Eosinophilic granuloma of the temporal bone in children.

Eosinophilic granuloma (EG) is a bony destructive disease that frequently occurs in children; it is a subtype of Langerhans cell histiocytosis. The aims of this study were to detect the presenting features of temporal bone lesions in children and to evaluate the efficacy of surgery combined with radiotherapy in treatment of the disease. A retrospective study on 12 children with EG of the temporal bone was done. Computed tomography and hearing assessment were performed for all patients. All patients were treated with cortical mastoidectomy followed by postoperative radiotherapy. Follow-up was carried out for at least 2 years. The patients' presenting symptoms were external ear canal mass in 10 patients (83.3%), postauricular swelling in 8 patients (66.7%), and persistent otorrhea in 4 patients (33.3%). Ten patients (83.3%) showed conductive hearing loss, whereas 2 patients (16.7%) showed mixed hearing loss on the affected side. Computed tomography showed osteolytic defects without sclerotic margins filled with soft tissue masses involving the mastoid bone. Histopathologic examination showed eosinophils and Langerhans cells that were immune reactive for CD1 antigen and S-100 protein. Postoperative follow-up showed complete cure of the disease in 10 children (83.3%), with recurrence detected in 2 patients (16.7%) who needed second surgical intervention. We concluded that temporal bone EG in children may present with features that mimic the features of chronic suppurative otitis media. However, computed tomography and histopathologic examination are diagnostic. Cortical mastoidectomy together with postoperative radiotherapy is an achievable treatment in most cases.

Closure of anterior post-palatoplasty fistula using superior lip myomucosal flap.

OBJECTIVE: (a) Surgical repair of palatal fistulas are technically difficult due to excessive tissue fibrosis with high failure rate. (b) The aim of this study is to evaluate the efficacy of closure of anterior palatal fistula using myomucosal superior lip flap. METHODS: 33 cases with anterior palatal fistulas after cleft palate repair were subjected to closure in two-layers, the first is the oral mucoperiosteum hinge flap to reconstruct the nasal side and the second is a myomucosal flap from the inner surface of the superior lip to reconstruct the oral side. Follow up was carried out for 12 months. RESULTS: The fistulas were completely closed in 30 cases (91%) and partially closed in 3 cases (9%) due to necrosis of the tip of the flap. CONCLUSIONS: Closure of anterior palatal fistula by the use of superior lip myomucosal flap is a useful method with high success rate and no morbidity.