Endolymphatic sac tumor with intralabyrinthine hemorrhage: a case report / 临床耳鼻咽喉头颈外科杂志

A 27-year-old female patient suffering endolymphatic sac tumor with intralabyrinthine hemorrhage was reported. The patient had hearing loss in the left ear with continuous tinnitus, and MRI showed the soft tissue shadow of endolymphatic sac. Considering that the tumor involved semicircular canal and vestibule,endolymphatic cyst tumor resection was performed by labyrinth route. After surgery, there was no cerebrospinal fluid leakage and facial nerve function was normal. More importantly, enhanced MRI of temporal bone showed no tumor recurrence 1 year after surgery.

Quiste epidermoide en conducto auditivo externo: reporte de caso / Epidermoid cysts of the external auditory canal: case report

Resumen El quiste epidérmico es una lesión benigna y común de la piel. Se desarrolla por un bloqueo de la unidad pilosebácea, con la consecuente proliferación de células epiteliales y secuestro de queratina. El 7% se desarrollan en cabeza y cuello, sin embargo, son infrecuentes en canal auditivo externo. Su patrón de crecimiento es lento y progresivo durante años, siendo asintomáticos. Al aumentar de tamaño causan sintomatología variable, acorde a su localización; en el canal auditivo tienen un comportamiento obstructivo que genera síntomas como otalgia e hipoacusia. Se presenta caso de una paciente de 69 años, con acúfeno e hipoacusia progresiva derecha. Durante la otoscopia se observó una neoformación obstructiva del 100% de la luz del conducto. Se realizaron estudios de imagen que reportaron tumoración de características quísticas de conducto auditivo derecho, bien circunscrita, sin erosión ósea. Para el diagnóstico definitivo, se realizó resección quirúrgica y biopsia reportando quiste epidérmico. Durante el seguimiento posoperatorio sin hallazgos de recidiva.

Abstract The epidermal cyst is a common and benign lesion of the skin. It develops due to a blockage of the pilosebaceous unit, with the consequent proliferation of epithelial cells and keratin sequestration. Seven percent develop in the head and neck; however, they are infrequent in the external auditory canal. Its growth pattern is slow and progressive over the years, being asymptomatic. As they increase in size, they cause variable symptoms, according to their location. In the ear canal they have an obstructive behavior that generates symptoms such as earache and hearing loss. A case of a 69-year-old female with tinnitus and progressive right hearing loss is presented. At otoscopy, a 100% obstructive neoformation of the canal lumen was observed. Imaging studies showed a well circumscribed, cystic tumor of the right ear canal, without bone erosion. For the definitive diagnosis, a resection and biopsy were performed, reporting an epidermal cyst. During follow up there was no recurrence of tumor.

Plasmocitoma extramedular de canal auditivo externo: caso clínico / Extramedullary plasmacytoma of external auditory canal: a case report

Resumen El plasmocitoma extramedular es una neoplasia de células plasmáticas poco frecuente, que se ubica en 80% a 90% de los casos en la cabeza o cuello. Esta neoplasia representa menos del 1% de toda la patología maligna de cabeza y cuello. Dada la poca frecuencia de la patología y la escasez de casos publicados, esta entidad presenta una gran dificultad clínica y terapéutica. El diagnóstico se basa en el análisis histológico con inmunohistoquímica de la muestra obtenida, y el tratamiento varía según la ubicación, donde se puede realizar radioterapia o cirugía. En este artículo presentamos el caso de una paciente de 56 años, con antecedentes de otorrea de larga data en oído derecho, al examen físico presentaba un tumor que obstruía todo el conducto auditivo externo. Se realizó exéresis tumoral y la biopsia evidenció un plasmocitoma.

