1/7. Mature teratoma of the middle ear.OBJECTIVE: The authors report a case of mature teratoma of the middle ear in a 3-year-old girl with a 1-year history of otitis media. methods AND RESULTS: Radiologic investigation revealed a partially cystic lesion of the petrous portion of the right temporal bone. It produced opacification of the middle ear as well as destruction of septal air cells. The patient underwent a subtotal petrosectomy. Histologically, the tumor was composed of an intimate admixture of mature tissues representing all three germ layers, including brain, myelinated nerve trunks, skeletal muscle, bone, immature cartilage, seromucinous glands, and respiratory epithelium. Of note within the brain tissue was choroid plexus within an ependyma-lined rudimentary ventricle. Immunohistochemical studies were also performed. Twenty months after surgery, the patient was well, with complete recovery from symptoms. CONCLUSION: Teratomas of the middle ear are rare neoplasms. Only a few examples have been reported. As a rule, they are cured by resection and do not require adjuvant therapy.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
2/7. Jugular foramen syndrome caused by choleastatoma.Unilateral paresis of 9th-11th cranial nerves together is defined as jugular foramen (Vernet's) syndrome. A cholesteatoma case that penetrated into intracranial area after eroding temporal bone and led to jugular foramen syndrome is presented here, since such a case has not been reported in the literature hitherto. A 46-year-old male patient was evaluated for hoarseness. It was learnt from his anamnesis that he had been operated for otitis media nearly 20 years ago. uvula deviated towards right. Loss of gag reflex was remarkable on the left. paresis was found on the left vocal cord. There was weakness in rotation of the head to the right. Computerized tomography (CT) scan revealed that the temporal bone lost its integrity and that there was an extra-axial hypodense mass neighboring pontocerebellum. Post-contrast magnetic resonance imaging showed that the mass, which showed thin, regular circular contrasting and which was hypointense in T1-weighted MR and hyperintense in T2-weighted MR, extended to the left jugular foramen. The mass was totally removed with left sub-occipital approach in the treatment. After the treatment, hoarseness, weakness in the rotation movement of the head and loss of gag reflex recovered totally, while deviation in the uvula was permanent. Cholesteatomas can extend to posterior fossa and cause jugular foramen syndrome. Early surgery is important to completely reverse the lost nerve functions in treatment.- - - - - - - - - - ranking = 1218.2518931967keywords = paresis (Clic here for more details about this article) |
3/7. Repair of iatrogenic temporal lobe encephalocele after canal wall down mastoidectomy in the presence of active cholesteatoma.OBJECTIVE: Although mastoid and middle ear obliteration provides the ultimate repair of an encephalocele, retained squamous epithelium may result in the occult recurrence of cholesteatoma. For most patients, a preferable technique is to perform a canal-wall-up mastoidectomy with middle fossa craniotomy. However, temporal lobe encephaloceles are occasionally found in patients with canal-wall-down cavities along with active cholesteatoma. We sought to describe our management strategy for this dilemma. STUDY DESIGN: Retrospective review. SETTING: Tertiary referral center. patients: We reviewed all patients with encephaloceles treated by the primary surgeon. patients without active cholesteatoma and a canal-wall-down cavity were excluded. INTERVENTION: Surgical management of the encephalocele and cholesteatoma. MAIN OUTCOME MEASURE: Successful repair and a noninfected ear. RESULTS: Three patients met the inclusion criteria. All had previous canal-wall-down surgery for cholesteatoma by outside surgeons and presented with chronic otorrhea, large tegmen defects, and brain herniation into the mastoid cavity. All had incomplete removal of their posterior canal wall. Our management strategy involved completing the canal-wall-down mastoidectomy and repairing the temporal floor defect using a three-layer closure via a middle fossa craniotomy. This included suture repair of the dural defect with or without a graft, a temporalis muscle rotation flap, and a split-calvarial bone graft. All patients recovered from their surgery without evidence of further cerebrospinal fluid leak, encephalocele, or cholesteatoma with a minimum follow-up time of 6 months. CONCLUSIONS: A temporal lobe encephalocele can be safely repaired while maintaining a mastoid bowl. This may be the safest treatment option for patients with active cholesteatoma.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
