Temporal Bone Osteoradionecrosis: An 18-year, Single-Institution Experience.

OBJECTIVES/HYPOTHESIS: To report the largest single-institution review of temporal bone osteoradionecrosis (TBORN), and characterize the disease's natural history, prognostic factors, management, and outcomes. STUDY DESIGN: Retrospective chart review. METHODS: Retrospective review was conducted to identify patients with TBORN. Pertinent data were extracted. Descriptive statistics were used to summarize patient, tumor, and treatment characteristics. Multivariable analyses were conducted to explore associations between these characteristics and time to TBORN diagnosis and risk of developing diffuse disease. RESULTS: TBORN was identified in 145 temporal bones from 128 patients. Mean age at diagnosis was 62 years, and mean time to diagnosis after radiotherapy was 10 years. Age greater than 50 years was associated with earlier diagnosis. According to the Ramsden criteria, 76% of TBs had localized and 24% had diffuse disease at initial diagnosis; 37% had diffuse disease at last follow-up. On multivariable analysis, diabetes, three-dimensional conformal radiotherapy (3D-CRT), and periauricular skin malignancy were significant risk factors for developing diffuse disease. Localized disease was successfully managed with conservative measures, whereas surgery was often necessary for diffuse disease. When TBORN spread outside the mastoid or infratemporal fossa, conservative measures were always unsuccessful. CONCLUSIONS: TBORN occurs earlier in older patients. While diffuse disease is less common than localized disease, it occurs more frequently in patients with diabetes, history of 3D-CRT, and periauricular skin malignancies. Conservative management is appropriate for localized disease, while surgery is often necessary for diffuse disease. The prognostic factors identified helped propose a TBORN staging system and treatment guidelines which may improve patient risk stratification and disease management. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:2578-2585, 2021.

Temperature Measurements of the Semicircular Canal During Green Laser Irradiation of the Canal: A Preliminary Study.

BACKGROUND: Laser irradiation of the semicircular canal (SCC) is a good treatment for intractable benign paroxysmal positional vertigo. However, there were few reports on the temperature changes during laser irradiation. OBJECTIVE: To measure the internal temperature of the SCC and vestibule during green laser irradiation of the SCC and investigate morphologic changes using human temporal bones. METHODS: After the lateral SCC was blue-lined, a thermocouple was inserted into the SCC through a hole made in the canal wall. Another thermocouple was inserted into the vestibule through the oval window. Green laser was irradiated to the lateral canal wall. After the irradiation, the tissues were inspected as paraffin using HE staining. RESULT: The internal temperature of the SCC rose from 33 ° to 52 °C by a single laser irradiation of 1.5 W × 2 seconds and 82 °C by a single laser irradiation of 1.7 W × 3 seconds to the canal wall with a black spot. Continuous laser irradiation of 1.5 W × 3 seconds, 10 times resulted in a temperature rise of 92 °C from 33 °C. Throughout the whole experiments, temperatures within the vestibule were unchanged. Histopathology showed that the irradiated areas of the lateral canal wall were partially deficient with or without carbonization after single irradiation. By continuous laser irradiations, the SCC bony wall showed a peroration of 40 µm in diameter with carbonized edges. CONCLUSIONS: Green laser irradiation of the SCC produced char formation with perforation in the canal wall. High temperatures within the SCC were recorded for a short period of less than 30 seconds. However, the vestibule didn't show temperature changes.

A novel index for assessing treatment plan quality in stereotactic radiosurgery.

