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1.
Otolaryngol Head Neck Surg ; 164(1): 67-73, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32660367

RESUMO

OBJECTIVE: To investigate small-particle aerosolization from mastoidectomy relevant to potential viral transmission and to test source-control mitigation strategies. STUDY DESIGN: Cadaveric simulation. SETTING: Surgical simulation laboratory. METHODS: An optical particle size spectrometer was used to quantify 1- to 10-µm aerosols 30 cm from mastoid cortex drilling. Two barrier drapes were evaluated: OtoTent1, a drape sheet affixed to the microscope; OtoTent2, a custom-structured drape that enclosed the surgical field with specialized ports. RESULTS: Mastoid drilling without a barrier drape, with or without an aerosol-scavenging second suction, generated large amounts of 1- to 10-µm particulate. Drilling under OtoTent1 generated a high density of particles when compared with baseline environmental levels (P < .001, U = 107). By contrast, when drilling was conducted under OtoTent2, mean particle density remained at baseline. Adding a second suction inside OtoTent1 or OtoTent2 kept particle density at baseline levels. Significant aerosols were released upon removal of OtoTent1 or OtoTent2 despite a 60-second pause before drape removal after drilling (P < .001, U = 0, n = 10, 12; P < .001, U = 2, n = 12, 12, respectively). However, particle density did not increase above baseline when a second suction and a pause before removal were both employed. CONCLUSIONS: Mastoidectomy without a barrier, even when a second suction was added, generated substantial 1- to 10-µm aerosols. During drilling, large amounts of aerosols above baseline levels were detected with OtoTent1 but not OtoTent2. For both drapes, a second suction was an effective mitigation strategy during drilling. Last, the combination of a second suction and a pause before removal prevented aerosol escape during the removal of either drape.


Assuntos
Aerossóis/efeitos adversos , Transmissão de Doença Infecciosa/prevenção & controle , Otopatias/cirurgia , Mastoidectomia/métodos , Procedimentos Cirúrgicos Otológicos/normas , Equipamento de Proteção Individual , Cadáver , Comorbidade , Otopatias/epidemiologia , Humanos , Processo Mastoide/cirurgia , Procedimentos Cirúrgicos Otológicos/métodos
2.
J Otolaryngol Head Neck Surg ; 49(1): 71, 2020 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-33023663

RESUMO

Within Neurotology, special draping systems have been devised for mastoid surgery recognizing that drilling of middle ear mucosa is an aerosol generating medical procedure (AGMP) which can place surgical teams at risk of COVID-19 infection. We provide a thorough description of a barrier system utilized in our practice, along with work completed by our group to better quantify its effectiveness. Utilization of a barrier system can provide near complete bone dust and droplet containment within the surgical field and prevent contamination of other healthcare workers. As this is an early system, further adaptations and national collaborations are required to ultimately arrive at a system that seamlessly integrates into the surgical suite. While these barrier systems are new, they are timely as we face a pandemic, and can play a crucial role in safely resuming surgery.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , Otopatias/epidemiologia , Processo Mastoide/cirurgia , Procedimentos Cirúrgicos Otológicos/métodos , Pneumonia Viral/epidemiologia , Base do Crânio/cirurgia , Comorbidade , Otopatias/cirurgia , Humanos , Pandemias , Equipamento de Proteção Individual
3.
Otol Neurotol ; 41(9): 1230-1239, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925848

RESUMO

BACKGROUND: COVID-19 has become a global pandemic with a dramatic impact on healthcare systems. Concern for viral transmission necessitates the investigation of otologic procedures that use high-speed drilling instruments, including mastoidectomy, which we hypothesized to be an aerosol-generating procedure. METHODS: Mastoidectomy with a high-speed drill was simulated using fresh-frozen cadaveric heads with fluorescein solution injected into the mastoid air cells. Specimens were drilled for 1-minute durations in test conditions with and without a microscope. A barrier drape was fashioned from a commercially available drape (the OtoTent). Dispersed particulate matter was quantified in segments of an octagonal test grid measuring 60 cm in radius. RESULTS: Drilling without a microscope dispersed fluorescent particles 360 degrees, with the areas of highest density in quadrants near the surgeon and close to the surgical site. Using a microscope or varying irrigation rates did not significantly reduce particle density or percent surface area with particulate. Using the OtoTent significantly reduced particle density and percent surface area with particulate across the segments of the test grid beyond 30 cm (which marked the boundary of the OtoTent) compared with the microscope only and no microscope test conditions (Kruskall-Wallis test, p = 0.0066). CONCLUSIONS: Mastoidectomy with a high-speed drill is an aerosol-generating procedure, a designation that connotes the potential high risk of viral transmission and need for higher levels of personal protective equipment. A simple barrier drape significantly reduced particulate dispersion in this study and could be an effective mitigation strategy in addition to appropriate personal protective equipment.


