Giant Epidermoid Cyst of the Maxillary Sinus: A Postoperative Complication?

Epidermoid cysts are benign lesions, which are usually detected on the floor of the mouth in the head and neck region. They can develop from abnormal epithelial components of an ectoderm tissue during the embryological life or alternatively they can arise from the implanted epithelium after trauma or surgery. The diagnosis of an epidermoid cyst in the maxillary sinus can be challenging and it could be easily mistaken for any benign or malign lesion of the nasal cavity and paranasal sinuses. In this case, we present a 44-year-old man with a giant epidermoid cyst in the right maxillary sinus with a previous history of paranasal sinus surgery. We present a very rare case of epidermoid cyst and also discuss the importance of radiological imaging modalities in differential diagnosis of a unilateral expansile mass in the maxillary sinus.

Sensorineural hearing loss after ossicular manipulation and drill-generated acoustic trauma in type I tympanoplasty with and without mastoidectomy: A series of 51 cases.

Recognized causes of high-frequency sensorineural hearing loss (SNHL) after tympanoplasty with and without mastoidectomy include acoustic trauma from manipulation of the ossicles, the noise generated by suctioning and, in the case of mastoidectomy, the noise generated by temporal bone drilling. We conducted a retrospective study to identify the effects of ossicular manipulation and mastoid drilling on high-frequency SNHL. Our study population was made up of 51 patients-20 males and 31 females, aged 10 to 59 years (mean: 28.5). Of this group, 26 patients had undergone a unilateral over-under tympanoplasty only (tympanoplasty group) and 25 had undergone a unilateral tympanoplasty plus additional mastoid surgery (mastoidectomy group). Bone-conduction audiograms were obtained pre- and postoperatively; the latter were obtained within 24 hours after surgery and again at 6 months of follow-up. In the tympanoplasty group, a significant SNHL, primarily at 2 kHz, was seen in 6 patients (23%) at 24 hours, but at 6 months there was no depression of bone-conduction thresholds. In the mastoidectomy group, a significant SNHL, primarily at 2 and 4 kHz, occurred in 12 patients (48%) at 24 hours, and bone-conduction deterioration was still present in 4 patients (16%) 6 months after surgery. The difference between the preoperative audiograms and the 6-month audiograms in both groups was statistically significant (p = 0.034). We conclude that (1) over-under tympanoplasty, which requires significant manipulation of the ossicles, can cause temporary SNHL after surgery, and (2) prolonged exposure to the noise generated by mastoid drilling can result in permanent SNHL.

A novel method for internal nasal valve reconstruction: H-graft technique.

OBJECTIVES: The aim of this study was to determine the efficacy of a novel method for internal nasal valve reconstruction that enables lateralization of the superior segment of upper lateral cartilages (ULC) from the septum to a greater extent than the spreader graft method with lateral wall support. STUDY DESIGN: Prospective, controlled study set at a tertiary medical center. METHODS: The study group was composed of 19 consecutive patients with pure internal nasal valve dysfunction who underwent surgery with the presented technique. All patients completed the Nasal Obstruction Symptom Evaluation (NOSE) and Rhinoplasty Outcomes Evaluation (ROE) tests preoperatively and at 12th month postoperative control to compare functional and aesthetic outcomes. RESULTS: Based upon pre- and postoperative calculations made using NOSE scores, there was significant improvement regarding nasal blockage or congestion, troubled breathing and sleeping, and air through nose during exercise, respectively (P < .05). There were no aesthetic changes encountered by the patient when pre- and postoperative ROE scores were compared (P > .05). CONCLUSIONS: The H shape of the graft not only improves the graft stability on dorsal septum but also has the advantage of combining the spreader and the splay effects. Current data from this prospective study suggest that this technique may be used in the surgical treatment of internal nasal valve dysfunction.

Prolene mesh mentoplasty.

Augmentation mentoplasty is a cosmetic surgical procedure to correct chin retrusion or microgenia which usually requires placement of an alloplastic material over the pogonion, and which results in increased chin projection and a more aesthetically balanced facial profile. Polypropylene mesh is easy to purchase, widely available in a general hospital and most commonly used by general surgeons. In this series of 192 patients, we wanted to demonstrate our simple mentoplasty technique using prolene mesh that can easily be combined with a rhinoplasty procedure, with possible causes of infection and the rationale for using prolene mesh in such procedures.

