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Intracranial extension for sphenoethmoid mucocele
POLITZERATION REVISITED To the Editor: In the resolution phase of long-standing otitis media with effusion, the eardrum retracts and atrophies. In these situations the membrane can return to its natural position if the middle ear is ventilated sufficiently. But when the tympanic membrane is completely thinned and placed on promontory mucosa, it is very difficult to insert a ventilation tube. In these cases, we first apply politzeration. Such an eardrum may elevate after politzeration. If it can keep its form for an hour, we do myringotomy and insert a ventilation tube. After politzeration, we have not seen sudden hearing loss, vertigo, eardrum perforation, or bone displacement in any of our patients. After inserting ventilation tubes, these eardrums return to their natural positions and thickness in 2 to 3 months. Politzeration is useful in eustachian tube dysfunction and treatment of otitis media with effusion, and it is also very helpful in inserting ventilation tubes to completely thinned and retracted eardrums.
transseptal approach to the problem of complex sphenoid problems since lateral visualization of the sphenoid where the carotid artery, cavernous sinus, and optic nerves reside is completely inaccessible and invisible to view with this technique. A drainage and marsupialization of the mass without lateral instrumentation are certainly safe and appear to have been successful in this instance. I would like to register a note of caution, however, in this regard and suggest that for more manipulative procedures where instrumentation may be required laterally, the septal translocation approach provides appropriate visualization and safety. The posterior ethmoid cell groups and optic canal can be identified anterior to the sphenoid for proper anatomical perspective. I am concerned that readers might misconstrue the applicability of the transseptal approach for other sphenoid problems involving the lateral wall with potential risk to the optic nerve and carotid artery. Robert A. Sofferman, MD College of Medicine, Section of Otolaryngology Ulliversity of Yermont
Osman Mamikoglu, MD Bulent Mamikoglu, MD Ankara, Turkey University of Marmara TurketJ
Burlington , VT
REFERENCES INTRACRANIAL EXTENSION FOR SPHENOETHMOID MUCOCELE To the Editor: I enjoyed reading the December 1991 issue of Operative Techniques in Otolaryngology-Head and Neck Surgery, and I would like to make a few comments concerning the article "Management of a Large Sphenoethmoid Mucocele With Intracranial Extension" by Dr. Ernster.' By way of introduction to the comments, I should indicate that I was somewhat dismayed that Dr. Ernster did not refer to my publication on the septal translocation procedure.f Dr. Ernster contacted me by telephone several weeks before undertaking the surgical procedure for thoughts and guidelines that I might have since the optic nerves were at risk and I had published on this topic. I suggested a septal translocation procedure via the sublabial approach. He seemed not only appreciative of my thoughts and recommendations, but in addition forwarded copies of the preoperative and postoperative MRI scans for my files. I realized on reviewing his presentation that the technique which he used was the standard transseptal approach to the sphenoid rather than the translocation method, but I would have very much appreciated his acknowledgment of assistance and discussion. I would like to take issue with the use of the standard
146
1. Ernster JA: Management of a large sphenoethmoid mucocele with
intracranial extension. Operative Tech Otolaryngol Head Neck Surg 2:275-281, 1991 2. Sofferman RA: Septal translocation procedure: An alternative to lateral rhinotomy. Otolaryngol Head Neck Surg 98:18-25, 1988
In Reply: In planning my management of the case presented in the article, I contacted four different individuals across the United States who had previously published on sphenoethmoid mucoceles or who I knew were interested in surgery in this area. I decided to use the technique of Sellars and De Villiers.! described in 1981 and referenced in my article. Ghorayeb'' described use of the same technique in 1987. I ended up not using the specific techniques of any of those individuals I contacted by phone. Dr. Sofferman was one of those individuals. I realize now that although I did not use their techniques, I should have recognized their willingness to share their thoughts with me in an acknowledgment at the end of the article. I can only claim a little bit of rudeness and perhaps some inexperience. I must point out my concerns about performing a septal translocation procedure for mucoceles and other masses in the sphenoid sinus in certain situations. I have performed this identical technique on two more patients; one case was very similar to the published case in which a large sphenoethmoid mucocele with bony deformation
