent right upper quadrant (RUQ) pain and associated tenderness on palpation of the RUQ in the setting of gallstones.
The standard treatment is a cholecystectomy to prevent recurrent cholecystitis or sequelae of gallstones. Timing of the cholecystectomy is dependent on length of symptoms, which reflect the degree of inflammation. This is the case of a 74-year-old male who presented with six days of acute cholecystitis symptoms who was initially managed with antibiotics. After improvement of his pain and no systemic symptoms of infection, he underwent an interval robotic cholecystectomy. This article and the associated video describe the pertinent history, evaluation, and operative steps of the procedure.
Drainage of Cystic Mass on First Left Toe Jasmine Beloy1; Jaymie Ang Henry, MD, MPH2; Marcus Lester R. Suntay, MD, FPCS, FPSPS, FPALES3 1Lake Erie College of Osteopathic Medicine 2Florida Atlantic University 2Philippine Children’s Medical Center
Cutaneous cysts are closed, sac-like, or encapsulated structures that may be filled with air, liquid, or semi-solid material, and are generally benign. Many types of cysts can occur in almost any place throughout the body and can form in all ages. They are seen as slow-growing and painless lumps underneath the skin. However, some cysts may be painful if they are particularly large. Treatment depends on several factors including the type of cyst, location, size, and the degree of discomfort caused. Large, symptomatic cysts can be removed surgically, while smaller, asymptomatic cysts can be drained or aspirated. Here, we present the case of a 12-year-old male with a pus-filled cystic mass on his first left toe and discuss surgical management and follow-up.
Upper blepharoplasty is one of the most commonly performed oculoplastic procedures. It is aimed at correcting the involutional changes of the upper eyelids, characterized by loose, excess eyelid skin (dermatochalasis) and preaponeurotic fat herniation (steatoblepharon) as well as some cases of ptosis. These conditions could result in functional symptoms, such as reduced visual fields, as well as cosmetic concerns and perceived body dysmorphia.
In this case, the patient underwent upper blepharoplasty for cosmetic improvement and to remove xanthomatous lesions. This article discusses and demonstrates the preoperative assessment of the patient, the preparation, the surgical technique, and possible complications.
Laparoscopic Sleeve Gastrectomy Ozanan R. Meireles, MD1; Julia Saraidaridis, MD1; Amir Guindi2 1Massachusetts General Hospital 2Ross University School of Medicine
The goal of obesity treatment is to reach and maintain a healthy weight. The primary treatment consists of diet and physical exercise; however, maintaining weight loss is difficult and requires discipline. Medications such as orlistat, lorcaserin, and liraglutide may be considered as adjuncts to lifestyle modification.
One of the most effective treatments for obesity is bariatric surgery. There are several bariatric surgery procedures, including laparoscopic adjustable gastric banding, Roux-en-Y gastric bypass, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch. Sleeve gastrectomy is the most commonly performed bariatric surgery worldwide. It is performed by removing 75% of the stomach, leaving a tube-shaped stomach with limited capacity to accommodate food. This is the case of an obese patient who undergoes laparoscopic sleeve gastrectomy.
An umbilical hernia occurs due to weakened umbilical fascia or at the site where the involuted umbilical vessels exited. Depending on the hernia contents—preperitoneal fat, omentum, or small intestine—symptoms may include a new bulge at the umbilical site, abdominal pain, tenderness to palpation, color changes to the surrounding skin, as well as obstructive symptoms such as nausea, emesis, and constipation. Given that umbilical hernias tend to have narrow necks compared to size of the sac, incarceration and strangulation are relatively common. Elective repair of symptomatic umbilical hernias is done to minimize these risks.
Here we present the case of an 81-year-old male with a recurrent umbilical hernia who first presented secondary to obstructive symptoms caused by an incarcerated umbilical hernia. After reduction was successful, he underwent an elective robotic transabdominal (rTAPP) umbilical hernia repair with intra-abdominal preperitoneal underlay mesh (IPUM). This article and the associated video describe the pertinent history, evaluation, and operative steps of the procedure.
Foley catheterization is a frequently-employed medical procedure to treat urinary retention, aid in bladder drainage/decompression, and facilitate measurement of urine output. This article provides an overview of the indications for Foley catheterization, the steps involved in its insertion, proper care guidelines, and potential complications associated with its use. It is of utmost importance for healthcare practitioners to be comfortable with catheterization procedures to guarantee the comfort, safety, and general welfare of their patients.
The spleen is highly vascular, is the largest secondary lymphoid organ, and is the most commonly injured organ in the setting of blunt abdominal trauma. Patients may present asymptomatically or with abdominal pain, nausea and vomiting, or signs of hemodynamic instability. Although many splenic injuries caused by blunt abdominal trauma may be managed conservatively, free intra-abdominal fluid with hemodynamic instability warrant surgical management in the form of exploratory laparotomy and splenectomy.
This video report demonstrates the management of a patient who was assaulted, sustaining blunt abdominal trauma and a hemodynamically significant grade IV splenic laceration. An exploratory laparotomy and splenectomy were performed.
Maintenance of intact skin throughout the body is essential to prevent dehydration, to act as a barrier to infection, to allow unrestricted movement, and to provide a normal appearance. A flap is a piece of body tissue, usually skin and fat, that always has its own blood supply. Therefore, a flap can be moved anywhere it can reach without worrying about the circulation present at the place that needs it, which is called the recipient site. When compared with all other possible choices, a flap best meets all the requirements for any area needing skin replacement.
The keystone type flap as one such option is so named because its design has the shape of the keystone of a Roman arch. If taken from loose tissues adjacent to a defect, it can be simply cut and advanced for any necessary skin coverage. Direct closure of the donor site where this flap comes from is possible so that usually a quite good overall cosmetic result is also obtained. These virtues are shown as an overview in this video where a keystone flap is transferred after removal of a common basal cell skin cancer from the lower lip.
