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Behind Suspected Orbital Cellulitis: Luc's Abscess
No full textLuc’s abscess should be considered in cases of preauricular or facial swelling accompanied by ipsilateral
otalgia, along with cheek and eyelid edema (present in 30% of cases). Typically, mastoid involvement occurs
several days after the onset of preauricular and facial swelling. A computed tomography scan is the preferred imaging method. Early clinical diagnosis can be challenging for pediatricians, because the initial signs include facial swelling mainly involving the zygomatic region, accompanied by cheek and eyelid edema
Techniques of Endoscopic Ossiculoplasty.
Get PDFThe utilization of endoscopes in modern otology has evolved from diagnostic purposes to the development of exclusive endoscopic ear surgery. This technique offers a panoramic view of the middle ear and provides an optimal magnification of the oval window region, the stapes' suprastructure, and the footplate, allowing great precision in prosthesis positioning during ossiculoplasty (OPL). Various techniques for ossicular chain reconstruction have been described in the literature. Either autologous or synthetic materials can be used for reconstruction. The use of a patient's own tissue minimizes the risk of implant rejection or extrusion of the prosthesis through the tympanic membrane. On the other hand, synthetic materials like titanium are light and rigid and do not require time-consuming prosthesis remodeling. The main objective of this article is to present a comprehensive step-by-step guide that serves as a surgical manual for exclusive endoscopic OPL. This guide will explain various forms of OPL using synthetic and autologous materials. The goal is to provide a comprehensive understanding of the various surgical techniques and support the integration into clinical practice
Digital image enhancement may improve sensitivity of cholesteatoma detection during endoscopic ear surgery.
Get PDFOBJECTIVES
This study investigates the possible benefits and limitations of the digital image enhancement systems provided by Storz Professional Image Enhancement System (SPIES) during endoscopic ear surgery (EES) for cholesteatoma. An increased detection of cholesteatoma residuals during the final steps of endoscopic surgery using DIE technology was hypothesized.
DESIGN
Cross-sectional study.
SETTING
Tertiary referral hospital.
METHODS
A total of 10 questionnaires of 18 intraoperative pictures with equal numbers of cholesteatoma and non-cholesteatoma images, each presented in three different image-enhancing modalities (Clara, Spectra A, Spectra B), were generated. Fifty-one experienced ear surgeons participated to the survey and were randomly assigned to a questionnaire and completed it at two time points. The experts were asked to rate for each picture whether cholesteatoma was present or not. The answers were compared with the histopathological reports.
RESULTS
Clara showed the highest accuracy in cholesteatoma detection, followed by Spectra A and lastly Spectra B. In contrast, Spectra B showed the highest sensitivity and Clara the highest specificity, while Spectra A was placed in the middle for both values. Using the Spectra B modality, most responses agreed across the two time points. Ear surgeons assessed the usefulness, as well as preference among image modalities for cholesteatoma surgery, in the following order: Clara, Spectra B, Spectra A.
CONCLUSION
Digital enhancement technologies are applicable to EES. After complete cholesteatoma removal, Spectra B showed the highest sensitivity in the detection of cholesteatoma residuals as compared with Clara and Spectra A. Thus, Spectra B may be recommended to avoid missing any cholesteatoma residuals during EES
Features Associated With High Risk of Recurrence in Saccular Laryngeal Cysts: A Systematic Review and Qualitative Synthesis
No full textIntroduction: Saccular cysts are rare benign anomalies of the larynx (1.5% of laryngeal anomalies) determined by dilatation of the laryngeal saccule. They can be congenital or acquired. Clinical manifestation depends on the site of the cyst and the age of the patient. Children frequently have stridor and dyspnea, while adults usually complain of dysphonia.The therapeutic approach can be surgical or nonsurgical (needle aspiration or drainage).However, guidelines on the management of this disease are lacking in the literature.This systematic literature review was conducted through an interferential analysis with the aim of detecting the association between clinical, diagnostic, and operative factors and the recurrence of saccular cysts. Materials and methods: This systematic literature review was evolved following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist statement Papers published up to August 2023 containing relevant clinical data were searched in Embase/PubMed, Web of Science, Scopus, and Cochrane database. Full texts lacking information on the patient's data, clinical, radiological, and/or histological diagnosis of saccular cysts of the larynx were excluded. Articles with follow-up inferior to 6 months and not reporting any treatment of the cyst were excluded, too. Data concerning signs and symptoms, cyst characteristics, and the type of treatment were described, and the risk of recurrence was studied in association with these features. A qualitative synthesis of the results was performed. Results: Ninety-eight articles were screened. One hundred two patients were involved in the analysis. The articles with low or intermediate risk of bias were 22 (8 case reports and 14 case series) and they were included in the statistical analysis. Median age was 25 years (range 0-81). Saccular cysts were congenital (46/102, 45%) of cases acquired (56/102, 55%). Relying on the available data, all patients were symptomatic, with stridor as the main symptom (59%). Surgical approach was performed in 85% of cases, while drainage or needle aspiration of the cyst was the treatment of choice in the remaining 25% of cases. Twenty-four percent of patients had recurrence of the disease within 3 months. Median age at recurrence was 9 years. Cysts characteristics, preoperative management, and type of treatment were associated with an increased risk of disease recurrence (P < 0.05). Conclusions: Saccular cysts are rare congenital or acquired laryngeal diseases. Data regarding their management and factors associated with the risk of recurrence are still limited. Congenital cysts treated conservatively have a higher risk of recurrence than acquired cysts treated by open surgical techniques or by microlaryngoscopy. A better knowledge of factors associated with a higher risk of recurrence could help choose the best treatment