OPERATIVE TECHNIQUES IN OTOLARYNGOLOGY-HEAD AND NECK SURGERY, VOL 3, NO 2 (JUN). 1992: PP 146·147
transseptal approach to the problem of complex sphenoid problems since lateral visualization of the sphenoid where the carotid artery, cavernous sinus, and optic nerves reside is completely inaccessible and invisible to view with this technique. A drainage and marsupialization of the mass without lateral instrumentation are certainly safe and appear to have been successful in this instance. I would like to register a note of caution, however, in this regard and suggest that for more manipulative procedures where instrumentation may be required laterally, the septal translocation approach provides appropriate visualization and safety. The posterior ethmoid cell groups and optic canal can be identified anterior to the sphenoid for proper anatomical perspective. I am concerned that readers might misconstrue the applicability of the transseptal approach for other sphenoid problems involving the lateral wall with potential risk to the optic nerve and carotid artery. Robert A. Sofferman, MD College of Medicine, Section of Otolaryngology Ulliversity of Yermont
Osman Mamikoglu, MD Bulent Mamikoglu, MD Ankara, Turkey University of Marmara TurketJ
Burlington , VT
REFERENCES INTRACRANIAL EXTENSION FOR SPHENOETHMOID MUCOCELE To the Editor: I enjoyed reading the December 1991 issue of Operative Techniques in Otolaryngology-Head and Neck Surgery, and I would like to make a few comments concerning the article "Management of a Large Sphenoethmoid Mucocele With Intracranial Extension" by Dr. Ernster.' By way of introduction to the comments, I should indicate that I was somewhat dismayed that Dr. Ernster did not refer to my publication on the septal translocation procedure.f Dr. Ernster contacted me by telephone several weeks before undertaking the surgical procedure for thoughts and guidelines that I might have since the optic nerves were at risk and I had published on this topic. I suggested a septal translocation procedure via the sublabial approach. He seemed not only appreciative of my thoughts and recommendations, but in addition forwarded copies of the preoperative and postoperative MRI scans for my files. I realized on reviewing his presentation that the technique which he used was the standard transseptal approach to the sphenoid rather than the translocation method, but I would have very much appreciated his acknowledgment of assistance and discussion. I would like to take issue with the use of the standard
146
1. Ernster JA: Management of a large sphenoethmoid mucocele with
intracranial extension. Operative Tech Otolaryngol Head Neck Surg 2:275-281, 1991 2. Sofferman RA: Septal translocation procedure: An alternative to lateral rhinotomy. Otolaryngol Head Neck Surg 98:18-25, 1988
In Reply: In planning my management of the case presented in the article, I contacted four different individuals across the United States who had previously published on sphenoethmoid mucoceles or who I knew were interested in surgery in this area. I decided to use the technique of Sellars and De Villiers.! described in 1981 and referenced in my article. Ghorayeb'' described use of the same technique in 1987. I ended up not using the specific techniques of any of those individuals I contacted by phone. Dr. Sofferman was one of those individuals. I realize now that although I did not use their techniques, I should have recognized their willingness to share their thoughts with me in an acknowledgment at the end of the article. I can only claim a little bit of rudeness and perhaps some inexperience. I must point out my concerns about performing a septal translocation procedure for mucoceles and other masses in the sphenoid sinus in certain situations. I have performed this identical technique on two more patients; one case was very similar to the published case in which a large sphenoethmoid mucocele with bony deformation
OPERATIVE TECHNIQUES IN OTOLARYNGOLOGY-HEAD AND NECK SURGERY, VOL 3, NO 2 (JUN). 1992: PP 146·147