Assuntos
Aerossóis , Infecções por Coronavirus/prevenção & controle , Processo Mastoide/cirurgia , Mastoidectomia/efeitos adversos , Exposição Ocupacional/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Betacoronavirus , Cadáver , Fluoresceína , Humanos , Microscopia , Saúde do Trabalhador , Salas Cirúrgicas , Equipamento de Proteção Individual , Cirurgiões , Osso Temporal/cirurgia
4.
Otol Neurotol ; 41(9): 1175-1181, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925833

RESUMO

: Since the beginning of 2020, the world has been confronted by the Covid-19 pandemic. The lock-down aims to limit the circulation of the virus and thus avoid overwhelming healthcare systems. Healthcare workers have had to adapt by postponing consultation and surgical activities. Otolaryngologists are particularly exposed to infection from the upper airway where the virus is highly concentrated. Literature has previously reported other human coronaviruses in the middle ear and mastoid, suggesting a risk of infection to staff during ear surgery where aerosolizing procedures are usually used. The aim of this article is to propose a strategy for planning consultations and surgeries for ear and lateral skull base diseases, in the context of the current active evolution of the pandemic and of the future gradual recovery to normal practice.


Assuntos
Infecções por Coronavirus/prevenção & controle , Exposição Ocupacional/prevenção & controle , Saúde do Trabalhador , Procedimentos Cirúrgicos Otológicos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Betacoronavirus , Simulação por Computador , Desinfecção , Orelha Média/cirurgia , Hospitalização , Humanos , Processo Mastoide/cirurgia , Salas Cirúrgicas , Otorrinolaringologistas , Pacientes Ambulatoriais , Período Pré-Operatório , Base do Crânio/cirurgia , Carga Viral
5.
Eur Arch Otorhinolaryngol ; 277(12): 3529-3532, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32914255

RESUMO

BACKGROUND: Mastoidectomy is associated with extensive bone-drilling which makes it a major aerosol generating procedure. Considering the ongoing COVID-19 global pandemic, it is essential to devise methods to minimize aerosolization and hence ensure safety of the healthcare workers during the operative procedure. METHODS: Two disposable surgical drapes are used to create a closed pocket prior to commencement of mastoid bone-drilling. This limits aerosolization of bone-dust in the external operating theatre environment. CONCLUSION: Two-drape closed pocket technique is an easy, cost-effective and safe method to limit aerosolization of tissue particles during mastoidectomy.


Assuntos
Infecções por Coronavirus/transmissão , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Salas Cirúrgicas/normas , Otolaringologia/normas , Pandemias/legislação & jurisprudência , Pneumonia Viral/transmissão , Aerossóis/efeitos adversos , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Poeira , Humanos , Processo Mastoide/cirurgia , Mastoidectomia , Otolaringologia/instrumentação , Pandemias/prevenção & controle , Equipamento de Proteção Individual/virologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Equipamentos Cirúrgicos
6.
Artigo em Chinês | MEDLINE | ID: mdl-32791772

