"Q-tip" Retractor in Endoscopic Cranial Base Surgery

OBJECTIVE: A practical alternative for endonasal retraction is presented. TECHNIQUE: Following 100 endoscopic endonasal procedures at the University of Pittsburgh, a simple alternative for gentle tissue retraction was introduced for endoscopic endonasal procedures: the "Q-tip" cotton swab. Its fine shape allows it to be inserted through one of the nostrils, sharing the space with the other instruments and the endoscope while preserving freedom of movement. Its long dimension allows it to reach deep areas while it is actively held by one of the surgeons, and its stiffness allows more or less force to be applied in any direction. Its soft head permits gentle touch of retraction without causing injury to the noble neurovascular structures of the cranial base. CONCLUSION: During endoscopic endonasal surgery, the instruments are operated through the nostrils, which are restricted passages. Any retractor utilized has to be thin to share the space with the other instruments, long enough to reach the cranial base, and soft to avoid tissue damage. All of these characteristics were encountered in the "Q-tip" cotton swab.