Septal Perforation Repair Using Bilateral Rotational Flaps With Interposed Mastoid Periosteal Graft.

OBJECTIVES/HYPOTHESIS: To evaluate the outcomes of endonasal repair of septal perforations utilizing opposing bilateral rotational flaps and a periosteum interposition graft. METHODS: Retrospective review of a single surgeon, tertiary referral center experience of patients who underwent septal perforation repair. Patient demographics, etiology of perforation, closure rate, and complication data were obtained. Patients screening positively for cocaine use or anti-neutrophil cytoplasmic antibodies (ANCA) were not offered repair. RESULTS: A total of 104 patients were included, 65 male and 39 female with mean age of 45.4 years. Etiology of perforations included prior surgery in 45, trauma in 15, and unknown in 44, and the average perforation size in each etiologic group were 1.35 cm, 1.25 cm, and 1.30 cm, respectively. The greatest dimension of perforations repaired ranged from 0.5 cm to 1.5 cm. The overall success rate was 87.5% at 6 month follow-up. Successful closure was achieved in 95.6%, 86.7%, and 79.5%, respectively (χ2  = 5.264, P = .0218). CONCLUSION: Our described technique is a reliable endonasal approach with predictable outcomes in septal perforations up to 1.5 cm in size. Having an unknown etiology of septal perforation may be a risk factor for failure. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:1497-1500, 2021.

[Reconstruction of tympanomastoid using autogenous mastoid cortical bone].

The reconstruction of tympanomastoid, such as scutum, lateral wall of attic, posterior wall of external auditory canal, mastoid cortex and auditory ossicular bone, is an important method to restore the function of middle ear and improve the living quality of patients. At present, there are a lot of new materials used to reconstruct the tympanomastoid, the autogenous mastoid cortical bone is still one of selective materials, we will introduce our experiences and review the related research about those reconstructions using this material in this paper.

Versatility of retroauricular mastoid donor site: a convenient valuable warehouse of various free graft tissues in cosmetic and reconstructive surgery.

Soft-tissue deficiency is a critical issue in facial cosmetic and reconstructive surgery. Harvesting autografts from other anatomical sites has been a common practice in overcoming soft-tissue insufficiency for many years. However, donor-site complications and visible scars are of important concerns. Therefore, we would like to introduce an alternative donor site of free-tissue grafts and its inherent advantages: the retroauricular mastoid area located along the mastoid hair line. From August 1991 to June 2011, we performed facial reconstructive surgeries for cosmetic correction of disfigurements from both congenital and complications of previous cosmetic procedures on a total of 213 patients. These patients had undergone either 1 or more facial cosmetic surgeries in the past. In this study, our primary goal focused on revising facial asymmetries or defects from previous surgical scars, tissue contraction, undercorrection, or underdevelopment. For autograft harvesting, we incised an elliptical shape along the retroauricular hairline. We then harvested sufficient amount of skin, dermal fat, fascia, or a piece of the mastoid bone if needed. After harvesting, we closed the incisional area and covered it with a compressive dressing. In evaluation of our results, we compared the preoperative photographs with postoperative and constructed a survey on patient satisfaction. Overall, the patients in this study were greatly satisfied with their surgical results. No major complications were reported. As a result of our long-term study, we believe that the retroauricular mastoid area has been shown to be an indispensable donor site for a variety of autograft tissues in terms of safety, convenience, and versatility of its unique structural composition consisting of skin, dermal fat, fascia, and bone.

[The morphological study of the Perfoost demineralized bone alloimplant applied for the plastic reconstruction of the posterior wall of the external auditory canal].

