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PubMed1980

[Irradiation of basal cell epitheliomas of the face: a handicap for the surgeon in some cases of recurrence (author's transl)].

A case is reported which illustrates the progressive relapsing nature and local invasive character of certain irradiated basal cell epitheliomas. One such case, that involved the tragus initially, and had been irradiated on five occasions, successively invaded the lobe of the ear, the auditory canal, the helix, the mastoid, and the zygomatotemporal region in spite of six operations and the use of cryotherapy.

Aged↗
PubMed1981

[Possibilities of reconstruction by de-epithelization (author's transl)].

By definition de-epithelization is a technique by which a graft or a flap is thinned out of the split thickness or full thickness skin layer. The underlying fat tissue is thus covered more or less by corium only. The indications for this procedure are as follows: 1. A subcutaneous defect. 2. Resurfacing defects in a cavity (for example in the pharynx) 3. Subcutaneous implantation of a flap pedicle. The advantages of de-epithelization are: 1. Widening the scope of surgical technique. 2. In many cases second surgery can be avoided. 3. The way from the donor to the recipient site is shorter. 4. A large regional flap can be used not only for reconstruction of the superficial defect but also for subcutaneous filling of a hole. Possible complications are disturbances in the nutrition of the flap and formation of subcutaneous cysts and fistulas which may lead to infections. It is obvious that careful assessment of the indication and precise technique performance are mandatory. Out of 221 flap procedures done in our department since February 1979 we used the de-epithelization technique in 7 cases (3.2%).

Ear Neoplasms↗
PubMed1977

How aging affects the ear.

With aging, a different variety of ear diseases becomes more common. External ear disease is often a local reflection of generalized skin problems aggravated by retained water or local manipulation. Hearing loss may be the result of long-standing middle ear disease rather than aging. In this situation, the inconveniences and possible dangers of a chronically infected ear may be resolved with surgical intervention. Nasopharyngeal or lymphomatous disease must be suspected in any geriatric patient manifesting middle ear disease for the first time. Like presbyopia, presbycusis is a normal consequence of aging. It may be severe, but it does not lead to total deafness and equally involves both ears. Early discovery of the condition and institution of hearing rehabilitation methods will minimize the individual's communicative handicap and tendency to withdraw from society. Unilateral or asymmetric sensorineural hearing loss should be thoroughly evaluated for the purpose of identifying a curable and potentially life-threatening disease.

Aged↗
PubMed1998

[Facial epitheliomas: general considerations, surgical techniques and indications].

Carcinoma of the face is the skin disease most frequently encountered by plastic surgeons in everyday practice. Although basal cell carcinomas and squamous cell carcinomas are generally easy to recognize, their treatment remains subject to various schools of thought, or even individual practices, which are often difficult to define. This article defines a general plan of management of these tumours; their histological duality corresponds to a therapeutic duality. Resection of a basal cell carcinoma requires safety margins of 3 to 4 mm, versus at least 5 mm for a squamous cell carcinoma. In a high-risk subject, with a sclerodermiform carcinoma or undifferentiated squamous cell carcinoma, this safety margin may be as much as 10 mm or more. Frozen section examination is preferable in these situations. Six anatomical regions are studied selectively to define the main rules of reconstruction: nasal region, orbitopalpebral region, labial region, malar region, frontal region and auricular region. Each region will be subdivided into several subterritories, each requiring different strategies. The objectives, methods and indications of each reconstruction are selectively defined. The final strategy proposed is based not only on the author's personal experience, but also on the results of the national survey on carcinomas. As a complement to these therapeutic guidelines, the authors raise the problem of incomplete resection, which requires the definition of a peripheral infiltration index predictive of the recurrence rate. Surgery obviously cannot constitute exclusive treatment carcinomas, hence the value of presenting other methods currently available in the therapeutic armamentarium. Surveillance is essential in every case, determined by the patient's risk of recurrence or even metastatic dissemination.

