ABSTRACT
Epitympanic fixation of the incus and malleus may be surgically corrected by transcanal atticotomy and removal of the fixed incudomalleolar mass. Restoration of serviceable hearing has resulted in five of six cases by repositioning the natural incus or using a homograft incus.
Subject(s)
Ear Ossicles/abnormalities , Stapes Mobilization/methods , Hearing , Humans , Postoperative PeriodABSTRACT
A series of 54 patients treated for frontal sinus fractures at Charity Hospital, New Orleans, from 1967-77 is presented. There were a large number of suppurative complications related to the various medical and surgical managements. Initial treatments included: observation (15), exploration and open reduction (22), obliteration (16), and ablation (1). Four patients with open fractures were not explored and developed recurrent frontal sinusitis; one progressed to an osteomyelitis. Two with posterior table fractures were not explored and developed meningitis (one was then obliterated and developed an epidural abscess). Three patients developed frontal sinus abscesses after obliterations for anterior wall fractures. Fat gave fewer complications than the other commonly used materials. Exploration is advocated for most frontal sinus fractures. Obliteration should be avoided when possible. Fat is the material of choice when obliteration is required.
Subject(s)
Fractures, Bone/complications , Fractures, Bone/surgery , Frontal Sinus/injuries , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Suppuration/etiologyABSTRACT
Utrasonic irradiation of the labyrinth via the round window is effective in controlling otological vertigo. This method of surgical management for incapacitating vertigo is presented with demonstrative intraoperative electronystagmograms and irradiated cat neuro-epithelium. Such data suggest that more intense irradiation doses than previously reported should be applied to effectively destroy the diseased labyrinthine end organs. Precise end points of destructive irradiation are defined by characteristic intraoperative electronystagmograms. The authors suggest this is an ideal procedure when the situation of an unaffected cochlea, coexisting with a diseased labyrinth, requires a minimally invasive, destructive procedure which preserves hearing while eradicating vertigo.
Subject(s)
Electronystagmography , Electrooculography , Meniere Disease/therapy , Ultrasonic Therapy , Ear, Inner , Ear, Middle , Follow-Up Studies , Humans , MethodsABSTRACT
Seven cases are presented to illustrate four cervical surgical approaches to the upper mediastinum and thorax. These surgical approaches are described and illustrated, and we have termed these the retrosternal, retroclavicular, posterior, and lateral approaches. Two cases of thymic cyst, one of recurrent metastatic pretracheal adenopathy, a case of tracheal stenosis, a foreign body of the left subclavian artery, a large Zenker's diverticulum, and a neoglottic reconstruction are presented to illustrate the surgical anatomy, dissection technique, and postoperative complications.
Subject(s)
Head and Neck Neoplasms/surgery , Adolescent , Aged , Child, Preschool , Female , Humans , Male , Mediastinal Cyst/surgery , Methods , Middle Aged , Tracheal Neoplasms/surgery , Tracheal Stenosis/etiology , Tracheal Stenosis/surgery , Tracheotomy/adverse effectsABSTRACT
By retrospective analysis of 35 surviving gunshot injuries to the temporal bone and by presentation of 6 representative cases, the management and reconstructive procedures of these injuries in the Tulane University affiliated hospitals are presented. The most frequent single injury was facial nerve paralysis (16 cases), followed by external canal injury and conductive hearing loss. Anacusis occurred in 12 cases. In conductive hearing loss the intact posterior wall tympanoplasty with mastoidectomy (16 cases), or the modified radical mastoidectomy (5 cases), allowed middle ear reconstruction. Transmastoid facial canal decompression, combined with the above procedures or with a middle fossa craniotomy, was performed in 6 cases. Delayed facial reconstruction (5 cases) utilized microneural anastomosis between facial-facial and hypoglossal-facial nerves and fascia lata slings. Intracranial complications of thrombosis of internal carotid artery, dural venous lacerations, temporal lobe aphasia, bitemporal hemianopsia, cerebral abscesses and meningitis are also discussed.
Subject(s)
Temporal Bone/injuries , Wounds, Gunshot/surgery , Adolescent , Adult , Aged , Brain Stem/injuries , Child , Child, Preschool , Ear/surgery , Ear Canal/injuries , Ear, Inner/injuries , Ear, Middle/injuries , Facial Nerve/surgery , Facial Nerve Injuries , Female , Humans , Male , Mastoid/injuries , Mastoid/surgery , Middle Aged , Petrous Bone/injuries , Temporal Lobe/injuriesABSTRACT
During a 10-year period (1984-1994) 1229 stapes operations for otosclerosis were performed at our respective institutions by experienced surgeons well trained in the various techniques. Procedures included 691 stapedectomies, 234 small-fenestrae stapedotomies, and 304 revision operations. These primary and revision cases resulted in 20 ears with severe sensorineural hearing loss or anacusis noted during the immediate postoperative period. This article will critically evaluate those procedures that resulted in profound hearing loss and attempt to determine possible reasons for this occurrence. It is hoped that these data will allow surgeons to identify before and/or during surgery patients at risk for development of this complication and therefore decrease the overall morbidity rate of this exacting procedure.