RESUMO

Objective: To compare the effect of hearing improvement after canal wall down mastoidectomy and tympanoplasty(CWDM) and canal wall up mastoidectomy and tympanoplasty(CWUM). Methods: 88 patients who underwent CWDM or CWUM in 2014-2017 with complete follow-up data were retrospectively studied. There were 45 males and 43 females, aged 12-68 years old, and the average follow-up time was 12.3 months. Among them, 42 cases underwent CWDM and 46 cases underwent CWUM. A series of improvements were made in the clinical practice of CWDM: (1) to expand the indications properly, including limited lesions with sclerotic mastoid and narrow tympanic sinus; (2) to form disciform cavity strictly during operation in order to retain the appropriate height of facial nerve crest; (3) to avoid the cleaning of mastoid cavity in the post-operation follow up, thus the operative cavity was effectively constricted; and (4) to transfer the temporal muscle flap in pneumatic mastoid to reduce the cavity. The condition of dry ear and the size of cavity were observed after operation. The average pure tone threshold (PTA) before/after operation and threshold changes of each frequency were compared between the two groups. SPSS 19.0 software was used to analyze the data. Results: The mastoid cavity of CWDM was significantly narrowed after operation and the width of the external auditory canal was close to the CWUM group. The postoperative PTA of the CWDM and CWUM group was reduced by 11.4 dB and 10.4 dB respectively, with no significant difference (t=0.290, P=0.770). The average value of bone conduction threshold after operation was reduced by 1.8 dB and 1.9 dB respectively, with no significant difference (t=-0.076, P=0.940). The mean value of ABG after operation was shortened by 9.6 dB and 8.4 dB respectively, with no significant difference (t=-0.370, P=0.712). The threshold decrease of 1 000 Hz of CWUM was slightly better than that of CWDM, and the threshold decreases of the other frequencies of CWDM were slightly better than those of CWUM, however, the differences were not statistically significant (P>0.05). Conclusion: Through the adjustment of indications and a series of intraoperative and postoperative improvements, CWDM can achieve the same effect of postoperative hearing improvement as CWUM.


Assuntos
Otopatias/cirurgia , Mastoidectomia , Timpanoplastia , Adolescente , Adulto , Idoso , Criança , Meato Acústico Externo/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Processo Mastoide/cirurgia , Mastoidectomia/métodos , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Timpanoplastia/métodos , Adulto Jovem
7.
J Laryngol Otol ; 134(6): 493-496, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32618542

RESUMO

OBJECTIVE: Safe cochlear implantation is challenging in patients with canal wall down mastoid cavities, and the presence of large meatoplasties increases the risk of external canal overclosure. This paper describes our results of obliteration of the mastoid cavity with conchal cartilage as an alternative procedure in cases of canal wall down mastoidectomy with very large meatoplasty. METHODS: The cases of seven patients with a canal wall down mastoidectomy cavity who underwent cochlear implantation were retrospectively reviewed. Post-operative complications were analysed. The mean follow-up duration was 4.5 years. RESULTS: There was no hint of cholesteatoma recurrence and all patients have been free of symptoms during follow up. Only one patient showed cable extrusion six months after surgery, and implantation of the contralateral ear was needed. CONCLUSION: Pseudo-obliteration of the mastoid cavity with a cartilage multi-layered palisade reconstruction covering the electrode may be a safe alternative in selected patients with a large meatoplasty.


Assuntos
Cartilagem/transplante , Meato Acústico Externo/cirurgia , Processo Mastoide/cirurgia , Mastoidectomia/efeitos adversos , Adulto , Idoso , Colesteatoma da Orelha Média/epidemiologia , Doença Crônica , Implante Coclear/métodos , Eletrodos Implantados/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Processo Mastoide/patologia , Pessoa de Meia-Idade , Otite Média/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Recidiva , Estudos Retrospectivos
8.
Laryngoscope ; 130(11): 2693-2699, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32720316

RESUMO

OBJECTIVES/HYPOTHESIS: The overall aim of this study was to evaluate personal protective equipment (PPE) that may facilitate the safe recommencement of cochlear implantation in the COVID-19 era, with the broader goal of minimizing the period of auditory deprivation in prelingually deaf children and reducing the risk of cochlear ossification in individuals following meningitis. METHODS: The study design comprised 1) an objective assessment of mastoid drilling-induced droplet spread conducted during simulated cochlear implant (CI) surgery and its mitigation via the use of a protective drape tent and 2) an evaluation of three PPE configurations by otologists while performing mastoid drilling on ex vivo temporal bones. The various PPE solutions were assessed in terms of their impact on communication, vital physiological parameters, visual acuity and fields, and acceptability to surgeons using a systematic risk-based approach. RESULTS: Droplet spread during simulated CI surgery extended over 2 m, a distance greater than previously reported. A drape tent significantly reduced droplet spread. The ensemble of a half-face mask and safety spoggles (foam lined safety goggles) had consistently superior performance across all aspects of clinical usability. All other PPE options were found to substantially restrict the visual field, making them unsafe for microsurgery. CONCLUSIONS: The results of this preclinical study indicate that the most viable solution to enable the safe conduct of CI and other mastoid surgery is a combination of a filtering facepiece (FFP3) mask or half-face respirator with safety spoggles as PPE. Prescription spoggles are an option for surgeons who need to wear corrective glasses to operate. A drape tent reduces droplet spread. A multicenter clinical trial to evaluate the effectiveness of PPE should be the next step toward safely performing CI surgery during the COVID-19 era. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:2693-2699, 2020.


