scholarly journals Cautionary Findings for the Presence of Facial Canal Dehiscence During Cholesteatoma Surgery

2019 ◽  
Vol 99 (5) ◽  
pp. 327-330
Author(s):  
Muammer Melih Sahin ◽  
Melih Cayonu ◽  
Ayse Secil Kayalı Dinc ◽  
Suleyman Boynuegri ◽  
Fulya Eker Barut ◽  
...  
Keyword(s):  
Posterior Wall ◽  
Ossicular Chain ◽  
Facial Canal ◽  
Canal Wall ◽  
Tegmen Tympani ◽  
Canal Wall Down ◽  
Facial Canal Dehiscence ◽  
The Relationship ◽  
Cholesteatoma Surgery ◽  
Canal Dehiscence

Our aim was to investigate the relationship between facial canal dehiscence (FCD) and surgical findings and procedures in patients with cholesteatoma. A total of 186 patients (118 males, 39.2 ± 15 years) who underwent surgery for advanced cholesteatoma between 2013 and 2018 were included in the study. The relationship between FCD and surgical findings was investigated via the surgical registries. The prevalence of FCD was 36.6% (68/186). The prevalence of FCD was 44%, and 13.2% for the patients who underwent canal wall down mastoidectomy (62/141) and canal wall up mastoidectomy (6/45), respectively ( P < .001). Facial canal dehiscence was detected in 73.9% of the 23 patients who had a lateral semicircular canal (LSCC) defect ( P < .001), in 61.9% of 21 patients who had a tegmen tympani defect, and in 58.1% of the 31 patients who had erosion on the posterior wall of the external auditory canal (EAC; P < .05). The prevalence of FCD was 3.1% in patients with isolated incus erosion, 59.1% in patients with erosion of malleus and incus, 60.7% in patients with erosion of stapes suprastructure and incus, and 43.2% in patients with whole ossicular chain deformation ( P < .001). The defects on LSCC, EAC, tegmen tympani, and malleus and incus might be cautionary findings for the presence of FCD during cholesteatoma surgery.

scholarly journals Relation between Ossicular Erosion and Destruction of Facial and Lateral Semicircular Canals in Chronic Otitis Media

2016 ◽  
Vol 21 (03) ◽  
pp. 239-242 ◽  
Author(s):  
Suphi Bulğurcu ◽  
İlker Arslan ◽  
Bünyamin Dikilitaş ◽  
İbrahim Çukurova
Keyword(s):  
Facial Nerve ◽  
Otitis Media ◽  
Chronic Otitis Media ◽  
Semicircular Canals ◽  
Ossicular Chain ◽  
Facial Canal ◽  
Canal Wall ◽  
Radical Mastoidectomy ◽  
Canal Wall Down ◽  
Canal Wall Up

Introduction Chronic otitis media can cause multiple middle ear pathogeneses. The surgeon should be aware of relation between ossicular chain erosion and other destructions because of the possibility of complications. Objective This study aimed to investigate the rates of ossicular erosion in cases of patients with and without facial nerve canal destruction, who had undergone mastoidectomy due to chronic otitis media with or without cholesteatoma. Methods We retrospectively analyzed three hundred twenty-seven patients who had undergone tympanomastoidectomy between April 2008 and February 2014. We documented the types of mastoidectomy (canal wall up, canal wall down, and radical mastoidectomy), erosion of the malleus, incus and stapes, and the destruction of facial and lateral semi-circular canal. Results Out of the 327 patients, 147 were women (44.95%) and 180 were men (55.04%) with a mean age 50.8 ± 13 years (range 8–72 years). 245 of the 327 patients (75.22%) had been operated with the diagnosis of chronic otitis media with cholesteatoma. FNCD was present in 62 of the 327 patients (18.96%) and 49 of these 62 (79.03%) patients had chronic otitis media with cholesteatoma. The correlation between the presence of FNCD with LSCC destruction and stapes erosion in chronic otitis media with cholesteatoma is statistically significant (p < 0.05). Conclusion Although incus is the most common of destructed ossicles in chronic otitis media, facial canal destruction is more closely related to stapes erosion.

scholarly journals Relationship Between Ossicular Chain Erosion and Facial Canal Dehiscence in Chronic Otitis Media Squamous