Abstract Extramedullary plasmacytoma is a rare plasma cell neoplasm, affecting 80% to 90% of the head or neck. This neoplasm represents less than 1% of all malignant head and neck pathology. Given the infrequency of the pathology and the scarcity of published cases, this entity presents great clinical and therapeutic difficulty. Diagnosis is based on histology and immunohistochemistry and treatment varies depending on the location, where radiation therapy or surgery can be performed. In this article, we present the case of a 56-year-old patient with a history of long-standing otorrhea in the right ear. Physical examination presented a tumor that obstructed the entire external auditory canal. Tumor excision was performed, and the biopsy revealed a plasmacytoma.

Colgajo giratorio retroauricular / Retroauricular flip-flop flap

Resumen El colgajo retroauricular en isla (flip-flop flap) fue descrito por Masson en 1972 y consiste en tejido dermoepidérmico irrigado por un pedículo de patrón aleatorio subcutáneo de ramas de la arteria auricular posterior. Proviene de la región mastoidea y retroauricular y aporta buena cobertura para la región anteromedial del pabellón auricular. Se describen dos casos, en que se realizó cobertura inmediata secundario a un defecto de la concha auricular posterior a resección neoplásica, obteniendo resultados satisfactorios y sin complicaciones.

Abstract The retroauricular island flap (flip-flop flap), was described by Masson in 1972 and consists on dermoepidermal tissue irrigated by a random subcutaneous pedicle of branches of the posterior auricular artery. It comes from the mastoid and retroauricular region and provides a good coverage for the anteromedial region of the pinna. Two cases are described, in which immediate coverage was performed secondary to a defect in the auricular concha after a neoplastic resection, obtaining satisfactory results without complications.

Recurrence of Cholesteatoma: A Retrospective Study Including 1006 Patients for More than 33 Years

Abstract Introduction Cholesteatomas are benign tumors consisting of skin, and growing inside a retraction pocket in the tympanic membrane. Cholesteatomas can occupy the entirety of the middle ear, and are known for their osteolytic capabilities. Surgery is the only curative treatment for cholesteatomas. Objective To describe the risk of recurrence after first-time surgically-treated middle- ear cholesteatoma (STMEC1) on the island of Funen from 1983 to 2015. Methods Cases of STMEC1 were identified in the Danish National Hospital Register. The medical records were reviewed. Time-to-event analyses were applied. The ears were followed from STMEC1 to a secondary cholesteatoma, emigration, death, or end of follow-up. Results Records from 1,006 patients with STMEC1 were reviewed. A total of 54 patients were submitted to surgery on both ears. The total sample consisted of 1,060 ears with STMEC1; 300 were children's (< 16 years) ears, and 760 were adult's ears. The total observation time was of 12,049 years. The overall estimated proportion with recurrence 5 years after surgery was of 37% in children and of 15% in adults. The older the child was at the first surgery, the risk decreased by 7% per year. In children, canal wall up (CWU) mastoidectomy without obliteration was associated with a hazard ratio for recurrence of 1.9 (95% confidence interval [95%CI]: 1.2-3.0) compared with CWU with obliteration. Conclusion Compared with adults, children were had 2.6 times more risk of recurrence. Procedures performed without mastoidectomy had the lowest risk of recurrence. In children, obliteration was associated with a significantly lower risk of recurrence. However, patients were not randomized regarding the surgical approach; thus, the association between approach and risk of recurrence was likely influenced by confounding factors.

Retalho retroauricular ilhado para reconstrução parcial de orelha: relato de casos / Retroauricular island flap for partial ear reconstruction: case reports

Defeitos parciais de orelha podem ser tratados de diversas formas, dentre elas o fechamento primário, cicatrização por segunda intenção ou retalhos. Diversas opções técnicas foram descritas para a sua reconstrução de modo a manter o contorno natural da orelha, sem sacrificar tecido sadio ou alterar sua estética e função. Apresentamos neste artigo dois casos atendidos no Instituto do Câncer do Hospital de Base de São José do Rio Preto de reconstrução de defeitos condrocutâneos de orelha após ressecção de carcinoma basocelular em região central da orelha, com a confecção de retalho retroauricular ilhado transposto através de uma janela cartilaginosa e com o pedículo desepidermizado. Área doadora com fechamento primário. Tal procedimento constitui técnica segura, pois a região retroauricular é ricamente vascularizada, é de fácil execução, em único estágio e com resultado estético e funcional satisfatório.

