Combined Heermann and Tos (CHAT) technique in cholesteatoma surgery: surgical technique and preliminary results

2005 ◽  
Vol 119 (6) ◽  
pp. 429-435 ◽  
Author(s):  
Cem Uzun ◽  
Recep Yagiz ◽  
Abdullah Tas ◽  
Mustafa K Adali ◽  
Muhsin Koten ◽  
...  
Keyword(s):  
Middle Ear ◽  
Long Term Results ◽  
Type I ◽  
Canal Wall ◽  
Auricular Cartilage ◽  
Cortical Mastoidectomy ◽  
Thin Bridge ◽  
Stage 1

The combined Heermann and Tos (CHAT) technique is the combination of Heermann’s ’cartilage palisade tympanoplasty’ and Tos’s ’modified combined approach tympanoplasty = modified intact canal wall mastoidectomy’. The first author (Cem Uzun) performed the CHAT technique as a one-stage operation in 15 ears of 15 patients with cholesteatoma. Two patients (one with a follow up of less than six months and one who did not show up at the final re-evaluation) were excluded from the study. Median age in the remaining 13 patients was 37 years (range: 14–57 years). Cholesteatoma type was attic, sinus (Tos tensa type 1) and tensa retraction (Tos tensa type 2) in six, five and two ears, respectively. Cholesteatoma stage was Saleh and Mills stage 1, 2, 3, 4 and 5 in one, three, four, four and one ear, respectively. The eustachian tube was not involved with cholesteatoma in any ear. After drilling of the superoposterior bony annulus, transcanal atticotomy with preservation of thin bridge and cortical mastoidectomy with intact canal wall, the cholesteatoma was removed, and the eardrum and atticotomy were reconstructed with palisades of auricular cartilage. Type I tympanoplasty was performed in two ears, type II in nine ears and type III (stapes absent) in two ears, with either autologous incus (eight cases), cortical bone (two) or auricular cartilage (one). No complication occurred before, during or after surgery. Oto-microscopy and audiometry were done before and at a median of 13 months after surgery (mean 14 months, range 7–30 months). There was no sign of residual or recurrent cholesteatoma in any patient during the follow-up period. At the final examination, all ears were dry and had an intact eardrum except one with a small, central hole, which had been seen since the early post-operative period. Clean and stable attic retraction with a wide access was observed in two ears. Post-operative hearing at the final evaluation was better (change > 10 dB) than the pre-operative one in nine ears and did not change in the remaining four. Pre- and post-operative mean hearing values were, pure-tone average 47 and 35 dB (p = 0.01) and air-bone gap 30 and 20 dB (p = 0.02), respectively. With the CHAT technique, cholesteatoma can be completely and safely removed from the middle ear, and a durable and resistant reconstruction of the middle ear with reasonable hearing can be achieved. However, a further study should analyse long-term results of a larger patient group.

scholarly journals CANAL WALL RECONSTRUCTION SURGERY IN RETRACTION PATHOLOGYEXPERIENCE AT AL NAHDHA HOSPITAL*, OMAN

2020 ◽  
Vol VOLUME 8 (ONE) ◽  
pp. 17-23
Author(s):  
M Kashoob
Keyword(s):  
Tympanic Membrane ◽  
Middle Ear ◽  
Long Term Results ◽  
Surgical Removal ◽  
Canal Wall ◽  
Surgical Methods ◽  
Middle Ear Cholesteatoma ◽  
Defect Repair

