The Keio journal of medicine
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Review
What are the limits of endoscopic sinus surgery?: the expanded endonasal approach to the skull base.
The advent of endoscopic technologies and techniques has expanded the limits of conventional endoscopic sinus surgery. The expanded endonasal approach describes a series of surgical modules in the sagittal and coronal planes that allow surgical access to the entire ventral skull base. The sagittal plane extends from the frontal sinus to the second cervical vertebra. ⋯ The introduction of the septal mucosal flap for dural reconstruction has decreased the incidence of postoperative cerebrospinal fluid leaks to less than 5%. Early data suggests that oncological outcomes for malignant sinonasal tumors with skull base involvement are comparable to conventional techniques. Proper training in endonasal surgical techniques is essential to prevent unnecessary morbidity and achieve good outcomes.
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Professionalism is a core competency of physicians. In this article, the statements of professional societies (e.g., the Charter on Medical Professionalism), the expectations of patients and society regarding professionalism, and a framework for defining medical professionalism are described. The framework's foundation consists of clinical competence, communication skills, and a sound understanding of the ethical and legal aspects of medicine. ⋯ Professionalism assessments can be used for formative and summative feedback, evaluation of professionalism education programs, and generating hypotheses for professionalism research. Finally, the rich history and culture of clinical excellence and professionalism and specific programs for teaching and assessing professionalism at Mayo Clinic are described throughout this article. Indeed, the Mayo Clinic experience validates professionalism a s a core physician competency.