1,720,975 research outputs found
Endoscopic exclusive transcanal approach to the tympanic cavity cholesteatoma in pediatric patients: our experience
No full textLearning Objectives: The aim of the present study is to
describe our experience in the management of tympanic
cavity cholesteatoma in pediatric patients, treated with endo-
scopic exclusive transcanal approach.
Objectives: Describe our experience in the management of
tympanic cavity cholesteatoma in pediatric patients treated
with endoscopic exclusive transcanal approach.
Methods: Review of surgical cases performed between
January 2007 and December 2013. Patients presenting with
cholesteatoma of the tympanic cavity with no mastoid
involvement were included in the first group and underwent
an exclusive transcanalar endoscopic approach (TEA).
Patients with mastoid extension of the pathology were
included in the control group and underwent a canal wall
up microscopic technique (CWU).
Results: 59 ears of 54 patients were reviewed. Median age
was 9.6 years (range 4 – 16 years). 31 cholesteatomas under-
went a TEA approach, while 28 underwent a CWU approach,
based on inclusion criteria. No differences from congenital
vs acquired form was made. The ossicular chain was pre-
served in 26.6% of patients (16 ears): 42% of patients (13
ears) undergoing a TEA and 10% of patients undergoing a
CWU approach (3 ears) (P = 0.006). Second look surgery
was executed in 41.6% of patients (25 ears). In partial ossi-
cular prosthesis reconstructions, the mean preoperative
pure-tone average (PTA) was 29.4 dB, while the mean post-
operative PTA was 27.1 dB, with a mean increase of 2.3 dB.In total ossicular prosthesis reconstructions, the mean pre-
operative PTA was 47.8 dB, while the mean postoperative
PTA was 26.5 dB, with a mean increase of 21.3 dB.
Recurrence rate was 12.9% (4 ears) for the TEA group and
17.2% (5 ears) for the CWU approach. Residual disease
was present in 26.6%: 19.3% (6 ears) for the TEA and
34.4% (10 ears) for the CWU approach. The mean follow
up was 36 months (range 8 – 88). Kaplan-Meier analysis at
36 months showed a lower recurrence risk for the TEA com-
pared with the CWU approach, but this data was not statistic-
ally significant (P = 0.58).
Conclusion: TEA represents a feasible, minimally invasive
and conservative technique for the management of pediatric
middle ear cholesteatoma
Anatomy of the Lacrimal Drainage System
No full textThe knowledge of the anatomy is mandatory for both opthalmologies and otorhinolaryngologies to understand the physiology, the pathology, and the surgical approaches to the nasolacrimal system
Updates on Larynx Cancer: Risk Factors and Oncogenesis
Full text linkLaryngeal cancer is a very common tumor in the upper aero-digestive tract. Understanding its biological mechanisms has garnered significant interest in recent years. The development of laryngeal squamous cell carcinoma (LSCC) follows a multistep process starting from precursor lesions in the epithelium. Various risk factors have been associated with laryngeal tumors, including smoking, alcohol consumption, opium use, as well as infections with HPV and EBV viruses, among others. Cancer development involves multiple steps, and genetic alterations play a crucial role. Tumor suppressor genes can be inactivated, and proto-oncogenes may become activated through mechanisms like deletions, point mutations, promoter methylation, and gene amplification. Epigenetic modifications, driven by miRNAs, have been proven to contribute to LSCC development. Despite advances in molecular medicine, there are still aspects of laryngeal cancer that remain poorly understood, and the underlying biological mechanisms have not been fully elucidated. In this narrative review, we examined the literature to analyze and summarize the main steps of carcinogenesis and the risk factors associated with laryngeal cancer
Stapes malformations: the contribute of the endoscopy for diagnosis and surgery
No full textThe aim of this study is to investigate the contribute of the endoscopic exclusive transcanalar approach for the management of stapes malformations. A retrospective chart review was made at our tertiary referral centers. 17 patients with stapes malformations underwent surgery with endoscopic exclusive transcanal approach. A complete audiological and radiological assessment before and after surgery was performed. 12/17 (70 %) underwent a surgical endoscopic correction, In case of fixed platina underwent five endoscopic stapedotomy and one endoscopic stapedectomy were performed. In case of mobile platina five endoscopic ossiculoplasties with partial ossiculoplasty replacement prosthesis were performed, 3 with autologous remodeling incus and 2 with malleus head remodeling. In 1 case, only an endoscopic stapes mobilization was made. In 5/17 (30 %), due to difficult anatomical findings an endoscopic explorative tympanotomy was finally performed. The mean preoperative air conduction (AC), bone conduction (BC) and air-bone gap (ABG) were, respectively, 60.7, 26.3 and 34.4 dB. The mean postoperative AC, BC and ABG were, respectively, 33.8, 26.5 and 7.3 dB, with a mean improvement of the ABG of 27.1 dB. Discharge from hospital was on the first post-surgery day. No relevant postoperative complications were noted. The median follow-up was 3.6 years (range 1-6). The endoscopic approach results very adequate for the diagnosis and treatment of stapes malformations, checking variations of the ossicles conformation and functioning and performing safe surgery, under direct control of middle ear structures
A clockwork ear
