[Unremitting otitis, subacute mastoiditis. Diagnostic difficulties, importance of the course of the treatment].
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Extra-canalicular osteomas of the temporal bones are rare benign tumours. We report a retroauricular osteoma in a 18 years old patient. Usually symptomless, they may present for cosmetic reasons. We briefly comment this type of tumours.
Cholesteatomas were intraoperatively removed from subjects under 14 years of age presenting widespread cholesteatoma with bone erosion. The samples were studied under light and transmission electron microscopy in order to consider the features of inflammation and bone erosion. The results showed that the perimatrix of cholesteatoma in children is rich in mononuclear inflammatory elements and generally presents the features of chronic, as well as acute, inflammation. The perimatrix infiltrates and erodes the surrounding bone. Next to the resorption areas many areas were observed having new bone the surface of which is lined with osteoblasts. The new bone formation activity is marked in these cases of childhood cholesteatoma and appears to be an attempt at spontaneous repair which is thwarted by the persistence of inflammation.
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The possibility of connections between Canalis mastoideus and Cellulae mastoideae is checked by means of probation in 30 human skulls and 10 selected skulls (out of this 30) by x-ray investigation. In 4 cases such connection were seen. It is evident that the migration of inflammations along such connections is possible.
We have presented the first child in Delaware with malignant external otitis associated with IgG4 deficiency. Our patient needed three courses of intravenous antibiotics and twice required mastoidectomy, but has recovered completely following the restoration of the natural barrier between the internal and external ear, using a fascial graft from the large temporalis muscle. Some hearing deficit remains.
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