2020 ◽  
Vol 42 (2) ◽  
pp. 1-4
Author(s):  
Bijaya Kharel ◽  
Ashok Shreepaili ◽  
Prashant Tripathi ◽  
Yogesh Neupane ◽  
Urmila Gurung ◽  
...  
Keyword(s):  
Otitis Media ◽  
Chronic Otitis Media ◽  
Retrospective Chart Review ◽  
Ossicular Chain ◽  
University Teaching ◽  
P Value ◽  
Facial Canal ◽  
Adjacent Structures ◽  
Facial Canal Dehiscence ◽  
Canal Dehiscence

Introduction Chronic otitis media squamous is a gradually expanding destructive lesion and leads to complications by eroding the adjacent structures. Facial canal and ossicles are in close proximity in the middle ear space and they share the same pathogenesis of the bony erosion. Ossicular chain erosion found intraoperatively due to cholesteatoma, may suggest the likelihood of facial canal dehiscence. This study was conducted to assess the relationship between ossicular chain erosion and facial canal dehiscence in chronic otitis media squamous. MethodsIt is a retrospective chart review of patients who had mastoidectomy done for chronic otitis media squamous in Tribhuvan University Teaching Hospital from January 2014 to December 2018. The operative findings of facial canal dehiscence were correlated with ossicular chain status. ResultsAmong 158 cases, facial canal dehiscence was seen in 20 (12.7%), of which, 19/20 (95%) had ossicular erosion. Majority (90%) of dehiscence was in the horizontal segment. Incus was the most common ossicle to be eroded. Among the ossicles, stapes erosion was related to the facial canal dehiscence with odds ratio of 3.216 (1.235-8.374) and p-value 0.03. ConclusionAmong the ossicles, there is a relationship between the stapes erosion and the facial canal dehiscence in chronic otitis squamous. Erosion of ossicular chain especially stapes should alert surgeons towards the possibility of facial canal dehiscence.

Tensa retraction cholesteatoma: treatment and long-term results

1989 ◽  
Vol 103 (2) ◽  
pp. 149-157 ◽  
Author(s):  
T. Lau ◽  
M. Tos
Keyword(s):  
Ossicular Chain ◽  
Observation Time ◽  
Long Term Results ◽  
Mastoid Process ◽  
Canal Wall ◽  
Pars Tensa ◽  
Results Of Treatment ◽  
Acquired Cholesteatoma ◽  
Canal Wall Down

AbstractTo obtain the best possible results of treatment of acquired cholesteatoma, we made a subdivision of cholesteatoma types into attic and pars tensa cholesteatomas, and subdivided the latter further into tensa retraction cholesteatoma and sinus cholesteatomas. Tensa retraction cholesteatoma is defined as arising from a retraction or perforation of the whole pars tensa, whereas sinus cholesteatoma is defined as arising from a retraction or perforation of the postero-superior part of the tensa. We present the long-term results obtained in tensa retraction cholesteatomas treated with one stage surgery from 1964 to 1980. Median observation time was 9 years, range 2 to 19 years. Sixty-one ears were treated without mastoidectomy, whereas 71 ears had canal wall-up mastoidectomy and 64 ears had canal wall-down mastoidectomy. The total recurrence rate was 13.3 per cent; 17 ears had residual cholesteatoma, and nine ears had recurrent cholesteatoma. The best results were obtained in ears with an intact ossicular chain where mastoidectomy was not performed. In 49 per cent of the cases, the cholesteatoma was confined to the tympanic cavity without reaching the aditus, antrum or mastoid process. About one-third to one-quarter of the ears had tympanoplasty only, with removal of the cholesteatoma through the ear canal.

scholarly journals Four layers reconstruction of the posterior ear canal wall in one stage surgery

2021 ◽  
Author(s):  
Khaled M. Mokbel Khalefa
Keyword(s):  
Otitis Media ◽  
Recurrent Infection ◽  
Posterior Wall ◽  
Chronic Suppurative Otitis Media ◽  
Canal Wall ◽  
Suppurative Otitis Media ◽  
Posterior Canal ◽  
One Stage ◽  
Canal Wall Down ◽  
Canal Wall Down Mastoidectomy