OBJECTIVEStereotactic radiosurgery (SRS) is characterized by high levels of conformity and steep dose gradients from the periphery of the target to surrounding tissue. Clinical studies have backed up the importance of these factors through evidence of symptomatic complications. Available data suggest that there are threshold doses above which the risk of symptomatic radionecrosis increases with the volume irradiated. Therefore, radiosurgical treatment plans should be optimized by minimizing dose to the surrounding tissue while maximizing dose to the target volume. Several metrics have been proposed to quantify radiosurgical plan quality, but all present certain weaknesses. To overcome limitations of the currently used metrics, a novel metric is proposed, the efficiency index (η50%), which is based on the principle of calculating integral doses: η50% = integral doseTV/integral dosePIV50%.METHODSThe value of η50% can be easily calculated by dividing the integral dose (mean dose × volume) to the target volume (TV) by the integral dose to the volume of 50% of the prescription isodose (PIV50%). Alternatively, differential dose-volume histograms (DVHs) of the TV and PIV50% can be used. The resulting η50% value is effectively the proportion of energy within the PIV50% that falls into the target. This value has theoretical limits of 0 and 1, with 1 being perfect. The index combines conformity, gradient, and mean dose to the target into a single value. The value of η50% was retrospectively calculated for 100 clinical SRS plans.RESULTSThe value of η50% for the 100 clinical SRS plans ranged from 37.7% to 58.0% with a mean value of 49.0%. This study also showed that the same principles used for the calculation of η50% can be adapted to produce an index suitable for multiple-target plans (Gη12Gy). Furthermore, the authors present another adaptation of the index that may play a role in plan optimization by calculating and minimizing the proportion of energy delivered to surrounding organs at risk (OARη50%).CONCLUSIONSThe proposed efficiency index is a novel approach in quantifying plan quality by combining conformity, gradient, and mean dose into a single value. It quantifies the ratio of the dose "doing good" versus the dose "doing harm," and its adaptations can be used for multiple-target plan optimization and OAR sparing.

Clinical application of radiation dose reduction for head and neck CT.

CT has advantages over MRI including rapid acquisition, and high spatial resolution for detailed anatomical information on the head and neck region. Therefore, CT is the first choice of imaging modality for the larynx, hypopharynx, sinonasal region, and temporal bone. Introduction of multi-detector CT (MDCT) scanning has allowed reduction in scan time, availability of isovoxel image, and relevant 3D image reconstruction; however, it leads to over-ranging due to helical scanning, and increased radiation dose due to 3D-volume imaging, and small detector size. In head and neck CT, reduction and optimization of radiation dose is very important, especially for prevention of the occurrence of cataract development due to radiation to lens, and prevention of the development of malignant tumour development from radiosensitive organs such as the salivary gland, thyroid gland, and retina, especially in children. The goal of dose reduction is "as low as reasonably achievable" (ALARA) level with preservation of appropriate image quality in clinical practice. Reduction of radiation dose per examination is essential; however, indication of repeat examination such as perfusion CT, dynamic contrast-enhanced CT, and follow-up study of malignant tumours should be optimized.

Effects of radiation on the temporal bone in patients with head and neck cancer.

Radiotherapy is a key component in the treatment of many head and neck cancers, and its potential to cause long-term adverse effects has become increasingly recognized. In this review, we describe the short-term and long-term sequelae of radiation-associated changes in and injury to the temporal bone and its related structures. The pathophysiology of radiation-induced injury and its clinical entities, including sensorineural hearing loss, chronic otitis media, osteoradionecrosis, and radiation-associated malignancies, are described. We also discuss radiation dose to the head and neck as it relates to these conditions. An improved understanding of radiation's effects on the temporal bone will enable physicians and researchers to continue efforts to reduce radiotherapy-related sequelae and guide clinicians in diagnosing and treating the various otologic conditions that can arise in patients with head and neck cancer who have received radiotherapy. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1428-1435, 2016.

Outcomes and complications of osseointegrated hearing aids in irradiated temporal bones.