Partial ear defects can be treated in several ways, including primary closure, healing by secondary intention, or flaps. Several surgical options have been described for reconstruction in order to maintain the natural contour of the ear, without sacrificing healthy tissues or changing the aesthetics and function. In this article, we present two cases of reconstruction of chondrocutaneous defects of the ear after resection of basal cell carcinoma in the central region of the ear, with the production of a retroauricular island flap transposed through a cartilaginous window with the de-epidermized pedicle. The donor area healed following a primary closure. This procedure can be performed in a single stage, yields satisfactory aesthetic and functional results, and is safe because the retroauricular region is richly vascularized.

Reconstrução da hélice: tripla transposição / Helix reconstruction: triple transposition

O câncer da pele não melanoma é a neoplasia maligna mais comum em humanos, sendo os carcinomas basocelulares responsáveis por aproximadamente 80% dos casos. A exposição cumulativa à radiação ultravioleta é o principal fator de risco associado ao carcinomas basocelulares, ocorrendo maior incidência nas áreas fotoexpostas, incluindo a região auricular. A região auricular é uma unidade cosmética nobre, cujas peculiaridades anatômicas tornam as cirurgias, com necessidade de excisão de grande quantidade de tecido, um desafio para o cirurgião dermatológico. Os autores apresentam caso de reconstrução da hélice e região retroauricular por meio de retalho com tripla transposição.

Non-melanoma skin cancer is the most common neoplasia in humans, and basal cell carcinomas (BCC) account for approximately 80% of cases. Cumulative exposure to ultraviolet radiation (UV) is the main risk factor associated to BCC, with a higher incidence in photoexposed areas, including the auricular region. The auricular region is a noble cosmetic unit, with anatomical peculiarities that lead surgeries to require the excision of a large amount of tissue, presenting a challenge for the dermatological surgeon. The authors present a case of helix reconstruction with a triple transposition flap.

Retalho pré-auricular tunelizado insular de base superior para reconstrução de defeitos auriculares / Superiorly-based, preauricular tunneled insular flap for reconstruction of auricular defects

O complexo auricular representa sede frequente de lesões, especialmente de origem tumoral ou resultante de eventos traumáticos. Diversas são as opções cirúrgicas para restaurar a integridade anatômica da orelha. Relatamos o caso de um paciente que apresentou lesões tumorais em mais de uma ocasião na face anterior da orelha esquerda e que precisou de intervenção cirúrgica para a correção do defeito gerado pela excisão tumoral. Como procedimento proposto, planejamos e executamos um retalho insular de base superior, que por meio de um túnel criado na projeção da fossa triangular foi rodado para a fossa escafoide, reparando-a em um único tempo cirúrgico, apresentando resultados estético e funcional satisfatórios ao paciente.

The auricular complex is commonly affected by tumors or traumatic events. Several surgical options are available for restoration of ear anatomy. We report the case of a patient who presented with tumor lesions on more than one occasion in the anterior left ear and required surgical intervention to correct the defect generated by excision. As a proposed procedure, we designed and executed a superiorly-based insular flap that was rotated to the scaphoid fossa through a tunnel created in the projection of the triangular fossa; this was performed in a single stage, and the patient was satisfied with the aesthetic and functional results.

Reconstrução da hélice da orelha sem triângulo de compensação / Ear's helix reconstruction without the compensation triangle

Os cânceres da pele na região da cabeça e do pescoço correspondem a 70-75% dos tumores cutâneos malignos, e, destes, 80% são do tipo carcinoma basocelular. O pavilhão auricular é a localização dos tumores cutâneos malignos em percentual que varia de três a 6% dos casos. Relatamos técnica alternativa para reconstrução da hélice após exérese de tumores sem a utilização do triângulo de compensação clássico, de modo a proporcionar cicatriz na dobra da hélice, com melhor resultado estético, sem retrações inestéticas ou cicatrizes transversais à hélice.

