RESUMO
OBJECTIVES: We describe the clinical, radiographic, and histopathologic characteristics of fungus balls. METHODS: We performed a retrospective review of 24 consecutive patients with the diagnosis of a paranasal sinus fungus ball (mycetoma) from 2001 to 2008. RESULTS: We found that 18 of the 24 primarily involved sinuses had bony thickening, and 13 of the 24 had notable dilatation of the ostium. Eleven of the 24 patients were found to have some degree of immunocompromise (from organ transplantation, diabetes, etc). The patient's immune status correlated with the type of fungus involved. (Mucor-like fungi were more common in immunocompetent patients, and aspergillus-like fungi were more common in immunocompromised patients.) Also, there was a predilection for immunocompetent patients to have dilatated ostia, whereas immunocompromised patients were more likely to have a nondilatated ostium (p = 0.019). CONCLUSIONS: Our series of paranasal sinus fungus balls defines a group of patients heretofore poorly described in the literature. Our data reveal an increased incidence in immunocompromised patients. We also found consistent radiographic patterns, correlations between immune status and the fungal pathogen, correlations between ostial enlargement and immune status, and the presence of cranial nerve pareses. These represent new findings that merit further study.
Assuntos
Aspergilose/diagnóstico por imagem , Aspergilose/patologia , Mucormicose/diagnóstico por imagem , Mucormicose/patologia , Sinusite/microbiologia , Sinusite/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Aspergilose/complicações , Estudos de Coortes , Feminino , Humanos , Hifas , Masculino , Pessoa de Meia-Idade , Mucormicose/complicações , Radiografia , Estudos Retrospectivos , Fatores de Risco , Sinusite/diagnóstico por imagem , Adulto JovemRESUMO
Facial nerve paralysis can be difficult to treat because it presents a variety of functional, aesthetic, and psychosocial challenges. The goals of treatment include facial symmetry at rest, corneal protection, oral competence, restoration of voluntary and spontaneous facial movements, and minimal synkinesis. A multitude of static and dynamic procedures have been used to achieve these goals. Facial nerve reapproximation or interpositional grafting is associated with the best end results. The results of dynamic procedures are generally better than those of static procedures. Optimal reconstruction of the paralyzed face usually requires multiple surgeries with both types of procedures. Patients must be extensively counseled regarding expected results before they embark on what is an oftentimes lengthy reconstructive process. In this article, we discuss the anatomy of the facial nerve, the etiologic factors associated with facial nerve paralysis, the evaluation of the patient with facial paralysis, and the various surgical options for static and dynamic reconstruction of the paralyzed face. We also review the literature.
Assuntos
Face/cirurgia , Paralisia Facial/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Algoritmos , Face/patologia , Paralisia Facial/patologia , Humanos , Procedimentos de Cirurgia Plástica/instrumentaçãoRESUMO
OBJECTIVE: Review largest series of patients treated with transtympanic steroids, including outcomes, steroid dosing and adverse outcomes. Review first reported cases of systemic side effects from transtympanic steroids. METHODS: A retrospective case series of 166 patients who underwent placement of transtympanic Silverstein tube with microwick for steroid administration was reviewed. RESULTS: 5/166 patients developed systemic side effects, 9/166 patients developed local side effects. 48/166 (29%) of patients had a persistent perforation after therapy. The percent of patients with improvement as a function of symptoms: hearing loss 42%, tinnitus 56%, vertigo 68%, aural fullness 25% and dysequilibrium 66%. CONCLUSIONS: While our study revealed a significant risk of persistent tympanic membrane perforation, the incidence of systemic and local side effects from transtympanic steroid administration is low.
Assuntos
Glucocorticoides/administração & dosagem , Perda Auditiva/tratamento farmacológico , Membrana Timpânica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Audiometria de Tons Puros , Sistemas de Liberação de Medicamentos , Feminino , Glucocorticoides/efeitos adversos , Humanos , Instilação de Medicamentos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
OBJECTIVES/HYPOTHESIS: Although the overall incidence of perilymphatic gushers is approximately 1%, patients with inner ear anomalies are at an increased risk for development of perilymphatic gushers. As cochlear implantation becomes more common in patients with inner ear anomalies (e.g., Mondini defect or common cavity defect), the ability to successfully seal such leaks becomes of paramount importance to reduce the risk of subsequent meningitis. METHODS: A 1.0-mm and a 1.5-mm cochleostomy were placed superior to the round window in two respective temporal bones. Cochlear implant electrodes (Cochlear [Lane Cove NSW, Australia], Med-El [Insbruck, Austria] and Advanced Bionics [Valencia, CA]) were placed in the cochleostomy and sealed with porcine periosteum. A fixed amount of pressure was applied to the inner ear, and the presence or absence of a leak was recorded for 10 different packings of each cochleostomy diameter at 0, 10, 15, 20, and 30 cm H(2)O. RESULTS: For the Cochlear, Med-El, and Advanced Bionics electrode, no statistically significant difference was noted between the 1.0-mm and the 1.5-mm cochleostomy at 0, 10, 15, and 20 cm H(2)O. At 30 cm H(2)O, no leaks were noted with the 1.5-mm cochleostomy for any brand. For the 1.0-mm cochleostomy at 30 cm H(2)O, 6/10 of the Cochlear trials leaked (P = .004), 2/10 of the Med-El trials leaked (P = .24), and 5/10 of the Advanced Bionics trials leaked (P = .03). CONCLUSIONS: The 1.5-mm cochleostomies are associated with a decreased risk of perilymphatic fistula as compared to 1.0-mm cochleostomies at 30 cm H(2)O; this likely represents a phenomenon of packing adequacy.
Assuntos
Cóclea/cirurgia , Implante Coclear/métodos , Perilinfa , Implante Coclear/efeitos adversos , Implantes Cocleares , Fístula/etiologia , Fístula/prevenção & controle , Humanos , Doenças do Labirinto/etiologia , Doenças do Labirinto/prevenção & controleRESUMO
BACKGROUND: Mandibular reconstruction using free fibular flaps can be performed using various plating techniques. Miniplates (