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  • ISSN: 2379-948X
    Volume 3, Issue 11
    Short Communication
    Kurren S Gill, Mindy Rabinowitz, David Hsu, James Evans, Christopher Farrell, Gurston Nyquist, and Marc Rosen*
    Introduction: Large cranial base defects after transsphenoidal surgery exposes the brain to iatrogenic injury via insertion of endonasal tubes. It has been reported in the literature that nasogastric tubes have inadvertently been placed into the brainstem or spinal cord postoperatively. This can have devastating ramifications including neurologic sequelae or fatality. For these reasons, it is prudent to implement surgical techniques to help protect the cranial base against iatrogenic injury after endoscopic, endonasal skull base surgery.
    Methods: We performed a Pub Med literature review of cases of inadvertent intracranial placement of a NGT. We categorized the causes as traumatic, non-traumatic, and surgical, and identified trends to assess potential risk factors. Articles not in English were excluded from our review.
    Results: We identified 37 articles describing 41 instances of a misguided NGT intracranially. Twenty-seven cases (65.8%) were in the setting of trauma, 7 (17%) in non-traumatic settings, and 7 (17%) after surgery. Sixteen of forty-one (39%) died of various causes and 5 (31.3%) were directly attributable to intracranial insertion of the NGT.
    Discussion: We describe several techniques to protect the cranial base including middle turbinate preservation and medialization, limited posterior nasal septectomy and trans-septal approaches. In addition, we provide a video illustrating the how the cranial base is protected using these methods.
    Conclusion: Operative techniques in endoscopic transsphenoidal skull base surgery that facilitate closure of the sphenoid sinus likely decrease the risk of postoperative iatrogenic injury via inadvertent placement of endonasal tubes.
    Omer N. Develioglu, Halim A. Is, Hakan Ekmekci, Ozlem Ekmekci, Zeynep Gungor, Murat Yener, Mehmet Yılmaz, Gunay Can, Mehmet Kulekci, Ozgun Enver, Huseyin Sonmez, and Mine Kucur*
    Objectives: Gastroduodenal agents may have the differential role in GERD (gastroesophageal reflux disease). Besides pepsin and bile acid reflux, trypsin might also play a significant role in the middle ear pathologies. The aim of the current study was to identify trypsin with the presence of bile acid and pepsin in the middle ear fluids of children undergoing myringotomy and tube placement for OME, to compare it with the serum levels, and to investigate possible relationship between GER and OME pathogenesis. Study design: Randomized clinical trial.
    Setting: Tertiary health center.
    Subjects and methods: Twenty-five patients (14 boys, 11 girls) with OME who underwent myringotomy with tube placement at the Department of Otorhinolaryngology of Taksim Education and Research Hospital and Cerrahpasa Medical Faculty Otorhinolaryngology and Head&Neck Surgery were enrolled in a prospective study to evaluate the presence of pepsin, bile acid and trypsin in middle ear aspirates. Cochlear implant group (n:25) was considered as the control group.
    Results: Measurable levels of pepsin, bile acid and trypsin were present in all MEEEs from the patients. The difference between the levels of pepsin, bile acid and trypsin measured in MEE and serum was statistically significant (p=0.001).
    Conclusion: We were able to demonstrate for the first time the presence of trypsin in middle ear samples of children with OME. Reflux of the duodenal contents including trypsin has been reported to contribute to the development of esophageal mucosal damage and inflammation. By similar mechanisms trypsin might play a role in the development of otitis media.
    Case Report
    Lo Ren Hui*, Mazlina Selamat, Zubaidah Hamid, Azreen Zaira Abu Bakar, and Tristan Hilary Thomas
    Retropharyngeal abscesses in pediatric is becoming increasingly rare with the availability and advancement of broad spectrum antibiotics in recent years. It is a life-threatening emergency condition because it can lead to airway compromise and induce other catastrophic complications. We report a child with supraglotitis which was then complicated with an extensive retropharyngeal abscess.
    Sarpreet Sekhon, Javier Ospina*, and Arif Janjua
    The introduction of the nasoseptal flap (Hadad-Bassagaisteguy flap) was paramount in addressing the complications associated with endoscopic skull base surgery for anterior skull base lesions. This approach involves harvesting donor muco-perichondrium/periosteum from the nasal septum as a means to reestablish the barrier between the cranial compartment and sinonasal tract, and has reduced many of the complications of endoscopic skull base surgery including CSF leakage, meningitis, pneumocephalusand post-operative meningo(encephalo)celes. Despite its benefits, crusting of the exposed nasal septum, synechiae formation, and delayed recovery and repair of the donor site became notable concerns following nasoseptal flap harvest. Although studies have described the use of fascia lata grafts and/or biomaterials to minimize these issues, the alteration of the healing process that occurs with the simple use of Silastic applied on the exposed cartilaginous and/or bony nasal septum has not yet been examined. We describe a simple technique of positioning a Silastic sheet over the exposed nasal septum for 4 weeks after nasoseptal flap harvest. In ourcentre, this simple stenting procedure has led to reduced crusting, improved healing and accelerated re-mucosalization of the denuded septum. Additional advantages of this approach include its speed, cost-efficiency, absence of a secondary donor site and high customizability allowing adjustment based on the intra-nasal anatomy of the patient.
    Short Note
    Paul Carding*
    Speech Pathologists use behavioural voice therapy to treat a wide variety of patients who suffer from dysphonia. In all cases these voice disorders can result in severe disability, distress and handicap as well as economic hardship and psychological trauma for the individual) [1-3]
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