scholarly journals Retrospective analysis of difficulties during mastoid surgeries in tertiary referral center in Nepal

2021 ◽  
Vol 7 (3) ◽  
pp. 420
Author(s):  
Yogesh Neupane ◽  
Bijaya Kharel ◽  
Kripa Dongol ◽  
Rabindra B. Pradhananga ◽  
Pabina Rayamajhi ◽  
...  
Keyword(s):  
Chronic Otitis Media ◽  
Major Complication ◽  
Taste Disturbance ◽  
Tertiary Referral Center ◽  
Surgical Difficulty ◽  
Major Complication Rate ◽  
Temporal Bone Anatomy ◽  
Hearing Assessment ◽  
Operative Findings ◽  
Mastoid Surgery

<p class="abstract"><strong>Background:</strong> Complications can occur during and following mastoidectomy because of the variation in the temporal bone anatomy and surgical factors. The operating surgeon needs to be aware of potential difficulties and their clinical relevance to avoid the dread complication. This study aims to study various per-operative difficulties and complications encountered during mastoid surgery.</p><p class="abstract"><strong>Methods:</strong> A retrospective study was conducted, including 152 cases of chronic otitis media squamous type who underwent mastoidectomy from June 2017 to January 2019. Revision cases and cases with missing records on per-operative findings, early postoperative status, hearing assessment were excluded from the study.  </p><p class="abstract"><strong>Results:</strong> Out of 152 cases, there were 80 males and 72 females with a mean of 27.5 years. Dural plate breach was recognized in 19 cases (12.5%) with iatrogenic injury in 16 cases. Breach of sinus plate and exposure of sigmoid sinus was noted in 11 cases (7.24%) and all were iatrogenic. Korner’s septum was noted in five cases (3.29%). The facial canal was dehiscence in 25 cases (16.4%) with the majority in the horizontal segment, but the sheath was intact in all cases. Immediate postoperative facial nerve palsy was seen in four cases (2.6%). Fistula in the lateral semi-circular canal was noted in two cases. Taste disturbance was noted in 13 cases. Local complications related to the surgical site was seen in 19 cases.</p><p class="abstract"><strong>Conclusions:</strong> The anatomic variations and surgical difficulty are common in mastoid surgery. The major complication rate is around 2-3% despite various mastoid variation and difficulties.</p>

scholarly journals Radiographic imaging of mastoid in chronic otitis media: need or tradition?

2020 ◽  
Vol 6 (9) ◽  
pp. 1592
Author(s):  
Sabeeh Beig ◽  
Saifullah Khalid ◽  
Satish Chandra Sharma
Keyword(s):  
Otitis Media ◽  
Predictive Value ◽  
Plain Radiograph ◽  
Chronic Otitis Media ◽  
Bone Destruction ◽  
Limited Information ◽  
Radiological Findings ◽  
Plain Radiographs ◽  
Operative Findings ◽  
Mastoid Surgery

<p class="abstract"><strong>Background:</strong> Computed tomography is the imaging of choice in chronic otitis media (COM) but it is neither available at every centre nor is affordable to masses of economically weaker countries. In this situation where only X-ray facility is available should plain radiographs of mastoid be done ?. If yes then what is the analytical evidence? This study, was conducted to find the utility of plain radiographs of mastoid by comparing radiological findings vis-a-vis operative findings.</p><p class="abstract"><strong>Methods:</strong> Pre-operative radiographs of mastoids (Schuller’s view (s/v)) were taken and the radiological findings were statistically analysed with the operative findings.  </p><p class="abstract"><strong>Results:</strong> Plain radiograph of mastoid (s/v) predicted some of the surgical landmarks of mastoid surgery viz tegmen and sinus plates with a fair degree of accuracy. The positive predictive value (PPV) for radiolucent shadow (assumed to indicate bone destruction and thus cholesteatoma) was also high but at the same time, a low negative predictive value and a Cohen’s kappa test showing only a fair agreement underscores the point that absence of a radiolucent shadow does not rule out the presence of cholesteatoma.</p><p class="abstract"><strong>Conclusions:</strong> Radiographs of mastoid are helpful in providing a prior knowledge of the surgical landmarks in mastoid surgery. Hence with this information, if a surgeon finds himself more at ease in operating a patient then this imaging should be done when CT scan facility is unavailable. However, citing the limited information on other aspects of the disease, its use as a ‘routine’ investigation in chronic otitis media is discouraged.</p><p class="abstract"> </p>