<p class="abstract"><strong>Background:</strong> Canal wall down mastoidectomy are still practiced in cases of chronic suppurative otitis media with cholesteatoma to ensure complete disease removal. The resulting cavity is prone to recurrent infection, chronic discharge and frequent care. Reconstruction of the posterior canal wall should be planned by the surgeon. Various techniques for external auditory canal (EAC) reconstruction have been recommended to eliminate open cavity problems. The surgeon should choose the type of grafts either autologous, homografts or synthetic materials. Furthermore, the surgeon should decide whether to do the reconstruction either immediate in the first stage of surgery or delayed as a second stage.</p><p class="abstract"><strong>Methods:</strong> In this study, the ridge was reconstructed at the same time of mastoidectomy by autologous tissues. The presenting study reconstructed the posterior canal wall in four layers; skin, perichondrial flap, cartilage and periosteal flap in that order from the meatal side to the mastoid side. The presenting study included 48 patients (32 males and 16 females) with age ranged from 18-55 and 20-50 years. All included patients were presented at the outpatient clinic with unilateral chronic suppurative otitis media with persistent discharge. They had been operated at our tertiary hospital between January. 2012 to March 2014.</p><p class="abstract"><strong>Results:</strong> Successful reconstruction was obtained in all cases, with no dehiscence or necrosis.</p><p class="abstract"><strong>Conclusions:</strong> The reconstruction of the posterior wall by the four layers technique was successful and efficient. It is recommended to do this repair concomitantly with canal wall down mastoidectomy as one stage surgery.</p>

scholarly journals Hearing Status After Ossiculoplasty in Open Cavity Mastoidectomy

2020 ◽  
Vol 23 (2) ◽  
pp. 195-198
Author(s):  
Md Zakaria Sarker ◽  
DC Talukder ◽  
Khabir Uddin Patuary ◽  
Md Rafiqul Islam ◽  
Saif Rahman Khan ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Ossicular Chain ◽  
Ear Reconstruction ◽  
Canal Wall ◽  
Prospective Longitudinal Study ◽  
Hearing Gain ◽  
Canal Wall Down ◽  
Canal Wall Down Mastoidectomy ◽  
Middle Ear Reconstruction ◽  
Prospective Longitudinal

To evaluate the hearing outcome in canal wall down mastoidectomy with middle ear reconstruction, prospective longitudinal study was done at National Institute of ENT, Dhaka from March 2015 to September 2016. Total 22 patients were included in the study undergoing canal wall down mastoidectomy with 6 months postoperative followup. Hearing outcomes were observed and compared with the preoperative hearing tests. Among the 22 patients 9 (39.1% of subjects) patients had hearing gain, 12 (52.2%) had hearing loss and 1 (4.3%) had no change in hearing postoperatively.Although disease clearance is the main objective in canal wall down mastoidectomy, hearing gain can be achieved if combined with ossiculoplasty and tympanoplasty. The hearing gain or loss depends upon the extension of disease and status of the ossicular chain. Most patients usually experience hearing loss more than the preoperative period due to removal of ossicle or ossicles for the sake of disease clearance. Bangladesh J Otorhinolaryngol; October 2017; 23(2): 195-198

scholarly journals Management of Benign Middle Ear Tumors: A Series of 7 Cases

2017 ◽  
Vol 96 (10-11) ◽  
pp. 426-432
Author(s):  
Z. Jason Qian ◽  
Amy M. Coffey ◽  
Kathleen M. O'Toole ◽  
Anil K. Lalwani
Keyword(s):  
Surgical Management ◽  
Middle Ear ◽  
Ossicular Chain ◽  
Clinical Findings ◽  
Mastoid Cavity ◽  
Canal Wall ◽  
Tumor Excision ◽  
Canal Wall Down ◽  
Canal Wall Down Mastoidectomy ◽  
Rare Group

Benign middle ear tumors represent a rare group of neoplasms that vary widely in their pathology, anatomy, and clinical findings. These factors have made it difficult to establish guidelines for the resection of such tumors. Here we present 7 unique cases of these rare and diverse tumors and draw from our experience to recommend optimal surgical management. Based on our experience, a postauricular incision is necessary in nearly all cases. Mastoidectomy is required for tumors that extend into the mastoid cavity. Whenever exposure or hemostasis is believed to be inadequate with simple mastoidectomy, canal-wall-down mastoidectomy should be performed. Finally, disarticulation of the ossicular chain greatly facilitates tumor excision and should be performed early in the procedure.

scholarly journals Can MDCT Scan of the Temporal Bone Looking at Pneumatization Predict Surgical Vulnerability of the Facial Nerve?

