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PubMedDate not supplied

Thermal injury from mastoid bone burrs.

Marked bone temperature elevations and surface osteocyte necrosis result from cutting and diamond burrs used without continuous irrigation. Temperatures generated may injure the facial nerve even if drilling is carried on a millimeter or more distant from the nerve. Irrigation of the operative field maintains bone and nerve temperatures at safe levels. Cutting and diamond burrs obey different thermodynamic principles. Higher rotation speeds, greater applied pressures and greater surface contact area increase cutting burr thermogenesis. Burrs with more flutes generate greater heat than those with fewer flutes. Diamond burr heat generation varies in proportion to applied pressure, but is independent of rotation speed or contact area. Haversian canal blood vessels do not contribute to postoperative revascularization. Rather, vessels immigrate from adjacent intact periosteum, penetrating arterioles and exposed marrow. Surface thermal injury does not impede revascularization and should not impair the healing of tissue grafts applied to the bone surface.

Animals↗
PubMedDate not supplied

Obliteration of the mastoid in the treatment of tumors of the temporal bone.

A retrospective analysis of 29 cases of squamous cell carcinoma of the external and middle ear and 15 cases of glomus jugulare tumors of the middle ear was performed to evaluate the incidence of osteoradionecrosis of the temporal bone following surgery and/or radiotherapy. Osteoradionecrosis occurred in 42% (8/19) of cases of squamous cell carcinoma which were treated with radical mastoidectomy, lateral or subtotal temporal bone resection leaving an open cavity and followed by an average of 5,840 rad postoperatively. No osteoradionecrosis, wound breakdown or otorrhea occurred in another group of six patients who were treated by surgical exenteration, total cavity obliteration, and an average of 5,700 rad of postoperative radiotherapy. Thus, cavity obliteration significantly decreased the incidence of these complications (p less than 0.05). In contrast, in 15 patients treated by surgery and postoperative irradiation (average dose = 4,610 rad) for glomus jugulare tumors, no osteoradionecrosis occurred despite use of an open cavity technique.

Adenocarcinoma↗
PubMed1996

Schneiderian-type mucosal papillomas of the middle ear and mastoid.

Five cases of schneiderian-type mucosal papillomas arising in the middle ear space are reported. The patients were all women, ranging in age from 19 to 57 years (median, 31 years). Clinical complaints--unilateral conductive hearing loss, pain, or otorrhea--ranged from those lasting several months to recurrent problems spanning 20 years. All of the patients had a history of chronic otitis media predating the development of the papillomas; none of the patients had a history of sinonasal or nasopharyngeal schneiderian-type papillomas. Clinically, three patients had intact tympanic membranes, while the other two patients had perforated tympanic membranes through which a bulging polypoid mass was identified. Radiographic studies showed opacification of the middle ear space without evidence of osseous destruction. The intraoperative findings were of polypoid lesions filling the middle ear space, including involvement of the eustachian tube orifice. Histologically, the tumors were identical to sinonasal schneiderian papillomas. Immunohistochemical evaluation for human papillomavirus was negative. Surgical excision is the treatment of choice. In four of the patients, recurrent tumor was identified, necessitating additional surgery. In only one patient did the initial surgery result in complete ablation of the tumor. All patients are alive and free of recurrent disease over periods ranging from 6 months to 120 months (median, 84 months).

Adult↗