hello my name is dr. Eric Nash Tibbett or dr. ent I'm an otolaryngologist surgeon today I
will be reviewing a scene from the TV show Grey's Anatomy Season 5 episode 3 depicting
a patient with a long-standing severe headache ultimately found to be due to a nasal problem
check it out we're 63 has been experiencing chronic headaches for the past seven years
has been treated with narcotics anti-seizure medications antidepressants and antipsychotics
indications with no success how's the pain today let's kill him once again as always I just want
mr. Penton where's last consult suggested a bilateral single monitor a frontal lobotomy
for a headache please could you do something about the buzzing we need all these machines
mr. Patmore has been experiencing intense pain I'd say every day for seven years but a cingulotomy
could cause seizures or cognitive defects or behavioral changes which is why we are going
to explore every other possible option before resorting to such a radical surgery more tests
yes dr. yang you'll be assisting dr. Shepherd today this unfortunate patient apparently has
seen a neurologist given the numerous different types of migraine medications without success
the headache most likely is coming from the forehead region given a frontal lobotomy as
being considered something that is rarely if ever performed today for headaches dr.
Sun and I'm working with Shepherd today on a pain patient and read this article while
I was helping George study ascetic yes I know I'm pathetic but I did read this article and
I do have a photographic memory and the Chiefs on his new thing where he wants the interns to
be heard and not just fewer words good I think he needs an ENT you're an ENT right the intern
clearly has thought of an alternative explanation for the patient's severe headaches that has a more
nasal source given she's approaching dr. Sloan who is not only a plastic surgeon but also an
ENT some ents do go on to specialize in plastic surgery after completing their ent training but
such surgeons are relatively rare thanks for the quick test on your patient he's in a lot of pain
mark I don't think he needs a tummy tuck no it's funny well dr. gray came in with an interesting
idea and unlike you I'm taking the Chiefs new teaching protocol seriously so I listen I read
a thing about swelling and compression of the ethmoid nerve I believe if we were to stick a
caudal elevator up his nose so every time sorry up his nose if dr. Grey's on the right track the
patient lies no okay there's a padwar of dr. Sloan on the head of plastic surgery and an ear nose and
throat specialists like to mark with tests so I can have your permission I've seen 16 ents now
one could tell me no breathe normally patients who suffer from severe unrelenting frontal headaches
often see many different neurologists and ents currently dr. Sloan is opening up the nose using
a nasal speculum in his left hand the caudal instrument is being held in his right hand
when using the nasal speculum the vast majority of ents would use the nasal speculum from the
side of the nose and not above the nose as dr. Sloan does here also although the caudal
instrument can be used in this situation most ents today would use a nasal endoscope to not
only manipulate the area of concern but to also visualize the nasal anatomy clearly soon here
let me know when you feel like that's it that's the pain oh my god oh my god
anterior ethmoid neurovascular complex a simple middle turban act Emile fix it unless you still
want to chop out the front of his brain what the patient is suffering from is essentially
a pinched nerve near the top of the nose next to the corner of the eye called the anterior
ethmoid neurovascular complex this condition is analogous to sciatica of the leg when this
region is pinched it can cause a severe headache in this vicinity that can fluctuate in severity
this condition is often called salutis neuralgia or contact point headache though middle turban
ectomy can be performed most ents today would alternatively perform a more limited procedure
that may involve septoplasty and or endoscopic sinus surgery before any sign of nasal surgery
is performed a dedicated CT sinus scan should be obtained if not already done so diagnose that
nerve because I've never even heard of that condition before I've remembered an article
from the British Journal of ent and was issue number 47 page 19 from 1964 I do not believe
there actually exists a journal called British Journal of ent most likely made up so there you
have it a headache condition actually due to a nasal problem one surgical decompression has
been performed the headaches should essentially be cured without the need for any further medication