OBJECTIVES/HYPOTHESIS: To compare the complication rate for osseointegrated hearing aids (OIHA) in patients with or without irradiation. STUDY DESIGN: Retrospective case review. METHODS: We studied patients with OIHAs implanted between January 1, 2005, and July 15, 2013 in a tertiary university center with a referral otology and neurotology practice. Demographics, history of oncologic surgery, follow-up length after OIHA implantation, radiation history and dosage, postoperative complications, and chronologic relationship between oncologic resection, OIHA implantation, and irradiation were reviewed to collect information. Soft tissue complications were graded according to a modified Holgers classification. RESULTS: The study included 48 patients. Twenty-nine patients (32 implants) did not undergo radiotherapy and 19 patients (19 implants) did. In the radiotherapy group, six patients had OIHAs implanted before radiotherapy, and 13 had OIHAs implanted in irradiated bone. Of these 13 patients, one had OIHA implanted during primary oncologic surgery; 11 had OIHA implanted during secondary surgery; and one patient did not have oncologic surgery. Patients with both OIHA implantation and radiotherapy had more complications than patients without radiotherapy (31.6% vs. 24.1%, P > 0.05) and more major complications than patients without radiotherapy (26.3% vs. 3.4%, P > 0.05). Patients with OIHAs implanted before radiotherapy did not have any complications. There were significantly fewer and less severe complications in patients with OIHAs implanted during primary oncologic resection than in patients with OIHAs implanted secondarily (0/8 vs. 8/11, P < 0.05). CONCLUSIONS: The rate and severity of complications of OIHAs can be minimized by implanting the device before irradiation, ideally at the time of primary oncologic surgery. LEVEL OF EVIDENCE: 4. Laryngoscope, 126:1187-1192, 2016.

Radiation-Induced Necrosis of the Temporal Bone: Diagnosis and Management.

OBJECTIVE: To document our experience with osteoradionecrosis (ORN) of the temporal bone. STUDY DESIGN: Retrospective case review. SETTING: Tertiary care medical center. PATIENTS: Patients who developed exposed necrotic bone of the external auditory canal after radiation therapy to the head and neck. INTERVENTIONS: Temporal bone ORN was managed conservatively in all patients with a combination of systemic antibiotics, antibiotic ear drops, and in-office debridement. Three patients required surgery, two of which were for a cholesteatoma. MAIN OUTCOME MEASURE: The need for surgical intervention in the management of ORN. RESULTS: Twenty-three patients with ORN of the temporal bone comprise the study group. The average age of patients at the time of diagnosis was 58 years (range, 34-75 yr). The parotid gland was the most common primary tumor site (n = 10). The mean lag time from completion of radiotherapy to diagnosis of ORN was 11 years (range, 2-48 yr). The most common presenting symptom was hearing loss (n = 18), followed by tinnitus (n = 13) and otorrhea (n = 13). All 23 patients were managed conservatively with antibiotic therapy and in-office debridement of necrotic bone. None of the patients required temporal bone resection and/or free-flap reconstruction. CONCLUSION: ORN of the temporal bone is a rare adverse event that can occur after radiotherapy for a variety of neoplasms of the head, neck, and central nervous system. Conservative management, which includes directed antibiotic therapy and regular in-office debridement of necrotic bone, can adequately control the disease process and symptomatology, thus avoiding more invasive surgical interventions.

Imaging Optimization of Temporal Bones With Cochlear Implant Using a High-resolution Cone Beam CT and the Corresponding Effective Dose.

OBJECTIVE: To evaluate the impact of tube voltage, tube current, pulse number, and magnification factor on the image quality of a novel experimental set-up and the corresponding radiation. MATERIALS AND METHODS: Six human temporal bones with cochlear implant were imaged using various tube voltages, tube currents, pulse numbers, and magnification. The effect of radiation was evaluated using a metaloxide semiconductor field-effect transistor (MOSFET) dosimeter device on an anthropomorphic RANDO RAN102 male head phantom. A copper and aluminum combination filter was used for hardware filtration. RESULTS: Overall, 900 frames, 11 mA, and 88 kV provided the best image quality. In temporal bones imaged with the optimized parameters, the cochlea, osseous spiral lamina, modiolus, stapes, round window niche, and oval window landmarks were demonstrated with anatomic structures still fully assessable in all parts and acceptable image quality. The most dominant contributor to the effective dose was bone marrow (36%-37 %) followed by brain (34%-36%), remainder tissues (12%), extra-thoracic airways (7%), and oral mucosa (5%). CONCLUSIONS: By increasing the number of frames, the image quality of the inner ear details obtained using the novel cone-beam computed tomography improved.

