[Bacteroides-infection in chronic otitis with mastoiditis].
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OBJECTIVE: To provide specific informations about the arterial related anatomy of the trunk of the facial nerve from the stylomastoid foramen to its bifurcation. METHODS: Dissection of 30 facial nerves in fresh cadavers after arterial casting with red-colored latex. RESULTS: A great anatomic variability does exist. The facial nerve is most often in relation to the stylomastoid artery which arises from the posterior auricular artery. The stylomastoid artery originates sometimes from the occipital artery or from the external carotid artery. In 19 cases of 30 the stylomastoid artery passes medially to the nerve, and 11 cases laterally. CONCLUSION: During parotid surgery, the main trunk of the facial nerve may be difficult to identify because of a large-caliber stylomastoid artery which can mask it. Therefore it is preferable to dissect this artery with caution, remaining at distance from the dangerous.
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An open operative technique was used in 36 (38%) of 95 patients with chronic cholesteatomatous otitis followed up by the same surgeon between 1986 and 1990. Although a good anatomical result was obtained in 88% of cases the functional result was less evident, since 57% of patients were left with a liminal tonal loss of less than 30 décibels. The reasons for using an open technique are analyzed, but in only 5% of cases could the possibility of using a closed technique be envisaged, making the classical discussion between open and closed methods of treatments of only academic interest. Petromastoidian evidement with reorganization of the cavity is considered to be effective therapy for cholesteatoma, but indications and technical procedures must be adhered to strictly.