Skin prick test reactivity in patients with chronic eczematous external otitis.

OBJECTIVES: To investigate the incidence of skin prick test (SPT) positivity in patients with eczematous external otitis. METHODS: Forty-six patients with eczematous external otitis and forty-four healthy volunteers were included in the study. All the patients were skin-tested by prick test. Reactions were assessed by the degree of redness and swelling and the size of the wheal produced. RESULTS: According to SPT positivity and total immunoglobulin E values, the difference between the study and the control groups was statistically significant (P<0.05). The most common skin reactions were against to mites and grasses in this study. CONCLUSION: Eczematous external otitis is perhaps the most difficult to treat of all forms of external otitis because the provocative agents usually remain undiagnosed. Patients suffering from eczematous external otitis symptoms should be investigated for allergens and be informed for prevention of the causative agents. SPT might be performed in cases of prolonged or treatment-resistant external otitis.

Esterified hyaluronic acid improves cartilage viability in experimental tracheal reconstruction with an auricular graft.

OBJECTIVE: The aim of this study was to determine the efficacy of esterified hyaluronic acid (HYAFF) on the vitality of auricular cartilage grafts used for tracheoplasty, with respect to macroscopic and microscopic parameters. STUDY DESIGN: Prospective, controlled. SETTING: Academic research laboratory. SUBJECTS AND METHODS: The study included 14 New Zealand rabbits acquired specifically for the study. The rabbits were divided into two groups: the control group, in which free cartilage grafts were not exposed to any materials or additional procedures (n = 7), and the hyaluronic acid (HA) treatment group, in which auricular grafts and anastomosis lines were covered with HYAFF (n = 7). Free auricular cartilage grafts used for the reconstruction of experimentally created tracheal defects were anastomosed extraluminally. All the rabbits were sacrificed two months post surgery. Samples were collected and examined histopathologically. The sections were stained with hematoxylin-eosin, Masson's trichrome, and inducible nitric oxide synthase (iNOS) and examined under a light microscope. RESULTS: Fibrosis and cartilage mass significantly differed between the control and HYAFF group (P < 0.05). Immunohistochemical examination showed that more chondrocytes stained with iNOS in the control group than in the HYAFF group, according to histologists' observations. CONCLUSION: HYAFF catalyzed wound healing with less fibrous tissue formation, had chondroprotective and stimulatory effects on chondrocyte metabolism, and decreased nitric oxide production and apoptosis via improving the nourishment of free auricular cartilage grafts, subsequently preventing hypoxia and oxidative stress, particularly in the early postimplantation period.

The influence of smoking on success of tympanoplasty measured by serum cotinine analysis.

The aim of this study was to evaluate the effects of smoking on surgical outcome and hearing results in tympanoplasty by serum cotinine analysis as an objective method. Furthermore, type of grafting for the smoking patients has been investigated in a prospective cohort in a tertiary medical center. The overall success rate of long-term surgical outcome was 70.1% out of 77 tympanoplasty operations. On the basis of cotinine enzyme immunoassay, 56 patients had a serum cotinine measurement below 17.5 ng/ml and 21 patients above that. While the graft take rate in the non-smoking group was 76.8%, it was 52.4% in the smoking group and this difference was statistically significant (p = 0.037). While mean graft take rate in the temporalis fascia group was 25% for smokers, mean graft take rate in cartilage shield tympanoplasty group it was 88.9%, and for smokers it was 52.4%. Cotinine is a major metabolite of nicotine and is a reliable marker to differentiate smoking patients from non-smokers. Smoking status was found as a significant prognostic factor influencing the success rate of tympanoplasty negatively and the influence of a more stable grafting technique was demonstrated on smoking patients undergoing tympanoplasty procedure.

Palisade cartilage tympanoplasty for management of subtotal perforations: a comparison with the temporalis fascia technique.

