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5 Tips for Otolaryngologists in Surgery

Think Outside the Box: Anterior Skull Base Lessons for all Otolaryngologists

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Sharing tips and tricks across disciplines can be invaluable when it comes to treating patients. To this end, healthcare professionals from different backgrounds came together to offer otolaryngologists a run-down of relevant lessons they’ve learned in their own careers.

  1. Prevent hemostasis when possible.

Jean Anderson Eloy, MD, of Rutgers New Jersey Medical School in Newark, shared pearls for hemostatic techniques during surgery.

The first principle of hemostasis, said Dr. Eloy, is to prevent it. Minimize vessel injury when possible and avoid pulling.

“In general, if you can prevent bleeding, it’s usually better than having to manage the bleeding. But there are cases when it’s unavoidable to prevent the bleeding, and we need to use hemostatic techniques to control it.”

  1. Monitor patients for delayed complications.

Stacey Tutt Gray, MD, of Harvard Medical School in Boston, Massachusetts, urged otolaryngologists to watch for delayed complications after surgery for anterior skull base malignancies.

“Usually when we think about complications, we think about in-the-moment, immediate complications that are happening during the time of surgery,” said Dr. Gray. “But as the immediate complication rate has diminished over time, I think we really have an opportunity to focus on patients who have more delayed complications … Many patients do, if you follow them long enough, end up having delayed complications.”

  1. Check the cranial nerves.

“If one cranial nerve is out, you must check them all,” said Erin L. McKean, MD, MBA, of the University of Michigan in Ann Arbor. “If two cranial nerves are affected, you must get an MRI.” You may find that there are several cranial nerves affected. Check everything to ensure you get the full story.

  1. Know your options for reconstruction.

Adam M. Zanation, MD, of the University of North Carolina in Chapel Hill, says the goals for skull base reconstruction should be to stop CSF leakage, separate the intradural space from the sinonasal cavity, maximize postoperative healing, and cover intradural structures and implants. To do this, consider reconstructive options such as vascularized flaps.

  1. Bring new technology into your practice.

“Technology has enabled expanded care and complex procedures,” said Anand K. Deviah, MD, of Boston Medical Center in Boston, Massachusetts. When evaluating a new technology, consider how it works, how it might benefit your patients, and what the risks may be. Do your due diligence to make sure the technology really is a value to your practice.