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.
Frontal Sinus Dissection (Cadaver)
C. Scott Brown, MD; Ralph Abi Hachem, MD, MSc
Duke University Medical Center
This cadaveric study aims to provide a detailed overview of the key steps involved in the dissection of the frontal sinus, including the identification of anatomical landmarks, performing of Draf I, II-A, II-B, and III procedures, and the preservation of mucosal structures. The meticulous identification and preservation of crucial anatomical landmarks, such as the frontal sinus outflow tract, the agger nasi, and the vertical lamella of the middle turbinate, are essential for avoiding complications, including injury to the AEA or inadvertent penetration of the cribriform plate.
By familiarizing themselves with the step-by-step approach outlined in this text and the accompanying video, surgeons can enhance their technical proficiency and improve patient outcomes in the management of frontal sinus-related conditions. For medical students and trainees, this video offers an invaluable learning opportunity to develop a deep understanding of frontal sinus anatomy and the nuances of endoscopic dissection techniques. By using this knowledge, healthcare professionals can enhance their surgical skills, improve patient care, and contribute to the advancement of the field of endoscopic sinus surgery.
Carotid Endarterectomy (Cadaver)
Meghan Robinson1; Laura Boitano, MD2; Samuel Schwartz, MD2
1Lake Erie College of Osteopathic Medicine
2Massachusetts General Hospital
Carotid stenosis is one of the leading causes of ischemic stroke worldwide. In the United States, nearly 800,000 strokes are reported each year, with ischemia accounting for 87% of them, and 15% traced to a carotid origin. Carotid endarterectomy represents an effective surgical treatment for carotid stenosis in preventing the risk of future ischemic stroke. This video-article demonstrates the surgical technique for carotid endarterectomy on a cadaver and discusses a typical case presentation of an individual who could potentially benefit from this procedure.
Ethmoid Artery Anatomy (Cadaver)
C. Scott Brown, MD; Jeevan B. Ramakrishnan, MD
Duke University Medical Center
The ethmoid arteries, comprising the anterior and posterior branches, are integral vascular structures that hold immense significance in the realm of sinus and skull base surgery. Originating from the third segment of the ophthalmic artery, these arteries traverse through the medial orbit before passing through the respective ethmoidal canals and entering the ethmoid air cells. Understanding the anatomical significance and clinical implications of the anterior and posterior ethmoid arteries is paramount in ensuring safe and effective management of sinus pathologies and associated complications. Accurate preoperative assessment, appropriate surgical techniques, and a thorough knowledge of these vascular structures are essential for optimizing patient outcomes and minimizing the risk of adverse events during surgical interventions.
Submandibular Approach to the Mandible (Cadaver)
Mark R. Rowan, MD, DDS; R. John Tannyhill, III, MD, DDS, FACS
Massachusetts General Hospital
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.
Thyroidectomy (Cadaver)
Duke University Medical Center
Daniel J. Rocke MD, JD,
Department of Surgery
Division of Head and Neck Surgery & Communication Sciences
C. Scott Brown MD,
Department of Surgery
Division of Head and Neck Surgery & Communication Sciences
Dr. Rocke instructs a cadaver lab at Duke University to train the residents on the finer points of a standard thyroidectomy. Anatomy is better visualized with the help of overlaying illustrations during the procedure.
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