4/7. Reconstruction of the tensor tympani tendon.We describe a case in which reconstruction of the tendon of the tensor tympani muscle was necessary for the successful restoration of sound conduction. The right ear of a nine-year-old boy was treated for cholesteatoma with staged surgery. During the first operation, the tendon was cut to ensure good visibility in the tympanic cavity. Post-operatively, maintenance of aeration of the middle ear required ventilation tubes at first and Valsalva manoeuvres later on. The position of the reconstructed tympanic membrane varied a great deal, moving between the medial wall of the tympanic cavity and extreme bulging. This made exact measurement of a columella for ossicular reconstruction impossible. The preserved handle of the malleus was bound to the cochleariform process with ionomer cement, using a piece of surgical suture material as a substitute for the tendon. This arrangement prevented the tympanic membrane from undergoing excessive lateral movement after inflation and the ossicular chain was replaced with a successful ossiculoplasty with an autogenous bone 'drum to footplate' columella. The pre-operative 55.0 dB air-bone gap decreased immediately to 3.3 dB, widening after three years to 15.0 dB.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
5/7. SPIR MRI usefulness for steroid treatment management in tolosa-hunt syndrome.A 40-year-old man underwent surgery for a right middle ear cholesteatoma. One month later, he presented with a subacute ocular pain that was followed one day later by the appearance of vertical diplopia attributable to a right superior rectus paresis, lid ptosis and hypoaesthesia in the territory of the I and the II right trigeminal branches. A fat-suppressed (selective partial inversion recovery, SPIR) gadolinium-enhanced MRI favours the detection of inflammatory pathological tissue inside the right cavernous sinus, and in this patient it suggested a diagnosis of tolosa-hunt syndrome. The pain disappeared quickly after steroid treatment was started whereas the ocular nerve involvement improved only slightly during the first week of treatment. After two months, the patient only complained of diplopia on up-gaze, but the therapy was discontinued two months later on the basis of both clinical signs and MRI findings. SPIR MRI may be useful not only to support a diagnosis of tolosa-hunt syndrome, but also to follow-up the disease course and to manage steroid treatment.- - - - - - - - - - ranking = 1218.2518931967keywords = paresis (Clic here for more details about this article) |
6/7. cholesterol granuloma of the petrous apex: establishment of a drainage route into the superior tympanic cavity--technical note.A 40-year-old male presented with a cholesterol granuloma of the petrous apex manifesting as progressive hearing loss and tinnitus. The lesion was treated via an extradural middle cranial fossa approach employing a new procedure to establish a drainage pathway into the superior tympanic cavity which preserved his hearing. The pathway was formed by a groove 5 mm wide and deep in the anterolateral aspect of the petrous bone, crossing the major petrosal nerve and carotid artery, running around the cochlea, crossing the tensor tympanic muscle, and entering the superior tympanic cavity above the orifice of the eustachian tube. This procedure is easy to perform without special techniques.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
7/7. Selective role of partial XI-VII anastomosis in facial reanimation.OBJECTIVES: review techniques available for transposition of an alternative motor neuron if end-to-end anastomosis or interposition nerve grafting cannot be accomplished when there has been a complete facial nerve loss. Describe the selective use of a partial spinal accessory-facial nerve anastomosis and highlight cases when this may be a useful alternative. Describe the modifications of decompression of the facial nerve for tension-free anastomosis and the use of the muscle pedicle for repair of cerebrospinal fluid leakage. STUDY DESIGN: Report of three cases and a review of the literature. methods: charts were reviewed and indications for the procedure were analyzed. The degree of facial movement was recorded as well as the resolution of any cerebrospinal fluid leak. RESULTS: The results varied between Class III and Class IV on the House-Brackmann scale following initial complete paralysis. In the two cases in which spinal fluid leakage had occurred before surgery the leakage was resolved. No donor site morbidity was noted. CONCLUSIONS: The potential of low morbidity associated with the use of the sternocleidomastoid branch, along with the potential for delivering a vascularized muscle pedicle to the temporal bone region, makes selective use of this procedure a valuable addition to the multiple reconstruction options for the paralyzed face.- - - - - - - - - - ranking = 2keywords = muscle (Clic here for more details about this article) |