HNO
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At present, modern skull base surgery is a highly sophisticated interdisciplinary collaboration of various diagnostic and therapeutic disciplines. The overall goal is the treatment of complex tumorous, traumatic, vascular and inflammatory processes or developmental disorders of the skull base with preservation of function. The paper presents modern concepts, procedures and minimally invasive strategies in skull base surgery and also critically discusses the current trend to endoscopic and robot-assisted surgical techniques.
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Total endoscopic or endoscopy-assisted surgical procedures are becoming more and more important for skull base surgery. In particular at the frontal skull base endoscopic procedures with planned opening of the subarachnoidal space have mostly replaced the microscope because of the good experiences in functional endoscopic sinus surgery (FESS). The advantages for the patients of endoscopic procedures with planned opening of the subarachnoidal space measured by criteria, such as mortality, morbidity or recurrence rate are unclear due to a lack of valid study data according to the criteria of evidence-based medicine.
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During the last century microsurgical approaches laid emphasis in descending order on preservation of life, total tumor excision and function. Today, the priority of microsurgery has changed to functional preservation. ⋯ In recent years, there has been an increase in observation-only management for small tumors, or radiotherapy in the case of tumor progression. The number of surgical procedures is in decline, with surgery being reserved mainly for large tumors.
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We present the case of an orbital fracture and a wooden foreign body found during surgery. The patient had undergone a pre-operative computed tomography scan but the foreign body had not been seen on these images. We discuss the difficulties in demonstrating wooden objects on CT and describe indicators in patient history, examination findings and radiological signs that might suggest the presence of a wooden object. We emphasise the necessity to explore any orbital injury if there are clinical signs suggesting an intraorbital foreign body.
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Extended tumors of the oral cavity, pharynx or larynx can severely compromise the performance of a necessary endotracheal intubation. Both transnasal fiberoptic intubation under spontaneous breathing as well as tracheotomy under local anesthesia require a great deal of cooperation from the awake patient. In cases with dyspnea due to a recurrent tumor the situation is much more difficult. These patients are often in a reduced general condition, show a lack of cooperation and often have postoperative or radiogenic scars of the pharyngeal and laryngeal structures. ⋯ In selected cases with extended tumors of the upper airway, temporary cricothyrotomy is an effective and convenient procedure to secure the respiratory tract.