Assuntos
/prevenção & controle , Implante Coclear/instrumentação , Transmissão de Doença Infecciosa/prevenção & controle , Procedimentos Cirúrgicos Otológicos/instrumentação , Equipamento de Proteção Individual , Aerossóis , Implante Coclear/efeitos adversos , Implante Coclear/métodos , Desenho de Equipamento , Humanos , Processo Mastoide/cirurgia , Exposição Ocupacional/prevenção & controle , Procedimentos Cirúrgicos Otológicos/efeitos adversos , Procedimentos Cirúrgicos Otológicos/métodos , Isoladores de Pacientes/virologia
9.
Eur Arch Otorhinolaryngol ; 277(12): 3307-3313, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32444965

RESUMO

PURPOSE: The purpose of this study is the evaluation of post-operative hearing threshold after revision surgery and obliteration of troublesome canal wall down mastoidectomy cavities (CWDMCs). The ability to use and tolerate conventional hearing aids (CHAs) was also evaluated. METHODS: A retrospective chart analysis of 249 patients with chronically draining CWDMCs who underwent revision surgery including obliteration of the mastoid cavity between 2007 and 2017 at the AMC location of the Amsterdam University Medical Centers (Amsterdam UMC) was performed. Patient characteristics, pre- and post-operative Merchant grade, surgical outcomes, pre- and post-operative hearing thresholds, and the ability/necessity to use a CHA or the ability/necessity to use a Bone Conduction Device (BCD) were recorded. RESULTS: Dry ears were found in 95% of the total cohort. Residual disease was detected in 1.6% during MRI follow-up with no residual cholesteatoma in the obliterated area. In 3.2% of the patients, recurrent disease was found. A significant improvement in mean air conduction level, mean bone conduction level, and mean air-bone gap (ABG) was found post-operatively (p < 0.05). For all types of ossicular chain reconstruction, a significant improvement in mean Pure Tone Average was observed (p < 0.05). The percentage of patients with an indication for CHA was similar pre- and post-operatively (67% both pre- and post-operatively). The ability to use a CHA improved from 3% pre-operatively to 57% post-operatively (p < 0.001). CONCLUSION: This study shows that revision surgery and obliteration of CWDMCs enable successful CHA rehabilitation post-operatively. Upon this type of surgery, hearing thresholds improve significantly, but the need for rehabilitation with a CHA remains necessary in most cases.


Assuntos
Auxiliares de Audição , Processo Mastoide/cirurgia , Mastoidectomia/métodos , Procedimentos Cirúrgicos Otológicos/métodos , Reoperação/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Audiometria de Tons Puros/métodos , Condução Óssea , Criança , Feminino , Humanos , Masculino , Processo Mastoide/patologia , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Resultado do Tratamento , Timpanoplastia , Adulto Jovem
10.
J Craniofac Surg ; 31(5): 1467-1468, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32310887

RESUMO

Autologous ear construction for microtia creates an auricle using a costal cartilage framework. To separate the construct from the mastoid, the most common methods incorporate the use of fascial flaps or skin grafting. The authors describe a V-Y skin and subcutaneous scalp advancement flap for ear elevation as part of autologous ear construction for microtia. The method is simple and reliable and offers advantages compared to other techniques.


Assuntos
Microtia Congênita/cirurgia , Cartilagem Costal/cirurgia , Pavilhão Auricular/cirurgia , Cartilagem da Orelha/cirurgia , Orelha Externa/cirurgia , Humanos , Processo Mastoide/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Couro Cabeludo/cirurgia , Transplante de Pele , Tela Subcutânea/cirurgia , Retalhos Cirúrgicos/cirurgia
11.
J Craniofac Surg ; 31(5): 1408-1411, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32310890

