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The micro-debrider system in FESS
P164
Otolaryngology Head and Neck Surgery
Instruction Courses-- Wednesday
COURSE4515-1 One-period course ($20)
May 1995
Room NOCC-64 1:15-2:15
The Micro-Debrider System in FESS JAY F. PlCClRILLO, MD, and STANLEYE. THAWLEY,MD
St. Louis, Mo.
Educational objectives: To understand the concepts behind micro-debrider surgery in functional endoscopic sinus surgery and to recognize clinical situations in which the microsurgical debrider will augment traditional and functional endoscopic sinus surgery.
With the introduction of endoscopic sinus surgery, the surgical approaches to the paranasal sinuses have become more refined. New approaches and modifications to the original technique are routinely reported. One new technique uses a powered microsurgical arthroscopy system. The microsurgical debrider, or "hummer," was originally introduced for the controlled removal of soft tissues (polyps) within the nose and paranasal sinuses. It has now been used for a variety of other paranasal procedures. This session will focus on the description of the microsurgical debrider, its capabilities within the nose and paranasal sinuses, its indications for use, cases in which it has been used, and outcomes of its use. The attenders will understand the utility of this new addition to endoscopic sinus surgery.
We will discuss epineurial repair by perineurial or fascicular techniques to end-to-end and graft anastomosis. The suture material (silk, nylon, or stainless steel), and the use of alternative methods such as fibrin glue or neural tubes will be discussed. The results and technical problems of these factors and variables will be considered in order to suggest the best technique to perform the adequate anastomosis in all possible surgical situations. The neurorrhaphy can be used in all situations; we prefer always an end-toend, fascicular anastomosis with nylon 10-0. Unfortunately, this method requires a very special technique and suture material and a microsurgeon with good microanastomosis training. The limiting factors include narrow operating field, the presence of continuously flowing cerebral spinal fluid, and severely damaged nerve stump. Under these circumstances, we prefer to use fibrin glue. The time of the repair should be as soon as possible after the trauma, and end-toend anastomosis is always preferable to autologous interposed nerve grafting.
COURSE 4517-2 Two-period course ($40)
Room NOCC-66 1:15-3:30
TE Voice Restoration Following Total Laryngectomy ERiC D. BLOM, PhD, RONALD C. HAMAKER, MD, and STEPHENB. FREEMAN, MD
Indianapolis, Ind. COURSE 4516-1
One-period course ($20)
Room NOCC-65 1:15-2:15
Anastomotic Methods of Facial Nerve Repair-How to Do It RICARDO F. BENTO,MD, PhD
$6o Paulo, Brazil
Educational objectives: To know about nerve degeneration and regeneration and how to choose the best technique for facial nerve anastomosis.
Traumatic facial paralysis may be iatrogenic (spontaneous or unintentional) or catastrophic (fractures, firearm shooting, cutting lesions of the face). When the facial nerve is severely injured, with a neurotmesis or partial loss of nerve, an end-to- end anastomosis or a nerve graft should be performed. This procedure can be performed by many different disciplines in medicine. The otolaryngologist, the neurosurgeon, and the head and neck surgeon sometimes are involved in facial nerve injuries that require an immediate anastomosis. In order to describe the most commonly used techniques of intratemporal and extratemporal facial nerve repair, the course will present clinical and research studies to show the practical steps of a nerve anastomosis.
Educational objectives." To perform primary and secondary tracheoesophageal voice restoration procedures and measure, fit, and trouble-shoot tracheoesophageal voice prostheses.
Tracheoesophageal puncture has become an established method of postlaryngectomy voice restoration since its introduction by Singer and Blom in 1979. Although this method is not technically difficult, selection of appropriate candidates, adherence to established surgical principles, and a brief postoperative program of speech therapy facilitate successful application. This course is designed to teach basic aspects of this method through lecture presentation, videotaped demonstration, and sufficient time for questions and discussion. Recent advances in surgical techniques and prostheses will be emphasized. Course content will include the following: 9 Tracheoesophageal prosthesis development 9 Patient selection considerations 9 Endoscopic tracheoesophageal puncture 9 Total laryngectomy with voice preservation 9 Voice prosthesis and tracheostoma valve fitting 9 Pharyngeal constrictor myotomy 9 Pharyngeal plexus neurectomy 9 Problems and solutions
Otolaryngology Head and Neck Surgery
Instruction Courses-- Wednesday
COURSE4515-1 One-period course ($20)
May 1995
Room NOCC-64 1:15-2:15
The Micro-Debrider System in FESS JAY F. PlCClRILLO, MD, and STANLEYE. THAWLEY,MD
St. Louis, Mo.