UNLABELLED: The use of cartilage as a grafting material has been advocated in cases at high risk for failure, such as subtotal perforations, adhesive processes, tympanosclerosis and residual defects after primary tympanoplasties. The cartilage palisade technique, in which the TM is fully reconstructed with palisade-shaped cartilage pieces, was first described by Heermann. Cartilage material has been criticized because of concerns regarding hearing results, however, large cartilage plates with thicknesses 50% of the whole TM area), intact ossicular chain, at least more than 1 month dry period and normal middle ear mucosa were included in the study. Palisade cartilage tympanoplasty group included 23 cases, whereas 28 patients were were in the fascia group. INTERVENTION: therapeutic. Graft take rates were noted in 51 patients and pre- and post operative audiograms were compared using the chi-square test with Yates' continuity correction, Fisher's exact test, t test and repeated measures ANOVA. Graft take was achieved in 22 patients (95.7%) in palisade cartilage group and in 21 patients (75%) in temporalis fascia group (P = 0.059). Mean speech reception threshold, air-bone gap and pure-tone average scores comparing the gain between both techniques showed no significant changes in the threshold (P > 0.05). However the functional success was achieved with the palisade cartilage technique postoperatively, regarding to mean air-bone gap and speech reception threshold changes. Our experience with palisade cartilage technique demonstrates that subtotal or total perforations at high risk for graft failure, can be treated efficiently and a durable and resistant reconstruction of the TM with reasonable hearing can be achieved.

Spherulocytosis of the maxillary sinus: a case report.

Spherulocytosis (myospherulosis) is an unusual foreign-body reaction usually occurring in tissues exposed to petrolatum-based products. Due to its occasional localization in the maxillary sinus, it is of interest to rhinologists and maxillofacial surgeons. The pathogenesis of spherulocytosis has remained a matter of controversy. We present the case of a 40-year-old female with no previous contact to petrolatum-based substances and suffering from spherulocytosis of the maxillary sinus. The review of literature with emphasis on etiopathogenesis and factors that predispose to the development of spherulocytosis, other than exposure to petrolatum-based ointment, are discussed.

The anti-oxidant effect of alpha-tocopherol in the prevention of experimentally induced myringosclerosis.

HYPOTHESIS: The objective of this study was to investigate the possible effect of alpha-tocopherol on the prevention of experimentally induced myringosclerosis. BACKGROUND: Myringosclerosis is a common sequela of ventilation tube treatment of otitis media with effusion. The relationship between oxygen-derived free radicals and occurrence of myringosclerosis has been proven in experimental models, and it was also shown that the formation of myringosclerosis after experimental myringotomy could be reduced by application of various free radical scavengers. METHODS: Eighteen Wistar albino rats were myringotomized on the left side and randomly separated into two groups: group A consisted of rats which received intramuscular alpha-tocopherol injections 100 mg/kg daily and group B which were injected with physiological serum only. The occurrence of myringosclerotic plaques in the tympanic membranes of the two groups was compared by otomicroscopy, histopathology, and tympanometry, which is a novel method of quantification. Blood samples were collected for biochemical evaluation, and the tympanic membranes were harvested on the 15th day of the experiment. RESULTS: In otomicroscopic evaluation, tympanic membranes in group B revealed varying degrees of myringosclerotic plaques; on the other hand, tympanic membranes in group A showed faint or no existence of myringosclerosis. The mean malondialdehyde levels were 1.33 +/- 0.11 micromol/L in group A and 7.49 +/- 1.37 micromol/L in group B (Z = -1.906, p = 0.057). In all ears from group B, the magnitude of the maximum admittance measured by tympanometry reduced to approximately 40% of the values obtained from group A (Z = -2,160, p = 0.031). The mean magnitude of the maximum admittance from group A was very close to the standardization values of Wistar albino rats, which predicts a functional outcome. CONCLUSION: The formation of myringosclerosis after experimental myringotomy can be diminished by intramuscular alpha-tocopherol injections.

Tympanometric changes in an experimental myringosclerosis model after myringotomy.

