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PubMedDate not supplied

Sternal segment dislocation in children.

Three cases of sternal segment dislocation in children are described. The primary mechanisms were direct blow in a 4-year-old boy, indirect forces in a 3-year-old boy, and osteomyelitis in a 10-year-old boy. The two former cases were dislocated at the junction of the manubrium with the sternal body, and the latter case was at the junction of the first and second sternal segments. The dislocated segments were gradually rotated for approximately 2 weeks and were finally stabilized after rotation. While in the dislocated state, the patients were observed conservatively, although all the dislocated segments were remodeled. Surgical treatment of sternal segment dislocation is not inevitable.

Bone Remodeling↗
PubMed2003

Scheuermann's disease as a model displaying the mechanism of venous obstruction in thoracic outlet syndrome and migraine patients: MRI and MRA.

Kyphosis of the thoracic spine rotates the scapulae anterior laterally, clavicles and subclavius muscles anteriorly, displaces the manubrium posteriorly, which increases the slope of the first ribs. This increases tension on the anterior scalene muscles and the neurovascular bundles which causes brachial plexopathy (TOS). Scheuermann's disease (spinal osteochondrosis; juvenile kyphoscoliosis) is a disorder which consists of vertebral wedging endplate irregularity and narrowing of the intervertebral disk space causing kyphosis of the thoracic spine and may also involve the lumbar space. It occurs at puberty and involves both male and females. Abduction external rotation of the upper extremities (arms overhead) posterior inferiorly rotate the clavicles and the subclavius muscles which enhances tension on the venous drainage and neurovascular supply that diminishes venous return. This triggers complaints of thoracic outlet syndrome (TOS) and migraine headache. Bilateral magnetic resonance imaging (MRI) demonstrates compressing abnormalities of the brachial plexus. Five patients with Scheuermann's disease were imaged with the 1.5 Tesla magnet (Signa; General Electric Medical Systems, Milwaukee, WI) 3-D reconstruction MRI. T1W and T2W pulse sequences were performed in transverse, the coronal, transverse oblique, sagittal, and coronal abduction external rotation planes using 4 mm slice thickness and 512 x 256 matrix size. Water bags were used to enhance the signal to noise ratio. Magnetic resonance angiography (MRA) 2-D Time Of Flight (TOF) was obtained to compression for anatomic display evaluate perfusion of the brachial plexus. MRI and MRA captured sites of brachial plexus. One patient was selected for this presentation, which demonstrates the compression of the brachial plexus and venous obstruction which triggered complaints of thoracic outlet syndrome.

Adult↗
PubMed2003

[Failure of regain full function after surgery for otosclerosis: causes, diagnosis and treatment].

OBJECTIVE: The aim of this study was to evaluate the causes, the diagnosis, the treatment and the results obtained by revision surgery, in cases of stapedectomy failures. MATERIALS AND METHODS: Retrospective study of 50 recent cases operated on between January 1997 and December 2001. DIAGNOSIS OF THE FAILURE: All reoperated patients had clinical and audiological assessment; CT scan with virtual endoscopy. RESULTS: The mean time of onset of failure was 23 months. The mean preoperative air bone gap was 25.5 dB. Otoscopy revealed a retraction pocket caused by poor eustachian tube function in 9 cases. CT scan proved to be very effective at differentiating the cause of the failure. OPERATIVE FINDINGS: In 11 cases the prosthesis was too short, in 8 cases the prosthesis had migrated out of the hole of stapedotomy and in 6 cases the piston was fixed in the stapedotomy hole. A partial or complete lysis of the long process of the incus was frequently associated, but in 9 cases it was the only cause of the failure. In all the cases when the piston was displaced, the stapedotomy was found to be covered by a thin mucous membrane, avoiding labyrinthine fistula. In 3 cases, the failure was due to recurrent otosclerosis. In 5 cases the failure was due to a local anomaly at the level of the oval window niche, 2 cases of failure were due to a malleus ankylosis. In 5 cases fibrous adhesion was found between the incus and the mucosa of the promontory. In one case a reparative granuloma was found at the level of the oval window. TREATMENT: In cases of partial lysis of the long process of the incus, a new prosthesis was placed in a 0.4 mm diameter stapedotomy, performed using a KTP laser. A 0.4 mm diameter piston was extended 0.2 mm below stapedotomy to avoid a new extrusion. Indeed some prosthesis extrusion could be due to increased movements of the ossicular chain in cases of eustachian tube dysfunction. In cases of complete lysis of the long process of the incus, or in cases of a very short long process of the incus, a piston was put in the stapedotomy and attached to the malleus manubrium. The results of revision stapedotomy were favorable in the absence of associated fibrous tissue adhesion or local malformation. The air bone gap was found to be less than 10 dB in 40 cases and between 10 and 20 dB in 8 cases. An impairment of the air bone gap was found in 2 cases. No case of bone conduction impairment was found in this series.