Abstract Objectives: Tympanic membrane retraction pathology is a frequently encountered middle ear problem that can be a self cleansing pocket, a deep sac with hidden cholesteatoma or a potential reservoir for its future formation. In selected cases, a defect in attic and posterior superior canal wall can result after surgical removal of the diseased epithelium and/or cholesteatoma. If this occurs, reconstruction is usually attempted. Avoiding an open cavity in such conditions is currently the preferred approach. We sought to study the cartilage reconstruction outcomes of the attic and/or posterior superior canal wall defects for selected cases of retraction pathology without a need for an open mastoid cavity. We investigated the short and long term results with regards to the resorption with time, displacement or recurrence of cholesteatoma. Methods: This is a retrospective study conducted at Al Nahda Hospital in Oman between 2008 and 2014. A total 301 patients who underwent inside-out atticotomy with attic defect repair or cortical mastoidectomy with atticotomy and attic defect repair were included in the study. Staging and classication criteria for middle ear cholesteatoma proposed by the Japan Otological Society (JOS) were applied based on surgical and follow-up notes in cases with recurrent cholesteatoma. The status of the reconstructed part of the outer attic wall with respect to survival and stability of cartilage was assessed carefully at less than six months (short term) and at more than two year periods (long term) after surgery. Results: Out of 301 patients who underwent mastoid surgeries between 2008 and 2014, 72 patients met the inclusion criteria. Results of both surgical methods were then assessed. It was noted that the longer the duration after postoperative period (> 2 years), the more chance to have a recurrence of disease, displacement/ resorption of the reconstructed part or retraction/perforation of tympanic membrane (p < 0.026). Moreover, the reconstruction part of the attic and posterior superior canal wall may be resorbed with time in some cases as shown in this study (9.4%). However, the rate is low and worth considering in all the cases of attic or selected atticoantral cholesteatomas. Conclusion: Resorption and displacement of the reconstructed part of the attic and/or posterior superior canal wall was observed during the follow–up period of this study. This may have contributed to the retraction pocket reformation followed by the recurrence of cholesteatoma. It was noted to be more obvious during long duration of follow-up. Hence, we recommend a longer follow-up of at least 2 years post operatively even if the ndings are showing good results during initial visits. Although the recurrence rate of disease with the used surgical methods in this study was 16.9%, in order to compare the results of this surgical method with either canal wall up or canal wall down, future surgical methods will require a randomized trial. Key words: Cholesteatoma, mastoidectomy, reconstruction, cartilage, canal wall, atticotomy

Anterior Palatoplasty for the Treatment of OSA

2009 ◽  
Vol 141 (2) ◽  
pp. 253-256 ◽  
Author(s):  
Kenny P. Pang ◽  
Raymond Tan ◽  
Puravi Puraviappan ◽  
David J. Terris
Keyword(s):  
Body Mass Index ◽  
Clinical Stage ◽  
Long Term Results ◽  
Apnea Hypopnea Index ◽  
Type I ◽  
Obstructive Sleep ◽  
The Mean ◽  
Anterior Palatoplasty

OBJECTIVE: Review long-term results of the modified cautery-assisted palatoplasty (mod CAPSO)/anterior palatoplasty for the treatment of mild-moderate obstructive sleep apnea (OSA). STUDY DESIGN: Prospective series of 77 patients. All patients were >18 years old, type I Fujita, body mass index (BMI) < 33, Friedman clinical stage II, with apnea-hypopnea index (AHI) from 1.0 to 30.0. The mean follow-up time was 33.5 months. The procedure involved an anterior soft palatal advancement technique with or without removal of the tonsils. The procedure was done under general or local anesthesia. RESULTS: There were 69 men and eight women; the mean age was 39.3 years old; and mean BMI was 24.9 (range 20.7–26.8). There were 38 snorers and 39 OSA patients. The AHI improved in patients with OSA, 25.3 ± 12.6 to 11.0 ± 9.9 ( P < 0.05). The overall success rate for this OSA group was 71.8 percent (at mean 33.5 months). The mean snore scores (visual analog score) improved from 8.4 to 2.5 (for all 77 patients). Lowest oxygen saturation also improved in all OSA patients. Subjectively, all patients felt less tired. CONCLUSION: This technique has been shown to be effective in the management of patients with snoring and mild-moderate OSA.

scholarly journals Long-Term Results of Autologous Auricular Cartilage Graft Applied in Anophthalmic Orbits Unable to Wear Prosthesis

