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PubMedDate not supplied

Mastoid obliteration by BMP-2/collagen composites: an experimental study using tissue engineering.

PURPOSE: Several materials have been used in the application of mastoid cavity obliteration during surgery for cholesteatoma; however, nothing has won universal acceptance. Through the advancement of tissue engineering, bone morphogenetic protein-2 (BMP-2)/collagen composites have been elucidated as inducers of heterogenic bone formation. This study was performed to investigate whether these composites are potentially obliteration materials for use in the mastoid cavity by using an animal experimental study. MATERIALS AND METHODS: The composites were implanted in the rat mastoid to investigate whether new bone would be tissue engineered in the mastoid and, if so, whether the newly formed bone was stable. The composites were examined histologically over a 24-week period. RESULTS: The composites implanted in the rat mastoid were able to tissue engineer new bone, and the newly formed bone was stable as assessed histologically, with almost normal bone structure, that was not resorbed during the 24-week period. Adverse immunological reactions were not found during our observation. CONCLUSIONS: Bone that was tissue engineered by the BMP-2/collagen composites was stable as assessed by histological examination and persisted in the rat mastoid. The present study shows that the composites have the potential to become real materials for use in mastoid obliteration.

Animals↗
PubMed1989

[Fibrin glue and tricalcium phosphate implants in middle ear surgery. An animal experiment study].

Tricalcium phosphate (TCP) with and without heterologous fibrin glue has been used for obliteration of the mastoid cavity in middle ear surgery. The use of TCP with a homologous fibrin glue has not been described so far. Obliteration of 22 epitympanic and 51 femoral defects in rabbits by means of TCP-granulates without and with homologous fibrin glue was performed in 18 animals. Follow-up was for 2 weeks to 6 months. Histological osteo-integration was studied microscopically. Fibrin glue induces the development of soft tissue impeding osseous integration of the calcium phosphate for at least 6 weeks.

Animals↗
PubMed2005

Salivary gland choristoma of the middle ear in an infant: a case report.

Salivary gland choristoma of the middle ear cavity is an extremely rare entity. Many patients with this entity usually present with conductive hearing loss. Many reports concentrate on the importance of conservative treatment of choristoma for fear of the possible injury of the facial nerve. We report another case of salivary choristoma of the middle ear in an 11-month-old girl. We performed a reconstruction surgery of the hearing mechanism, as well as tumor removal, and achieved satisfactory hearing results. If no remarkable facial nerve anomaly is detected in the preoperative evaluation, the reconstruction of the hearing mechanism with complete tumor removal might be considered.

Choristoma↗
PubMed1993

Knot to be condemned.

It is common practice following mastoid and middle ear surgery to apply a pressure bandage to the ear for a short post-operative period to reduce local swelling. The bandage is usually secured in such a way as to lift it away from the eye, sometimes with a length of ribbon gauze tied in a knot over the temporal region. Pressure from the knot may cause injury to the underlying tissues leading to post-operative complications which hitherto have not been described.

Adult↗
PubMed2003

A radiologic study of the tympanic bone: anatomy and surgery.

OBJECTIVE: The aim of this study was to obtain data on the anatomic structure of the tympanic bone using parasagittal reformatted images created from high-resolution axial computed tomographic scans. In particular, the thickness of the bone in the region of the temporomandibular joint and the floor of the external auditory canal was assessed. The findings are discussed with particular emphasis on the relevance to surgery in this area. BACKGROUND: Surgical management of the tympanic bone forms the basis of canalplasty, which is an essential step in the management of disorders of the external auditory canal. Adequate canalplasty is also crucial in the provision of access for tympanoplasty and to ensure optimal cavity geometry in canal wall down mastoidectomy. Tympanic bone removal is a major step in approaches to the lateral skull base and infratemporal fossa. The tympanic bone is also important because it has critical neurovascular relations in this region of the skull base. METHODS: Computed tomography of the tympanic bone (parasagittal reformatted images) in 54 consecutive adults. RESULTS: The mean thickness of the anterosuperior, anteroinferior, and inferior aspects of the tympanic bone are 2.6, 2.8, and 8 mm, respectively. CONCLUSION: Canalplasty is safely performed in the regions outlined. The technique of canalplasty described in this article is essential for good exposure in external ear, middle ear, mastoid, and skull base surgery.

Adult↗
PubMed1994

Subtotal petrosectomy with external canal overclosure in the management of chronic suppurative otitis media.