Adult↗
PubMed1992

Autograft tragal and conchal palisade cartilage and perichondrium in tympanomastoid reconstruction.

Since Utech's introduction of cartilage as a columella in ear surgery in 1969, we have used tragal and conchal autografts for reconstruction of the tympanic membrane and the auditory canal wall in 13,000 cases. As large pieces of cartilage can twist in later years, we place palisaded cartilage fragments with perichondrium parallel to the manubrium of the malleus in type I tympanoplasties and in type II or III procedures parallel to the long process of the incus. The "annulus-stapes plate" in type III tympanoplasties replaces the function of the incus (and malleus), crossing the promontory and reducing adhesions. A "tunnelplasty" keeps the eustachian tube entrance open with the semiring of cartilage ("simmering") apposed to the inside of the annulus, reconstructing the tympanomeatal niche. The "architrave" created rests on the tensor tympani while the palisaded epitympanum and antrum plasty allows ventilation of the antrum. Mastoid obliteration is performed with an autogenous perichondrial transplant to which the palisaded incised cartilage portions adhere, adapting to the underlying structure.

Cholesteatoma↗
PubMed1992

[A case report of radiation osteomyelitis 9 years after irradiation for thymoma].

Radiation osteomyelitis of the sternum is rare and usually difficult to cure. A 75-year-old man, who had undergone an exploratory sternotomy for a mediastinal tumor, not resected after all, 9 years earlier and received radiation therapy successively for the histological diagnosis of malignant thymoma, was admitted to our hospital with the chief complaint of fever and pus discharge of the anterior chest wall. He also suffered from diabetes mellitus. The skin around the fistula was dark-red and atrophic due to irradiation dermatitis and the manubrium was fissured in the midline. Open drainage and two-stage operation of direct closure was tried in vain. This case was treated successfully by resection of necrosed portion of sternum and pectoral muscle flap closure.

Aged↗
PubMed1992

The effects of different techniques of internal mammary artery harvesting on sternal blood flow.

We investigated chest wall blood flow in a canine model to determine if the technique used to harvest the mammary artery has a differential effect on residual chest wall blood flow. Eight dogs underwent bilateral internal mammary artery mobilization; one artery was harvested as a pedicle and the other was harvested as a skeletonized vessel. Residual blood flow to the chest wall distribution of each artery was measured with radioactive microspheres. Chest wall blood flow was significantly decreased from preharvest levels after internal mammary artery mobilization regardless of the technique used. Tissue blood flows decreased to 46.9%, 22.1%, and 41.2% of baseline values for the manubrium (p < 0.01), sternum (p < 0.001), and ribs (p < 0.05), respectively. Residual sternal blood flow on the side of the skeletonized vessel was significantly greater than on the side of the pedicle graft (2.60 +/- 0.68 versus 1.27 +/- 0.27 cm3/min/100 gm, p < 0.001). We conclude that minimization of tissue mobilization during internal mammary artery harvesting may reduce sternal devascularization. This finding may have clinical significance with respect to lowering the incidence of sternal wound complications in coronary bypass surgery using the internal mammary artery as a bypass conduit.

Animals↗
PubMed2003

[Surgical management of metastatic disease in the conjunctive area between neck and thorax].

OBJECTIVE: To study the surgical management of metastatic disease in the conjunctive area between the neck and thorax and its efficacy. METHODS: Fourteen cases with metastatic node disease in the area between neck and thorax were collected and analysed. Eleven tumors were from the thyroid cancer, and the other three were from the hypopharyngeal cancer, esophagual cancer and malignant pheochromocytoma, respectively. The clavicle was displaced or resected, and the upper half of the manubrium might also be resected when necessary. The recurrent laryngeal nerve and phrenic nerve were exposed and protected. The metastatic disease was completely removed with the internal jugular and/or the brachiocephalic vein resected or spared, depending on the disease condition. RESULTS: In 10 cases with metastases from the thyroid, no local recurrence was found within the follow-up period from 2 to 5 years. In contrast, no patient with metastatic disease from hypopharyngeal or esophageal cancer survived more than 11 months. No serious complications were found in this group. CONCLUSIONS: The surgical treatment of node metastases in the conjunctive area between neck and thorax from the well-developed thyroid cancer has promising effect and is comparatively safe.

