Lateral endoscopic access to the walls of the frontal sinus is excellent except for the sinus floor. Access to the orbital roof is reliable in the medial quarter only and minimal lateral to the midorbital point. The ability to predict the areas accessible by the endoscopic approach and those areas that might require ancillary approaches is important for both surgical planning and patient expectations.

For tonsillectomy, theultrasonicharmonicscalpelhasbeen purported to cause less tissue injury and postoperative morbidity whileproviding adequate levels of hemostasis. Weundertook aprospectivestudy tocompare outcomes in 162 patients who had undergone harmonicscalpel tonsillectomy and 40 patients who had undergone monopolar diathermy tonsillectomy overa33-monthperiod.Wefound that patients in the harmonic scalpel group experienced significantly less intraoperative bleeding (5.0 vs. 16.5 ml; p < 0.000l) . There wasno clinically significant difference between thegroups with respect to (l) theamount ofoperating time, (2) the incidence of postoperative nausea and vomiting, dysphonia, andprimary orsecondary bleeding, and (3) the amount of time patients needed to resume normal diet and activities.

The technique of endoscopic pharyngeal pouch stapling has the potential to achieve excellent results. The application of more than one row of staples may be necessary to divide the common wall. However, in our series this is associated with a significantly increased risk of esophageal or pouch perforation. Care should be taken during the placement of multiple rows of staples.

No abstract

No abstract