Middle ear promontory osteoma.

Osteomas are benign lesions of the lamellar bone that within the temporal region are common in the external ear canal. Osteomas of the middle ear are extremely rare and until now there are only 14 reported cases. They usually present with conductive hearing loss while others are asymptomatic and diagnosed incidentally.

Dose-dependent cochlear and vestibular toxicity of trans-tympanic cisplatin in the rat.

In vivo studies are needed to study cisplatin ototoxicity and to evaluate candidate protective treatments. Rats and mice are the preferred species for toxicological and pharmacological pre-clinical research, but systemic administration of cisplatin causes high morbidity in these species. We hypothesized that trans-tympanic administration of cisplatin would provide a good model for studying its auditory and vestibular toxicity in the rat. Cisplatin was administered by the trans-tympanic route in one ear (50µl, 0.5-2mg/ml) of rats of both sexes and two different strains. Cochlear toxicity was corroborated by histological means. Vestibular toxicity was demonstrated by behavioral and histological analysis. Cisplatin concentrations were assessed in inner ear after trans-tympanic and i.v. administration. In all experiments, no lethality and only scant body weight loss were recorded. Cisplatin caused dose-dependent cochlear toxicity, as demonstrated by hair cell counts in the apical and middle turns of the cochlea, and vestibular toxicity, as demonstrated by behavioral analysis and hair cell counts in utricles. High concentrations of cisplatin were found in the inner ear after trans-tympanic administration. In comparison, i.v. administration resulted in lower inner ear concentrations. We conclude that trans-tympanic administration provides an easy, reproducible and safe model to study the cochlear and vestibular toxicity of cisplatin in the rat. This route of exposure may be useful to address particular questions on cisplatin induced ototoxicity and to test candidate protective treatments.

Middle fossa approach: Applications in temporal bone lesions. / Abordaje por fosa media, aplicaciones en lesiones del hueso temporal.

The middle fossa approach is a surgical technique that is very useful for lateral skull base surgery. However, it is true that it has limited surgical indications and implementation due to its technical complexity. We present our experience in 10 patients in whom the middle fossa approach was the treatment of choice because of the extent of the injury and complexity of the lesion or process. Despite the complexity of the cases, there was no mortality associated with surgery. Postoperative complications were found in 2 patients who presented an epidural hematoma and a cortico-subcortical hematoma. Hearing function was preserved in 5 patients out of the 7 who had adequate hearing at the time of surgery. House/Brackmann I-II facial nerve function was achieved in 8 patients; the remaining 2 had no deterioration of the nerve function. In 9 out of 10 patients, the surgery achieved complete solution of the lesion. The middle fossa approach is a safe and reliable surgical technique. It gives us great control and exposure of different skull base processes. We consider its knowledge of great importance, because it may be the only viable surgical alternative in some specific patients. That is the reason why it is important to learn this approach and know about it in our specialty.

Facial reanimation surgery with micro-vascular gracilis free flap for unilateral facial palsy.

INTRODUCTION AND OBJECTIVES: Micro-neurovascular free muscle flap transfer is currently the procedure of choice for long-standing facial paralysis. We present a case series of patients treated with gracilis muscle free flap with motor innervation by the masseteric nerve. We discuss the surgical technique and quantify the movement granted by the muscle, the improvement in quality of life and aesthetic results. MATERIALS AND METHODS: We report ten patients with unilateral facial paralysis who underwent free gracilis muscle flap, between the years 2010 and 2012 in two tertiary hospitals. RESULTS: It is not reported any failure of the microsuture with survival of all flaps. The muscle movement was quantified by vectors at rest and contraction with an average of 1.7 cm that initiated around the fourth month after surgery. Patients also reported a significant improvement in symmetry at rest as well as oral and ocular competition. CONCLUSION: As currently presented in literature, microvascular free flaps are the technique of choice for facial reanimation. In our experience, we believe that gracilis muscle flap innervated by the masseteric nerve is a reliable and secure technique that provides adequate functional and aesthetic results.

