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PubMed2002

Mastoidectomy simulation with combined visual and haptic feedback.

Mastoidectomy is one of the most common surgical procedures relating to the petrous bone. In this paper we describe our preliminary results in the realization of a virtual reality mastoidectomy simulator. Our system is designed to work on patient-specific volumetric object models directly derived from 3D CT and MRI images. The paper summarizes the detailed task analysis performed in order to define the system requirements, introduces the architecture of the prototype simulator, and discusses the initial feedback received from selected end users.

Computer Simulation↗
PubMed1985

Acute and latent mastoiditis in children.

During the period from 1974 to 1981, surgery for acute mastoiditis was performed on 12 ears, giving an annual incidence of 0.004 per cent among cases of acute otitis media. All ears made a full long-term recovery. The low incidence is ascribed to the world-wide early use of antibiotics. During the same period 52 ears with secretory otitis media (SOM) underwent mastoidectomy. Histologically extensive mastoid inflammation was found in 96 per cent. The changes appeared as formation of secretory cells and cysts, resorption of bone, and infiltration of soft tissues with both mononuclear cells and polymorphonuclear leucocytes. The number of SOM patients undergoing mastoid operations account for 1.4 per cent of the patients admitted to hospital because of SOM. Thirty-four ears (65 per cent) have healed during the follow-up period (mean 2.9 years), while the tympanostomy tube is still in place in 18 ears (35 per cent). In the latter group, factors causing oedema in the pharyngeal end of the Eustachian tube are apparently still present.

Acute Disease↗
PubMed2001

[Intact-bridge tympanomastoidectomy procedure: a reasonable option in the surgery of chronic otitis media and mastoiditis with cholesteatoma and/or granulation tissue].

OBJECTIVE: To study and evaluate a surgical option for the treatment of otitis media and mastoiditis with cholesteatoma and/or granulation tissue. METHODS: The procedure is called intact-bridge tympanomastoidectomy (IBM). There are some modifications for the treatment of patients suffered from chronic otitis media and mastoiditis with cholesteatoma and/or granulation tissue. The features of IBM include: 1. the aditus, mastoid and attic opened and the intractable pathological tissues eradicated thoroughly. 2. the posterior tympanal space opened through the facial recess if necessary. 3. a widened middle ear space by lowering bony bridge established. 4. the adults blocked. 5. immediate or staging tympanoplasties conducted according to the conditions of mucosa in the tympanum. RESULTS: The modified IBM procedure was performed on 62 ears from 61 cases. The follow-up has been 12-38 months and more than two years in 51 ears. The dry ear was obtained within 5-13 weeks with an average of 6 weeks. In 24.2% of ears the air-bone gap(ABG) was 20dB HL or less and within 21-30 dB HL in 41.9% of ears, the ABG over 31 dB HL was 16.1%. CONCLUSION: Our results indicate that IBM procedure fulfills the desired purposes of both open- and close-cavity techniques, the thorough eradication of diseased tissue allow to get a dry ear and restoration of hearing. IBM, therefore, is a reasonable choice for the surgery of otitis media and mastoiditis with cholesteatoma and/or granulation tissue.

Adolescent↗
PubMed1996

The use of the temporoparietal fascial flap in temporal bone reconstruction.

After routine canal wall down mastoidectomy, local muscle flaps with and without bone paté, cartilage and fascia are the standard techniques available to otologists wishing to obliterate the mastoid and reconstruct the external auditory canal. Reconstructive options for temporal bone defects after extirpative surgery for cancer, osteoradionecrosis, and revision surgery for chronic granulomatous otitis media, however, are few. Although the neighboring temporoparietal fascia flap (TPFF), based on the superficial temporal vessels, has been frequently employed for auricular reconstruction, its versatility in temporal bone reconstruction has not been widely explored. The TPFF has recently been employed at our institution in 11 patients who presented with a variety of reconstructive problems, including defects after temporal bone resection, surgery for malignant otitis externa, and revision mastoid surgery. Follow-up in these patients ranged from 1 to 43 months (average 18.4 months) and surgical objectives of achieving a dry mastoid bowl, fully epithelialized canal, and/or reduction of mastoid cavity volume was attained in 100% of cases. The TPFF offers many advantages to the otologic surgeon when faced with reconstruction dilemmas that center around a poorly vascularized mastoid cavity and temporal bone. The TPFF is a reliable source of local well-vascularized tissue that is extremely pliable and facilitates both hearing and nonhearing preservation temporal bone reconstruction.

