1,721,043 research outputs found
Pseudotumoural hypertrophic neuritis of the facial nerve
No full text: In a retrospective study of our cases of recurrent paralysis of the facial nerve of tumoural and non-tumoural origin, a tumour-like lesion of the intra-temporal course of the facial nerve, mimicking facial nerve schwannoma, was found and investigated in 4 cases. This was defined as, pseudotumoral hypertrophic neuritis of the facial nerve. The picture was one of recurrent acute facial palsy with incomplete recovery and imaging of a benign tumour. It was different from the well-known recurrent neuritis, hypertrophic neuropathy and perineuroma. A portion of the intra-temporal course of the nerve with concurrent dilatation of the osseous walls was diagnosed pre-operatively as facial nerve schwannoma. The pathological picture showed inflammatory hypertrophy which was not a schwannoma but was likely of viral origin, with degeneration-regeneration of fibres and new connective tissue. Resection of the involved portion of the facial nerve and autologous graft in two cases was performed, decompression with biopsy in the other two. No recurrence of new episodes of paralysis after surgery was observed
Primary squamous cell carcinoma of the external auditory canal: surgical treatment and long-term outcomes
No full text: This study was conducted on patients with squamous cell carcinoma of the external auditory canal and temporal bone treated with surgery alone or surgery plus postoperative radiotherapy. It was designed as a retrospective investigation with complete long-term follow-up covering the years from 1983 to 2008. The setting was a tertiary referral centre. Forty-one consecutive cases underwent surgery involving en bloc lateral or subtotal temporal bone resection, parotidectomy and neck dissection plus radiotherapy in advanced cases. The Pittsburgh staging system was adopted. No cases were lost to follow-up, which ranged from 2 to 220 months, while for survivors ranged from 60 to 220 months and included clinical examinations and imaging. Outcome was expressed as NED (no evidence of disease), DOC (dead of other causes), DOD (dead of disease), AWD (alive with disease), disease-free survival (DFS) and disease-specific survival (DSS). Results were expressed with raw data and Kaplan Meyer curves. Patients with T1 and T2 disease had a DFS of 67% and a DSS of 92%. For T3 and T4 cases, the DFS was 41% and DSS was 48%. All treatment failures were due to local recurrences. The cases classified as T4 because the lesion extended from the cartilage canal to the periauricular soft tissues, or from the anterior wall to the parotid space, had a better outcome than the other T4 cases: this different prognosis suggests the need to stage tumours differently. Nodal disease coincided with a worse outcome due to local recurrence
Hearing preservation surgery in acoustic neuroma: long-term results
No full text: Long-term hearing was examined in 200 patients operated on during 1976-2000 with removal of acoustic neuroma with a retrosigmoid approach and hearing preservation technique. Ninety-four cases preserved hearing, and 91 cases were followed-up for at least 6 years (range 6 to 21 years). Hearing was measured with the PTA 0.5 KHz to 4 KHz and the SDS, and followed the guidelines of the American Academy of Otolaryngology and Head Neck Surgery (AAOHNS classification). Change (or stability) of the short to long-term class was the main outcome measure. Postoperative hearing of class A and B was preserved at long-term and within class B in 87% of cases. A total of 13% presented a decrease of class to C or D. Small size and good preoperative hearing correlated with good short- and long-term hearing [corrected]
Fibro-muscular-periosteal flap and bilobed flap for post-auricular cutaneous mastoid fistula closure
No full textBackground A post-auricular cutaneous mastoid fistula is a rare condition that can occur following radical mastoid surgery, chronic suppurative otitis media or spontaneous exteriorisation of cholesteatoma from the mastoid through the post-auricular skin surface. Management of a post-auricular cutaneous mastoid fistula can be challenging for the surgeon.Objective This paper describes a surgical refinement for post-auricular cutaneous mastoid fistula closure, involving a fibro-muscular-periosteal flap to cover the mastoid cavity, combined with a bilobed flap from the mastoid and lateral neck regions for skin closure.Method and results A case of a post-auricular cutaneous mastoid fistula developed after revision tympanoplasty for a cholesteatoma. The condition was successfully treated with the presented technique. Pre- and post-operative photographs are provided for demonstration.Conclusion The fibro-muscular-periosteal flap combined with a bilobed flap from the mastoid and lateral neck regions, in our view, can be considered a valid option for post-auricular cutaneous mastoid fistula closure
Audiological outcome for hearing preservation surgery in acoustic neuroma: the need of agreement in reporting results
Full text linkThe contribution of oncological lateral skull base surgery to the management of advanced head-neck tumors.
