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Biomedical subjects

M Sanna

Publications and source records attributed to M Sanna.

At least 127 records · Page 7Linked to original sources
PubMed1985

Surgical treatment of brain herniation into the middle ear and mastoid.

A series of thirty-five patients operated on for brain herniation into the middle ear and mastoid is presented. The etiologic factor was felt to be previous surgery in twenty-six cases, head trauma in four cases, chronic otomastoiditis in four cases, congenital dehiscence of the tegmen in one case, and subdural empyema in one case. Diagnosis and treatment of brain herniation are discussed. The mastoid approach for repair of tegmen defects from below with the use of homologous cartilage or autologous cortical bone is advocated. A combined procedure using the transmastoid approach plus a mini-craniotomy of the temporalis squama is suggested as an alternative treatment to middle cranial fossa repair for larger cerebral hernias.

Adolescent↗
PubMed1984

Pathology as it relates to ear surgery. V. Ossiculoplasty.

In the present state of the art, autografts and homografts behave equally well in ossiculoplasty. Allografts are to be reserved for cases in which these two are in short supply. Bone grafts, autogenous and homologous, did not show gross changes in physical characters or surface structure. No obvious remodelling occurred in the grafts eight years after their insertion in the middle-ear. Microscopically, progressive deposition of new bone occurred, resulting in narrowing of the bone lacunae and bone marrow spaces. Cartilage autografts underwent progressive ischemic calcification in the middle-ear. No evidence of erosion, dissolution or remodelling was apparent eight years after their insertion in the middle-ear. Plastipore prostheses resulted in a consistent local fibrous tissue and foreign body reaction. Micro-disintegration of the prostheses is questionable. No gross changes in the physical characters or surface structure of these prostheses was evident 34 months after their insertion in the middle-ear. Inadequate hearing results following ossiculoplasty in this series were most commonly due to loss of contact between the graft and the remaining ossicles. Eustachian tube dysfunction was another possibility. Dissolution of the grafts was not the cause in any of our cases.

Aged↗
PubMed1984

Management of the labyrinthine fistula in cholesteatoma surgery.

The presence of a labyrinthine fistula has remained one of the major problems in cholesteatoma surgery. Confronted with this problem, the surgeon may ultimately base his choice of procedure on four basic conditions: the size of the fistula, its location in the ear, the condition of the other ear, and the cochlear function. Our attitude has been changing, and currently we prefer to perform a staged closed tympanoplasty. When a closed technique is performed, we either remove the cholesteatoma matrix and then cover the fistula immediately or we leave the matrix in situ and re-explore the mastoid process 5 or 6 months later. The series consists of 88 cases out of a total of 701 patients with cholesteatoma operated on between January 1971 and June 1982. In 20 patients the matrix was left over the fistula at the first stage. The results suggest that a staged operation, i.e. closed tympanoplasty, is to be preferred even in cases with an extensive labyrinthine fistula.

Cholesteatoma↗
PubMed1984

Failures with Plasti-Pore ossicular replacement prostheses.

Plasti-Pore ossicular prosthesis failures found in our series of 246 patients with regular follow-up are reported and analyzed. Extrusions as well as poor functional results (postoperative air-bone gap greater than 25 dB) of the prostheses with and without cartilage on top have been reviewed. The overall extrusion rate was 9.3%: a higher extrusion rate occurred with prostheses without cartilage (18.4%) than with cartilage (4.4%). Thirty-six patients among those with poor postoperative hearing improvement have undergone revision surgery: the main causes of failure were a short prosthesis, a fixed stapes or footplate, adhesions of the prosthesis to surrounding structures, and the displacement of the prosthesis.

Cochlear Implants↗
PubMed1984

Histology of extruded Plasti-Pore ossicular prostheses.