Rate of Recovery of Taste Function after Preservation of Chorda Tympani Nerve in Middle Ear Surgery with Special Reference to Type of Disease

2003 ◽  
Vol 112 (1) ◽  
pp. 52-56 ◽  
Author(s):  
Masafumi Sakagami ◽  
Mieko Sone ◽  
Keijiro Fukazawa ◽  
Kojiro Tsuji ◽  
Yasuo Mishiro
Keyword(s):  
Recovery Of Function ◽  
Inflammatory Diseases ◽  
Chronic Otitis Media ◽  
Normal Function ◽  
Middle Ear Surgery ◽  
Chorda Tympani ◽  
Chorda Tympani Nerve ◽  
Taste Disturbance ◽  
Postoperative Symptoms ◽  
Rate Of Recovery

To study the recovery of function of the chorda tympani nerve, we examined by electrogustometry 79 patients (83 ears) with both preoperative normal function of the nerve and operative preservation of the nerve, every 2 days during hospitalization and at 6 months after surgery. For symptoms such as tongue numbness and taste disturbance, patients with noninflammmatory (NI) diseases (13/20 or 65.0%) showed a significantly higher rate of symptoms than did patients with chronic otitis media (COM; 13/35 or 37.1%) at 2 weeks after surgery (p = .032). The patients with NI diseases (5/20 or 25.0%) tended to show a higher rate of symptoms than did the COM patients (2/35 or 5.7%) or cholesteatoma patients (2/28 or 7.1%) at 6 months after surgery. The rate of recovery of the EGM threshold to normal at 2 weeks after surgery was significantly lower in NI disease patients (6/20 or 30.0%) than in COM patients (23/ 35 or 62.9%) or cholesteatoma patients (19/28 or 67.9%; p = .015 and .008, respectively). Thus, the patients with NI diseases had postoperative symptoms and elevation of EGM threshold more frequently than did the patients with inflammatory diseases.

scholarly journals Correlation between functional outcome and the SAMEO-ATO framework

2021 ◽  
Author(s):  
Vito Pontillo ◽  
Marialessia Damiani ◽  
Giusi Graziano ◽  
Nicola Quaranta
Keyword(s):  
Functional Outcome ◽  
Middle Ear ◽  
Petrous Bone ◽  
Canal Wall ◽  
Hearing Results ◽  
Tertiary Referral Center ◽  
Ossicular Reconstruction ◽  
Canal Wall Down ◽  
Mastoid Surgery ◽  
Canal Wall Up

Abstract Purpose To evaluate the recently proposed SAMEO-ATO framework for middle ear and mastoid surgery, by correlating it with the functional outcome in a large cohort of patients operated for middle ear and mastoid cholesteatoma in a tertiary referral center. Methods We retrospectively included all surgeries for middle ear and mastoid cholesteatoma undergone in our Department between January 2009 and December 2014, by excluding revision surgeries, congenital and petrous bone cholesteatoma. All surgeries were classified according to the SAMEO-ATO framework. The post-operative air bone gap (ABG) was calculated and chosen as benchmark parameter for the correlation analysis. Results 282 consecutive surgeries for middle ear and mastoid cholesteatoma were released in the study period on a total of 273 patients, with a mean age of 41.2 years. All patients were followed for an average period of 55.3 months. 54% of patients underwent M2c mastoidectomy (Canal Wall Down, CWD), while the remaining underwent Canal Wall Up (CWU) procedures, being M1b2a mastoidectomy the most common one (33%). Mean pre-operative and post-operative ABGs were 29.2 and 23.5 dB, with a significant improvement (p < 0.0001). ‘Mastoidectomy’ and ‘Ossicular reconstruction’ parameters of SAMEO-ATO showed significant association with postoperative ABG, with smaller residual gaps for the classes Mx and On, and worse hearing results for M3a and Ox. Conclusion Our results show the utility of SAMEO-ATO framework, and in particular of ‘M’ (Mastoidectomy) and ‘O’ (Ossicular reconstruction) parameters, in predicting the hearing outcome.

