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Displacement of dental implants into the maxillary sinus is one of the common dental complications. However, it is rare that dental implants cause the displacement of multiple components due to separation. Here, we describe an unusual case of a 43-year-old man who had a missing implant in the maxillary sinus after an implant procedure. There was a two-week waiting period before we performed the removal during which the cap had unexpectedly separated from the body and freely moved into the ostium by sinus activity. The body was independently extracted intraorally. The remaining cap was secondly removed by utilizing nasal endoscopy. There were no complications in the postoperative period and the patient reported no symptoms of sinusitis after two months of follow-up. We experience unexpected events in the course of treating a displaced implant into the maxillary sinus. Our case report may provide several learning points for the removal of a missing implant.

OBJECTIVE: Sinonasal mucoceles (SM) are benign, expansive neoformations which require surgical marsupialization to prevent severe complications. The present study reports the larger case history ever published: a 28-years expertise in the surgical management of SM.
METHODS: A retrospective study was conducted on patients surgically treated for SM at the Departments of Otorhinolaryngology of Varese and Pavia, between 1994 and 2022.
RESULTS: 398 patients were reported. An endoscopic endonasal marsupialization of SM was performed in 92,5% of cases. 7% of patients underwent a combined approach while 0,5% required an exclusive open surgery. The average follow-up after surgery was 10-60 months. SM overall recurrence was observed in 11,4% of cases.
CONCLUSIONS: Endonasal endoscopic SM marsupialization is a feasible technique which allows the preservation of the anatomy and physiology avoiding the surgical invasiveness of the external approaches. The well-established surgical expertise in the endonasal endoscopy together with technological improvements widened the indication range of the exclusive endoscopic technique over the traditional open surgery.

Distal cholangiocarcinoma (CCA) can pose diagnostic and therapeutic challenges, often leading to a poor prognosis. While curative resection is viable for a minority in the early stage, we report a case of successful endoscopic therapy. A 79-year-old patient, diagnosed with early-stage extrahepatic CCA, opted out of surgery and chemotherapy. Instead, he pursued a treatment strategy involving serial radiofrequency ablation with stent exchange at endoscopic retrograde cholangiopancreatography. The patient achieved remission, showcasing the potential for local control of distal CCA through radiofrequency ablation and covered self-expanding metal stents. This alternative becomes particularly relevant for patients unsuitable for surgery or chemotherapy and those who decline it.

BACKGROUND: Invasion of the CS is one of the limiting factors for total resection for PitNet tumors with cure rates less than 30%. Extended approaches may be considered in selective and well-studied cases of secreting adenomas.
METHODS: We describe the key steps of the endoscopic transcavernous approach for functional pituitary adenomas with a video illustration. The surgical anatomy is described along with the advantages and limitations of this approach.
CONCLUSIONS: A detailed knowledge of CS anatomy and familiarity with this surgical approach acquired in the laboratory is essential. Proper instrumentation is critical to decrease the risks of vascular injury.

(1) Background: Transsphenoidal pituitary surgery can be conducted via microscopic or endoscopic approaches, and there has been a growing preference for the latter in recent years. However, the occurrence of rare complications such as postoperative sinusitis remains inadequately documented in the existing literature. (2) Methods: To address this gap, we conducted a comprehensive retrospective analysis of medical records spanning from 2018 to 2023, focusing on patients who underwent transsphenoidal surgery for pituitary neuroendocrine tumors (formerly called pituitary adenoma). Our study encompassed detailed evaluations of pituitary function and MRI imaging pre- and postsurgery, supplemented by transnasal endoscopic follow-up assessments at the otolaryngology outpatient department. Risk factors for sinusitis were compared using univariate and multivariate logistic regression analyses. (3) Results: Out of the 203 patients included in our analysis, a subset of 17 individuals developed isolated sphenoid sinusitis within three months postoperation. Further scrutiny of the data revealed significant associations between certain factors and the occurrence of postoperative sphenoid sinusitis. Specifically, the classification of the primary tumor emerged as a notable risk factor, with patients exhibiting nonfunctioning pituitary neuroendocrine tumors with 3.71 times the odds of developing sinusitis compared to other tumor types. Additionally, postoperative cortisol levels demonstrated a significant inverse relationship, with lower cortisol levels correlating with an increased risk of sphenoid sinusitis postsurgery. (4) Conclusions: In conclusion, our findings underscore the importance of considering tumor classification and postoperative cortisol levels as potential predictors of postoperative sinusitis in patients undergoing transsphenoidal endoscopic pituitary surgery. These insights offer valuable guidance for clinicians in identifying at-risk individuals and implementing tailored preventive and management strategies to mitigate the occurrence and impact of sinusitis complications in this patient population.

Pituitary surgery, a critical intervention for various pituitary disorders, has sparked ongoing debates regarding the preference between endoscopic and microscopic transsphenoidal approaches. This systematic review delves into the outcomes associated with these techniques, taking into account the recent advancements in neurosurgery. The minimally invasive nature of endoscopy, providing improved visualization and reduced morbidity, stands in contrast to the well-established track record of the conventional microscopic method. Examining outcomes for disorders such as Cushing\'s disease and acromegaly, the review synthesizes evidence from Denmark, Bulgaria, and China. Noteworthy advantages of endoscopy encompass higher resection rates, shorter surgery durations, and fewer complications, endorsing its effectiveness in pituitary surgery. While emphasizing the necessity for prospective trials, the review concludes that endoscopic approaches consistently showcase favorable outcomes, influencing the ongoing discourse on the optimal surgical strategies for pituitary disorders.

