Emerging Roles of Coblation in Rhinology and Skull Base Surgery

Clinical Application of Low-Temperature Plasma Radiofrequency in the Treatment of Hemangioma in Nasal Cavity, Pharynx and Larynx

OBJECTIVE

Hemangioma is a common benign tumor in the head and neck. The therapeutic effect by conventional treatment was not very satisfactory. The purpose of this study is to explore the surgical strategy of low-temperature plasma radiofrequency in the treatment of hemangioma located in the nasal cavity, pharynx, and larynx.

METHODS

The clinical data of 29 cases with hemangioma in nasal cavity, pharynx, and larynx treated by low-temperature plasma radiofrequency ablation were retrospectively analyzed. The strategy of ablation before resection was performed for 16 cases of nasal capillary hemangioma. The other 13 cases of cavernous hemangioma in the pharynx and larynx were treated by the strategy of direct ablation.

RESULTS

All 29 patients underwent a successful operation with minimal intraoperative bleeding and no postoperative bleeding complications. There was no nasal septum perforation, dyspnea, dysphagia, dysphonia, or other complications. The patients were followed up for more than 3 years without recurrence.

CONCLUSION

Low-temperature plasma radiofrequency is a practical, minimally invasive, and accurate method for treating hemangiomas in the nasal cavity, pharynx, and larynx. For capillary hemangiomas, the strategy of ablation before resection may be an effective way to reduce bleeding, and for cavernous hemangiomas, the strategy of direct ablation is a simple and efficient method.

To Study the Efficacy of Coblation in the Endoscopic Surgery of Sinonasal and Skull Base Masses

Objective

To study the efficacy of coblation in the endoscopic surgery of sinonasal and skull base masses.

Study Design

Prospective Interventional Study.

Method

100 patients with signs and symptoms of nasal obstruction were enrolled for 14 months. On the basis of diagnosis they underwent endoscopic sinus surgery using coblator and their intra-operative blood loss, operation time, post-operative pain threshold using VAS(Visual analogue scale) were enlisted.

Result

80% had Sinonasal polyp followed by Inverted papilloma in 8%, Angiofibroma in 5%, Hemangioma in 3%, Esthesioneuroblastoma in 2% and Rhinosporidiosis in 2%. The Minimum blood loss was 50 ml and Maximum was 600 ml. 30% patients had no pain, 60% had Mild pain and 10% had Moderate pain post procedure. Mean Operation time was 112.86 min.

Conclusion

Coblation has proven to have reduced operation time, blood loss and faster wound healing. It has now established itself as an essential tool for advance tumours in nasal surgeries.

Long-Term Clinical Outcome of Low-Temperature Plasma Ablation Treatment for Recurrent Corneal Erosions

Purpose: To observe the therapeutic effect of low-temperature plasma ablation in treating patients with recurrent corneal erosions (RCEs). Materials and Methods: From 2020 to 2022, 35 participants with unilateral RCEs voluntarily enrolled. Here, 35 eyes of 35 patients were treated with low-temperature plasma ablation (coblation). All surgeries were performed by the same doctor (X.H.). The coblation went back and forth over the entire erosion area around five times for about five minutes. After the operation, patients were scheduled for follow-up visits at the outpatient clinic after 1 month, 3 months, 6 months, and 12 months, and at the end of the trial. During every visit, each patient underwent an evaluation of their ocular symptoms utilizing the following: pain score, intraocular pressure, slit lamp biomicroscopic examination, dry eye analysis, corneal topography, and corneal in vivo confocal microscopy (IVCM). Results: The mean follow-up time was 12.4 ± 6.1 months, ranging from 6 to 29 months. Of the 35 patients who had low-temperature plasma ablation, 32 eyes (91.43%) were completely symptom-free and three (8.57%) eyes had repeated episodes of recurrent corneal erosions after the surgery, at 3, 10, and 12 months, respectively. The typical RCE morphologic abnormalities observed in IVCM included the deformation and relaxation of the corneal epithelium, disorganized stromal fibers, reduced nerve fiber density, and disordered organization. After low-temperature plasma ablation, the loose cysts disappeared, and the epithelium became solid and tight. There was no obvious difference in the intraocular pressure (p = 0.090) or corneal astigmatism (p = 0.175) before and after treatment. The mean pain score decreased significantly, with a preoperative score of 7.7 ± 2.4 and postoperative score of 1.1 ± 1.8 (p < 0.001). The mean corneal thickness decreased from 562.6 ± 42.2 mm to 549.6 ± 26.9 mm (p = 0.031). The mean non-invasive keratograph tear meniscus height (NIKTMH) decreased from 0.210 ± 0.054 mm to 0.208 ± 0.045 mm (p = 0.001), and the mean TBUT decreased from 6.191 ± 2.811 s to 5.815 ± 2.802 s (p < 0.001), which manifested as a slight worsening of dry eyes. In one case, the patient’s corneal astigmatism became more severe, which may be related to the high instantaneous energy when the operation did not flush in a timely manner, and it was recovered after 6 months. Conclusions: Low-temperature plasma ablation is an effective and safe procedure to treat patients with recurrent corneal erosions.