Sporadic endolymphatic sac tumor--a diagnostic and therapeutic challenge.

Endolymphatic sac tumor (ELST) is a rare low-grade locally aggressive neoplasm of the inner ear that may occur sporadically or in the setting of von Hippel-Lindau syndrome. We herein present a case of sporadic ELST in a 39-year-old man, treated using an interdisciplinary approach (surgery+radiotherapy), with a 10-year follow-up. The patient presented with hearing loss of sudden onset. The treatment of choice for ELST is radical tumor resection, which is associated with a good long-term prognosis. Remission may last for years, but there may be local recurrences, probably as a result of incomplete resection. Adjuvant radiotherapy is an option in case of recurrence and could be discussed after incomplete resection. The purpose of this report is to call attention to ELSTs, which are difficult to diagnose due to their rarity and variety of presentations.

CT findings in temporal bone osteoradionecrosis.

PURPOSE: The goal of this study was to describe computed tomographic findings in patients with clinically proven temporal bone (TB) osteoradionecrosis (ORN) (TB-ORN). MATERIALS AND METHODS: Computed tomographic scans of 20 patients were retrospectively evaluated for bony and soft tissue abnormalities. Clinical severity was graded based on level of therapy administered: mild (observation), moderate (antibiotics/hyperbaric oxygen), or severe (surgery). RESULTS: Radiation dose to the primary tumor ranged from 30 to 75.6 Gy. Time to onset of ORN from completion of radiation therapy was 2 to 22 years (median, 7 years). CLINICAL FINDINGS: exposed bone, 20 of the 20 patients; otorrhea, 17 of the 20 patients; hearing loss, 11 of the 20 patients; otalgia, 10 of the 20 patients; facial nerve paralysis, 2 of the 20 patients; gait imbalance, 2 of the 20 patients. Computed tomographic findings: external auditory canal erosions, 18 of the 20 patients; mastoid effusion, 18 of the 20 patients; mastoid bony coalescence, 5 of the 20 patients; enhancing soft tissue, 6 of the 20 patients; soft tissue gas, 6 of the 20 patients; temporomandibular joint/condylar erosion, 3 of the 20 patients.Three patients developed an abscess. CONCLUSION: Mastoid effusion and external auditory canal erosions are commonly seen with TB-ORN. Clinically moderate or severe cases of TB-ORN are more likely to demonstrate enhancing soft tissue (P = 0.002), soft tissue gas (P = 0.002), and temporomandibular joint involvement (P = 0.07).

Osteoradionecrosis of the external auditory canal: three cases involving reconstruction with transposition of a split temporalis muscle flap.

OBJECTIVE: Osteoradionecrosis of the temporal bone is an uncommon but well documented finding after radiotherapy in the head and neck region, and results in exposed, necrotic bone with a soft tissue defect in the external auditory canal. The defect can be treated either conservatively or surgically. This paper aims to describe the results of reconstruction of the external auditory canal by transpositioning of the superficial layer of either the anterior or posterior part of the temporalis muscle to cover the defect. PATIENTS AND METHODS: Three patients with large, symptomatic defects in the external auditory canal were treated with transposition of the superficial layer of the temporalis muscle. RESULTS: The duration of follow up was 4 to 16 months. No complications occurred. In all patients, re-epithelialisation was complete within 3 months. CONCLUSION: During reconstruction of the external auditory canal, transposition of the superficial layer of the temporalis muscle provides a reliable flap with a satisfactory outcome.