No full textObjective tinnitus refers to a tinnitus that can also be heard by the examiner. It is a relatively rare condition, and can be misdiagnosed or neglected. Some causes of objective tinnitus are head and neck vascular malformations, or muscular myoclonus of the tensor tympani, stapedial, or palatal muscles. The case of an 11-year-old girl with an objective tinnitus lasting from 1 year is herein presented, and the diagnostic workup performed in this unusual case is described
Facial nerve hemangioma of the geniculate ganglion: an endoscopic surgical approach
No full textFacial nerve hemangiomas are rare benign tumors arising from the venous plexus surrounding the facial nerve. Surgical management of these tumors is controversial. The goal of surgery is complete tumor removal with restoration of facial nerve function and preservation of hearing, wherever possible. The approaches most used are the translabyrinthine and middle cranial fossa approaches. In this report, we describe the first facial hemangioma treated with an endoscopic transcanal approach, combined with a retroauricular transmastoid minicraniotomy for closure of the dural defect. A great auricular nerve graft was used to reconnect interrupted nerve segments. Histopathological examination confirmed the diagnosis of a hemangioma of the first genu of the facial nerve. With magnification of the structures, the transcanal endoscopic approach allowed a radical excision of the neoplasm permitting hearing function preservation, with the possibility to work with a minimally invasive approach with respect to the labyrinthine block and cochlea. Compared to a middle cranial fossa approach, the transcanal endoscopic approach avoided labyrinthine block removal and brain retraction
Round window chamber and fustis: endoscopic anatomy and surgical implications
No full textThe round window region is of critical importance in the anatomy of the middle ear. The aim of this paper is to describe its anatomy from an endoscopic point of view, emphasizing structures that have important surgical implications, in particular the fustis and the subcochlear canaliculus. The fustis, a smooth bony structure that forms the floor of the round window region, is a constant and important structure. It seems to indicate the round window membrane and the correct position of scala tympani. A structure connecting the round window region to the petrous apex, named the subcochlear canaliculus, is also described. A retrospective review of video recordings of endoscopic dissection and surgical procedures, carried out between June 2014 and February 2015, was conducted across two Tertiary university referral centers. A total of 42 dissections were analyzed in the study. We observed the fustis in all the cases and we identify two different anatomical conformations. The subcochlear canaliculus was found in 81.0 %, with a pneumatization direct to the petrous apex in 47.7 %. Conformation and limits of the round window niche may influence the surgical view of the round window membrane. Endoscopic approaches allow a very detailed view, which enables a comprehensive exploration of the round window region. Accurate knowledge of the anatomical relationships of this region has important advantages during middle ear surgery
Subtotal Petrosectomy: Pictorial Review of Clinical Indications and Surgical Approach
No full textSubtotal petrosectomy (STP) is characterized by obliteration of the middle ear and occlusion of the external auditory canal. The advent of the endoscope has allowed a reduction in morbidity for some conditions such as cholesteatoma and other middle ear disorders, but STP still plays an important role. A retrospective review of medical records and videos of patients who had undergone STP was performed. Perioperative data and images were collected from various clinical cases who had undergone subtotal petrosectomy at our tertiary referral university hospital in Verona. We confronted our experience with a review of the literature to present the main indications for this type of procedure. STP allows a variety of diseases to be managed effectively as it offers the possibility of a definitive healing with radical clearance of temporal bone. Moreover, it can be safely combined with other procedures with a very low complication rate. Although the endoscope represents a revolution in ear surgery, STP, when indicated, is nowadays a surgical option that should be included in the otosurgeon's portfolio
Traumatic Intraconal Foreign Body: Report of an Injury Corrected With Combined Surgical and Endoscopic Treatment
No full textBACKGROUND: Management of penetrating ocular splinter injuries is very controversial. Penetrating wounds of the orbit represent a complex therapeutic problem that requires a multidisciplinary approach. Endoscopic approaches to the orbit are currently performed through the lamina papyracea to access the medial part, or through large orbitotomies to access the lateral part.OBJECTIVE: To describe a novel, combined approach to the lateral part of the Orbit.METHODS: Clinical and surgical findings of intraorbital foreign body removal are presented. A minimal supraorbital osteotomy was performed, combined with endoscopic intraorbital dissection.RESULTS: The foreign body was removed, no postoperative complications were reported, and visual acuity increased from 2/10 preoperatively, to 8/10 one month after surgery.CONCLUSION: The present technique can be considered a safe and novel surgical approach to access the retrobulbar space and to treat the pathology of this anatomic region
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