HYPOTHESIS: The goal of this experimental study was to investigate the specific effect of myringosclerosis on tympanograms in the tympanic membranes of myringotomized rats by using otomicroscopy, tympanometry, and histopathology. BACKGROUND: Myringosclerosis is a common sequela of ventilation tube treatment of otitis media with effusion. The condition involves the hyalinization and calcification of the collagen layer in certain areas of the tympanic membrane. Previous animal experiments suggest an intimate relationship between the formation of myringosclerosis and an increased oxygen concentration in the environment of the wound after myringotomy. The result of a myringotomy therefore is an increased production of free oxygen radicals, initiating irreversible tissue damage involving fibrosis, hyalin degeneration, and finally apoptosis as observed in myringosclerosis. We propose an experimental model specific for creating sclerotic plaques solely on the tympanic membrane and for performing tympanometric measurements on this pure myringosclerosis model without creating any abnormality in the middle ear to test in what proportion myringosclerosis contributes to decrease of amplitude in tympanograms. METHODS: To assess the normal tympanometric values of Wistar albino rats, the pressure and peak admittance of the left middle ears were measured using a semiquantitative computerized clinical admittance meter using a sound frequency of 226 Hz. Twelve animals were randomly selected for the myringotomy group and perforations in the left ears were created. All tympanic membrane perforations in this group had healed and closed prior to the otomicroscopic examination and no pathologic reaction was observed in the external ear canals of rats. Otomicroscopic and tympanometric measurements were carried out on Day 15 and the degree of myringosclerosis was noted before the animals were killed. Twelve specimens in the myringotomy group were histopathologically examined for the presence of myringosclerotic plaques. RESULTS: Under light microscopy, extensive sclerotic lesions were found in the tympanic membranes of the myringotomy group, and these sclerotic deposits were located in the lamina propria. The myringosclerosis occurred predominantly adjacent to the handle of the malleus, but also near the annular region. In all ears with myringosclerosis, the magnitude of the maximum admittance reduced to approximately 50% of the Day-0 values, and this reduction was statistically significant (Z=-3.061, p=0.002). CONCLUSION: The present findings in this study are consistent with the fact that the movement of the tympanic membrane is hampered by lesions of sclerotic material, resulting in a decrease of amplitude in tympanograms (such as Type As) without any effusion or inflammation in the middle ear.

An intradermal nevus of the external auditory meatus.

We herein describe a rare case of an intradermal nevus arising in the external auditory meatus. A 36-year-old woman presented with progressive hearing loss on the right ear, and otomicroscopic examination revealed the presence of a large, violaceous, dome-shaped, papillomatous lesion originating from the posterior wall of the external canal of the right ear. Upon excisional biopsy, the tumor was diagnosed as an intradermal nevus. Thus, this is a unique case of intradermal nevus obstructing the external ear canal with the patient presenting with progressive hearing loss. The possibility of a benign nevomelanocytic nevus should not be underestimated when evaluating a lesion obstructing the ear canal, and all melanocytic nevi should be excised instead of biopsied to rule out melanoma.

An unusual foreign body in the floor of the mouth presenting as a gradually growing mass.

Foreign bodies in the upper aerodigestive tract represent one of the most common ENT emergencies, but patients with foreign bodies in the floor of the mouth rarely present to the otolaryngologist. Only a very small number of these foreign bodies are embedded under normal mucosa and can result in lethal complications. In this article, we report the case of a 3-year-old girl with a gradually enlarging mass in the floor of the mouth. On physical examination at admission, there was a 2x3-cm, elastic, tender mass on the left side of the floor of the mouth, with the overlying mucosa intact and normal in color. Taking the palpable lymph nodes into consideration, a congenital lesion or a pediatric malignancy was suspected initially. A blue pen cap with a surrounding pneumatocele was found intraoperatively. After a careful reevaluation of a previous MRI, a check valve mechanism at the possible site of entry was detected, leading to a pneumatocele, thus explaining the constant growth of the mass. This is a unique case of a foreign body in the floor of the mouth, mimicking a congenital lesion or a pediatric malignancy. Thus, the possibility of a foreign body should not be underestimated when evaluating a child with swelling in the floor of the mouth.