[Osteoradionecrosis of the temporal bone]. / Martwica popromienna kosci skroniowej.

INTRODUCTION: Radiotherapy is an effective, modern method of treating malignant neoplasms of head and neck and also intracranial tumours. Technological development and computerization of equipment used in radiotherapy enabled introduction of modern methods of treatment allowing decrease the risk of postradiation complications but not eliminating them completely. Postradiant necrosis of temporal bone that is osteoradionecrosis (ORN) is a quite well known complication of radiotherapy of head and neck tumours. Secretory otitis media, conductive deafness, excretion of sequesters through external auditory canal, inflammation and atresia of external auditory canal are common findings during examination. Cases of disseminated osteoradionecrosis need to be qualified for operation due to potential intratemporal and intracranial complications. Radical excision of necrotic tissue gives possibility of parallel cochlear implantation among patients with total bilateral deafness, which is a consequence of radiotherapy. AIMS: Aim of this study was clinical and epidemiological analysis of consequences and complications inside temporal bone which occurred after radiotherapy in the head and neck area. Conservative and surgical treatment possibilities according to progression of postradiant changes and severity of ailments were analyzed. Circumstances of conducting lateral petrosectomy with parallel cochlear implantation in case of osteoradionecrosis proceeding with total bilateral deafness were highlighted. MATERIAL AND METHODS: Retrospective analysis of 12 patients treated in the Department of Otolaryngology at the Medical University of Warsaw in 2000-2010 for postradiant consequences and complications inside the temporal bone was performed. The diagnosis of osteoradionecrosis was based on clinical ENT examination including meticulous microscopic examination, audiologic evaluation and CT scans of temporal bone. RESULTS: The group consisted of 5 men and 7 women. In 8 patients changes were unilateral and in 4 - bilateral. In total, 16 cases (ears) of osteoradionecrosis in the area of temporal bone were analyzed. Patients were mainly complaining about hearing loss or deafness, tinnitus, otalgia, otorhoea, feeling of fullness and distension in the ear. Presence of effusion in the middle ear was an indication for ventilation tube insertion. Cases of ORN potentially endangered by further complications needed surgical treatment, therein lateral petrosectomy. Case of osteoradionecrosis proceeding with total bilateral deafness needed a concurrent cochlear implantation. Only the patients with diffuse osteoradionecrosis confirmed by CT scans ere qualified for surgery. CONCLUSIONS: Radiotherapy of head and neck tumours is charged with risk of complications, both early and appearing later after therapy. Osteoradionecrosis is found many years after radiation and the course of illness is repeatedly tricky and potentially life-threatening. In the face of complications resulting from the essence of illness surgical treatment, therein lateral petrosectomy is necessary. Complications of radiotherapy cannot eliminate it as a method of independent treatment nor combined with other methods.

Incidence of osteoradionecrosis of the temporal bone.

BACKGROUND: Osteoradionecrosis of the temporal bone is a serious, late complication of radiotherapy to the temporal bone region. The aim of this study was to determine the incidence, risk and protective factors relating to the development of osteoradionecrosis of the temporal bone. METHODS: This is a retrospective review of prospectively collected data. A single surgeon collated a database over a 10-year period regarding patients undergoing surgery and subsequent radiotherapy for head and neck malignancies. This was reviewed, and information pertaining to demographics, nature of disease, radiation treatment regime and complications including osteoradionecrosis was extracted. Statistical analysis was then completed independently. RESULTS: A total of seven patients from the cohort of 82 developed osteoradionecrosis of the temporal bone within the period of the data collection. This represents an incidence of 8.5% (95% confidence interval = 3.6-13.4%). All who developed osteoradionecrosis had a metastatic parotid squamous cell carcinoma treated operatively with subsequent radiotherapy. There were no statistically significant risks or prognostic factors identified. Mean duration of follow-up was 32 months. CONCLUSION: The incidence of osteoradionecrosis of the temporal bone was 8.5% (95% confidence interval = 3.6-13.4%). Osteoradionecrosis of the temporal bone can present in excess of 10 years after treatment completion. This result may actually under -represent the true incidence of the complication. It has significant morbidity associated with its development and, occasionally, mortality. Those people undergoing radiotherapy to the parotid region may be at higher risk of osteoradionecrosis. A new classification system for osteoradionecrosis of the temporal bone has been proposed.

