Mastoid osteoplasty. Obliteration of mastoid cavity using autogenous cancellous bone: final progress report.
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Cholesteatoma↗
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[Endolymphatic sac adenocarcinoma: case report].
A case of endolymphatic sac adenocarcinoma is reported and the literature is reviewed. The clinical picture was presented by vertigo and progressive hearing loss caused by a tumor of the endolymphatic sac. The surgical removal was complete, via a retro and translabyrinthine approach. Endolymphatic sac tumors are locally invasive, involve the petrous bone and the mastoid. The radical surgery presents good outcome.
Adenocarcinoma↗
[Mobilization of the facial nerve in surgical interventions in the parotid-maxillary area (the topographic anatomical validation)].
A method for facial nerve mobilization is suggested, developed on cranial preparations of adult subjects. The authors have distinguished characteristic topographic and anatomic regularities that are essential in surgery of the mastoid process and parotid-masticatory area for tumor or nontumorous involvement of the parotid gland in case of the facial nerve involvement in the process.
Adult↗
[Spontaneous hernia of the brain into the temporal bone].
A case of spontaneous brain hernia into the middle ear cleft is described. Even without preceding infection, trauma or surgery of the mastoid, dural and cerebral tissue may protrude into the antrum or middle ear space. The pathology of this rare disease is discussed.
Aged↗
[Meningitis and cerebrospinal liquid fistula as a complication from the surgery of endolymphatic sac].
A 28 years old woman diagnosed of Méniére's disease was surgically treated with a drainage from endolymphatic system and a valve placed. Six years after surgery, the patient presented a bacteria meningitis an a cerebrospinal fluid leak to mastoid was found. New surgery was needed. Complications of endolymphatic system surgery, its treatment and frequency are discussed. This case is a very rare.
Adult↗
Mastoid subperiosteal abscess.
Subperiosteal abscess was the indication for surgery in every child with acute mastoiditis who underwent mastoidectomy at our institution since 1972. Nineteen such patients are discussed herein. Positive bacteriologic findings included Streptococcus pyogenes in three patients, Streptococcus pneumoniae in three patients, Mycobacterium tuberculosis in two patients, and enterococcus in the one patient with cholesteatoma. Cultures were more often positive for causative bacteria when taken directly from the abscess before or shortly after beginning antibiotic therapy.
Abscess↗
[Reparative surgery of pinna and external auditory canal in cases of aplasia and amputation: use of a mastoid osseous shell].
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Amputation, Traumatic↗
Aeration following intact canal wall mastoidectomy.
This study examines the prevalence and extent of re-aeration of the mastoid cavity following intact canal wall (ICW) mastoidectomy. Temporal bone computed tomography scans from patients with prior unilateral ICW mastoidectomy were identified. Three-dimensional volume reconstruction of the temporal bone was performed to measure aeration bilaterally. Thirty-five scans were analyzed; 16 (46%) showed good aeration in the operated ear and 19 showed poor aeration. The aeration (volume) in the surgical ears and the contralateral ears was significantly less than that in subjects without a history of ear disease. Those with poor aeration were more likely to require additional surgery. For temporal bone pairs with greater volume in the operated ear, the average difference was 1.3 cm3. Surgical creation of a mastoid cavity does not produce a large increase in aeration as compared with the contralateral ear. Following surgery, mastoid opacification may presage recurrent disease. Routine use of mastoidectomy in an attempt to improve aeration is not advocated.
Adolescent↗
Pinch grafting of the open mastoid cavity.
Secondary pinch skin grafting was performed on the mastoid cavities to promote healing of the mastoid wound after ear surgery using the open technique. Pinch grafts (multiple small grafts of the epidermal layer) were transplanted in 20 patients, soon after the mastoid cavities were covered with healthy granulation tissue in a mean of 28.5 days after the initial surgery. The grafts adapted well in 18 of the 20 patients. Epidermization was complete in a mean of 11.1 days after grafting, that is, within 40 days after the initial ear surgery. On the other hand, epidermization in 10 cases without grafting was completed in a mean of 83.3 days after the ear surgery. Thus, the pinch grafts reduced healing time by more than 40 days. The secondary application of pinch grafting was beneficial for healing of exposed mastoid cavities caused by use of the open technique tympanoplasty or radical mastoidectomy.
