Cases reported "Ear Neoplasms"

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1/8. Amelanotic malignant melanoma following cryosurgery for atypical lentigo maligna.

    cryosurgery is an alternative treatment option to surgical excision for lentigo maligna. Clinical evidence of recurrence is usually characterized by repigmentation at the treated site. We report two patients who developed amelanotic malignant melanoma following cryosurgery for a pigmented lentigo maligna. These cases illustrate the potential risk of treating lentigo maligna with cryosurgery.
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2/8. Effective management of difficult surgical defects using tissue-engineered skin.

    BACKGROUND: Graftskin, a bilayered living skin construct, is an effective therapeutic option in the management of chronic venous ulcerations and simple acute surgical excisions. However, it is not routinely used in the management of complicated surgical wound defects. OBJECTIVE: To determine the effectiveness of graftskin as a therapeutic modality in difficult surgical defects. methods: Two patients with complex surgical wound defects after Mohs micrographic surgery underwent a single application of graftskin. The engineered skin was fenestrated and sutured in place. The wounds were examined on a weekly basis. One hundred percent healing was defined as complete reepithelialization (wound coverage). RESULTS: Graftskin was well tolerated by these patients and resulted in complete wound healing within 9 weeks of application. CONCLUSION: Graftskin is an excellent alternative for difficult surgical wounds not amenable to other therapies. Graftskin results in a shortened healing time and decreased morbidity. It should be considered for wounds in which healing by secondary intention is preferably avoided.
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3/8. A radiation-shielding device for craniofacial implant placement.

    The use of radiation shields in the head and neck cancer patient receiving adjuvant radiation therapy is a treatment alternative for protecting anticipated prosthetic implant sites. Shields can be fabricated easily as part of an interdisciplinary treatment protocol. In this article, the methods used to fabricate an extraoral radiation shield are described, and a patient treatment that illustrates possible uses of the shield for both extraoral and intraoral sites is presented.
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4/8. Peninsular conchal axial flap to reconstruct the upper or middle third of the auricle.

    BACKGROUND: The reconstruction of partial amputations of the auricle is a continuous subject of publications, in particular, the techniques of ear reconstruction with postauricular flaps. OBJECTIVE: To present in detail the surgical procedure of a new peninsular conchal transposition flap. MATERIALS AND methods: This new conchal transposition flap has been used since 1998 to reconstruct seven partial amputations of the upper or middle third of the auricle. If we compare the flap to a tennis racket, the head corresponds to a skin-cartilage-skin flap harvested from the concha and the shaft to a post- and supra-auricular cutaneous and subcutaneous pedicle based around the posterior auricular artery and the superior auricular branch of the superficial temporal artery. The blood supply is reliable because the superior branch of the posterior auricular artery anastomoses with the superior auricular branch of the superficial temporal artery. RESULTS: There have been no significant complications, except one case of partial rim necrosis, which responded well to wound healing by secondary intention. CONCLUSION: Our peninsular flap could be an alternative to more complex procedures involving costal cartilage harvesting, provided that auricle amputations are confined to the upper or middle third of the peripheral structures and spare the concha.
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5/8. radiation induced carcinoma of the middle ear.

    radiation induced carcinoma of the middle ear is rare. Only four cases have been reported; an additional case is now described. The treatment approach for radiation induced carcinoma of the middle ear has not yet been established. radiation therapy for advanced cases is discussed as an alternative to surgical treatment. Previous reported cases are reviewed.
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6/8. Surgical management of benign necrotizing otitis externa.

    Benign necrotizing otitis externa (BNOE) is a rare condition of unknown aetiology which is characterized by the formation of an avascular bony sequestrum of the tympanic plate. The vascular supply of the tympanic plate is easily compromised as demonstrated by the development of avascular necrosis in radionecrosis of the tympanic plate and malignant otitis externa. Recognition of BNOE as distinct from malignant otitis externa and carcinoma of the external ear is important as the treatment differs greatly. BNOE also forms an important part of the differential diagnosis of recalcitrant otitis externa. Management of BNOE has been unclear with long-term medical treatment being advocated. In this series of five patients, the surgical management of four patients with BNOE is described. Surgery was successful in all these patients and is advocated as an alternative to medical management.
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7/8. Aggressive squamous cell carcinomas developing in patients receiving long-term azathioprine.

    We report three patients who developed unusually aggressive squamous cell carcinomas after receiving long-term azathioprine treatment for dermatological disorders. Two patients gave a history suggestive of moderate to excessive sun exposure, and the third suffered from chronic actinic dermatitis. Hence, ultraviolet light damage may have been a significant cofactor in the development of these malignancies. Careful follow-up is necessary in patients who are taking azathioprine long term, and who have previously been excessively exposed to ultraviolet light (UVL), or in whom future exposure is likely to be excessive. We suggest that strict sun avoidance measures are followed by patients on long-term azathioprine, or that alternatives to azathioprine therapy are considered, especially in individuals inherently at risk of UVL damage, and in those already showing clinical signs of such damage.
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8/8. 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.
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