Temporal bone osteoradionecrosis after surgery and radiotherapy for malignant parotid tumors.

OBJECTIVE: To assess the incidence of osteoradionecrosis (ORN) of the temporal bone after surgery with radiotherapy for malignant parotid tumors. SETTING: A tertiary care, academic medical center. PATIENTS: All patients who underwent surgical resection with postoperative radiotherapy (RT) for a malignant parotid tumor between July 1988 and July 2007. INTERVENTIONS: A retrospective chart analysis to determine the extent of surgery, the RT parameters, and the incidence of ORN of the temporal bone. MAIN OUTCOME MEASURES: The incidence of ORN in 3 subgroups of patients. RESULTS: The 221 patients with malignant parotid tumors who underwent surgical resection with postoperative RT were divided into groups 1, parotidectomy only; 2, parotidectomy with mastoidectomy; and 3, parotidectomy with subtotal petrosectomy. The overall incidence of temporal bone ORN in group 1 was 2 (2%) of 106; in group 2, 8 (13%) of 64; and in group 3, 0 (0%) of 51. CONCLUSION: The incidence of temporal bone ORN is higher after mastoidectomy for facial nerve identification or resection in patients undergoing parotidectomy with postoperative radiotherapy. Oversew of the ear canal with mastoid obliteration should be considered in this subgroup of patients to avoid this long-term complication of radiotherapy used in the treatment of malignant parotid tumors.

Image quality and radiation exposure in 320-row temporal bone computed tomography.

OBJECTIVES: The aim was to define image quality and radiation exposure in the recently introduced 320-row CT of the temporal bone (tb) in comparison to a 16-row tb CT. METHODS: A cadaveric head phantom was used for repeated tb volume CT studies (80-120 kV, 25-150 mAs), performed in a 320-row scanner (single rotation, 0.5 mm slice thickness, kernel FC 51) in comparison to 16-row helical CT using standard acquisition parameters (SAP) of 120 kV and 75 mAs (kernel FC 53). Qualitative image evaluation was performed by two radiologists using a 5-point visual analogue scale. Image noise (D(SD)) was determined by region of interest (ROI) based measurements in cadaveric as well as water phantom studies. Dosimetric measurements of the effective dose (ED) and organ dose (OD) of the lens were performed. RESULTS: Image quality of 320-row tb CT was equivalent to 16-row CT for SAP scans, resulting in image noise levels (D(SD) 16-/320-row) of 109/237 and 206/446 for air and bone respectively. D(SD) differences were predominantly (>90%) attributable to the different kernels available for tb studies in 16- and 320-row CT. Radiation exposure for 16-/320-row SAP scans amounted to 0.36/0.30 mSv (ED) and 10.0/8.4 mGy (lens dose). CONCLUSION: 320-row volume acquisition in tb CT delivers equivalent image quality to 16-row CT while decreasing radiation exposure figures by one sixth. Image noise increase in 320-row CT is negligible with respect to image quality.

Treatment and outcome of advanced external auditory canal and middle ear squamous cell carcinoma.

