1/19. cholesteatoma extending into the internal auditory meatus.We report our experiences in managing a patient with cholesteatoma complicated by meningitis, labyrinthitis and facial nerve palsy. The antero-inferior half of the tympanum was aerated but the postero-superior portion of the tympanic membrane was tightly adherent to the promontry mucosa. An attic perforation was present at the back of the malleolar head. High-resolution computed tomography also uncovered a fistula in the lateral semicircular canal. Surgical exploration of the middle ear cavity demonstrated that both the vestibule and cochlea were filled with cholesteatoma, and the cholesteatoma extended into the internal auditory meatus through the lateral semi-circular canal fistula. The cholesteatoma was removed by opening the vestibule and cochlea with a preservation of the facial nerve. Post-operatively, an incomplete facial palsy remained, but has improved slowly. There is no sign of recurrence to date after a 3-year period of observation.- - - - - - - - - - ranking = 1keywords = cholesteatoma (Clic here for more details about this article) |
2/19. cholesteatoma causing facial nerve transection.cholesteatoma is a well recognized cause of a facial nerve palsy. The usual mechanism for this complication is direct pressure on the nerve. We present a case in which the facial nerve has been transected by cholesteatoma and discuss the possible causes.- - - - - - - - - - ranking = 0.25keywords = cholesteatoma (Clic here for more details about this article) |
3/19. diagnosis of bell palsy with gadolinium magnetic resonance imaging.bell palsy is a condition resulting from a peripheral edematous compression on the nervous fibers of the facial nerve. This pathological condition often has clinical characteristics of no importance and spontaneously disappears in a short time in a high percentage of cases. Facial palsy concerning cranial nerve VII can also be caused by other conditions such as mastoid fracture, acoustic neurinoma, tumor spread to the temporal lobe (e.g., cholesteatoma), neoformation of the parotid gland, melkersson-rosenthal syndrome, and Ramsay-Hunt syndrome. Therefore, it is important to adopt an accurate diagnostic technique allowing the rapid detection of bell palsy and the exclusion of causes of facial paralysis requiring surgical treatment. magnetic resonance imaging (MRI) with medium contrast of the skull shows a marked increase in revealing lesions, even of small dimensions, inside the temporal bone and at the cerebellopontine angle. The authors present a clinical case to show the important role played by gadolinium MRI in reaching a diagnosis of bell palsy in the differential diagnosis of the various conditions that determine paralysis of the facial nerve and in selecting the most suitable treatment or surgery to be adopted.- - - - - - - - - - ranking = 0.25keywords = cholesteatoma (Clic here for more details about this article) |
4/19. facial nerve paralysis secondary to chronic otitis media without cholesteatoma.Numerous papers have been written on facial nerve paralysis caused by chronic suppurative otitis media. However the authors found none documenting the results of therapy in a series of patients in whom facial nerve dysfunction was caused by chronic otitis media without cholesteatoma. Thus, there is little factual information available to help select a specific therapeutic plan for such cases. Over the past decade, the senior author has managed five cases (6 ears) of chronic suppurative otitis media without cholesteatoma in which facial paresis (4 ears) or paralysis (2 ears) developed 10 days or less before surgery. The chronic otitis media involved the mastoid and middle ear in five cases; and the mastoid, middle ear, and petrous apex in one case. Modified radical mastoidectomy was performed in four ears, tympanomastoidectomy with facial recess exposure in one ear, and complete mastoidectomy with middle cranial fossa petrous apicectomy in one ear. Five patients had complete recovery of facial nerve function (House grade I), and one patient had 90 percent recovery (House grade II). The results provide support for semi-emergent surgery in the management of chronic suppurative otitis media when facial nerve paralysis supervenes.- - - - - - - - - - ranking = 1.5keywords = cholesteatoma (Clic here for more details about this article) |
5/19. Surgical complications and their management in a series of 300 consecutive pediatric cochlear implantations.OBJECTIVE: To report the short- and long-term complications encountered in a large number of consecutive children undergoing implantation in a single center. The current study also describes the management and sequelae of each complication. STUDY DESIGN: Prospective study assessing the surgical findings and complications of deaf children undergoing implantation. SETTING: Pediatric tertiary referral center for cochlear implantation. patients: The present study includes 300 consecutive children undergoing implantation, with a mean age at implantation of 5.1 years, ranging from 1.3 to 16.9 years. Of these children, 196 (65%) had congenital deafness of unknown cause. The commonest known cause was meningitis (73 of 300 [24%]) followed by congenital cytomegalovirus infection (17 of 300 [6%]). Children have been followed up regularly after implantation, typically at yearly intervals after the first year. The mean duration of follow-up at the time of the study was 4 years (range, 0.1-14 yr). RESULTS: There were no major perioperative (within 1 d after surgery) or major early postoperative (within 1 wk after surgery) complications. In the same periods, there were 19 and 15 minor complications, respectively. These complications (e.g., eardrum perforation, hematoma, flap swelling, wound infection, temporary facial weakness) settled with conservative treatment or minor intervention. With regard to the late surgical complications (>1 wk after surgery), there were 7 major (e.g., severe flap infection requiring explantation, cholesteatoma, persistent eardrum perforation) and 14 minor complications (e.g., mild flap infection, flap swelling, hematoma). A number of complications were encountered even 14 years after the original operation, and some of them needed repeated interventions, highlighting the importance of long-term follow-up. However, most of the complications occurred very close to the surgical procedure (<1 yr). CONCLUSION: An overall rate of 2.3% for major surgical complications and an overall rate of 16% for minor surgical complications suggest that cochlear implantation is a relatively safe surgical operation in experienced centers. Most surgical complications are minor and can be managed with conservative treatment or minor surgical intervention. However, meticulous attention to surgical detail, especially handling soft tissues and leaving the posterior canal wall intact, and long-term follow-up are of paramount importance in minimizing the incidence of surgical complications.- - - - - - - - - - ranking = 0.25keywords = cholesteatoma (Clic here for more details about this article) |