RESUMO

PURPOSE: Prominent ear deformity is usually characterized by antihelical fold deficiency, concha hypertrophy and earlobe deformity. MATERIALS AND METHODS: Between 2000 and 2018, 375 otoplasty patients aged 6 to 58 who underwent surgery in our clinic were included in this study. Among these 375 cases, 25 were unilateral and 350 were bilateral. As surgical techniques anterior rasping, concha-mastoid sutures and concha-scaphoid sutures were used. The average cephaloauricular angle, the upper pole-mastoid distance and the distance between the middle 1/3 of the ear and mastoid was measured preoperatively and postoperatively. Postoperative measurements were made on the 15th day, 3rd month and the 6th month after the surgery. The approximate follow-up period ranged from 6 months to 18 years. RESULTS: Concha-mastoid sutures can be used not only to reduce the concha but also to adjust the proportion between the width and height of the ear. Attenuation of the cartilage by rasping provides homogeneous thinning of the cartilage and prevents deformation. In all age groups, relapse and angle changes were observed in the first 6 months. After 6 months, there were no cases of recurrence or angle changes.


Assuntos
Otopatias/cirurgia , Adolescente , Adulto , Criança , Orelha Externa/cirurgia , Feminino , Humanos , Masculino , Processo Mastoide/cirurgia , Pessoa de Meia-Idade , Período Pós-Operatório , Procedimentos Cirúrgicos Reconstrutivos , Recidiva , Cirurgia Plástica , Suturas , Adulto Jovem
12.
J Craniofac Surg ; 31(4): e371-e372, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32176012

RESUMO

Precise identification and preservation of the facial nerve is mandatory to avoid dysfunction of the facial nerve during parotidectomy. In this article, the authors are introducing a new landmark to identify the facial nerve for parotidectomy that is more protective for the facial nerve. The authors use a simple approach to predict the position of facial nerve main trunk intraoperatively without geometric calculations and a lot of landmarks. An imaginary almost 2 cm line is drawn between mastoid tip inferiorly and bony-cartilaginous junction of the external auditory canal superiorly. The main trunk of the facial nerve can be visualized at the midpoint of this line. The authors have been using this landmark successfully for the last 10 years, without any functional deficit of the parotid nerve. Identifying the facial nerve at the trunk level by this landmark renders following the branches forward in the glandular parenchyma less complicated.


Assuntos
Nervo Facial , Glândula Parótida/cirurgia , Meato Acústico Externo , Humanos , Processo Mastoide/cirurgia , Neoplasias Parotídeas/cirurgia
13.
Audiol Neurootol ; 25(3): 151-157, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32018243

RESUMO

BACKGROUND: Chronic suppurative otitis media (CSOM) was considered as a contraindication of cochlear implantation (CI) in the past. Recently, various surgical options have been adopted for CI in CSOM patients with showing a low complication rate. OBJECTIVES: To evaluate surgical outcomes of CI in patients with CSOM and to propose a management algorithm for those patients. METHODS: Thirty-six consecutive patients with CSOM who underwent single stage or staged CI were enrolled. Speech performance, including Categories of Auditory Performance (CAP) test and sentence score, and complications were retrospectively analyzed. RESULTS: The average follow-up was 3.1 years (range 0.5-9.2 years). Postoperative median CAP and sentence scores were 6 and 78%, respectively. Three (8.3%) of the 36 patients had postoperative complications. One experienced breakdown of the ear canal closure. Recurrence of the pars tensa retraction was observed in another patient with adhesive otitis media who underwent CI and cartilage tympanoplasty as a single stage operation. Electrode extrusion occurred in another patient who underwent staged CI with maintenance of a previous open cavity. Subtotal petrosectomy and cavity obliteration were used to manage the latter 2 complications. All implant patients with good mastoid pneumatization exhibited no complications. There were no significant differences in postoperative speech performance and complication rates between single stage CI and staged CI. Based on these current findings, a management algorithm was proposed according to type of CSOM, presence of open cavity, and mastoid pneumatization. CONCLUSIONS: Patients with CSOM show good postoperative speech performance after CI. Proper surgical options according to type of CSOM, presence of open cavity, and mastoid pneumatization may help in reducing complications.