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Yi-Lin Liao ◽  
Shu-Ya Wu ◽  
Yueh-Ju Tsai
Keyword(s):  
Donor Site ◽  
Donor Site Morbidity ◽  
Long Term Results ◽  
Chang Gung Memorial Hospital ◽  
Cartilage Graft ◽  
Auricular Cartilage ◽  
Prosthesis Fitting ◽  
Prosthesis Retention

In anophthalmic patients, shallow lower fornices make wearing ocular prostheses impossible and maintaining normal social activities difficult. This study retrospectively investigated the long-term surgical outcomes of autologous auricular cartilage grafting for contracted orbits. From 1995 to 2013, 29 anophthalmic contracture sockets with inadequate lower fornices and poor prosthesis retention presented to Chang Gung Memorial Hospital in Linkou, Taiwan, were treated using this surgical method. The success rate, aesthetic outcome, recurrence, and complications were analyzed. Among the 29 patients, 15 were women, 14 were men, their mean age was 45 years, and the mean follow-up time was 52 months (range = 6–159 months). Satisfactory lid position was achieved in 25 cases (86%), and lower fornix retraction recurred in four cases (14%). Neither donor site morbidity nor auricular deformity was noted during the follow-up period. Therefore, an auricular cartilage graft can be used successfully as a compatible spacer for anophthalmic patients with shallow lower fornices and prosthesis-fitting problems in long-term follow-up.

scholarly journals Vibrant Soundbridge Implantable Hearing Device: Critical Review and Single-Surgeon Short- and Long-Term Results

2010 ◽  
Vol 89 (9) ◽  
pp. E9-E14 ◽  
Author(s):  
Charles M. Luetje ◽  
Sandra A. Brown ◽  
Robert D. Cullen
Keyword(s):  
Middle Ear ◽  
Final Analysis ◽  
Senior Author ◽  
Long Term Results ◽  
Direct Drive ◽  
Vibrant Soundbridge ◽  
Short And Long Term ◽  
Hearing Device

We conducted a retrospective descriptive study of a series of 31 consecutively presenting patients who had been implanted with the Vibrant Soundbridge middle ear hearing device. All implantations had been performed by the senior author. Three of these patients had undergone bilateral implantation, and 4 others had undergone subsequent explantation and reimplantation in response to known or suspected device failure, giving us a total of 34 ears and 38 implants. Our goal was to ascertain short- and long-term outcomes as measured by conventional audiometry (pure-tone average at 1 to 6 kHz) and long-term benefit as defined by the use or nonuse of the device. We found that at the initial activation session 2 months postoperatively, the average hearing thresholds were within 3 dB of the preoperative thresholds in all 34 ears and all 38 implants. The mean short-term gain at activation in the 38 implants was 28.1 dB. Nineteen patients (20 ears) were available for long-term evaluation, with the length of follow-up ranging from less than 1 year to 11 years (mean: 7.3). Of these 20 ears, 9 demonstrated further gain (mean: 10.8 dB) despite any natural hearing deterioration; of the remaining 11 ears, gain was unchanged in 2, diminished in 7 (mean: −3.6 dB), and gain data were unavailable in 2. In the final analysis, there were 20 user ears and 10 nonuser ears; 4 ears were lost to all follow-up. We conclude that direct-drive hearing with the Vibrant Soundbridge middle ear hearing device is beneficial and provides sustained audiometric gain. Factors that have a significant impact on patient use or nonuse include difficulty in obtaining audiologic support and the direct and indirect costs of the device. Without audiologic or financial support, some patients may choose to become nonusers and to either switch to conventional hearing aid amplification or become apathetic about hearing improvement.

scholarly journals Cystic Dilation of Extrahepatic Bile Ducts in Adulthood: Diagnosis, Surgical Treatment and Long. Term Results