Subtotal petrosectomy with external canal overclosure has been used in the management of 10 patients with chronic suppurative otitis media in the past four years. These patients fall into two categories. One group consisted of patients with end-stage chronically discharging mastoid cavities, despite aggressive medical therapy. The other group comprised patients who had developed disabling peripheral vestibular symptoms and had a mastoid cavity from past surgery for chronic otitis media. In both groups the affected ear had absent or poor auditory function. In the second group, a translabyrinthine section of the vestibular and/or cochlear nerves was performed in conjunction with subtotal petrosectomy. The procedure has been very successful in relieving the persistent otorrhoea, giving the patient an ear without a cavity that would need regular care. No restriction on swimming and participation in other water sports is an additional advantage. Illustrative cases are used to discuss the technique and indications.

Adult↗
PubMed1997

Comparison of long-term hearing results after vestibular neurectomy, endolymphatic mastoid shunt, and medical therapy.

OBJECTIVE: This study aimed to compare the hearing changes in the long term after vestibular neurectomy, endolymphatic mastoid shunt, and medical treatment in classic Meniere's disease. STUDY DESIGN: A retrospective case review was conducted based on audiologic follow-up between 5 and 21 years. SETTING: The study was performed at two centers in Bari University Hospital, one performing vestibular neurectomy as the first surgical procedure for Meinere's disease and the other, endolymphatic mastoid shunt. PATIENTS AND INTERVENTIONS: Of 68 patients with intractable idiopathic Meniere's disease, 29 underwent middle fossa vestibular neurectomy, and 17 had endolymphatic mastoid shunt; 22 were offered surgery but declined. MAIN OUTCOME MEASURES: Outcome measures were puretone average (PTA), speech reception threshold, and speech discrimination score before and after treatment. RESULTS: PTA declined by an average of 9.3 dB in neurectomy patients, 13.3 dB in patients undergoing endolymphatic mastoid shunt, and 18.1 dB in patients who were offered surgery but declined. Patients were subdivided into two cohorts based on their preoperative or initial PTA. In the patients who had PTA scores worse than 50 dB initially, the PTA declined an average of 4.3 dB in the vestibular neurectomy group, 11.5 dB in the endolymphatic sac group, and 4 dB in the nonsurgical group. In the patients with PTA > or = 50 dB initially, the PTA declined an average of of 25.3 dB in the vestibular neurectomy group, 16.1 in the endolymphatic sac group, and 26.2 dB in the nonsurgical group. Although shunt patients with good hearing initially deteriorated less than neurectomy patients and less than patients who declined surgery, the difference was not significant. CONCLUSIONS: These results indicate that patients with poor hearing stabilized, while patients with good hearing continued to deteriorate. The same conditions were observed in the patients who had surgery and those who were offered surgery but declined.

Adult↗
PubMed1998

Toynbee Memorial Lecture 1997. Middle ear mechanics in normal, diseased and reconstructed ears.

A review of the structure-function relationships in normal, diseased and reconstructed middle ears is presented. Variables used to describe the system are sound pressure, volume velocity and acoustic impedance. We discuss the following: (1) Sound can be transmitted from the ear canal to the cochlea via two mechanisms: the tympanoossicular system (ossicular coupling) and direct acoustic stimulation of the oval and round windows (acoustic coupling). In the normal ear, middle-ear pressure gain, which is the result of ossicular coupling, is frequency-dependent and smaller than generally believed. Acoustic coupling is negligibly small in normal ears, but can play a significant role in some diseased and reconstructed ears. (2) The severity of conductive hearing loss due to middle-ear disease or after tympanoplasty surgery can be predicted by the degree to which ossicular coupling, acoustic coupling, and stapes-cochlear input impedance are compromised. Such analyses are used to explain the air-bone gaps associated with lesions such as ossicular interruption, ossicular fixation and tympanic membrane perforation. (3) With type IV and V tympanoplasty, hearing is determined solely by acoustic coupling. A quantitative analysis of structure-function relationships can both explain the wide range of observed post-operative hearing results and suggest surgical guidelines in order to optimize the post-operative results. (4) In tympanoplasty types I, II and III, the hearing result depends on the efficacy of the reconstructed tympanic membrane, the efficacy of the reconstructed ossicular chain and adequacy of middle-ear aeration. Currently, our knowledge of the mechanics of these three factors is incomplete. The mechanics of mastoidectomy and stapedectomy are also discussed.

Biomechanical Phenomena↗
PubMed1989

New perspectives on lyophilized bone allografts.

In 1987, at the Congress of Implants in Otology in Venice, Italy, we first presented our experiences with stored lyophilized bone allografts for reconstruction of the tympano-ossicular chain. Since then, we have extended our experiences to include reconstruction of the external bony ear canal, the filling of defects in the mastoid bone, reconstructive nasal surgery and rehabilitation of major bony defects of the face. Additionally, we have tried to improve the preparation of the bony implants used clinically and have started a multicenter collaboration with other European universities.

Bone Transplantation↗
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↗