BACKGROUND: Extraforaminal lumbar disk herniations (ELDHs) are relatively rare and are, till today, diagnostic and therapeutic challenges. The transmuscular paramedian approach to the extraforaminal space is today the standard surgical approach. Nevertheless, controlling the correct trajectory to the extruded disk fragment continues to represent a challenge. The application of spinal navigation and spinal endoscopy seems to offer great advantages to ELDH treatment.
OBJECTIVE: The purpose of this study is to demonstrate the advantages of spinal navigation for ELDHs by taking a purely endoscopic transtubular approach, focusing on technical aspects and clinical outcomes.
METHODS: Nine consecutive patients who underwent a navigation-assisted, muscle-splitting, transtubular, purely endoscopic approach for ELDHs were retrospectively analyzed. Their clinical records were reviewed. Pain evaluations and neurological assessments were conducted.
RESULTS: We recorded a notable visual analog scale (VAS) score improvement in postoperative examinations. The mean operation time was 47.05 min. All patients were discharged on postoperative day 1.
CONCLUSIONS: The use of spinal navigation offers a great advantage to ELDH treatment. The aid of navigation allows for a patient-tailored approach and adequate surgical exploration even in face of complex lesion anatomies. The endoscopic transtubular navigated approach seems to offer a significant reduction in operative time, at least in the selected cases.

Airbag induced injuries such as skull and cervical spine fractures, epidural and subdural hematomas, atlantooccipital dislocations or brainstem lacerations are already documented in published literature, however, no previous case have been published about a penetrating foreign body of the skull base following airbag deployment. Removal of an intracranial foreign body is very dangerous and difficult, or even if it possible and necessary, requires open surgery in most of the cases. In this article we present the minimal invasive, transnasal removal of a coin from the intracranial, frontobasal region using high-resolution endoscopy combined with image-guided navigation.
We report the case of a 59-year-old male who was brought to the emergency department after a car accident. He suffered a penetrating injury by a coin that was placed on the car’s airbag at the moment of the accident. Upon the airbag being deployed the foreign body entered the skin through the right lower eyelid, crossing the orbital cavity, ethmoid cells, sphenoid sinus and the anterior part of the planum sphenoidale at an equal distance of 2mm from the two internal carotid arteries, extending into the intracranial space, without injuring the pituitary stalk and the chiasm. We proceeded to remove the coin endoscopically using a transnasal transseptal transsphenoidal approach under general anesthesia. The dura was closed with a multilayer skull base reconstruction technique using two layers of abdominal free fat and nasal septal mucoperiosteal flap. There were no postoperative complications, nor CSF rhinorrhea. The patient was discharged 10 days after the operation.
To our knowledge, this is the first publi­shed case of a penetrating foreign body of the skull base, extending into the intracranial cavity following airbag deployment. In some dedicated cases, a minimal invasive endoscopic approach should be considered as an alternative to anterior craniotomy if access is possible when foreign bodies from the skull base area need to be removed. This procedure is efficient, safe and minimally invasive. 

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Légzsák okozta koponya- és nyakigerinc-sé­rülések, epiduralis és subduralis hae­ma­tomák, atlantooccipitalis ficamok vagy agy­törzsi sérülések dokumentáltak a szak­iro­dalomban, azonban kinyíló légzsák utáni, intracranialisan penetráló, koponyabázist el­érő idegentest esete eddig nem került közlésre. Amennyiben szükség van rá, és tech­nikailag lehetséges, az intracranialis ide­gentest-eltávolítás igen veszélyes és kö­rülményes feladat, és az esetek nagy ré­szé­ben nyílt műtéti feltárást igényel. Ezen esetismertetésben egy minimálisan invazív, transnasalis műtéti technikát mutatunk be, mely során nagy felbontású sebészeti mikroszkópot, endoszkópot és neuronavigációt használtunk az idegentest eltávolításához.
Egy 59 éves férfi került beszállításra a sür­gősségi osztályra autóbaleset után. A bal­eset során a légzsákon elhelyezett pénzérme oko­zott intracranialisan penetráló sérülést. A légzsák kinyílását követően a rajta elhelye­zett pénzérme az alsó szemhéjon, majd a szemüregen, ethmoidalis sejteken, sinus és planum sphenoidalén keresztül jutott az intracranialis térbe, ahol egyenlő távolság­ra állt meg a két arteria carotis interna kö­zött, azoktól 2 mm-re, anélkül, hogy ezen érképleteket, a hy­pophysis nyelét vagy a chiasma opticumot megsértette volna. Eltávolítását általános érzéstelenítésben, transnasalis transseptalis megközelítés során endoszkóppal végeztük. A kemény agyhártyán levő szövethiányt több rétegű zárási technikával láttuk el, ami két réteg hasi zsírszövetből és orrnyálkahártya-lebenyből állt. Posztoperatív rhinorrhoea, illetve egyéb szövődmény nem jelentkezett. A beteget 10 nappal a beavatkozás után emittáltuk.
Ismereteink alapján ez az első intra­cra­nia­lisan penetráló idegentest okozta sérülés esete az irodalomban, ami légzsák kinyílása következtében jött létre. Hasonló, dedikált esetekben a koponyabázist is érintő idegentestek eltávolítása érdekében minimálisan in­vazív, endoszkópos megközelítés mérlege­lendő az anterior craniotomiás feltárással szemben. 

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Metastasis to the gastrointestinal (GI) tract should always be a consideration when melanoma, particularly metastatic disease, is diagnosed. While metastasis to the small intestine is common, given its rich blood supply, metastasis to the pancreatic ducts is extremely rare. In patients with pancreatic divisum, disease spread to the minor papilla can greatly increase the chance of developing pancreatitis due to the potential for increased pancreatic intraductal pressure. We present one unique case of metastatic melanoma to the minor duodenal papilla causing pancreatitis.