Skin cancers in the head and neck region account for 70-75% of malignant cutaneous tumors, of which 80% are basal cell carcinomas. Between 3-6% of malignant cutaneous tumors occur in the auricular pavilion. The authors of the present paper report an alternative technique for reconstructing the ear helix after excision of tumors, without the use of the classic compensation triangle. This method allows that the scar be located in the helical sulcus, resulting in a better aesthetic result, without unaesthetic retractions or scars located transversely to the helix.

A rare development of tumoral calcinosis of the ear auricle

Tumoral calcinosis is a condition characterized by deposition of calcium salts in the skin and sub- cutaneous tissue, commonly found around the joints. However, tumoral calcinosis of the auricle is extremely rare. We present the case of a 13-year-old boy with tumoral calcinosis of the helix of the ear auricle. A 13-year-old boy presented with a 10-year history of an enlarging mass on the left auricle. The mass was hard, non-tender, and non-compressible. The patient had no history of trauma. Complete surgical excision and pathological examination of the specimen was performed. The final diagnosis of the excised mass was tumoral calcinosis. After 9 months of follow-up, there were no signs of recurrence of the tumor and the patient was satisfied with the surgical results. Tumoral calcinosis of the auricle is extremely rare and may be misdiagnosed as other tumors. Pathological examination is essential for definitive diagnosis and complete surgical excision should be considered as the treatment of choice.

Prognostic Factors Affecting Surgical Outcomes in Squamous Cell Carcinoma of External Auditory Canal

OBJECTIVES: Carcinomas of the external auditory canal (EAC) are rare, and management remains challenging. Previous studies seeking prognostic factors for EAC cancers included cancers other than carcinomas. In this study, we analyzed the treatment outcomes of, prognostic factors for, and survival rates associated with specifically squamous cell carcinoma (SCC) of the EAC. METHODS: A retrospective review of 26 consecutive patients diagnosed with SCCs of the EAC in a 10-year period was performed in terms of clinical presentation, stage, choice of surgical procedure, and adjunct therapy. Overall survival (OS) and recurrence-free survival (RFS) were calculated and univariate analysis of prognostic factors was performed. RESULTS: The median age of the 26 patients with SCCs of the EAC was 63 years (range, 40 to 72 years), and 16 males and 10 females were included. According to the modified University of Pittsburgh staging system, the T stages were T1 in 11, T2 in six, T3 in four, and T4 in five cases. The surgical procedures employed were wide excision in three cases, lateral temporal bone resection (LTBR) in 17, and extended LTBR in four, and subtotal temporal bone resection in two. Two patients underwent neoadjuvant chemotherapy, and two underwent adjuvant chemotherapy. One patient received preoperative radiation therapy, and eleven received postoperative radiation therapy. Of the possibly prognostic factors examined, advanced preoperative T stage and advanced overall stage were significant predictors of RFS, but not of OS. CONCLUSION: The advanced T stage and overall stage were associated with decreased survival after surgical treatment in patients with SCC of the EAC, highlighting the importance of clinical vigilance and early detection.

Resonancia magnética con secuencia HASTE de carcinoma epidermoide del hueso temporal / HASTE magnetic resonance imaging of a squamous cell temporal bone carcinoma