Adenocarcinoma, Follicular↗
PubMedDate not supplied

Minimally invasive pulmonary artery banding: a new approach.

BACKGROUND: A variety of approaches have been described for banding of the pulmonary artery. The indications for this procedure are limited; however in developing countries, many patients still need pulmonary artery banding for a variety of reasons. We describe a new approach, minimally invasive, using only a split in the manubrium sterni to conduct the procedure. METHODS AND RESULTS: Between January 2000 and May 2002, 19 patients who had undergone pulmonary artery banding using a minimally invasive technique were compared with 20 cases of pulmonary artery banding performed by the conventional technique. The mortality was similar in the two groups (p=0.45). The period of intubation and duration of intensive care unit stay were significantly shorter in the minimally invasive group (p=0.015 and 0.002, respectively). The duration of hospital stay was not significantly different between the 2 groups (p=0.139). In the minimally invasive group, three patients underwent subsequent reoperation. CONCLUSIONS: Minimally invasive pulmonary artery banding is useful in babies with high-flow cardiac lesions and cardiac cachexia.

Case-Control Studies↗
PubMedDate not supplied

Pseudoaneurysm of the aorta after heart-lung transplantation: diagnosis by color flow Doppler mapping.

Five months after heart-lung transplantation for treatment of end-stage cystic fibrosis, a 14-year-old girl had a swelling over the manubrium that was identified as a pseudoaneurysm at the aortic anastomotic site by means of cross-sectional echocardiography with color flow Doppler mapping. The diagnosis was confirmed at operation, despite which she died. Biopsy material taken during the operation revealed chronic sternal osteomyelitis caused by Pseudomonas aeruginosa. Disruption of the aortic anastomosis by infection may be a major complication of heart-lung transplantation for treatment of cystic fibrosis.

Adolescent↗
PubMed2004

Bilateral sternales in relation to body of sternum.

The sternalis muscle on the manubrium sterni and its communication with sternocleidomastoid has been reported by many workers as unilateral or bilateral in both the sexes. The present report deals with bilateral sternales below the angle of sternum in a male cadaver during routine dissection. The proximal attachment of the muscle was from the manubriosternal joint on either side, right being broader than left and was found to be overlapping the lateral part of sternum and adjoining pectoralis major muscle. The muscle was running downwards and laterally and was attached on the cartilage of 6th and 7th ribs appearing to be continuous with rectus abdominis muscle. The muscle was found to be innervated by branches of the corresponding intercostal nerves of these spaces. The sternalis if present could be used for reconstructive surgical operations on the breast.

Cadaver↗
PubMed2004

Cartilage and tympanoplasty.

This study analyzes the morphological and hearing results obtained with cartilage tympanoplasty in retraction pocket, blunting and tympanic membrane lateralization, and cholesteatoma surgeries. Results obtained 3 years postoperatively in 80 patients operated on with cartilage reinforcement of the tympanic membrane (TM) were compared with those obtained 3 years postoperatively in 100 patients operated on with fascia or perichondrium TM reinforcement. Retraction pocket recurrence was found in the patients operated on with fascia or perichondrium in 24% of cases and only in 8% of cases in patients operated on with partial tympanic membrane cartilage reinforcement. No recurrence was found in patients operated on with a total reinforcement of the TM. Cartilage tympanoplasty with skin graft covering the bony external auditory canal (EAC) was performed in 6 cases of severe blunting and/or tympanic membrane lateralization. 3 years post-operatively, good morphological and functional results were obtained in 3 cases. One or two staged ICW procedures were performed in 390 adult patients (416 ears) suffering from a non operated middle ear cholesteatoma. Recurrent and residual cholesteatoma rates were evaluated. Cholesteatomas were operated on with removing the malleus, reinforcing all the tympanic membrane with cartilage and performing an ossiculoplasty with hydroxylapatite prosthesis. The results were compared to those obtained in ICW cholesteatoma surgery with preserving the malleus manubrium, partially reinforcing the eardrum with cartilage and predominantly using an ossicle to perform the ossiculoplasty. Removing the malleus and reinforcing the whole tympanic membrane with cartilage statistically reduced the cholesteatoma recurrence rate for the ICW procedure. This technique, using hydroxylapatite prosthesis for ossiculoplasty gives good hearing results.