Twenty-three Plasti-Pore ossicular prostheses removed from the human middle ear following partial or total extrusion were investigated by light microscopy. No specific tissue reaction other than the ingrowth of histiocytic cells elicited from the porous Plasti-Pore was found. The only histologic feature typical of extruded prostheses was the presence of granulocytes in all parts extruded. In our opinion this finding was the inflammatory reaction following the ischemic necrosis of tissue grown inside the pores and the superimposed bacterial colonization. We concluded that no histologic feature supports a biologic cause of extrusion, and that extrusion instead is related to biofunctional characteristics.

Cochlear Implants↗
PubMed1984

"Congenital cholesteatoma" of the middle ear. A report of 11 cases.

This article is based on a report presented at the Second International Conference on Cholesteatoma and Mastoid Surgery, in Tel Aviv, in March 1981. The principal aim is to illustrate our personal experience with the so-called congenital cholesteatoma of the middle ear, that is, a cholesteatoma growing inside the tympanic cavity affecting subjects with no inflammatory processes in their clinical history and a perfectly normal eardrum. Eleven cases out of a total of 429 cases with cholesteatoma (2.56%) operated on at the Otorhinolaryngology Clinic II of Parma are reported. All patients--nine children and two adults--underwent a combined-approach closed tympanoplasty. The diagnostic stages are analyzed in particular, as well as the clinical and impedance audiometric data, which are correlated with surgical findings. Pathogenetic mechanisms are discussed briefly. The need for screenings to be carried out in schools and an accurate evaluation of all unilateral impairments in hearing conduction are emphasized with a veiw to early diagnosis.

Adult↗
PubMed1984

Residual and recurrent cholesteatoma in closed tympanoplasty.

There are actually two principal approaches to the surgical treatment of middle ear cholesteatoma, a subject very much debated. First, the cholesteatoma can be exteriorized and treated with an open technique (classic or modified radical mastoidectomy, open tympanoplasty); and second, the radical removal of the cholesteatoma is also possible in the majority of cases by closed tympanoplasty. In this article we examine 283 patients (forty-four children and 239 adults) operated on by the closed technique to review and discuss the postsurgical cholesteatoma problem (residual and recurrent). Total incidence of residual cholesteatoma is 13.43 percent. It is higher in children (25 percent) than in adults (11.72 percent) and is more frequently localized in the mesotympanum (47.54 percent) than in the epitympanum (40.98 percent) or in the mastoid (6.56 percent). Recurrent cholesteatoma, with a total incidence of 7.77 percent, is much less frequent when staged tympanoplasty has been performed than when a one-stage operation has been done. No endotemporal or endocranial complications (labyrinthine fistula, facial nerve paralysis) have been noticed in cases of postsurgical cholesteatoma. These data confirm the opinion that staged tympanoplasty with Silastic sheeting and reconstruction of the erosions of the posterior wall is the technique of choice for surgical therapy of middle ear cholesteatoma.

Adult↗
PubMed1983

Vestibular neurectomy for dizziness after head trauma. A review of 28 patients.

28 patients with dizziness after head trauma were treated by vestibular neurectomy. Comparisons between the results of surgery and preoperative symptoms and findings showed that the best results were achieved in patients with episodic true vertigo and profound hearing loss. Patients who suffered from constant unsteadiness and/or postural vertigo usually improved, if both audiological and vestibular tests had shown clear pathology. Neurectomy gave poor results if functional tests had shown no pathology or reduced vestibular reaction only. The results support the view that in patients with post-traumatic unsteadiness not associated with hearing impairment, the symptoms probably originate from injury to vestibular pathways central to Scarpa's ganglion and these patients do not benefit by surgery.

Adult↗
PubMed1982

Regenerated middle ear mucosa after tympanoplasty.