Educational objectives: To understand the concepts behind micro-debrider surgery in functional endoscopic sinus surgery and to recognize clinical situations in which the microsurgical debrider will augment traditional and functional endoscopic sinus surgery.
With the introduction of endoscopic sinus surgery, the surgical approaches to the paranasal sinuses have become more refined. New approaches and modifications to the original technique are routinely reported. One new technique uses a powered microsurgical arthroscopy system. The microsurgical debrider, or "hummer," was originally introduced for the controlled removal of soft tissues (polyps) within the nose and paranasal sinuses. It has now been used for a variety of other paranasal procedures. This session will focus on the description of the microsurgical debrider, its capabilities within the nose and paranasal sinuses, its indications for use, cases in which it has been used, and outcomes of its use. The attenders will understand the utility of this new addition to endoscopic sinus surgery.
We will discuss epineurial repair by perineurial or fascicular techniques to end-to-end and graft anastomosis. The suture material (silk, nylon, or stainless steel), and the use of alternative methods such as fibrin glue or neural tubes will be discussed. The results and technical problems of these factors and variables will be considered in order to suggest the best technique to perform the adequate anastomosis in all possible surgical situations. The neurorrhaphy can be used in all situations; we prefer always an end-toend, fascicular anastomosis with nylon 10-0. Unfortunately, this method requires a very special technique and suture material and a microsurgeon with good microanastomosis training. The limiting factors include narrow operating field, the presence of continuously flowing cerebral spinal fluid, and severely damaged nerve stump. Under these circumstances, we prefer to use fibrin glue. The time of the repair should be as soon as possible after the trauma, and end-toend anastomosis is always preferable to autologous interposed nerve grafting.
COURSE 4517-2 Two-period course ($40)
Room NOCC-66 1:15-3:30
TE Voice Restoration Following Total Laryngectomy ERiC D. BLOM, PhD, RONALD C. HAMAKER, MD, and STEPHENB. FREEMAN, MD
Indianapolis, Ind. COURSE 4516-1
One-period course ($20)
Room NOCC-65 1:15-2:15
Anastomotic Methods of Facial Nerve Repair-How to Do It RICARDO F. BENTO,MD, PhD
$6o Paulo, Brazil
Educational objectives: To know about nerve degeneration and regeneration and how to choose the best technique for facial nerve anastomosis.
Traumatic facial paralysis may be iatrogenic (spontaneous or unintentional) or catastrophic (fractures, firearm shooting, cutting lesions of the face). When the facial nerve is severely injured, with a neurotmesis or partial loss of nerve, an end-to- end anastomosis or a nerve graft should be performed. This procedure can be performed by many different disciplines in medicine. The otolaryngologist, the neurosurgeon, and the head and neck surgeon sometimes are involved in facial nerve injuries that require an immediate anastomosis. In order to describe the most commonly used techniques of intratemporal and extratemporal facial nerve repair, the course will present clinical and research studies to show the practical steps of a nerve anastomosis.
Educational objectives." To perform primary and secondary tracheoesophageal voice restoration procedures and measure, fit, and trouble-shoot tracheoesophageal voice prostheses.
Tracheoesophageal puncture has become an established method of postlaryngectomy voice restoration since its introduction by Singer and Blom in 1979. Although this method is not technically difficult, selection of appropriate candidates, adherence to established surgical principles, and a brief postoperative program of speech therapy facilitate successful application. This course is designed to teach basic aspects of this method through lecture presentation, videotaped demonstration, and sufficient time for questions and discussion. Recent advances in surgical techniques and prostheses will be emphasized. Course content will include the following: 9 Tracheoesophageal prosthesis development 9 Patient selection considerations 9 Endoscopic tracheoesophageal puncture 9 Total laryngectomy with voice preservation 9 Voice prosthesis and tracheostoma valve fitting 9 Pharyngeal constrictor myotomy 9 Pharyngeal plexus neurectomy 9 Problems and solutions