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Otol Neurotol ; 2019 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-31821264


BACKGROUND: During skull base tumor surgery, temporomandibular joint (TMJ) dissection is commonly performed. The impact of this procedure on patients' postoperative diet and TMJ function is a matter of concern to surgeons. METHODS: We reviewed the Craniomandibular Index (CMI) for 32 patients (15 men and 17 women) who underwent TMJ dissection during surgery for skull base tumors between August 2015 and May 2018. RESULTS: Fifteen patients underwent removal of the mandibular condyle, and 17 had the condyle preserved. Twenty-one patients mainly underwent infratemporal fossa approach, and 11 underwent extended temporal bone resection. No significant difference between pre- and postoperative diet was observed in any group. Significant differences in CMI index were seen in all groups. The highest score was 0.115 of Dysfunction Index, observed postoperatively in the group that underwent condyle removal. CONCLUSIONS: For skull base tumor surgery, TMJ dissection has no significant impact on postoperative diet. Patients who underwent removal of the mandibular condyle have significantly worse postoperative TMJ function.

Otol Neurotol ; 40(10): 1306-1312, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31634284


OBJECTIVES: To determine the feasibility of endoscopic-assisted surgery for lesions involving the perilabyrinthine recesses, and develop and validate a technique for this kind of lesions that increases the possibility of preserving the labyrinth and cochlea. STUDY DESIGN: Observational study. SETTING: Referral center. CASES: Five patients who underwent endoscopy-assisted surgery for lateral skull base pathology involving the perilabyrinthine recesses between July 2010 and March 2016 were reviewed. INTERVENTIONS: Clinical data of the five patients were collected. MAIN OUTCOMES MEASURES: Hearing level and recurrence. RESULTS: Three of the five patients (three women, two men) had petrous bone cholesteatomas, one a facial neurofibroma, and one a petrous bone cholesterol granuloma. Complete excision with labyrinth and cochlea preservation was achieved using an endoscopic-assisted technique in all patients. Four had preoperative conductive hearing loss and one was totally deaf. In one patient, the postoperative air-bone gap was 30 dB lower than preoperatively levels, one stayed the same, and one was 30 dB because of closing of the external ear canal. After an average follow-up of 62.9 months, no patient had recurrence. CONCLUSIONS: Endoscope-assisted surgery is feasible for lesions involving the perilabyrinthine recesses and increases the likelihood to preserve the structure and function of labyrinth/cochlea, which may provide chances for artificial hearing devices implantation.

Laryngoscope ; 128(2): 468-472, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28498488


OBJECTIVES/HYPOTHESIS: Cochlear implantation for patients with common cavity deformity (CCD) can be difficult, with a higher incidence of intra- and postoperative complications; outcomes with CCD patients are also highly variable. In this study, surgical time was compared between the traditional facial recess approach (TFRA) and the transmastoid slotted labyrinthotomy approach (TSLA). Audiological outcomes and the benefit of using customized electrode arrays for CCD patients are also discussed. STUDY DESIGN: Retrospective review of 13 cochlear implant (CI) patients with CCD. METHODS: Six patients were implanted with the TFRA using traditional electrodes, and seven patients were implanted with the TSLA using customized electrodes. Intra- and postoperative complications were reviewed. Audiological outcomes were measured 3 months to 2 years after CI activation. RESULTS: The mean surgical time for TSLA group was nearly half as long as for the TRFA group (P < .05). Although mean audiological outcomes were better for the TSLA group, there was no significant difference between groups (P > .05). CONCLUSIONS: For CCD patients, TSLA for cochlear implantation is recommended due to shortened surgical time; customized electrode arrays may be additionally advantageous in terms of audiological outcomes. LEVEL OF EVIDENCE: 4. Laryngoscope, 128:468-472, 2018.

Implante Coclear/métodos , Orelha Interna/anormalidades , Orelha Interna/cirurgia , Eletrodos Implantados , Perda Auditiva/cirurgia , Adulto , Audiometria , Pré-Escolar , Implante Coclear/instrumentação , Implantes Cocleares , Potenciais Evocados Auditivos , Face/cirurgia , Feminino , Perda Auditiva/congênito , Perda Auditiva/fisiopatologia , Humanos , Lactente , Masculino , Processo Mastoide/cirurgia , Duração da Cirurgia , Período Pós-Operatório , Estudos Retrospectivos , Inteligibilidade da Fala , Resultado do Tratamento
Otol Neurotol ; 38(5): 685-693, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28306651


OBJECTIVE: To compare imaging and outcome data in cochlear implant (CI) patients with and without cochlear nerve deficiency (CND). STUDY DESIGN: Retrospective study comparing presurgical imaging (via high-resolution computed tomography and three-dimensional magnetic resonance imaging) to postsurgical auditory outcomes in CI patients with and without CND. PATIENTS: Forty-three CI patients with CND diagnosed according to preoperative imaging were included in the CND group. A control group (non-CND; n = 43) was matched to the CND group in terms of age at implantation, CI device type, preoperative hearing threshold, and sex. RESULTS: Across all subjects, internal auditory canal (IAC) diameter, cochlear nerve canal (CNC) diameter, and the number of nerve bundles were significantly correlated with all auditory outcome measures (p < 0.0125 in all cases). Across CND subjects, CNC diameter was significantly correlated with SIR, MUSS, and MAIS-IT/ MAIS scores (p < 0.0125 in all cases). Auditory outcomes were significantly poorer for CND patients with one rather than two nerve bundles. Across non-CND subjects, CNC diameter was significantly correlated only with SIR scores (p < 0.0125). IAC diameter, CNC diameter, and the number of nerve bundles were significantly smaller, and auditory outcomes were significantly poorer for the CND group than for the non-CND group (p < 0.05 in all cases). Results were similar when data only from patients ≤ 5 years old (n = 31) were analyzed. CONCLUSIONS: CNC diameter and the number of nerve bundles can significantly predict auditory outcomes for CI patients with CND. The results suggest that presurgical imaging may be useful in predicting CI outcomes for congenitally deaf patients.

Implantes Cocleares , Nervo Coclear/diagnóstico por imagem , Pré-Escolar , Implante Coclear , Nervo Coclear/cirurgia , Feminino , Humanos , Imagem Tridimensional , Imagem por Ressonância Magnética/métodos , Masculino , Prognóstico , Estudos Retrospectivos , Tomografia Computadorizada por Raios X