This is a retrospective study to evaluate the outcomes and complications of combined treatment, surgery with or without adjunctive intraoperative radiotherapy, of locally advanced temporal bone squamous cell carcinoma. A series of 17 patients with locally advanced squamous cell carcinoma of the temporal bone were treated between September 2002 and February 2007. Eleven patients had primary tumors, and 6 patients had recurrences. According to the University of Pittsburgh staging system, 5 patients were stage II (T2 N0), 6 patients were stage III (5, T3 N0 and 1, T1 N1), and 6 patients were stage IV (5, T3 N2b and 1, T4 N0). All patients underwent lateral temporal bone resection and pedicle flap reconstruction. Eight patients received intraoperative and postoperative radiotherapies, 4 patients underwent postoperative radiation alone, whereas 5 patients did not receive any adjunctive treatment. Median follow-up was 29.5 months. No major complications were observed. No patients were found to have residual gross tumor. Disease-free survival was 73.3%, and overall survival was 75.6%. Radical external auditory canal and/or middle ear canal resection is of utmost importance to obtain a good surgical outcome. Postoperative radiotherapy is necessary to obtain good local control; no major adverse effects were observed in the intraoperative radiotherapy patients. The incidence of major complication is minimal after pedicle flap reconstruction.

Definitive radiotherapy in the management of paragangliomas arising in the head and neck: a 35-year experience.

BACKGROUND: An evaluation of the treatment results for 104 patients with 121 paragangliomas of the temporal bone, carotid body, and/or glomus vagale who were treated with radiation therapy (RT) at the University of Florida between 1968 and 2004. METHODS: Eighty-nine paragangliomas (86%) were treated with conventional megavoltage techniques, 15 (14%) patients with stereotactic fractionated radiation therapy, 6 (6%) patients with stereotactic radiosurgery (SRS), and 11 (11%) patients with intensity-modulated radiation therapy (IMRT). RESULTS: There were 6 local recurrences. One recurrence was salvaged with additional RT. The actuarial local control and cause-specific survival rates at 10 years were 94% and 95%. The overall local control rate for all 121 lesions was 95%; the ultimate local control rate was 96%. The incidence of treatment-related complications was low. CONCLUSION: Fractionated RT offers a high probability of tumor control with minimal risks for patients with paragangliomas of the temporal bone and neck.

Chronic ear surgery in irradiated temporal bones.

OBJECTIVE: To analyze outcomes of chronic ear surgery in patients with irradiated temporal bones. STUDY DESIGN: Retrospective case review. METHODS: Fifteen patients who received radiation involving the temporal bone underwent 21 surgical procedures from 1977 to 1997. Intraoperative findings, long-term complications, and hearing outcomes were analyzed. RESULTS: Over 50% of cases involved abnormal intraoperative findings including facial nerve dehiscence, labyrinthine fistulas, or dural exposure. Audiologic data revealed that these patients suffered from conductive, mixed, and sensorineural hearing loss. Long-term complications included tympanic membrane perforation and recurrent cholesteatoma. All patients had dry, non-draining ears at the end of the study. CONCLUSIONS: Irradiated temporal bones present difficult intraoperative anatomy and often require multiple procedures to cure otologic disease. Although radiation significantly reduces vascularity and hampers healing, vascularized reconstruction flaps are not necessary for good outcomes.

Ruptured pseudoaneurysm of the internal maxillary artery complicating CT-guided fine-needle aspiration in an irradiated, surgical bed.

BACKGROUND: CT-guided fine-needle aspiration (FNA) is a safe procedure, but major complications can occur rarely. Pseudoaneurysm rupture in the head and neck region following CT-guided FNA is an emergency that can result in life-threatening hemorrhage. This case emphasizes the salient risk factors for pseudoaneurysm formation and rupture in the head and neck region following CT-guided FNA. METHODS: A patient was seen with oral and facial hemorrhage as a result of a ruptured pseudoaneurysm 11 weeks following CT-guided FNA in a previously irradiated surgical bed. RESULTS: The patient was treated with coil embolization in and around the pseudoaneurysm and discharged without any further complications. CONCLUSIONS: Although CT-guided FNA is a safe and effective procedure, some patients may be at increased risk for rare but major complications. Caution should be used in proceeding with CT-guided FNA in an irradiated surgical bed of the head and neck.