Otomastoidite, trombosi venosa cerebrale e ipertensione endocranica: alcune condivisioni sulla gestione
No full textAn Integrated (Microscopic/Endoscopic) Dissection Ear Surgery Course
No full textTraditionally, otologic surgical training consisted of microscopic cadaveric dissections. However, during the last decades the endoscope has significantly changed the surgical perspective in the otologic field. Thus, the modern ear and lateral skull base surgeon should master the entire spectrum of endoscopic and microscopic approaches, with the aim of tailoring the procedure and guaranteeing the best possible functional outcome. This work proposes a step-by-step guided and illustrated dissection course, including indications for the setup of the cadaver lab and the integration of the microscope and endoscope to enhance the use of both instruments. The alternation of the endoscope and microscope allows the novice to train the correct handling of the instruments in the surgical field under both optical views. This aspect is of utmost importance since it is not advisable to start off a technique without practicing the other one, as both are important and complementary in the modern otologic surgery setting
Trombosi venosa cerebrale associata a otomastoidite con segni di ipertensione endocranica
No full textCerebral venous thrombosis, Otomastoiditis, Diplopia, Papilledema, Endocranial hypertension, Anticoagulant therapy
Venous thrombosis of the cerebral sinuses can complicate acute otitis media (AOM) due to the close anatomical relationship between these structures. This condition presents a diag-nostic challenge for clinicians, as it often manifests with nonspecific symptoms like head-aches and carries the risk of quickly developing into intracranial hypertension. The paper presents the case of a 10-year-old child with a history of AOM who developed headache, later diagnosed as otomastoiditis complicated by thrombosis of the sigmoid sinus and jugu-lar-sigmoid junction. The patient required surgical intervention, along with antibiotic and anticoagulant therapy, leading to a full resolution of the thrombos
Assessment of a novel patient-specific 3D printed multi-material simulator for endoscopic sinus surgery
Get PDFBackground: Three-dimensional (3D) printing is an emerging tool in the creation of anatomical models for surgical training. Its use in endoscopic sinus surgery (ESS) has been limited because of the difficulty in replicating the anatomical details. Aim: To describe the development of a patient-specific 3D printed multi-material simulator for use in ESS, and to validate it as a training tool among a group of residents and experts in ear-nose-throat (ENT) surgery. Methods: Advanced material jetting 3D printing technology was used to produce both soft tissues and bony structures of the simulator to increase anatomical realism and tactile feedback of the model. A total of 3 ENT residents and 9 ENT specialists were recruited to perform both non-destructive tasks and ESS steps on the model. The anatomical fidelity and the usefulness of the simulator in ESS training were evaluated through specific questionnaires. Results: The tasks were accomplished by 100% of participants and the survey showed overall high scores both for anatomy fidelity and usefulness in training. Dacryocystorhinostomy, medial antrostomy, and turbinectomy were rated as accurately replicable on the simulator by 75% of participants. Positive scores were obtained also for ethmoidectomy and DRAF procedures, while the replication of sphenoidotomy received neutral ratings by half of the participants. Conclusion: This study demonstrates that a 3D printed multi-material model of the sino-nasal anatomy can be generated with a high level of anatomical accuracy and haptic response. This technology has the potential to be useful in surgical training as an alternative or complementary tool to cadaveric dissection
En plaque meningioma of the temporal bone: A systematic review on the imaging and management of a rare tumor
Get PDFObjective: To review the published cases of meningioma en plaque of the temporal bone (TB-MEP), to gather evidence on the clinical assessment and management of this rare entity. Methods: Following PRISMA statement recommendations, 383 abstracts were screened independently by two authors. Inclusion criteria were articles of human patients affected by TB-MEP; English or Italian language; availability of the abstract articles unrelated to TB-MEP, guidelines and systematic reviews were excluded. Only full-text articles reporting the diagnostic work-up and the management of the TB-MEP were considered for analysis. Results: A total of 12 articles were included, for a total of 25 patients with a mean age of 52 years (range: 31–71). The average time elapsed between the onset of symptoms and the actual diagnosis of TB-MEP was 36.5 months (range: 2–120). In most cases, the pathology presented with hearing loss (80 %), often accompanied by effusive otitis media (52 %), aural fullness (32 %), and tinnitus (32 %). The main Computed Tomography (CT) findings were hyperostosis (76 %), hairy appearance of bony margins (16 %), involvement of the mastoid and middle ear (48 %). Magnetic Resonance Imaging (MRI) revealed dural enhancement (28 %), temporal hyperostosis (20 %), a clearly enhancing extra-axial mass (28 %), compression of the surrounding vasculo-nervous structures (8 %) and the possible involvement of the temporal lobe (8 %). Forty percent of patients underwent various medical and surgical treatment before reaching the diagnosis. Forty-four percent of patients were sent to definitive surgical treatment, 44 % to follow-up while 8 % received radiotherapy. Conclusions: Meningioma en plaque (MEP) is a rare tumour, particularly when it originates within the temporal bone. Appropriate imaging in patients complaining of audiological sign and symptoms is mandatory to avoid diagnostic delays, avoid inappropriate surgical procedures, and adopt the appropriate treatment
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