Primary mucocele of the mastoid: An incidental finding.

Mucocele is an accumulation of secretion products, desquamation, and inflammation within a body cavity: Localization in the mastoid is extremely rare. Erosion of bony walls and invasion of surrounding structures expose a patient to intra- and extracranial complications. Proper imaging work-up and complete removal through mastoidectomy is warranted.

Management of undifferentiated high-grade pleomorphic sarcoma of parotid region in elderly women.

Undifferentiated high-grade pleomorphic sarcoma is a slow-growing tumor rarely localized in the head and neck region. The treatment of UHPS should be based on large surgical resections in free margins associated with neck dissection. Postoperative radiotherapy improves local control of the disease and the prognosis quod vitam.

Management of radial artery pseudoaneurysm in radial forearm free flap: case report and review of the literature.

The formation of a pseudoaneurysm in a revascularized free flap is an extremely rare complication in microsurgery. The most effective treatment modality is still the subject of debate. We present the management of a case of pseudoaneurysm of the arterial pedicle of a radial free flap used after hemiglossopelvectomy in a patient with squamous cell carcinoma of the tongue. In our case, a 74-year-old man with the pseudoaneurism was successfully treated by endovascular stenting. Endovascular stenting can be considered an effective and safe procedure and a relevant alternative to open neck surgical treatment.

Pneumolabyrinth secondary to temporal bone fracture: a case report and review of the literature.

Pneumolabyrinth following temporal bone fracture is an extremely rare condition. It results from air entering the inner ear when a communication between the air-filled middle ear spaces and inner ear is established. The imaging modality of choice for pneumolabyrinth is high-resolution computed tomography of the temporal bone. Treatment options include conservative management (bed rest, antibiotics, corticosteroids) or surgery (exploratory tympanotomy). We present the case of a 31-year-old female who had pneumolabyrinth secondary to a temporal bone fracture. The patient was treated surgically and made a full clinical recovery.

Acquired middle ear cholesteatoma in children with cleft palate: experience from 18 surgical cases.

OBJECTIVES: To review an institutional experience with the surgical management of middle ear cholesteatoma in children with cleft palate. MATERIALS AND METHODS: We analyzed retrospectively 18 children diagnosed with cleft palate who underwent surgery for acquired middle ear cholesteatoma between 2000 and 2007. The following data were recorded: age, sex, history of ventilation tube insertion, status of the contralateral ear, cholesteatoma location and extension, and surgical technique involved. Cholesteatoma recidivism, stable mastoid cavity and hearing levels were the main outcomes measured. RESULTS: Follow-up ranged from 5 to 12 years (mean 8 years). Twelve children underwent planned staged canal wall up mastoidectomy: a residual cholesteatoma was found and removed during the second-look procedure in 2 ears (16.6%); two children (16.6%) showed a recurrent cholesteatoma and required conversion to canal wall down mastoidectomy. A modified Bondy technique was chosen in two children with an epitympanic cholesteatoma with an intact tympano-ossicular system, while in the remaining four subjects a canal wall down mastoidectomy was performed because of an irreparable erosion of the postero-superior canal wall: no cases of recurrent cholesteatoma were observed in these 6 children; revision mastoidectomy was needed in one patient for cavity granulation. A postoperative air-bone gap result of 0-20dB was achieved in 11 children (61.1%); in 5 cases (27.7%) postoperative air-bone gap was between 21 and 30dB, while in 2 (11.1%) was >30dB. Bone conduction thresholds remained unaffected in all cases. CONCLUSIONS: Our results indicate that most cleft palate children with cholesteatoma can be managed with a canal wall up mastoidectomy with low complication rates. In extensive disease with large erosion of the canal wall as well in presence of a retraction pocket in the contralateral ear, a canal wall down mastoidectomy should be considered. In epitympanic cholesteatomas with an intact tympano-ossicular system and mesotympanum free of disease, the modified Bondy procedure is an effective surgical option. As in the general pediatric population, improvement or preservation of hearing can be obtained in most patients.

Single-stage canal wall-down tympanoplasty: long-term results and prognostic factors.

OBJECTIVES: We sought to identify factors associated with anatomic and functional results of canal wall-down tympanoplasty. METHODS: One hundred eighty-nine primary or relapsing cholesteatomas were consecutively operated on by a single surgeon. Cholesteatoma recurrence rates were evaluated. Predictive values of the patient, disease, and surgical characteristics on cholesteatoma recurrence were estimated. The effect of these variables on keratin pearl development, recurrent otorrhea or granulation tissue formation, and hearing function was tested. RESULTS: The mean follow-up was 8 years (range, 4 to 15 years). The cholesteatoma relapse rate (+/- SE) estimated by the Kaplan-Meier method was 2.1% +/-1.1%. No variables were associated with relapsing disease. The log-rank test showed a significantly higher probability of keratin pearls in male patients (16.7% versus 2.1%; p = 0.001), young patients (less than 16 years; 51.4% versus 6.2%; p = 0.0001), patients with unencapsulated cholesteatomas (19.5% versus 5.3%; p = 0.06), patients with petrous or accessory cellularity invasion (17.9% versus 7.1%; p = 0.02), and patients with overlay myringoplasty (25% versus 7.9%; p = 0.03). Recurrent otorrhea and granulation tissue were associated with homograft temporalis fascia myringoplasty (14.3% versus 3.8%; p = 0.04). The overall postoperative air-bone gap was within 20 dB in 30.7%; it was within 20 dB in 43.9% (47/107) for intact or reconstructed ossicular chains and in 13.4% (11/82) for nonreconstructed, eroded ossicular chains (p = 0.0001). The air-bone gap was within 20 dB in 42.6% (46/108) when the mucosa of the tympanic cavity was normal and in 14.8% (12/81) when there was granulation tissue within the tympanic cavity (p = 0.0001). CONCLUSIONS: Single-stage canal wall-down tympanoplasty is an appropriate treatment for acquired tympanomastoid cholesteatoma.