Plasma Ablation-Assisted Endoscopic Endonasal Transpterygoid Approach to Sphenoid Lateral Recess Cerebrospinal Fluid Leaks: Technique and Outcome

BACKGROUND

Management of sphenoid lateral recess (SLR) cerebrospinal fluid (CSF) leaks present a challenge because of the location and requiring complete visualization of the defect for a successful repair. The endoscopic endonasal transpterygoid approach (EETPA) is considered the gold standard in addressing these defects. We lay out our experience in implementing this approach with plasma ablation.

METHODS

This is a case series of 11 diagnosed patients of SLR CSF leaks who underwent plasma ablation-assisted EETPA repair by a single surgeon between 2011 and 2020 at our institution. Outcomes in terms of surgical field grade on the Wormald 11-point grading scale, postoperative complications, healing on nasal endoscopy and imaging, and surgical success rate were assessed.

RESULTS

The etiology was spontaneous leak in 10 (90.9%) patients and secondary to temporal lobe abscess and/or meningitis in one (9.09%). Three (27%) patients were previously operated elsewhere by the transsphenoidal route, which we reoperated by this technique. As per Wormald grading, grade 1 field in 3 (27.27%), grade 2 in 6 (54.5%), and grade 3 in 2 cases (18.18%) were noted. Complications occurred in 3 patients (27%) in the form of dry eye (9%), meningitis (9%), and transient CSF rhinorrhea in the immediate postoperative period (9%). Repair sites were well healed on follow-up nasal endoscopy and imaging. The surgical success rate was 100%.

CONCLUSIONS

Plasma ablation-assisted EETPA allows for a uninostril approach to the SLR, easy accessibility, and better visualization with a bloodless field, which allows appropriate repair, thus minimizing complications and preventing recurrence.

Navigation-Assisted Treatment of Giant Cysts in the Pterygopalatine Fossa With Endoscopy Method

A couple of cysts lying in the pterygopalatine fossa are rare. The authors report a case of a 28-year-old woman who was admitted to the authors' hospital with a 1-month history of headache and numbness on the left head. Three-dimensional computed tomography revealed a large soft mass in the pterygopalatine fossa. Magnetic resonance imaging showed that there were a couple of cysts in the pterygopalatine fossa. One cyst measured 41 × 38 × 34 mm and the other 23 × 19 × 19 mm. A transpterygoid transnasal endoscopic approach and resection of the lesion was performed. The authors opened the cyst with coblation and the lesion showed a lot of transparent thick yellow liquid. The authors located the posterior wall the other cyst with ENT image navigation. The puncture was conducted and a lot of yellow liquid flowed out of the lesion. The patient recovered rapidly. The headache and numbness were alleviated and disappeared after 1 month. The patient currently has no evidence of recurrence at 1 year postoperatively. The coblation and ENT image navigation make the surgeon more easily to achieve risk-free surgery under endoscopy.

Antenna Designs for Microwave Tissue Ablation

Microwave (MW) ablation has emerged as a minimally invasive therapeutic modality and is in clinical use for treatment of unresectable tumors and cardiac arrhythmias, neuromodulation, endometrial ablation, and other applications. Components of image-guided MW ablation systems include high-power MW sources, ablation applicators that deliver power from the generator to the target tissue, cooling systems, energy-delivery control algorithms, and imaging guidance systems tailored to specific clinical indications. The applicator incorporates a MW antenna that radiates MW power into the surrounding tissue. A variety of antenna designs have been developed for MW ablation with the objective of efficiently transferring MW power to tissue, with a radiation pattern well matched to the size and shape of the targeted tissue. Here, we survey advances in percutaneous, endocavitary, and endoscopic antenna designs as an integral element of MW ablation applicators for a diverse set of clinical applications.

Industry Involvement in Otolaryngology: Updates from the 2017 Open Payments Database

Objective

To characterize drug and device industry payments to otolaryngologists in 2017 and compare them with payments from 2014 to 2016.

Study Design

Retrospective cross-sectional analysis.

Setting

2017 Open Payments Database.

Subjects and Methods

We identified otolaryngologists in the Open Payments Database receiving nonresearch industry payments in 2017. We determined the total number and value of payments and the mean and median payments per compensated otolaryngologist. We characterized payments by census region, nature of payment, and sponsor subspecialty.

Results

A total of 8131 otolaryngologists received 66,414 payments totaling to $11.2 million in industry compensation in 2017. This is decreased from $14.5 million in 2016. The mean and median payment per compensated otolaryngologist was $1383 ($10,459) and $159 ($64-$420), respectively. Of the total compensation, 85% was received by the top 10th percentile of otolaryngologists. Speaking fees accounted for $3.1 million (28% of total payments), and food and beverage was the most common payment type (57,691 payments; 87%). Consulting fees decreased by $1 million from 2016 to 2017, and ownership interests decreased by $1.2 million from 2016 to 2017. The south had the highest total compensation value ($4.2 million), while the west had the highest mean payment value ($1561). Rhinology accounted for the highest proportion of payments of all otolaryngology subspecialties at $3.9 million (34%).

Conclusion

Industry payments to otolaryngologists decreased to $11.2 million in 2017 from $14.5 million in 2016. Much of the decrease can be attributed to decreases in consulting fees and ownership payments. It is important that otolaryngologists remain aware of changes in industry funding with each release of the Open Payments Database.