HPB Surgery ◽  
1998 ◽  
Vol 10 (6) ◽  
pp. 379-385 ◽  
Author(s):  
G. Belli ◽  
G. Rotondano ◽  
A. D'Agostino ◽  
A. Iannelli ◽  
I. Marano ◽  
...  
Keyword(s):  
Endoscopic Sphincterotomy ◽  
Operative Mortality ◽  
Anastomotic Stricture ◽  
Long Term Results ◽  
Type I ◽  
Hida Scan ◽  
Extrahepatic Bile Ducts ◽  
Results Of Surgery

To evaluate the long-term results of surgery for choledohal cyst in adulthood, a series of 13 patients over the age of 16 operated on for choledochal cyst during a period of six years and followed-up for a minimum of 3 years was analyzed. Patients with type I and IVa cysts underwent extrahepatic cyst resection and Roux-en-Y hepatico-jejunostomy. Choledochoceles (type III) were managed endoscopically. No operative mortality or morbidity occurred. Type I and III cysts showed almost ideal follow-up with no sign of stricture on HIDA scan. One type IVa cyst patients developed recurrent cholangitis due to anastomotic stricture, managed percutaneously. Whenever possible, complete cyst resection and Roux-en-Y reconstruction is the treatment of choice for all extrahepatic biliary cysts. Intra- and extrahepatic dilatations are adequately treated by extrahepatic resection and careful endoscopic or radiologic surveillance. Small choledochoceles can be safely managed by endoscopic sphincterotomy.

Long-term results after posterior fossa decompression in syringomyelia with adult Chiari Type I malformation

2012 ◽  
Vol 17 (5) ◽  
pp. 381-387 ◽  
Author(s):  
Alex Alfieri ◽  
Giampietro Pinna
Keyword(s):  
Craniocervical Junction ◽  
Long Term Results ◽  
Symptom Duration ◽  
Posterior Fossa Decompression ◽  
Type I ◽  
Duration Of Symptoms ◽  
Initial Symptoms ◽  
Csf Leakage

Object There is little information about the long-term effectiveness and complications following decompressive surgery for syringomyelia related to Chiari malformation Type I (CM-I). Methods Examining long-term clinical and radiological follow-up, the authors studied a mixed retrospective and prospective single-institution cohort of 109 consecutive surgically treated adult patients with syringomyelia and CM-I. All patients underwent a standardized surgical protocol: decompression of the craniocervical junction, arachnoid exploration, and shrinkage of the cerebellar tonsils. Factors predicting outcome were investigated. Results The retrospective arm consisted of 41 cases treated between 1990 and 1994, and the prospective arm comprised 68 patients treated between 1994 and 2001. The mean overall age was 45.9 years, and 58.8% of the population was female. The median follow-up period was 12.7 years. The most frequent initial symptoms were pain and sensory and gait disturbances. There was no perioperative death or neurological deterioration. The comprehensive perioperative complication rate was approximately 11%, with 3 cases (2.7%) of CSF leakage. Regression analysis showed that the best combination of clinical and radiological outcome predictors was age and duration of symptoms. Clinical follow-up confirmed surgical result stability with clinical improvement of greater than 90% of the spinal and cranial manifestations over a long-term period. Two patients had radiological recurrences of syringomyelia without clinical signs 85 and 124 months after surgery. Conclusions Certain clinical predictors of poor clinical and radiological prognosis were identified—namely, age at time of surgery and symptom duration. The results of the study provide additional long-term data that support the effectiveness and safety of relieving CSF block at the craniocervical junction in CM-I–related syringomyelia.

scholarly journals Large Cholesterol Granuloma of the Middle Ear Eroding into the Middle Cranial Fossa

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Tessei Kuruma ◽  
Tohru Tanigawa ◽  
Yasue Uchida ◽  
Ogawa Tetsuya ◽  
Hiromi Ueda
Keyword(s):  
Middle Ear ◽  
Middle Cranial Fossa ◽  
Uneventful Recovery ◽  
Petrous Apex ◽  
Cholesterol Granuloma ◽  
Canal Wall ◽  
Cortical Mastoidectomy ◽  
Cranial Fossa ◽  
Canal Wall Down