El carcinoma epidermoide del hueso temporal es una neoplasia derivada de células epidérmicas del estrato espinoso, y que dado su baja incidencia, y presentación clínica similar a un cuadro de otitis media crónica colesteatomatosa, su diagnóstico es habitualmente tardío. El estudio del carcinoma epidermoide del hueso temporal se realiza con tomografía computarizada, la que evidencia erosión ósea. Sin embargo, existen distintos diagnósticos diferenciales, tanto malignos como benignos, que pueden provocar hallazgos similares en la tomografía computarizada. La resonancia magnética (RM) es un método de exploración de gran valor complementario para el estudio del carcinoma de oído medio. La RM con secuencia de difusión HASTE ha surgido como herramienta de estudio en patología de hueso temporal, tales como colesteatomas y teratomas de oído medio, pese a esto, no existen reportes en la literatura de la presentación imagenológica del carcinoma epidermoide de hueso temporal utilizando este método. En este artículo se presenta un caso clínico de una paciente con carcinoma epidermoide de oído medio, cuyo estudio preoperatorio incluyó RM-HASTE. Aun cuando se requiere un mayor número de casos para establecer el patrón imagenológico, se concluye que esta técnica es de utilidad para diferenciar este tumor de otitis media crónica colesteatomatosa.

Squamous cell carcinoma of the temporal bone (SCC) is a malignancy originated from epidermis spinous cells. Its low incidence and similar presentation to cholesteatomas, contributes to its late diagnosis. The most widely used study for this tumor is computed tomography (CT), which mainly evidences erosion of the temporal bone. There are several other diagnoses, malignant and benign, that could provoke similar findings at the CT. Magnetic resonance imaging (MRI) is a method of great value to study SCC. MRI with HASTE diffusion sequence has recently emerged as an important tool in the study of temporal bone pathologies, such as cholesteatoma and middle ear teratoma, despite this, there are no reports in the literature of the imaging presentation of SCC using this method. This article presents a clinical case of a patient with SCC, in whose preoperative study was performed HASTE-MRI. Although a larger number of cases are required to establish an imaging pattern, it is concluded that this technique is useful to differentiate this tumor from middle ear cholesteatomas.

Meningioma extradural de oído medio: reporte de un caso y revisión de la literatura / Extradural meningioma of middle ear: reporting a case and literature review

Los meningiomas son los tumores no gliales más comunes del sistema nervioso central constituyendo el 24%-30% de los tumores intracraneales y el 25% de los tumores de médula espinal. Se originan de células de la aracnoides y en general presentan un comportamiento benigno. Existe un subtipo llamado meningioma extracraneal primario o extradural que es poco frecuente y afecta principalmente el área de cabeza y cuello. Debido a su baja prevalencia y síntomas poco característicos son a menudo diagnosticados por fortuna, siendo la inmunohistoquímica fundamental. Se presenta el caso de una mujer adulta con una lesión tumoral en oído medio diagnosticada inicialmente mediante una biopsia incisional como un granuloma de colesterol. Luego del tratamiento quirúrgico y estudio de inmunohistoquímica se concluye el diagnóstico definitivo de meningioma extradural de oído medio. Se analiza la literatura al respecto y se discute sobre su epidemiología, clínica, estudio y manejo.

Meningiomas are the most common non-glial tumors of the central nervous system constituting 24-30% of intracranial tumors and 25% of spinal cord tumors. They originate from arachnoid cells and generally exhibit benign behavior. The subtype primary extracranial meningioma or extradural meningioma that is uncommon and affects the head and neck area. Due to their low prevalence and uncharacteristic symptoms are often diagnosed by fortune, being the immunohistochemistry fundamental. We present the case of an adult woman with a tumor lesion in the middle ear initially diagnosed by an incisional biopsy such as a cholesterol granuloma. After the surgical treatment and immunohistochemical study, the definitive diagnosis of extradural meningioma of the middle ear is concluded. The literature on this subject is analyzed and its epidemiology, clinical practice, study and management are discussed.

Post-auricular full thickness skin graft by M-plasty technique: an alternative to classical elliptical technique

Benign lesions over the auricular region are not uncommon. Most lesions require an excisional biopsy for its histopathological confirmation. If excised, the resultant would be a small to medium sized soft tissue defect, exposing the cartilaginous portion of the ear. Options for reconstruction include a full-thickness skin graft, local flap cover or a wedge composite excision to retain the aesthetic appearance of the auricle. Local flap cover or wedge composite resection are not without demerits. If a full thickness graft is needed, the donor area is usually the post auricular region. We present a modified elliptical incision M-plasty technique to minimize the tissue loss in donor post auricular area when harvesting full thickness skin graft. Although the traditional elliptical incision is used by majority of surgeons to harvest full thickness skin graft from the post-auricular region, the M-plasty technique used in our case is a modification of the traditional elliptical incision which preserves tissue that allows the surgeon to close the wound with less tension and short scar