The objective of the present study was to enhance the effectiveness of the surgical treatment of chronic suppurative otitis media (CSOM) by means of the application of the Perfoost demineralized bone alloimplant for the plastic reconstruction of the posterior wall of the external auditory canal. This aim was attained by the elucidation of morphological features the Perfoost alloimpalnt at the site of surgical intervention one year after the operation. The study included 12 patients presenting with CSOM (epi- and epimesotympanitis) who had underwent "closed-type" sanation surgery of the middle ear. A Perfoost demineralized bone implant (DBI) plate was used for plastic reconstruction of the posterior wall of the external auditory canal. The secondary intervention within one year after the implantation was used to obtain 5×5 mm biopsy specimens containing a fragment of Perfoost DBI together with the adjacent cicatrical tissue bordering the "living" bone. The biopsies were subjected to standard histological treatment. It was shown that the fragment of the transplanted bone tissue underwent resorption accompanied by neo-osteogenesis. The source of formation of the new bone was fibroblastic elements of connective tissue of the recipient undergoing transformation into osteoblasts under the influence of resorbable components of the alloimplant. The presence of pre-existing bone canals and perforation holes in the implant provides the favourable conditions for its invasion by connective tissue that ensures its strong immobilization and gradual replacement by the newly formed bone tissue which corresponds by "carcass" regeneration. The results of the present study give evidence of the high clinical effectiveness of reconstructive surgery for the treatment of CSOM with the application of the Perfoost demineralized bone alloimplant used for the plastic correction of the posterior wall of the external auditory canal.

[Mastoid bone graft in implantology. A case report]. / Greffe d'os mastoïdien en implantologie orale. À propos d'un cas.

INTRODUCTION: In implantology, autogenous bone remains currently a useful-material to rebuild horizontal and vertical osseous defects. Usually, it is the needed osseous volume that indicates the grafting procedure, intraoral one for small and middle volume and extraoral one for severely atrophied jaws. The originality of this case report is to show an alternative to usual grafting procedure borrowed from ENT surgeons: osseous mastoid graft. TECHNICAL NOTE: A 63-year-old patient with maxillary sinus pathology underwent during same surgical time maxillary sinus curetting and osseous grafting to finalize the dental treatment. DISCUSSION: Mastoid cortical bone is a source of bone usable in oral implantology. Its use has been proved to be reliable in oto-surgery. Mastoid bone harvesting implies the presence of ENT surgeon; it is nevertheless interesting to know this site from a biological point of view and because of its functional and economical aspects.

Reconstruction of lateral attic wall using autogenous mastoid cortical bone.

PURPOSE: To explore the outcomes of lateral attic wall (LAW) reconstruction using autogenous mastoid cortical bone in cases with poorly developed zygomatic root cells and/or a low tegmen or with significant anterior or lateral sigmoid sinus in tympanomastoid surgery. MATERIAL AND METHODS: Thirty-five ears with chronic suppurative otitis media, all of them either with poorly developed zygomatic root cells and/or a low tegmen (26/35 ears), or with significant anterior or lateral sigmoid sinus (9/35 ears), were included. LAWs were removed temporarily to offer exposure of the attic; after removal of the pathological conditions in the attic and the mastoid, LAW was reconstructed using autogenous mastoid cortical bone. The condition of the reconstructed LAW and tympanomastoid aeration was evaluated by computed tomographic scan or/and otoendoscopy. RESULTS: The pathological conditions in the attic, the antrum, and the mastoid could be removed with safety in all cases; no serious complications occurred, the new canal appeared to be of normal size and shape, and no dislocation or necrosis of the repaired part was noted. Most of the cases had no significant attic retraction and kept good tympanomastoid aeration postoperatively. CONCLUSION: The reconstruction of LAW is especially suited to the cases in our study, and the reconstructed LAW can produce an almost normal anatomical external auditory canal, prevent the formation of attic retraction, and restore the mastoid cavity aeration in most of the cases.

Mastoid bone as a new graft material in rhinoplasty.