Background. Cholesterol granuloma of the middle ear is extremely rare in comparison to cholesterol granuloma of the petrous apex but sometimes shows an aggressive course.Case Report. We report herein a case involving a large, aggressive cholesterol granuloma of the middle ear that eroded the middle cranial fossa. A 64-year-old woman presented with pain in the left ear and hearing loss. Cholesterol granuloma was finally diagnosed from diffusion-weighted imaging, and cortical mastoidectomy was performed with canal wall down tympanoplasty type III. Recovery was uneventful recovery and the patient well at the 3-year follow-up.Conclusion. This case demonstrates the rare but clinically important pathology of aggressive cholesterol granuloma of the middle ear.

scholarly journals Takayasu’s aortoarteritis

2005 ◽  
Vol 52 (3) ◽  
pp. 95-98 ◽  
Author(s):  
Lazar Davidovic ◽  
R. Sindjelic ◽  
Z. Jovanovic ◽  
V. Bozic ◽  
D. Markovic
Keyword(s):  
Vascular Graft ◽  
Complex Disease ◽  
Far East ◽  
Proximal Part ◽  
Long Term Results ◽  
Type I ◽  
Therapeutic Approaches ◽  
Arterial Lesions

Surgical treatment of two female patients aged 32 and 41 years, with neurological problems causes by type I Takayasu?s aortoarteritis, are presented here. both of them were treated with by pass from ascending aorta to left common carotid and left subclavian arteries, using transsternal approach. During the follow up period (3.5 years for the first, and 2 years for the second patient) both patients were free of neurological symptoms. Corticosteroid therapy was given to the first patient for controlling of active diseases, immediately after the operation and during the first three postoperative months. By this reason an infection at the proximal part of sternal wound was developed. MRI showed involvement of the vascular graft. Due to high risk of reoperation, medical treatment was performed. Takayasu?s aortoarteritis is very uncommon in our country, as well as in other countries which don?t belong to Far East. In cases with hemodinamic important arterial lesions produced disabling symptoms, a standard PTA and reconstructive vascular procedures are indicated. Takayasu?s aortoarteritis is a complex disease. It requires combined diagnostic and therapeutic approaches which produce satisfied long-term results.

scholarly journals The long-term results of benign bile duct strictures reconstruction

2003 ◽  
Vol 131 (1-2) ◽  
pp. 55-59
Author(s):  
Radoje Colovic ◽  
Dragoljub Bilanovic ◽  
Miodrag Jovanovic ◽  
Nikica Grubor
Keyword(s):  
Bile Duct ◽  
Long Term Results ◽  
Type I ◽  
Unsatisfactory Result ◽  
Type Iv ◽  
Intrahepatic Lithiasis ◽  
Endemic Nephropathy ◽  
Mean Time