Assuntos
Percepção Auditiva/fisiologia , Implante Coclear , Audição/fisiologia , Processo Mastoide/cirurgia , Otite Média Supurativa/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Gerenciamento Clínico , Feminino , Testes Auditivos , Humanos , Masculino , Pessoa de Meia-Idade , Otite Média Supurativa/fisiopatologia , Período Pós-Operatório , Recidiva , Estudos Retrospectivos , Timpanoplastia , Adulto Jovem
14.
Am J Otolaryngol ; 41(3): 102407, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32014300

RESUMO

PURPOSE: To report our long-term results in surgical management of invasive intralabyrinthine cholesteatoma. MATERIAL AND METHODS: The study is a case series in a tertiary referral center. Retrospective chart review of all mastoid operations performed for chronic ear disease between 1994 and 2019 at University Health Network, Toronto. The type of surgery, intraoperative findings, hearing outcome, recurrence of disease and the need for revision surgery were evaluated. RESULTS: 10 cases of extensive petrous bone cholesteatoma medial to the otic capsule were identified in 616 mastoid surgeries. All but one patient with extensive petrous bone cholesteatoma who underwent an exteriorizing procedure to preserve cochlear function failed the first surgery. A second procedure was needed in all cases due to complications which included facial palsy, recurrent cholesteatoma or internal auditory canal (IAC) abscess. Hearing was not preserved in any patient. In contrast, 57 ears with cholesteatomatous labyrinthine fistula lateral to the otic capsule had matrix exteriorized and had very good long-term results. CONCLUSION: We were rarely able to preserve hearing in massive petrous bone cholesteatoma. There should be no hesitation to remove the otic capsule to exteriorize diseases even under circumstances where residual cochlear and vestibular function is present if required to provide a safe ear.


Assuntos
Colesteatoma/fisiopatologia , Colesteatoma/cirurgia , Audição , Osso Petroso/cirurgia , Adolescente , Adulto , Feminino , Humanos , Masculino , Processo Mastoide/cirurgia , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
15.
J Craniofac Surg ; 31(1): 300-302, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31449229

RESUMO

The posterior auricular nerve (PAN) is the first branch of the facial nerve after it leaves the stylomastoid foramen. The literature describing the anatomy of the PAN is very sparse. Therefore, the purpose of this study was to clarify the detailed anatomical features of the PAN and consider its clinical and surgical applications. The authors examined 10 sides from 6 fresh frozen adult cadaveric Caucasian heads. The PAN was observed as the first branch of the facial nerve in all specimens. During the dissection of the PAN, the posterior auricular artery was constantly near the PAN. Moreover, the PAN was located under the investing layer of deep cervical facia covering the sternocleidomastoid and mastoid process in all specimens. The diameter of the PAN was 0.82 ±â€Š0.21 mm (range from 0.55 to 1.21). The distance from the stylomastoid foramen to where the PAN branched from the facial nerve was 0.40 ±â€Š1.25 mm (range from 0 to 4.35). The distance from the location of this branching point of the PAN to the entering point of the PAN to any muscles was 28.03 ±â€Š5.51 mm (range from 19.71 to 38.75). Understanding the anatomical features of the PAN is essential for performing surgical procedures in this region.


Assuntos
Nervo Facial/anatomia & histologia , Glândula Parótida/anatomia & histologia , Idoso , Idoso de 80 Anos ou mais , Cadáver , Nervo Facial/cirurgia , Feminino , Cabeça/anatomia & histologia , Humanos , Masculino , Processo Mastoide/anatomia & histologia , Processo Mastoide/cirurgia , Pessoa de Meia-Idade , Pescoço/anatomia & histologia , Músculos do Pescoço/anatomia & histologia , Glândula Parótida/cirurgia , Osso Temporal/anatomia & histologia
16.
Otol Neurotol ; 41(1): e55-e63, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31584500

RESUMO

OBJECTIVE: To assess long-term results and present experience with a high-porosity hydroxyapatite ceramic for obliterating large open mastoid cavities. STUDY-DESIGN: Cross-sectional cohort study. SETTING: Tertiary academic referral center. PATIENTS: All patients who underwent tympanomastoid surgery for chronic middle ear disease or revision surgery with reduction of an open mastoid cavity using a highly porous hydroxyapatite matrix material (HMM) between May 2005 and June 2013 were assessed for eligibility. Twenty three patients (56.9 ±â€Š18.3 yr) were included. INTERVENTION: Primary middle ear surgery or revision surgery using a HMM. MAIN OUTCOME MEASURES: Pure-tone average, computed tomography (CT), and magnetic resonance imaging (MRI) to investigate osseoinduction, osseointegration and presence of cholesteatoma, current quality of life assessed by Zurich Chronic Middle Ear Inventory and change in quality of life post-intervention assessed by the Glasgow Benefit Inventory. RESULTS: Patients were reexamined after a mean follow-up period of 88.3 months (SD 21.4 mo) after obliteration of the open mastoid cavity with HMM. Compared with visit 1, patients showed a significantly reduced ABG at visit 2 (29.22 dB ±â€Š2.71 dB versus 12.77 dB ±â€Š3.46 dB).CT scan was carried out in 21 patients (91%) patients and 17 patients (74%) underwent MRI.Revision surgery was required in a total of 17 cases (74%). In four patients recurrent cholesteatoma was found at follow up. CONCLUSIONS: Poor cavity obliteration, a high rate of revision surgery and difficult differentiation between recurrent cholesteatoma and granulation tissue in CT scan was observed.