2019 ◽  
pp. 014556131987952
Author(s):  
Mikail Inal ◽  
Nuray Bayar Muluk ◽  
Mehmet Hamdi Şahan ◽  
Neşe Asal ◽  
Gökçe Şimşek ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Facial Canal ◽  
Nerve Injuries ◽  
Mastoid Pneumatization ◽  
Computed Tomography Scans ◽  
Facial Nerve Injuries ◽  
Important Landmark ◽  
Facial Canal Dehiscence ◽  
Males And Females ◽  
Canal Dehiscence

Objectives: The aim of this study is to investigate the scutum–cochleariform process (CP) and scutum–promontorium distances according to the mastoid pneumatization condition. Methods: Two hundred temporal multidetector computed tomography scans (90 males and 110 females) were evaluated retrospectively. The scutum-CP and scutum–promontorium distances were measured. Facial canal dehiscence (FCD) in the tympanic segment and mastoid pneumatization were also evaluated. Results: The distances between scutum-CP and scutum–promontorium were not different between males and females and between right and left sides. Facial canal dehiscence in the tympanic segment was detected: 5.6% (right) and 7.8% (left) in males and 5.5% (right) and 10.0% (left) in females. Grade 4 (100%) pneumatization was detected mainly in 55.6% to 57.8% of the patients in both genders. Grade 0 (0%) pneumatization (sclerosis) was detected in 22.2% to 28.2% of both males and females. In more pneumatized mastoids, the scutum-CP and scutum–promontorium distances increased. In sclerotic mastoids, the scutum-CP and scutum–promontorium distances decreased. Facial canal dehiscence rates were not related to the mastoid pneumatization levels. Conclusion: Cochleariform process is an important landmark to localize the tympanic segment of the facial canal. In sclerosed mastoids, scutum-CP and scutum–promontorium distances decreased. There was no relationship between FCD rates and mastoid pneumatization levels. It may be due to the development of FCD that occurs during the intrauterine period. In endoscopic and classic ear surgeries, mastoid pneumatization must be evaluated preoperatively to avoid facial nerve injuries.

Role of ossiculoplasty in canal wall down tympanoplasty for middle-ear cholesteatoma: hearing results

2006 ◽  
Vol 121 (4) ◽  
pp. 324-328 ◽  
Author(s):  
E De Corso ◽  
M R Marchese ◽  
B Sergi ◽  
M Rigante ◽  
G Paludetti
Keyword(s):  
Middle Ear ◽  
Bone Conduction ◽  
Consecutive Series ◽  
Canal Wall ◽  
Hearing Results ◽  
Middle Ear Cholesteatoma ◽  
Canal Wall Down ◽  
The Mean ◽  
Air Conduction ◽  
Cholesteatoma Surgery

The aim of this study was to evaluate the hearing results of ossiculoplasty in canal wall down tympanoplasty in one stage middle-ear cholesteatoma surgery.We carried out a retrospective review of a consecutive series of 142 cases which had undergone type two or three canal wall down tympanoplasty with ossicular reconstruction, between January 1995 and December 2002, due to chronic otitis media with cholesteatoma.Pre-operative audiometric testing revealed a mean air conduction pure tone average (PTA) of 50.97 dB and a mean bone conduction PTA of 22.14 dB. The mean post-operative result for air conduction PTA was 37.62 and for bone conduction PTA was 23.37 dB. The mean pre- and post-operative air–bone gaps (ABGs) were 28.83 and 13.94 dB, respectively, with a gain of 14.89 dB. Almost 62.67 per cent of patients closed their ABGs to within 20 dB.Our functional results are comparable with those of other authors. In the present study, we show that hearing improvement is possible following cholesteatoma surgery with canal wall down tympanoplasty and ossicular chain reconstruction.

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