Over 27 year period (1.01.1974-31.12.2001) a 168 patients (pts) were operated on for benign bile duct strictures of types I to IV according to Bismuth,s classification. Reconstruction of fresh lesions and lesions and strictures of sectoral or segmental ducts were not taken into account. The later are to be the subject of separate publication. There were 107(63,7%) women and 61(36,3%) men of average age of 46 years (ranging from 14 to 76 years). The average time from injury to our reconstruction was 8,2 years. In 162 pts (96,4%) an operative injury was the cause of the stricture, in 150 (89,3%) during cholecystectomy, in 8 (4,76%) during distal gastrectomy for duodenal ulcer and in 4 (2,38%) during surgery of the central hydatid cyst of the liver. In 112 (66,66%) pts 1 to 6 previous attempts of reconstructions had been performed elsewhere. According to the Bismuth,s classification there were 27 (16,07%) strictures of type I, 46 (27,38%) of type II, 66 (39,28%) of type III and 29 (17,26%) of type IV. The most frequent preoperative complications were intrahepatic lithiasis (34%), fibrosis or cirrhosis of the liver in 9,5%, liver abscesses in 6%, bilioduodenal fistula in 4,16% biliary peritonitis in 4,16% and incisional hernia in 8,9% of pts. Suture mucosa-to-mucosa hepaticojejunostomy with 75 cm long Roux-en-Y jejunal limb described by Blumgart was performed in 161 (95,8%), choledochoduodenostomy in 3 (1,8%) and strictureplasty in 2 (1,2%) while in 2 pts the reconstruction was not technically possible. Three pts died during the first 6 months, 2 in whom the reconstruction was not possible and 1 with chronic endemic nephropathy. Eight of the rest 165 pts were lost from follow up being from Bosnia and Croatia due to well known war events. Six out of the 157 pts died in the mean time, 2 due to variceal bleeding (they had cirrhosis and portal hypertension at the time of reconstruction) an 4 due to unrelated causes (2 due to pancreatic carcinoma, 1 due to myocardial infarction and 1 due to stroke). Out of 151 alive fully followed pts, good result (pts symptom-free as after standard cholecystectomy) was achieved in 121 (80,13%), satisfactory (mild occasional symptoms but not cholangitis) in 27 (17,88%) and unsatisfactory result in 3 pts (2%), 2 of which were successfully reoperated (1 passed into group with good and 1 into group with satisfactory results).

Surgical reconstruction for unilateral iliac artery lesions in patients younger than 50 years

VASA ◽  
2011 ◽  
Vol 40 (6) ◽  
pp. 474-481 ◽  
Author(s):  
Radak ◽  
Babic ◽  
Ilijevski ◽  
Jocic ◽  
Aleksic ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Limb Salvage ◽  
Iliac Artery ◽  
Graft Patency ◽  
Long Term Results ◽  
Surgical Reconstruction ◽  
Safe Procedure ◽  
Term Survival

Background: To evaluate safety, short and long-term graft patency, clinical success rates, and factors associated with patency, limb salvage and mortality after surgical reconstruction in patients younger than 50 years of age who had undergone unilateral iliac artery bypass surgery. Patients and methods: From January 2000 to January 2010, 65 consecutive reconstructive vascular operations were performed in 22 women and 43 men of age < 50 years with unilateral iliac atherosclerotic lesions and claudication or chronic limb ischemia. All patients were followed at 1, 3, 6, and 12 months after surgery and every 6 months thereafter. Results: There was in-hospital vascular graft thrombosis in four (6.1 %) patients. No in-hospital deaths occurred. Median follow-up was 49.6 ± 33 months. Primary patency rates at 1-, 3-, 5-, and 10-year were 92.2 %, 85.6 %, 73.6 %, and 56.5 %, respectively. Seven patients passed away during follow-up of which four patients due to coronary artery disease, two patients due to cerebrovascular disease and one patient due to malignancy. Limb salvage rate after 1-, 3-, 5-, and 10-year follow-up was 100 %, 100 %, 96.3 %, and 91.2 %, respectively. Cox regression analysis including age, sex, risk factors for vascular disease, indication for treatment, preoperative ABI, lesion length, graft diameter and type of pre-procedural lesion (stenosis/occlusion), showed that only age (beta - 0.281, expected beta 0.755, p = 0.007) and presence of diabetes mellitus during index surgery (beta - 1.292, expected beta 0.275, p = 0.026) were found to be significant predictors of diminishing graft patency during the follow-up. Presence of diabetes mellitus during index surgery (beta - 1.246, expected beta 0.291, p = 0.034) was the only variable predicting mortality. Conclusions: Surgical treatment for unilateral iliac lesions in patients with premature atherosclerosis is a safe procedure with a low operative risk and acceptable long-term results. Diabetes mellitus and age at index surgery are predictive for low graft patency. Presence of diabetes is associated with decreased long-term survival.

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