Staged retroauricular flap for helical reconstruction after Mohs micrographic surgery

Abstract Staged retroauricular flap is a great option for full-thickness defects along the helical rim and antihelix. Donor site consists of the posterior ear, postauricular sulcus and mastoid area. The advantages of this flap include hidden donor scar, donor tissue similarity and rich vascularity. We present a case of collision tumor on the left helix treated with Mohs micrographic surgery and the resulting full-thickness defect repaired with a staged retroauricular flap. This flap is an effective technique for full-thickness helical defect repair with relatively little operative morbidity. High esthetic and functional results may be obtained restoring the ear size and shape.

Carcinoma escamoso de conducto auditivo externo: reporte de 3 casos / Squamous cell carcinoma of the external auditory canal: report of three cases

El carcinoma escamoso de conducto auditivo externo es poco frecuente. La sintomatología puede semejar una otitis externa u otitis media crónica, lo que puede retrasar el diagnóstico. La falta de un sistema de clasificación y el número limitados de casos hace difícil la elaboración de guías de tratamiento. Se describe una serie de casos de esta neoplasia, asf como una revisión de la literatura actual.

Squamous cell carcinoma of the external auditory canal is rare. The symptoms may resemble an external otitis or chronic otitis media, which can delay diagnosis. The lack of a classification system and the limited number of cases makes it difficult the development of treatment guidelines. We present a case series of this neoplasia, as well as a review of the literature.

Carcinoma espinocelular del oído externo con extensión parotídea: a propósito de un caso / Squamous cell carcinoma of the external ear with parotid extension: case report

El pabellón auricular y el conducto auditivo externo constituyen una región anatómica que puede ser asiento de múltiples patologías, entre ellas procesos inflamatorios, infecciosos y neoplásicos, tanto benignos como malignos. Con respecto a los tumores, los diversos tipos suelen presentarse con síntomas y signos similares y en general es difícil inferir la variedad histológica del tumor a través del examen físico, por lo cual es necesario el estudio histopatológico para determinar el diagnóstico. La mayoría de los tumores del oído externo son carcinomas; entre ellos se destacan el carcinoma basocelular, el más frecuente, y el carcinoma espinocelular. Menos frecuentemente se encuentran otros tipos de tumores como los melanomas, adenocarcinomas, carcinomas de glándulas ceruminosas, carcinomas mucoepidermoides, sarcomas, procesos linfoproliferativos, etc. Suelen ocurrir en la edad media y avanzada (50-70 años) y con mayor periodicidad en el sexo masculino. En el presente trabajo se describe un caso clínico de carcinoma espinocelular del oído externo, tratado exitosamente mediante cirugía y radioterapia, así como también se describen las características clínicas de esta enfermedad, con especial atención al compromiso del oído externo por ella.

The pinna and the ear canal are an anatomical region that can be affected by many diseases, including inflammatory, infectious and benign and malignant neoplastic processes. With regard to tumors, various types usually present with similar symptoms and usually is very difficult to know the histological type through physical examination, so histopathological examination is necessary in order to determine the diagnosis. Most tumors are carcinomas; they can be basal cell carcinoma (more frequently), or squamous carcinoma. Less frequently are other types of tumors such as melanomas, adenocarcinomas, ceruminous glands carcinomas, mucoepidermoid carcinomas, sarcomas, lymphoproliferative disorders, etc. They usually present in middle and advanced age people (50-70 years) and are more frequently in men. In this article we present a case of squamous cell carcinoma of the external ear with extention to parotid gland, successfully treated with surgery and radiotherapy, as well as we describe the clinical characteristics of this disease, with special attention to the compromise of the external ear. (AU)