BACKGROUND: The management of certain nasal deformities, especially after prior rhinoplasty, may require grafting material. In this study we describe the use of mastoid bone as a viable and low morbidity autologous graft. METHODS: Mastoid bone was used for nasal augmentation, smoothing dorsal nasal irregularities, or augmentation of radix. Candidates for mastoid bone graft were patients undergoing primary rhinoplasty suffering from low radix or saddle nose deformity and candidates for secondary rhinoplasty suffering from prior overresection of the osteocartilaginous structures. RESULTS: Fifty-six patients met the study criteria. Eighteen patients underwent secondary rhinoplasty and suffered from prior overresection of osteocartilaginous structures and 38 patients underwent primary rhinoplasty. Of these, 18 patients had a low radix and 20 patients had a saddle nose deformity. Follow-up was 6-49 months (mean, 23 months). All cases resulted in an augmented straightened nasal dorsum, increased tip projection, and adjusted radix. There were no cases of graft infection. In two cases the graft was displaced requiring revision. The amount of graft absorption even after 2 years follow-up was acceptable. There were no donor site complications. CONCLUSIONS: The mastoid bone graft provides adequate autologous bone in most cases of primary or revision rhinoplasty. The donor site carries low morbidity and a well camouflaged scar. It is easily accessible especially for the otolaryngologist who is accustomed to operating on the mastoid bone.

Type III ossiculoplasty with mastoid cortical bone--"in situ" shaping of the ossicle.

The authors describe their technique to harvest a cortical bone ossicle. It consists of sculpting and shaping the ossicle while it is still attached to cortical bone. The technique is simple and safe.

Reconstruction of the nasal tip including the columella and soft triangle using a mastoid composite graft.

This paper describes the use of a composite graft from the mastoid area consisting of full-thickness skin peripherally and selectively localised fascia-fat tissue underneath the skin centrally for immediate reconstruction of moderate defects of the nasal tip including the columella and soft triangle. Mastoid composite grafting is a simple and safe procedure that avoids partial graft loss and provides adequate augmentation of soft tissue, easy reshaping of the new nostril rim, minimal post-operative shrinkage, and no donor-site morbidity. Then, it results in a satisfactory nasal appearance with adequate tip projection and symmetry. This procedure may represent a preferred method of nasal tip reconstruction.

Underlay tympanoplasty with laser tissue welding.

We investigated the feasibility of using laser tissue welding techniques to perform transcanal underlay tympanoplasty. We used 10 temporal bones obtained from human cadavers. After creating a subtotal tympanic membrane perforation, we introduced harvested periosteum through the perforation and used laser tissue welding to secure the periosteum graft in place in an underlay fashion. The procedure was performed via a transcanal approach and did not require middle ear packing. Immediately after the graft had been placed, we qualitatively tested its integrity with a blunt probe. The graft was as strong as the native cadaver tympanic membrane in all 10 cases. We conclude that laser transcanal underlay tympanoplasty is a feasible and effective method of repairing a tympanic membrane. The ultimate goal is to develop a technique that will allow physicians to routinely perform underlay tympanoplasty on moderately sized perforations in an office setting.

Surgical treatment of retraction pocket with bone pate: scutum plasty for cholesteatoma.

OBJECTIVES: Postoperative attic retraction pocket is a critical issue and may be indicative of disease recurrence after canal-up tympanoplasty for middle ear cholesteatoma. Although scutum plasty is an acceptable procedure that can be used to prevent the pocket formation, how the scutum is reconstructed has remained controversial. The aim of this study was to clarify the value of scutum plasty using bone pate. STUDY DESIGN: Retrospective study. SETTING: Bone pate scutum plasty was performed in 69 ears during first-stage operations. We attempted to reconstruct a smooth attic bony wall. At the time of the second-stage operations, the results of the scutum plasty were examined. RESULTS: The incidence of retraction pocket was statistically reduced from 20.2% to 5.8%. CONCLUSION: Although the reconstructed scutum showed atrophy to some extent, bone pate scutum plasty is effective in preventing postoperative retraction pocket if a smoothly shaped attic wall can be reconstructed.

Bone and temporal fascia graft for the closure of septal perforation.