The surgeon's attitude towards the diseased middle ear mucosa during intact canal wall tympanoplasty has remained a controversial problem. Our approach consists of the complete removal of the irreversibly diseased mucosal lining. A planned staged operation has been carried out in most cases of tympanoplasty with the use of Silastic sheeting. At the time of the second operation, the middle ear and mastoid process appear to be lined by the regenerated mucosa and pneumatized. 54 mucosal biopsies taken during the second stage of the operation showed a normal flat, cuboidal and pseudostratified ciliated epithelium with functional features (secretory granules, microvilli and cilia). It is concluded that the diseased middle ear mucosa can be removed whenever necessary during staged closed-tympanoplasty operations because under the Silastic sheeting the mucosa will be regenerated within 12 months.

Biopsy↗
PubMed1982

Dizziness after head trauma: clinical and morphologic findings.

Twelve patients with balance problems resulting from head injury were treated by a translabyrinthine or middle fossa vestibular neurectomy. The clinical, otoneurologic, and surgical data combined with morphologic findings on the removed operative eighth nerve specimens were evaluated with the aim of deciding the site of primary lesion in each case. In six patients a peripheral lesion was interpreted. Four of them had features of delayed endolymphatic hydrops syndrome, the fifth patient might have suffered a fracture of the stapedial footplate with associated perilymphatic fistula. The sixth patient had a deforming fracture of the internal auditory canal that had produced severe hearing loss and constant unsteadiness because of the compression of the eight nerve, which had atrophied as a result. Half of the patients were diagnosed as having a central lesion. Only one of them benefited from the neurectomy. This patient had a large arterial loop within the internal auditory canal and the symptoms may have arisen because of friction of the vessel of the proximal portion of the vestibular nerve. The other five patients probably had a lesion at the level of eighth nerve brain-stem junction or central to it.

Adult↗
PubMed1982

Enhanced biofunctionality of plastipore ossicular prostheses with the use of homologous cartilage.

Functional results with Plastipore prostheses inserted in 150 staged intact canal wall tympanoplasties at our Clinic are reported. Two groups of patients have been reviewed: The first group consists of those cases in which the prosthesis is directly in contact with the tympanic graft (77 cases); the second one comprises all cases with interposition of homologous cartilage between the head of the prosthesis and the tympanic graft (73 cases). The aim of this article is to see whether extrusion rate and audiometric and impedance result differences exist between the two groups. We have found a 15.4 percent extrusion rate in the group without cartilage but only a 1.9 percent rate in the group with cartilage (9.3 percent is the overall extrusion rate). There were no substantial differences in functional results between the two groups. It is valuable to outline the different functional results between the two types of prosthesis: TORPs got 56.8 percent excellent results and 78.4 percent good results, while PORPs had only 47.7 percent excellent results and 60 percent good results. Normal compliance (static compliance greater than 0.3 cc) was found in 61.6 percent of cases without cartilage and in 46.7 percent of cases with cartilage.

Biocompatible Materials↗
PubMed1981

Ossicular chain reconstruction with plastipore prostheses.

Proper reconstruction of the ossicular chain is a fundamental prerequisite for good hearing results in staged tympanoplasties. The history of modern middle ear surgery shows that various synthetic materials have been proposed in past years for sound conducting mechanism reconstruction but all gave discouraging results and were soon abandoned. Plastipore is a new plastic material that seems to be well tolerated in the middle ear, and it is commercially available as pre-formed prostheses. We are reporting our experience with 140 cases operated on in our clinic (92 TORPs and 48 PORPs). Two groups of patients are reviewed: the first group consists of the cases in which the prosthesis is in direct contact with the tympanic graft; the second one includes the cases with interposition of cartilage between the head of the prosthesis and the tympanic graft. The purpose is to see whether extrusion rate differences exist in the two groups. Functional results (evaluated after at least six months show an air-bone gap of less than 15 dB in 57 percent of cases and an air-bone gap of less than 25 dB in 82 percent of cases. Five extrusions are reported (3.57 percent). We believe that staged tympanoplasties and tympanic reconstruction with molded heterograft can explain the excellent hearing results and the low extrusion rate of the prosthesis.

Cochlear Implants↗