Assuntos
Durapatita/efeitos adversos , Otopatias/cirurgia , Orelha Média/cirurgia , Mastoidectomia/métodos , Timpanoplastia/métodos , Adulto , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Masculino , Processo Mastoide/cirurgia , Pessoa de Meia-Idade , Porosidade , Qualidade de Vida , Reoperação , Estudos Retrospectivos
17.
J Int Adv Otol ; 15(3): 386-390, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31846916

RESUMO

OBJECTIVES: Since its introduction in 2002, the staging system for congenital cholesteatoma, as defined by Potsic, has been used widely owing to its simplicity and predictability. The aim of the present study was to analyze the clinical characteristics and surgical treatment outcomes of congenital cholesteatoma and to correlate them with postoperative recurrence. MATERIALS AND METHODS: A retrospective chart review was performed for 38 patients who were diagnosed with congenital cholesteatoma and who underwent surgical resection between August 2007 and November 2014 at the Department of Otorhinolaryngology of our hospital. RESULTS: The mean age of the patients was 7.9±8.2 years, and the number of males and females was 20 and 18, respectively. The mean follow-up period was 30±26 months. Of the 38 patients, 9 (24%) had residual or recurrent cholesteatoma during follow-up examination after primary surgery. The results showed that the size (≥4 mm) of the lesion was significantly correlated with residual or recurrent disease (p=0.026). The disease extent (single vs. multiple quadrant involvement), type (closed vs. open type), and stage; applied surgical method (with mastoidectomy vs. without mastoidectomy); and preoperative hearing level (normal vs. abnormal) were not significantly correlated with residual or recurrent disease. CONCLUSION: The disease extent, type, and stage; applied surgical methods; and preoperative hearing level were not significantly correlated with residual or recurrent disease. The size (≥4 mm) of congenital cholesteatoma was significantly correlated with residual or recurrent disease.


Assuntos
Colesteatoma/congênito , Mastoidectomia , Adolescente , Criança , Pré-Escolar , Colesteatoma/patologia , Colesteatoma/cirurgia , Feminino , Seguimentos , Audição , Humanos , Masculino , Processo Mastoide/patologia , Processo Mastoide/cirurgia , Período Pós-Operatório , Recidiva , Estudos Retrospectivos , Resultado do Tratamento
18.
J Int Adv Otol ; 15(3): 400-404, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31846919

RESUMO

Canal wall down mastoidectomy is a surgical technique used for the eradication of middle ear disease. The remaining large mastoid bowl is associated with a number of issues; one of the main techniques that have been developed in order to avoid such problems is the obliteration of the mastoid cavity. The materials used for this reason are either biological or synthetic. The purpose of this survey is to review the published literature related to the therapeutic value of mastoid obliteration with synthetic materials. We searched Web of Science, PubMed, and MEDLINE from 2008 to 2018 using the criteria mastoid obliteration, canal wall down mastoidectomy, chronic otitis media, and cholesteatoma. The search focused on papers concerning the mastoid obliteration with synthetic material, as we focused on looking for outcomes and reported complications. Out of a total of 244 citations, 15 articles were identified, where patients underwent mastoid obliteration with synthetic materials. Most authors used bioactive glass as a filler material. Mastoid obliteration resulted in a decrease in the complications associated with the open mastoid cavity. On the basis of the available limited literature, it seems that mastoid obliteration with synthetic materials is a valuable and safe surgical technique for patients who undergo canal wall down mastoidectomy. The bioactive glass appears to be the most reliable synthetic material.