6/19. Infantile congenital petrosal cholesteatoma: a case report and literature review.Congenital cholesteatoma of the middle ear is frequently seen in younger children including infant. By contrast, that of the petrous bone is rarely seen in younger children. We report an exceptional case occurring in 23-month-old infant who presented with unilateral facial nerve paralysis at about 18-month-old. Computed tomography and magnetic resonance imaging revealed congenital cholesteatoma measuring approximately 2 cm in the area of the right geniculate ganglion. The mass was completely eradicated via the middle fossa approach, which allowed for preservation of hearing. The facial nerve maintained intact during surgery and paralysis showed partial recovery after the operation. To our knowledge, the present case seems to be the youngest case of congenital petrosal cholesteatoma reported, and also demonstrates congenital petrosal cholesteatoma could exhibit facial nerve paralysis in early childhood.- - - - - - - - - - ranking = 2keywords = cholesteatoma (Clic here for more details about this article) |
7/19. diagnosis and management of aggressive, acquired cholesteatoma with skull base and calvarial involvement: a report of 3 cases.A prospective case review of 3 patients treated at a tertiary referral center from 1997 to 2002 are presented. Three men, age 30 to 68 (mean, 45) years, were treated for acquired cholesteatoma with skull base invasion. Two patients had no prior otological surgery, and 1 was detected after 4 prior mastoid procedures. One presented with progressive unilateral facial palsy, 1 with otorrhea, and 1 with temporal mass above a modified radical mastoidectomy cavity. All 3 patients were treated with single-staged canal wall-down mastoidectomy. patients were followed up with otoscopy and neuroimaging from 40 to 61 months. Two patients had no recurrence of cholesteatoma, and 1 had squamous debris in the mastoid cavity removed in the outpatient clinic. One had complete ipsilateral facial nerve paralysis preoperatively and recovered to House-Brackmann grade III within 1 year of surgery. Patient 1 had labyrinthine involvement before surgery and had ipsilateral anacusis after resection and repair. No other complications occurred. Initial presentation, workup, surgical challenges, disease follow-up, facial nerve function, hearing results, and complications are reported.- - - - - - - - - - ranking = 1.5keywords = cholesteatoma (Clic here for more details about this article) |
8/19. facial nerve and medially invasive petrous bone cholesteatomas.Eight patients with extensive petrous bone cholesteatomas that invaded the labyrinth and fallopian canal are presented. The eight cases are added to a tabulation of prior literature reports to elucidate concepts of routes of extension of medially invasive temporal bone cholesteatoma. Medially invasive petrous bone cholesteatoma develops insidiously, often without symptoms other than facial palsy and/or unilateral deafness. Typically, a history of chronic ear disease can be obtained. While hearing is unlikely to be preserved in this group of patients, facial nerve function can usually be preserved, and a facial nerve graft was not necessary in our series. Acute facial nerve palsy or facial nerve paresis progressing to palsy in patients with a history of chronic ear disease should be studied radiographically for petrous bone cholesteatoma, even if there is no physical evidence of cholesteatoma.- - - - - - - - - - ranking = 2.25keywords = cholesteatoma (Clic here for more details about this article) |
9/19. Anterior epitympanic cholesteatoma with facial paralysis: a characteristic growth pattern.Epitympanic cholesteatoma may involve the facial nerve at several anatomic locations resulting in functional impairment. The most common site of nerve compression is the middle-ear segment where the nerve is frequently devoid of bony covering. In five patients with facial palsy due to epitympanic cholesteatoma, a characteristic pattern of growth was recognized in which the cholesteatoma traversed the anterior epitympanum rather than taking the more common posterior route. Extension anteromedial to the head of the malleus leads to compression of the facial nerve in the region of the geniculate ganglion at the level of the middle cranial fossa floor. The most probable pathogenesis of this lesion is extension of disease along the embryologic course of either the saccus anticus or the anterior saccule of the saccus medius. Management of these lesions is surgical and may require, in addition to mastoidectomy with anterior and/or posterior atticotomy, middle fossa craniotomy and/or partial removal of the labyrinth for complete excision.- - - - - - - - - - ranking = 1.75keywords = cholesteatoma (Clic here for more details about this article) |
10/19. Complicated cholesteatomas: CT findings in inner ear complications of middle ear cholesteatomas.patients with facial palsy and middle ear disease, which may be chronic but clinically occult, may have a cholesteatoma with extension medially along the facial canal. In two patients, axial computed tomographic (CT) scans demonstrated involvement of the medial petrous bone. patients with vertigo and chronic middle ear disease may have a cholesteatoma with a "fistula" between the middle and inner ears. Although the fistula usually involves the lateral semicircular canal, the cholesteatoma may pass through the oval window. In two patients, coronal CT scans showed extension to the oval window in one and through it in the other.- - - - - - - - - - ranking = 2.75keywords = cholesteatoma (Clic here for more details about this article) |
| | Next -> |