Adult↗
PubMedDate not supplied

[Ultrasound in prevention of postoperative immunodeficiency].

Phonoprophylaxis of postoperative immunodeficiency was developed and tested in 34 patients. From the first day of hospitalization to the day of elective surgery the patients were daily exposed to ultrasound on the area of the manubrium sterni according to the labile technique through petrolatum or glycerol medium (0.05 W/cm2, 120-150 s, each other day, 4-6 procedures per course). Immune status studies after surgery prove a prophylactic effect of the above ultrasonic procedures.

Adolescent↗
PubMed2005

[Clinical classification and treatment of localized attic cholesteatoma].

OBJECTIVE: To investigate the clinical classification and treatment of localized attic cholesteatoma through surgical management. METHOD: Twenty-one patients (21 ears) of localized attic cholesteatoma accepted atticotomy. Then different surgical managements were carried out according to the extent of cholesteatoma and whether the malleo-incudal joint was destroyed or not. If the cholesteatoma has only reached the surface of the malleo-incudal joint, it was regarded as type I (5 patients). To this type, the cholesteatoma was removed and the ossicular chain was preserved. If the cholesteatoma has entered the anterior attic space and destroyed the malleo-incudal joint, it was regarded as type II (16 patients). Besides the removing of cholesteatoma, the head of malleus and incus should be removed also in this condition. Then reconstruction of the ossicular chain was performed by putting PORP artificial auditory ossicles between the manubrium mallei and staple. In all these 21 patients, the lateral wall of attic was reconstructed with the cartilage of tragus. The perichondrium of the cartilage was used to repair the perforation in the non-vibrant membrane. Healing of the lateral wall of attic and the tympanic membrane and recovery of hearing level were investigated after the operation. RESULT: The follow-up period lasted 1 year to 5 years. Healing of the lateral wall of attic and the tympanic membrane were satisfying in all 21 patients. According to the pure tone audiometry after the operation, A-B gap was less than 10 decibel in 10 patients,less than 20 decibel in 7 patients, less than 30 decibel in 3 patients, and over 30 decibel in only 1 patient. Acoustic transmission function was preserved or reconstructed. No vertigo or tinnitus happened after operation. CONCLUSION: Diagnosis of localized attic cholesteatoma should be made early. If it can be treated by clinical classification properly, not only the removing of cholesteatoma, but also the reservation and recovery of acoustic transmission function can be obtained. It is worthy of further discussion.

Adolescent↗
PubMed2006

A rare presentation of tuberculosis.

Primary involvement of the musculoskeletal system with tuberculosis is rare. We present a case of a young, immunocompetent woman with primary sternal tuberculosis. The disease led to destruction of the manubrium and a portion of the gladiolus and required extensive debridement and partial sternectomy, followed by musculocutaneous flap closure. Long-term postoperative management included four-drug antitubercular therapy.

Adult↗
PubMed2006

[Landmark of facial nerve in middle ear surgery].

OBJECTIVE: To re-evaluate landmarks for facial nerve in middle ear surgery through temporal bone dissection and facial nerve surgery. METHODS: Some relative landmarks were found through 44 facial nerves dissection in cadaver and 106 cases of facial nerve decompression surgery. RESULTS: (1) Landmarks for vertical segment of the facial nerve: the vertical line in combined point between posterior and middle 1/3 horizontal semicircular canal clews the posterior edge of facial nerve; the prolong line of superior radian of incus short process clues to the anterior edge of the facial nerve, the facial nerve and horizontal semicircular canal are almost in the same plane. (2) Landmarks for horizontal segment of the facial nerve: the facial nerve tracks forward inferior to short process of incus and anterior to horizontal semicircular canal carina in 30 angel. The facial nerve, locating posterior and superior to cochleariform process and parallel with it, forms the step of middle-superior tympanic cavity and tracks forward to geniculate ganglion. (3) location of geniculate ganglion: The same distance prolong line of stapes head to cochleariform process clues to geniculate ganglion. (4) Location of the chorda tympani nerve: chorda tympani nerve, leaving tympanic sulcus at 3 clock of bone canaline left ear and at 9 clock of bone canaline right ear, tracks forward along tympani sulcus and then cross between long process of incus and manubrium. It lies in the border of pars tensa and pars flaccid and is about 5 - 8 mm from the stylomastoid foramen to where the chorda tympani nerve leaves the facial nerve. There is no difference of facial nerve structure in temporal bone dissection and in surgery. CONCLUSIONS: The fixed landmarks of middle ear are the frame of reference of facial nerve, in which horizontal semicircular canal is most invariable; and the safety of surgery will be improved by the reference of the facial nerve.