No full textBackground: Lateral skull base is a complex area between the brain and the neck that is characterized
by a large anatomic variability in narrow spaces and wide heterogeneity of tissues. The complexity of
the anatomy makes it more difficult to accurately identify tumor spread and surgical planning is here
particularly demanding.
Aims: Oncological skull base surgery is conceived for malignant lesions originating in, secondarily infiltrating,
or in close proximity to the lateral skull base. It is also conceived for selected aggressive or
benign lesions of the parapharyngeal space and infratemporal fossa abutting the skull base, or crossing
it from above downwards to the neck. This paper is focused on the role that oncological skull
base surgery plays to resect tumors in this area.
Methods and results: Three main types of head and neck lesions can be identified as paradigms of
the philosophy of oncological lateral skull base surgery, and are herein presented: (i) primary malignant
tumors of the ear; (ii) advanced malignant parotid tumors; (iii) primary malignant or locally
aggressive tumors of the infratemporal fossa-parapharyngeal space. The en-bloc lateral and subtotal
temporal bone resections, the en-bloc temporo-parotid resection and the combined subtemporaltranscervical-
transparotid resection are described, respectively.
Conclusions and significance: Different histologies are found in the lateral skull base and adjacent
areas, and each histology has its own pattern of growth and undetected spreading in a difficult-to-reach
surgical area. The leading principle is to create a wide access through soft tissues and bone removal far
enough from the tumor to obtain a complete resection, en-bloc radical resection in malignancies. The
entity of dissection is obviously modulated on the tumor triad (histology, pattern of growth, extent) and
is achieved through the en-bloc and combined approaches that are here described
En bloc temporal bone resections in squamous cell carcinoma of the ear. Technique, principles and limits.
No full textCONCLUSIONS:
En bloc resection should always be primarily considered in ear carcinoma, also in advanced tumors growing beyond the walls of the external auditory canal, because it achieves a full specimen for histopathological evaluation and allows a correlation between clinical, pathological features, and outcomes.
OBJECTIVE AND METHODS:
Dismal outcome of surgical and radiotherapic therapies for advanced ear carcinoma required a critical discussion of the oncological principles of treatment. Our analysis involved preliminarily a detailed description of surgical technique including the contribution of modern skull base microsurgery.
RESULTS:
Evident limits in diagnostic protocols, surgical treatment and outcome evaluation modalities pointed to the need of a new approach towards an accurate definition of pre-operative tumor location, size, and behavior. En bloc resection achieved a specimen for a final pathological evaluation and an adjunctive piecemeal excision was necessary only whenever resection was not felt falling in safe, tumor-free tissue. Chemotherapy and radiotherapy should be considered in selected cases for adjuvant treatment
Efficacy of selective lymph node dissection in clinically negative neck
No full textOBJECTIVE. The purpose of this study was to evaluate the efficacy of selective neck dissection (SND) for elective treatment of the clinically negative neck in head and neck squamous cell carcinoma (SCC).
METHODS: A retrospective review was undertaken on 91 previously untreated patients with T1-4 SCC of oral cavity (23), oropharynx (5), hypopharynx (7), larynx (56), and clinically negative neck (NO), undergoing 126 SrND from January 1990 to March 1999 at a single institution. Twenty-five patients received postoperative radiation therapy on the basis of histologic evidence of >2 positive nodes, extracapsular spread (ECS), and/or the presence of advanced primary lesion.
RESULTS: On pathologic examination the average number of lymph nodes was 20.5 per neck, occult disease was detected in 14 (11.11 %) of 126 necks; of necks with positive nodes, 6 (42.85%) of 14 had ECS. The median follow-up was 36 months. Overall recurrence rate (local, regional, and distant) was 12.8% (11 of 91). Recurrent disease developed in the neck of one patient, outside the dissected field. There was no difference in recurrence rate between pN0 and pN+ patients, as well as between pN+ with or without ECS. Overall survival rate was 84% (77 of 91), with a statistically significant difference between pN0 and pN+ necks.
CONCLUSION. SND seems to be a pragmatic approach,that is as effective as comprehensive procedures for staging and treating the clinically negative neck
Spontaneous genial tubercle fracture: management of a rare condition and literature review
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