Adult↗
PubMed1978

The mastoid air cell system in ear surgery.

Despite the overall high success rate of myringoplasty, the long-term results in ears with preoperative dysfunction of the Eustachian tube and with a small mastoid air cell system are disappointing. In this communication, we report an 83% healing rate after myringoplasty that included mastoidectomy with posterior and anterior tympanotomy in a selected group of patients with poor tubal function and small mastoids.

Air↗
PubMed1982

Endolymphatic-mastoid shunt operation: results of the 24 cases and revision surgery with the silastic sheet.

Endolymphatic-mastoid shunt operation due to Kitahara's method was performed on 24 patients with Meniere's disease. In 14 patients, the vertiginous attack was controlled with satisfactory preservation of hearing for longer than one year. In 2 patients, the vertiginous attack subsided but the hearing worsened. In the remaining 8 patients, long-term control of the vertiginous attack was not attained. Of these 8 recurrent cases, revision was performed on 4, revealing shunt obstruction with granulation or scar tissue. After reopening the endolymphatic sac, a large triangular Silastic sheet was placed into its lumen. The vertiginous attack was controlled thus far in the revised cases using this procedure.

Adult↗
PubMed2006

Titanium mesh for functional reconstruction of the mastoid cortex after mastoidectomy.

OBJECTIVE: To describe a rapid and effective means of reconstructing the mastoid cortex after mastoidectomy for chronic otitis media with and without cholesteatoma. STUDY DESIGN: Retrospective. SETTING: Tertiary referral otology clinic. PATIENTS: Those undergoing tympanoplasty and mastoidectomy for chronic otitis media. INTERVENTION: After tympanoplasty and mastoidectomy, the mastoidectomy defect was reconstructed using titanium mesh with subsequent closure as routine. MAIN OUTCOME MEASURES: Evaluation of soft-tissue ingrowth into the mastoid 12 to 24 months after surgery and clinical evaluation of the postauricular surgical site for accentuation of the postauricular sulcus. RESULTS: In 99 patients, the mastoidectomy defect was reconstructed using titanium mesh. None was found to have pitting of the postauricular sulcus. One patient had partial extrusion of the mesh through the ear canal. No instance of wound infection was observed. Soft-tissue growth into the mastoid cavity was found to be minimized. CONCLUSION: Titanium mesh is a rapid and effective means of minimizing soft-tissue ingrowth into the mastoid and preventing accentuation of the postauricular sulcus after mastoid surgery.

Adolescent↗
PubMed1997

Management of acquired cholesteatoma of the middle ear and the mastoid by combined approach tympanoplasty: a long-term view.

Mastoid cavities following surgery for cholesteatoma of the middle ear and the mastoid can be subject to recurrent infections, life-long attendance for cavity cleaning and restrictions in social activity. These problems may be avoided with a successful combined approach tympanoplasty. One hundred and forty-one patients (151 ears) treated by combined approach tympanoplasty, followed over a period ranging from 5 to 23 yr were analysed. The results are presented with an average follow-up of 14.5 yr. A fixed retraction pocket, recurrent cholesteatoma or conversion to a cavity was regarded as a failure. Failures and evidence of future failures in the form of fixed retraction pockets occurred in the first 5 yr. By not including cases with a follow-up period of less than 5 yr, we have attempted to achieve stable long-term results; 73.5% of the cases were successful. The success rate could be improved further and should provide an acceptable method of treatment.

Adolescent↗
PubMed2002

Revision tympanomastoid surgery.

We conducted a retrospective study of 50 ears in 48 patients in whom we performed revision tympanomastoid surgery for chronic otitis media. We found that the most common probable causes for the failure of previous surgery were incomplete lowering of the facial ridge (94% of cases), persistent sinodural-angle air-cell disease (92%), persistent tegmental air-cell disease (88%), recurrent or persistent cholesteatoma (66%), persistent mastoid-tip air-cell disease (62%), a small meatus (60%), and persistent hypotympanic air-cell disease (56%). After a mean postoperative follow-up of 26 months, we found no appreciable difference in success rates between patients who had undergone only one previous surgery (93%) and those who had undergone more than one previous surgery (95%) prior to referral to our center. Follow-up hearing data revealed a statistically significant improvement in air and bone conduction and a nonsignificant reduction in the air-bone gap. We conclude that revision mastoid surgery following multiple earlier surgical failures does not carry an appreciably higher risk of failure than does initial revision surgery. Moreover, there appears to have been no change in the causes of failure following mastoid surgery over the past 3 decades.

Adolescent↗