Ear, Middle↗
PubMed2006

[Circumferential subannular grafting technique in tympanoplasty: preliminary results].

OBJECTIVES: We evaluated the preliminary results of the circumferential subannular grafting technique, which has been proposed as a modification of the standard underlay method. PATIENTS AND METHODS: Twenty patients (15 females, 5 males; mean age 32.4 years; range 13 to 65 years) with chronic otitis media were operated on with the use of the circumferential subannular grafting technique. The mean follow-up was 13.6 months (range 1 to 36). RESULTS: No complications were encountered related to graft survival or the external ear canal. The mean air-bone gap was 25.2+/-8.6 dB preoperatively and 15.8+/-7.4 dB postoperatively, with a mean decrease of 10+/-7.9 dB. CONCLUSION: Circumferential subannular grafting was found to be effective in restoring tympanic membrane perforations in all the quadrands. The main limitations of the technique are the need for surgical skills and the necessity of an intact or remnant manubrium mallei.

Adolescent↗
PubMed2006

[The use of palisade technique in tympanoplasties after Heermann].

INTRODUCTION: The palisade tympanoplasties-technique with using of tragal and conchal autografts for reconstruction of the tympanic membrane and the auditory canal wall was described. MATERIAL AND METHODS: The operation started with the endaural incision. Tragal and conchal autograft palisade fragments with perichondrium for reconstruction of the tympanic membrane and the auditory canal wall have been used up to 1996 in 15,300 cases. We placed palisaded cartilage fragments parallel to the manubrium of the malleus in type I tympanoplasties and in type II or III procedures parallel to the long process of the incus. The "tunnel plasty" in the eustachian tubal entrance is performed with "simmering", "architrave" and "anti-architrave" to keep the tubal entrance open. This "tunnel plasty" results in a nice reconstruction of the tympano-meatal niche. The "annulus-stapes plate" in type III tympanoplasties replaces the function of the incus, crossing the promontory and reducing adhesions. This annulus-stapes bridge is fixed with a further palisade cartilage, "step plasty", which connects the "tunnel-plasty" with "annulus-stapes plate". The palisade-epitympanum-antrum plasty allows ventilation of the antrum via a tunnel constructed of well-fitting parallel pieces of cartilage fixed by self-tension (no glue) and replacing the bony canal wall. The "columella-tunnel plasty" has an L-shaped notch in the "annulus-stapes plate" fixing a columella of cartilage, placed in the oval window. Only in a case with a narrow oval window niche, a type IV palisade plasty can be performed or a prosthesis placed. RESULTS: The "annulus-stapes cartilage plate" is more stable reconstruction in type III tympanoplasties than are incus of foreign body interpositions. Adhesions on the promontory are found more often with fascia than with cartilage fragments. Histologic study of autograft cartilage showed good preservation of cartilage cells even 26 years after transplantation. CONCLUSIONS: The use of palisade cartilage technique brings very good functional and better long-term results.

Audiometry↗
PubMed1991

[Osteoarticular infections associated with catheterization of the subclavian vein].

Access to a central way through catheterization of the subclavian vein is a widely used technique. Not uncommonly, the procedure is followed by infective complications among which clavicular osteomyelitis and septic sternoclavicular arthritis represent a rare eventuality. We report two cases of staphylococcic bacteremia produced after subclavian vein catheterization. Both patients presented septic sternoclavicular arthritis and osteomyelitis of the sternal manubrium. The isolated microorganisms were Staphylococcus aureus and Staphylococcus epidermidis methicillin-resistant, respectively. The clinical course under antibiotic therapy was satisfactory in both cases. Septic metastases appear to be the most likely pathogenic mechanism for the osteoarticular complications.

Adult↗