Miringoplastia con cartílago en alas de mariposa. Nuestra experiencia / Inlay butterfly miringoplasty. Our experience

Introducción: Se han propuesto múltiples técnicas quirúrgicas para cerrar perforaciones timpánicas. Eavey, hace dos décadas, describió una técnica destinada a cerrar perforaciones centrales en niños. Para ello diseñó un injerto de cartílago con forma de alas de mariposa que se colocaba entre la membrana timpánica. Dicha técnica demostró gran efectividad para el cierre de perforaciones así como baja morbilidad, rapidez y gran diferencia económica. Métodos: Se realiza un estudio descriptivo de serie de casos analizando 32 intervenciones en niños y adultos con la técnica de Eavey modificada, durante el periodo de enero de 2012 a noviembre de 2016. Se evaluaron los resultados quirúrgicos y los resultados funcionales audiométricos. Resultados: El éxito quirúrgico se logró en el 93% de los casos, incluyendo los cierres completos en 27 pacientes (84%) y 3 casos en los que se presentaron dehiscencias mínimas asintomáticas. Se presentó un rechazo del injerto y persistencia de la perforación y en un caso una perforación residual. No se describen complicaciones quirúrgicas o posquirúrgicas mayores asociadas al procedimiento. La mejoría de la media del gap audiométrico fue de 17 dB preoperatorio a 7dB posterior a la intervención. Conclusiones: La técnica de Eavey modificada es un procedimiento con baja morbilidad, costo-efectiva, con facilidad técnica que demuestra ser eficaz para el cierre de perforaciones timpánicas en adultos y niños (AU)

Introduction: Multiple surgical techniques have been proposed to close tympanic perforations. Eavey, two decades ago, described a technique aimed at closing central perforations in children. For this, he designed a butterfly-shaped cartilage graft that was placed between the tympanic membrane in an inlay manner. This technique showed great effectiveness for the closure of perforations as well as low morbidity, rapidity and great economic difference. Methods: We performed a descriptive study of a series of cases analysing 32 interventions in children and adults with the modified Eavey technique, during the period from January 2012 to November 2016. We evaluated the surgical and audiometric functional results. Results: Surgical success was achieved in 93% of cases, including complete closures in 27 patients (84%) and 3 cases in which minimal asymptomatic dehiscences occurred. There was rejection of the graft and persistence of the perforation in only one case. No major surgical or postoperative complications associated with the procedure were described. The mean improvement in the audiometric gap was from 17 dB preoperatively to 7 dB after the intervention. Conclusions: The modified Eavey technique is a low morbidity, cost-effective procedure with a technical facility that proves effective for the closure of tympanic perforations in adults and children (AU)

Abordaje por fosa media, aplicaciones en lesiones del hueso temporal / Middle fossa approach: Applications in temporal bone lesions

El abordaje por fosa media es una técnica quirúrgica de gran utilidad en la cirugía de base de cráneo lateral. Si bien es cierto, que por sus restringidas indicaciones así como por su complejidad técnica ha tenido una implantación limitada. Presentamos nuestra experiencia en 10 pacientes en los cuales por gran complejidad del proceso, la situación o la extensión de la lesión, el abordaje por fosa media fue el tratamiento de elección. A pesar de la gran complejidad de los casos no hubo ningún caso de mortalidad asociada a la cirugía. De la morbilidad registrada destacar un hematoma epidural y un hematoma córtico-subcortical. La función auditiva se preservó en 5 pacientes de los 7 pacientes que presentan audición en el momento de la cirugía. En 8 pacientes se logró una función facial House/Brackmann I-II y en los 2 restantes no hubo empeoramiento de la misma función. En 9 de los 10 pacientes se realizó una cirugía resolutiva de la patología. El abordaje por fosa media es una técnica quirúrgica segura y fiable. Nos proporciona un gran control y exposición de los diferentes procesos patológicos de la base de cráneo. Consideramos de gran importancia su conocimiento, pues en determinados pacientes puede ser la única alternativa viable y resolutiva, de ahí la importancia de difundir este abordaje en nuestra especialidad (AU)

