A case of Dr. Cristobal Langdon
Endoscopic endonasal surgery is an advanced and minimally invasive technique that allows treating complex pathologies in the fronto-orbital and sphenoid cavities, such as mucocele. In this intervention performed by the Dr. Cristobal Langdon and climb to the SurgSchool surgical training app, the key steps of resection of a fronto-orbital and sphenoid mucocele and implant placement are shown. Propel from Medtronic to optimize recovery and prevent recurrences.
Introduction to the Case
In this procedure, Dr. Langdon is dealing with a fronto-orbital mucocele and a sphenoid mucocele, both of which developed as sequelae of previous oncologic surgery in a pediatric patient. The patient, already successfully treated for lymphoblastic leukemia, had developed these mucoceles following radiation therapy following her orbital resection. The surgical team relies on magnetic resonance imaging to identify the precise location and extent of each mucocele before beginning surgery.
Key Steps of Surgery
- Key Anatomy Identification
Surgery begins with the identification of important anatomical structures, such as the ascending process of the maxilla and the Agger Nasi, which facilitates a frontal anteroposterior approach to the mucocele. - Creation of the Bone Window and Milling
A bony window is created to expose the bone and, by means of drilling with specific tools such as a burr, access is opened until reaching the frontal sinus and mucocele. Careful drilling allows the affected area to be cleared and enlarged for better visualization and access. - Mucocele Drainage
Using a precise technique, Dr. Langdon locates and drains the mucocele fluid, which appears on MRI images to have less protein concentration. This step is key to decreasing pressure and relieving symptoms related to the mucocele. - Sphenoidotomy Extension
A straight Hosemann forceps is used to widen the sphenoidal access, completely exposing the sphenoidal mucocele and cauterizing small arteries, in case of bleeding, without compromising the bone structure or surrounding tissues. - Placement of Propel implant
Once drainage and reaming are complete, a Propel implant is placed in the treated area to facilitate healing and reduce the risk of mucocele recurrence. Dr. Langdon adjusts the implant inferiorly and superiorly, ensuring it is well positioned and stable.
Benefits of the Propel Implant in Endoscopic Surgery
The Propel implant is an innovative slow-release corticosteroid device that reduces inflammation and improves healing of the naso-sinusal structures. This device is especially useful in cases like this patient's, where previous interventions and radiotherapy may predispose to scar formation and recurrence.
Conclusion
Endoscopic endonasal surgery for fronto-orbital and sphenoid mucoceles is a complex technique that requires precision and a thorough knowledge of anatomy. The use of implants such as Propel optimizes the results, benefiting the patient with a faster recovery and a lower risk of postoperative complications.