Basal Cell Carcinoma↗
PubMed1976

The radiological manifestations of intracranial rhabdomyosarcoma.

Two cases of rhabdomyosarcoma, one arising in the parotid gland and the other within the middle ear cavity, are presented. Both cases developed neurological signs of intracranial extension, which, in one, were non-localizing. The angiographic characteristics of these two cases as well as those reported in the literature are discussed. Angiography delineated the extent of tumor involvement and influenced the treatment ports. Isolated reports of long term survivals and some promising preliminary results from more aggressive therapy warrant delineation of tumor extent. To this end angiography is helpful.

Adolescent↗
PubMed1983

Carcinoma of the middle ear and external auditory canal.

Thirty-one patients with malignant tumors of the middle ear and external auditory canal (EAC) were observed at the University of Virginia Hospital from 1956 through 1980. Of 27 patients with carcinoma, 21 had squamous cell carcinoma, 4 had basal cell carcinoma and 2 had adenoid cystic carcinoma. One Ewing's sarcoma and 3 rhabdomyosarcomas occurred in an age group of one to 10 years. The 27 patients with carcinoma are reviewed with regard to clinical presentation, treatment modality, results and complications. The majority (67%) of patients had a history of chronic ear drainage, 22% had a previous mastoidectomy or polypectomy and 7% had an associated cholesteatoma. The treatment modalities employed depended on the extent of disease and the patient's general condition. Eighty percent of patients with carcinoma limited to EAC were alive and well at 5 years, compared to 43% of patients with involvement of the middle ear. Fifty-six percent of patients without invasion of the petrous bone were alive at 5 years compared to only 20% of patients with petrous bone involvement. The data strongly suggest that survival depends on the extent of disease. The corrected disease free 5 year survival rates were 14% for patients who had surgery alone and 50% for those who had surgery and radiotherapy. Of the three patients with advanced disease who received radiotherapy alone, none survived five years. Surgery or radiotherapy alone is not sufficient for most of the cases of carcinoma of the middle ear, since these patients often present with advanced disease. We recommend combined therapy, especially postoperative radiotherapy, except for early lesions that do not involve the mastoid or petrous bone. Other series suggest radiotherapy would be adequate and more effective than surgery for early lesions. Surgery will provide the diagnosis, determine the extent of disease, offer adequate drainage of infected material and relieve most pain before radiation therapy.

Adult↗
PubMed2006

Further application of the bilobed flap: the split bilobed flap for reconstruction of composite posterior auricular and mastoid defects.

In this article a modified bilobed flap from mastoid and lateral neck skin for reconstruction of complex defects of the posteromedial surface of the auricle and mastoid skin, with the preservation of the retroauricular sulcus, is described. Reconstruction of the postero-medial auricular surface has almost never been a concern for reconstructive surgeons. It is in fact a shaded area with little aesthetic relevance and direct closure, skin grafting and even secondary healing are used for skin cancer defects repair. Also mastoid skin defects can be repaired with simple techniques such as skin grafts or transposition flaps from the remaining mastoid skin or from the neck. On the other hand, cancers involving the postero-medial auricular surface, the retroauricular sulcus and the mastoid skin require wide and deep resections that involve the posterior auricular muscles and reach the perichondral and periosteal surfaces. Direct closure with undermining, if feasible, will obliterate the retroauricular sulcus causing asymmetry with the contralateral ear and, if defects are cephalad will impair the possibility of wearing spectacles, thus leaving functional and aesthetic impairment. Transposition flaps from the remaining mastoid skin, due to the lack of skin laxity, are not feasible because the donor site cannot be closed. Two patients, both affected by basal cell carcinoma involving the posteromedial auricular surface and the mastoid skin have been treated with this flap. In both cases the use of the modified bilobed flap described in this article allowed preservation of the retroauricular sulcus and closure of the donor site. Scars were hidden along minimal tension lines and the possibility of wearing spectacles along with sensitivity all over the reconstructed area were maintained.

Aged↗