Cholesteatoma↗
Rate of nitrous oxide exchange across the middle ear mucosa in monkeys before and after blockage of the mastoid antrum.
OBJECTIVES: We tested the hypothesis that mastoid volume buffers the rate of change in middle ear pressure caused by transmucosal, inert gas exchange. STUDY DESIGN: Twelve monkeys were randomly assigned to group 1 or group 2. Right ears of group 1 had sham surgery and of group 2 had obstruction of the mastoid antrum. Before and after surgery, the time constant for transmucosal N(2)O exchange was estimated from N(2)O breathing experiments. The hypothesis predicts that the postoperative time constant measured for right ears of group 2 but not group 1 is greater than that measured before surgery. RESULTS: Mastoid antrum block significantly decreased right middle ear volume but did not affect the time constant for transmucosal N(2)O exchange. CONCLUSION: A mastoid gas-reserve function is not supported by the experimental data. SIGNIFICANCE: These results for monkeys and the theory developed to explain the effect of mastoid volume on transmucosal inert gas exchange suggest that the results for previous experiments in humans interpreted as evidencing a mastoid gas-reserve function are consistent with alternative explanations.
Animals↗
[Vascularization and innervation of the sternocleidomastoid muscle and its cutaneous covering: anatomical bases for its use in plastic surgery].
The commonest use of the sternocleido-mastoid muscle (SCM) and its cutaneous recovering in plastic surgery remains the rotation flap. With the improvement in microsurgery, it is tempting to anticipate the free transfer of the muscle with vascular and nervous anastomosis. 40 SCM muscles from fresh human adult cadavers were studied. The authors stress the richness of the arterial blood supply of the upper portion of the muscle. They give precise details about its venous drainage, the arterial anastomosis, the blood supply of the superficial cutaneous planes and the motor and sensory innervation.
Arteries↗
Assessment of the gas exchange function of the middle ear using nitrous oxide. A preliminary study.
A method for assessing the gas exchange through the middle ear (ME) mucosa using nitrous oxide is introduced. Increases in the ME pressure was determined by a tympanogram or a micropressure sensor inserted into the mastoid cavity during ear surgery under general anesthesia using 67% nitrous oxide, 33% oxygen, and sevoflurane on 30 normal ears, 12 ears with otitis media with effusion (OME), and 3 postoperative ears with chronic adhesive otitis media or cholesteatoma. All the 30 normal ears except one showed varying pressure increase, and an inverse correlation was observed between pressure increase and area of mastoid on radiographs. Pressure increase was observed in 6 (50%) ears with OME, and this finding correlated well with the presence or absence of air space in the ME on computed tomography images examined preoperatively, on ears which had ear surgery, the presence or absence of pressure increase correlated with the degree of previous surgical intervention on the mastoid. The rationale and possibility of clinical application of this method is discussed.
Acoustic Impedance Tests↗
Postauricular myocutaneous flap in otologic surgery.
Management of a large mastoid defect resulting from skull base operations or extensive surgical procedures because of chronic ear disease continues to challenge the otologic surgeon. Various local muscle or periosteal rotation flaps have been used to help reduce the size of the postoperative mastoid cavity. With these techniques there are problems with flap retraction and epithelization that may result in delayed healing or chronic drainage. Closure of the ear canal and tissue obliteration of the mastoid results in a maximal conductive hearing loss. A postauricular myocutaneous flap based on the occipital artery and sternocleidomastoid muscle has been used effectively to reconstruct mastoid defects after both surgical procedures for chronic ear disease and skull base operations. The skin muscle flap reduces the mastoid cavity and promotes rapid healing of the surgical defect. Although postauricular myocutaneous flaps have been found to be reliable, their viability may be compromised by arterial embolization used in larger glomus tumors. Indications for and creation of a postauricular myocutaneous flap, with results in 18 cases, are presented.
Adolescent↗
Extended temporal bone resection for squamous cell carcinoma.
