Otolaryngologic clinics of North America
-
Shared decision-making affords patients and their families the autonomy to make difficult decisions after receiving comprehensive information about medical facts and treatment options. It is essential that patients' values are respected. ⋯ Once the treatment options and outcomes important to patients are identified, an actual decision can be made. This activity is complex and requires a commitment of time and is enhanced through employment of a multidisciplinary team approach.
-
Otolaryngol. Clin. North Am. · Jun 2017
ReviewEndoscopic Skull Base Reconstruction: An Evolution of Materials and Methods.
Endoscopic skull base surgery has developed rapidly over the last decade, in large part because of the expanding armamentarium of endoscopic repair techniques. This article reviews the available technologies and techniques, including vascularized and nonvascularized flaps, synthetic grafts, sealants and glues, and multilayer reconstruction. Understanding which of these repair methods is appropriate and under what circumstances is paramount to achieving success in this challenging but rewarding field. A graduated approach to skull base reconstruction is presented to provide a systematic framework to guide selection of repair technique to ensure a successful outcome while minimizing morbidity for the patient.
-
Otolaryngol. Clin. North Am. · Apr 2017
ReviewCombined Endoscopic and Open Approaches in the Management of Sinonasal and Ventral Skull Base Malignancies.
Combined transcranial and endoscopic endonasal approaches remain useful in the treatment of ventral skull base malignancies. The extended bifrontal transbasal approach provides wide access to the anterior ventral skull base and paranasal sinuses without transfacial incisions. In more extensive lesions, the bifrontal transbasal approach can then be combined with an endoscopic endonasal approach (EEA) from below. This article reviews the indications, surgical technique, and operative nuances of combined transbasal and EEA (cranionasal) approaches for the surgical management of ventral skull base malignancies.
-
Otolaryngol. Clin. North Am. · Feb 2017
ReviewExtended Endoscopic and Open Sinus Surgery for Refractory Chronic Rhinosinusitis.
This review discusses extended endoscopic and open sinus surgery for refractory chronic rhinosinusitis. Extended maxillary sinus surgery including endoscopic maxillary mega-antrostomy, endoscopic modified medial maxillectomy, and inferior meatal antrostomy are described. ⋯ Extended endoscopic frontal sinus procedures, such the modified Lothrop procedure, are described. Extended open sinus surgical procedures, such as the Caldwell-Luc approach, frontal sinus trephine procedure, external frontoethmoidectomy, frontal sinus osteoplastic flap with or without obliteration, and cranialization, are discussed.
-
Otolaryngol. Clin. North Am. · Dec 2016
ReviewPositive Airway Pressure Therapy for Obstructive Sleep Apnea.
Positive airway pressure (PAP) is considered first-line therapy for moderate to severe obstructive sleep apnea and may also be considered for mild obstructive sleep apnea, particularly if it is symptomatic or there are concomitant cardiovascular disorders. Continuous PAP is most commonly used. ⋯ Despite the proven efficacy of PAP in treating obstructive sleep apnea syndrome and its sequelae, adherence to therapy is low. Close follow-up of patients for evaluation of adherence to and effectiveness of treatment is important.