The middle fossa approach is a surgical technique that is very useful for lateral skull base surgery. However, it is true that it has limited surgical indications and implementation due to its technical complexity. We present our experience in 10 patients in whom the middle fossa approach was the treatment of choice because of the extent of the injury and complexity of the lesion or process. Despite the complexity of the cases, there was no mortality associated with surgery. Postoperative complications were found in 2 patients who presented an epidural hematoma and a cortico-subcortical hematoma. Hearing function was preserved in 5 patients out of the 7 who had adequate hearing at the time of surgery. House/Brackmann I-II facial nerve function was achieved in 8 patients; the remaining 2 had no deterioration of the nerve function. In 9 out of 10 patients, the surgery achieved complete solution of the lesion. The middle fossa approach is a safe and reliable surgical technique. It gives us great control and exposure of different skull base processes. We consider its knowledge of great importance, because it may be the only viable surgical alternative in some specific patients. That is the reason why it is important to learn this approach and know about it in our specialty (AU)

Cirugía reparadora de la parálisis facial mediante colgajo libre microvascularizado de músculo gracilis / Facial reanimation surgery with micro-vascular gracilis free flap for unilateral facial palsy

Introducción/objetivos: La transferencia de colgajo libre muscular microneurovascular es actualmente el procedimiento de elección para la parálisis facial de larga evolución. Presentamos una serie de casos de pacientes tratados con colgajo libre de músculo gracilis con inervación motora por el nervio maseterino. Se analiza la técnica quirúrgica y cuantificamos el movimiento otorgado por el músculo, así como la mejoría en la calidad de vida y los resultados estéticos obtenidos. Materiales y métodos: Se analizan 10 pacientes con parálisis facial unilateral, quienes fueron intervenidos con colgajo muscular libre gracilis, durante los años 2010 y 2012 en 2 centros hospitalarios de tercer nivel. Resultados: No encontramos fallo de la microsutura con supervivencia de todos los colgajos realizados. El movimiento muscular se cuantificó mediante vectores en reposo y contracción, con un promedio de 1,7 cm, se inició aproximadamente hacia el cuarto mes después de la intervención. Se demuestra también una mejoría significativa de la simetría en reposo, así como de la competencia oral y ocular. Conclusiones: Como se presenta actualmente en la literatura los colgajos libres microvascularizados son la técnica de elección para la reanimación facial. En nuestra experiencia consideramos que el colgajo con músculo gracilis inervado por el nervio maseterino es una técnica fiable y segura, que ofrece adecuados resultados tanto funcionales como estéticos (AU)

Introduction and objectives: Micro-neurovascular free muscle flap transfer is currently the procedure of choice for long-standing facial paralysis. We present a case series of patients treated with gracilis muscle free flap with motor innervation by the masseteric nerve. We discuss the surgical technique and quantify the movement granted by the muscle, the improvement in quality of life and aesthetic results. Materials and methods: We report ten patients with unilateral facial paralysis who underwent free gracilis muscle flap, between the years 2010 and 2012 in two tertiary hospitals. Results: It is not reported any failure of the microsuture with survival of all flaps. The muscle movement was quantified by vectors at rest and contraction with an average of 1.7 cm that initiated around the fourth month after surgery. Patients also reported a significant improvement in symmetry at rest as well as oral and ocular competition. Conclusion: As currently presented in literature, microvascular free flaps are the technique of choice for facial reanimation. In our experience, we believe that gracilis muscle flap innervated by the masseteric nerve is a reliable and secure technique that provides adequate functional and aesthetic results (AU)