OBJECTIVE: The aim of this study was to assess the surgical results of a series of patients from this unit who underwent extended temporal bone resection for recurrent squamous cell carcinoma as a salvage procedure. DESIGN: The surgical records of 15 patients were analyzed in detail. Each patient had salvage surgery in the form of an extended temporal bone resection with supraomohyoid block dissection, dural grafting, and free microvascular forearm or scalp rotation flap repair for recurrent squamous cell carcinoma in a radical mastoid cavity. RESULTS: Radical surgery yielded a 47% 5-year survival. Twenty-nine percent of the survivors had temporal lobe involvement that necessitated a partial excision of the temporal lobe of the brain. Histologic evidence of local lymph node involvement in the supraomohyoid neck dissection was present in 13% of cases. Those who died did so in the first postoperative year. All those with poorly differentiated tumors died. The survivors had well or moderately differentiated tumors. CONCLUSIONS: Radiotherapy alone or partial temporal bone resection, most commonly a radical mastoidectomy with or without preoperative or postoperative radiotherapy is used by the majority of otolaryngologists in treating squamous cell carcinoma of the temporal bone. The 5-year survival rate after this treatment remains depressingly low and the prognosis gloomy, particularly for advanced tumors. The findings in this series of extended temporal bone resections as salvage surgery in recurrent disease is encouraging, and radical surgery combined with radiotherapy from the outset may give much better 5-year survival figures in the future than the conventional partial temporal bone resection and radiotherapy.
Adult↗
Acute myelogenous leukemia presenting as atypical mastoiditis with facial paralysis.
Symptomatic otologic involvement by leukemic infiltration is unusual, most often occurring in the already-diagnosed leukemic patient as postauricular mass, acute hemorrhagic otitis media, mastoiditis, cranial neuropathy, vertigo, hearing loss, or leptomeningitis. We think ours is the first reported patient whose leukemia presented as atypical mastoiditis and facial paralysis due to granulocytic sarcoma (chloroma). At mastoidectomy, tan lobulated rubbery tumor filled the mastoid antrum and middle ear cleft. Complete remission and full return of facial nerve function was achieved with 2500 R local radiation and systemic chemotherapy. We discuss the role and extent of surgery in atypical acute mastoiditis when unsuspected middle ear and mastoid tumor, with inconclusive intra-operative histopathologic data, is found.
Adolescent↗
The relative importance of chemotherapy, antibiotics and surgery in the treatment of acute otitis media and mastoiditis.
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Acute Disease↗
The histopathology of mastoidectomy cavities, with particular reference to persistent disease leading to chronic otorrhoea.
Open cavity mastoidectomy remains the principal surgical treatment of middle ear cholesteatoma in the United Kingdom. A significant proportion of mastoid cavities are prone to intermittent or continuous discharge. In this study the histopathological features of material removed from 159 mastoid cavities at revision surgery were reviewed. Findings included squamous epithelium with acute and chronic inflammation, foreign body granuloma and aural polyps. Of particular note was the very infrequent finding of discharging cavities lined with respiratory epithelium, suggesting that retained mucosa in mastoid air cells is not a common cause of persistent otorrhoea.
Cholesteatoma↗
Magnetic resonance imaging of the mastoid cavity and middle ear: prevalence and clinical significance of incidental abnormal findings in a nonotolaryngologic adult and pediatric population.
OBJECTIVE: The purposes of this study were to determine the prevalence of abnormalities in the mastoid cavity and middle ear in a nonotolaryngologic population and to correlate the results with clinical data. DESIGN: Prospective, cross-sectional study. SETTING: An academic tertiary care centre. METHODS: We evaluated 100 adults and 30 children from May to July 2003. Patients who had a history of mastoid or middle ear surgery or were presently suffering from otitis media were excluded. Magnetic resonance imaging (MRI) was conducted for the suspected intracranial pathology. MAIN OUTCOME MEASURES: The T2-weighted image was reviewed. The abnormality detected by MRI was divided into (1) mastoid cavity abnormality and (2) middle ear abnormality. All patients were asked to complete a questionnaire pertaining to the symptoms of the mastoid or middle ear pathology and the history of the otitis media. Also, their ears were examined carefully by an otoscope or otomicroscope. RESULTS: In both groups, most of the abnormalities were found in the mastoid cavity. Analysis of the clinical data revealed that abnormal MRI findings of the mastoid cavity were significantly correlated to clinically significant mastoid or middle ear disease in adults. CONCLUSIONS: Incidental MRI abnormalities in the mastoid cavity and middle ear detected in a nonotolaryngologic population were relatively uncommon compared with incidental paranasal sinus abnormalities. However, clinicians should remember the possibility of the pathologies that demand active treatment among these abnormalities, especially when a high signal abnormality is found in the mastoid cavity of an adult.
Adolescent↗