Assuntos
Colesteatoma da Orelha Média/cirurgia , Processo Mastoide/cirurgia , Mastoidectomia/instrumentação , Otite Média/cirurgia , Retalhos Cirúrgicos , Doença Crônica , Meato Acústico Externo/cirurgia , Humanos , Mastoidectomia/métodos , Resultado do Tratamento
19.
J Laryngol Otol ; 133(12): 1083-1086, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31735177

RESUMO

OBJECTIVE: To assess the reliability of diffusion-weighted magnetic resonance imaging in differentiating recurrent cholesteatoma from granulation tissue after intact canal wall mastoidectomy. METHODS: A prospective study was conducted of 56 consecutive patients with suspected cholesteatoma recurrence after intact canal wall mastoidectomy who underwent diffusion-weighted imaging and delayed contrast magnetic resonance imaging of the temporal bone. The final diagnosis was recurrence in 38 patients and granulation tissue in 18 patients. RESULTS: Cholesteatoma detection on diffusion-weighted imaging based on two sets of readings had sensitivity of 94.7 and 94.7 per cent, specificity of 94.4 and 88.9 per cent, and accuracy of 94.6 and 92.8 per cent, with good intra-observer agreement (Κ = 0.72, p = 0.001). Cholesteatoma detection on delayed contrast magnetic resonance imaging had sensitivity of 81.6 and 78.9 per cent, specificity of 77.8 and 66.7 per cent, and accuracy of 80.4 and 75.0 per cent, with fair intra-observer agreement (Κ = 0.57, p = 0.001). The mean cholesteatoma diameter on diffusion-weighted imaging was 7.7 ± 1.8 and 7.9 ± 1.8 mm, with excellent intra-observer agreement (Κ = 0.994, p = 0.001). CONCLUSION: Diffusion-weighted imaging is a reliable method for differentiating recurrent cholesteatoma and granulation tissue after intact canal wall mastoidectomy.


Assuntos
Colesteatoma da Orelha Média/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética/estatística & dados numéricos , Tecido de Granulação/diagnóstico por imagem , Mastoidectomia/efeitos adversos , Complicações Pós-Operatórias/diagnóstico por imagem , Adolescente , Adulto , Colesteatoma da Orelha Média/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Processo Mastoide/diagnóstico por imagem , Processo Mastoide/cirurgia , Pessoa de Meia-Idade , Estudos Prospectivos , Recidiva , Reprodutibilidade dos Testes , Adulto Jovem
20.
Eur Arch Otorhinolaryngol ; 276(12): 3345-3352, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31541295

RESUMO

PURPOSE: Virtual reality (VR) simulation surgical skills training is well established, but self-directed practice is often associated with a learning curve plateau. In this study, we investigate the effects of structured self-assessment as a means to improve performance in mastoidectomy training. METHODS: The study was a prospective, educational study. Two cohorts of novices (medical students) were recruited for practice of anatomical mastoidectomy in a training program with five distributed training blocks. Fifteen participants performed structured self-assessment after each procedure (intervention cohort). A reference cohort of another 14 participants served as controls. Performances were assessed by two blinded raters using a modified Welling Scale and simulator-recorded metrics. RESULTS: The self-assessment cohort performed superiorly to the reference cohort (mean difference of final product score 0.87 points, p = 0.001) and substantially reduced the number of repetitions needed. The self-assessment cohort also had more passing performances for the combined metrics-based score reflecting increased efficiency. Finally, the self-assessment cohort made fewer collisions compared with the reference cohort especially with the chorda tympani, the facial nerve, the incus, and the malleus. CONCLUSIONS: VR simulation training of surgical skills benefits from having learners perform structured self-assessment following each procedure as this increases performance, accelerates the learning curve thereby reducing time needed for training, and induces a safer performance with fewer collisions with critical structures. Structured self-assessment was in itself not sufficient to counter the learning curve plateau and for continued skills development additional supports for deliberate practice are needed.


Assuntos
Simulação por Computador , Processo Mastoide/cirurgia , Mastoidectomia/educação , Autoavaliação , Treinamento por Simulação/métodos , Interface Usuário-Computador , Realidade Virtual , Adulto , Benchmarking , Competência Clínica , Estudos de Coortes , Educação de Pós-Graduação em Medicina/métodos , Feminino , Humanos , Curva de Aprendizado , Masculino , Mastoidectomia/métodos , Otolaringologia/educação , Estudos Prospectivos , Estudantes de Medicina
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