OBJECTIVES: To assess the reliability of temporal fascia and bone graft for the closure of septal perforation. STUDY DESIGN: Prospective longitudinal non-randomized. METHODS: The repair of septal perforation was performed using endonasal dissection; suture of the borders of the perforation on at least one side, and interposition of a graft of temporal fascia with bone, either a perpendicular plate of ethmoid (six) if available or mastoid cortex (three) if not. RESULTS: All patients had closure without re-perforation. Eight out of nine patients had complete closure of the perforation (88.8 per cent). These patients had perforations of less than 3 cm in diameter. The ninth patient had a perforation of more than 3 cm diameter (3.5 x 2.5 cm), and obtained a closure of about 80 per cent of the original perforation. The remaining perforation was in the posterior part of the nose. The patient was relieved of his symptoms (crusting and bleeding). This incomplete closure was most probably due to migration of the graft immediately after surgery. There was no morbidity of the donor site or the ear in the mastoid cortex graft group of patients. This is to our knowledge the first report of the use of the mastoid cortex as a graft in septal perforation. CONCLUSIONS: We consider that the graft of temporal fascia with bone is very reliable, and the use of bone ensures closure while avoiding the complications of a lax septum in large perforations. The technique is suitable for perforations up to 2.5 cm diameter. Perforations larger than 3 cm in diameter are more difficult to close, but closure of the anterior part of the perforation will relieve the patient from the most annoying symptoms.

[Outcomes of heterobrephomastoidoplasty in surgical treatment of chronic otitis media purulent in children]. / Rezul'taty primenenia geterobrefomastoidoplastiki pri khirurgicheskom lechenii khronicheskogo gnoinogo srednego otita u detei.

Otitis media purulenta chronica (OMPC) in children affects frequently the mastoid process necessitating plastic repair of the mastoid cavity. Taking this in consideration, in the surgery of 66 children with OMPC the authors used implants of demineralized lamb bone tissue. The graft retention occurred in 93.9% of cases.

[Repair of the attic wall by a mastoid osteofibrous graft]. / La réparation du mur attical par copeau ostéofibreux mastoïdien.

Closed techniques for the management of cholesteatomas often require repair of the external auditory meatus. Small losses of substance around the tympanic membrane or in the attic wall can be repaired by a mastoid cortical autograft. The originality of the procedure described on the basis of the various operative stages is based above all on the preservation of an osteoperiosteal fringe contiguous with the bone graft used. The value of the technique lies in availability of the graft at the operative site and the ease of its insertion into the defect requiring repair.

[Reconstruction of the wall of the canal]. / La reconstruction du mur de la logette.

In "intact" canal wall tympanoplasty, recurrent disease and retraction pockets must be avoided by repair of attic or lateral defects. Between 1983 and 1986, the authors used septal cartilage homograft in 38 cases and mastoid bone autograft in 47 cases. The uniqueness of the last technique is the preservation of fibroperiosteum with the cortical bone shaving, allowing a good adaptability in the defect. Histologic studies, clinical follow up and operative evaluation in case of second look intervention allows discussion on advantages and disadvantages of the two materials. The tolerance is good. The two procedures are variable and reliable in 80% of cases.

Endaural brain hernia: repair using mastoid cortical bone.

We present three cases of endaural brain hernia and a method of repair using sculptured mastoid cortical bone. The literature is reviewed to illustrate etiology, pathology, clinical presentation, and management options of this uncommon clinical entity. We classify the hernias as pedunculated or sessile, with associated factors such as viability of herniated brain, infection, CSF leak, and neurologic complications. A management scheme is proposed encompassing surgical options now available and their attendant risks and complications.

Pulsatile tinnitus: a dehiscent jugular vein.

A case is reported of a female patient with subjective tinnitus synchronous with her pulse, in the left ear. A dehiscent high seated jugular vein was found in the middle ear. A surgical technique is presented using a septal cartilage homograft to cover the dehiscent vein.