Congenital middle ear anomalies: anatomical and functional results of surgery.

The aim of this study was to describe the audiometric results following surgery in a consecutive series of pediatric patients with a congenital middle ear disorder. Retrospective chart review was performed for 29 consecutive children who underwent 33 middle ear surgeries for congenital ossicular chain anomaly between 1990 and 2012. Anomalies were classified into four groups according to the Teunissen and Cremers classification. Audiological parameters using four frequency averages (0.5, 1, 2 and 4 kHz) were assessed pre- and postoperatively. Clinical and audiometric follow-up times were, respectively, 49 ± 8 and 35 ± 5 months (mean ± SEM). Fifty-eight percent of all patients achieved an air-bone gap (ABG) ≤20 dB, 62.5% in class I, 50% in class II and 57.9% in class III. The improvement of the mean ABG was 13.6 dB, 19.2 dB for class I, 0.2 dB in class II and 15.4 dB in class III. Overall mean pure-tone averages improved 14.8 dB with 13.9 dB for class I; there was no improvement for class II and 20.2 dB for class III. The sensorineural hearing loss rate was 9%. This pediatric series showed that hearing results depend on type of anomaly. Class I and class III showed better hearing improvement than class II.

Blood supply to the human sternocleidomastoid muscle and its clinical implications for mandible reconstruction.

OBJECTIVES/HYPOTHESIS: The use of the sternocleidomastoid (SCM) flap for reconstructive surgery of the mandible seems to be a practicable although underestimated option. STUDY DESIGN: This study was conducted on 15 cadavers that had been neoprene-latex injected in the middle and inferior pedicles. METHODS: Lengths of the SCM were equally divided into upper, middle, and lower thirds. Each third was then subdivided into numbered quadrants. This procedure defined six levels in the SCM, each corresponding to two quadrants: one medial and the other lateral. For each third of the SCM, the origin of the main pedicles was recorded. The quadrants where neoprene-latex was detected were reported in the dissection book. RESULTS: The upper third of the SCM muscle was constantly supplied by branches of the occipital artery. The middle third of the SCM muscle received its blood supply from a branch of the superior thyroid artery (right SCM/left SCM: 53%/53%), the external carotid artery (27%/20%), or branches of both (20%/27%). The lower third of the muscle was supplied by a branch arising from the suprascapular artery (73%/73%), the transverse cervical artery (7%/13%), the thyrocervical trunk (13%/13%), or the superficial cervical artery (7%/0%). The neoprene-latex injected into the subclavian artery reached the four lower levels in all SCMs studied (the middle third of the SCM). In 13% of the SCMs, this injection also reached level II (the upper third of the SCM). With a double injection (inferior and middle pedicles), levels I and II were reached in 100% of the cases. CONCLUSIONS: This study shows that, used alone, the lower pedicle does not have the ability to ensure the full vascularization of the SCM muscle. A composite flap might be safely raised only if the integrity of both inferior and middle pedicles is respected.