125 Staged Endovascular Treatment of Ruptured Intracranial Aneurysms: Acute Coiling Followed By Delayed Flow Diversion

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 228-228
Author(s):  
Erick Michael Westbroek ◽  
Matthew Bender ◽  
Narlin B Beaty ◽  
Bowen Jiang ◽  
Risheng Xu AB ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Complication Rate ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Major Complication ◽  
Flow Diversion ◽  
Neurological Deficits ◽  
Major Complication Rate ◽  
Ruptured Intracranial Aneurysms

Abstract INTRODUCTION ISAT demonstrated that coiling is effective for aneurysm treatment in subarachnoid hemorrhage (SAH); however, complete occlusion of wide-necked aneurysms frequently requires adjuvants relatively contraindicated in SAH. As such, a limited “dome occlusive” strategy is often pursued in the setting of SAH. We report a single institution series of coiling of acutely ruptured aneurysms followed by delayed flow diversion for definitive, curative occlusion. METHODS A prospectively collected IRB-approved database was screened for patients with aneurysmal SAH who were initially treated by coil embolization followed by planned flow diversion at a single academic medical institution. Peri-procedural outcomes, complications, and angiographic follow-up were analyzed. RESULTS >50 patients underwent both acute coiling followed by delayed, planned flow diversion. Average aneurysm size on initial presentation was 9.5 mm. Common aneurysm locations included Pcomm (36%), Acomm (30%), MCA (10%), ACA (10%), and vertebral (5%). Dome occlusion was achieved in all cases following initial coiling. Second-stage implantation of a flow diverting stent was achieved in 49/50 cases (98%). Follow-up angiography was available for 33/50 patients (66%), with mean follow-up of 11 months. 27 patients (82%) had complete angiographic occlusion at last follow up. All patients with residual filling at follow-up still had dome occlusion. There were no mortalities (0%). Major complication rate for stage I coiling was 2% (1 patient with intra-procedural aneurysm re-rupture causing increase in a previous ICH). Major complication rate for stage 2 flow diversion was 2% (1 patient with ischemic stroke following noncompliance with dual antiplatelet regimen). Minor complications occurred in 2 additional patients (4%) with transient neurological deficits. CONCLUSION Staged endovascular treatment of ruptured intracranial aneurysms with acute dome-occlusive coil embolization followed by delayed flow diversion is a safe and effective treatment strategy.

Subtalar Joint Arthrodesis

2005 ◽  
Vol 95 (1) ◽  
pp. 34-41 ◽  
Author(s):  
Alan R. Catanzariti ◽  
Robert W. Mendicino ◽  
Karl R. Saltrick ◽  
Roman C. Orsini ◽  
Michael F. Dombek ◽  
...  
Keyword(s):  
Subtalar Joint ◽  
Major Complication ◽  
Postoperative Outcome ◽  
Nonoperative Treatment ◽  
Statistical Correlation ◽  
Posterior Tibial Tendon ◽  
Posterior Tibial Tendon Dysfunction ◽  
Average Patient ◽  
Post Traumatic ◽  
Major Complication Rate

Forty patients (12 men and 28 women) treated with isolated subtalar joint arthrodesis were retrospectively reviewed. The average patient age was 50 years (range, 21–76 years). Preoperative diagnoses included posterior tibial tendon dysfunction, post-traumatic arthritis, nontraumatic arthritis, and subtalar joint middle facet coalition. The average follow-up was 15 months (range, 12–74 months). Subjective postoperative questionnaire results were classified as satisfied (n = 32), satisfied but with reservations (n = 4), or dissatisfied (n = 4). Eighty-three percent of the patients (n = 33) stated that they would undergo the procedure again. Minor complications (those that resolved with nonoperative treatment) occurred in 55% of the patients. However, the major complication rate was only 12.5%. This study showed no statistical correlation between the preoperative diagnosis and the postoperative outcome. Our results also suggested that the prevalence of complications is slightly higher than in previous reports. Isolated subtalar joint arthrodesis is an effective treatment for pain and deformity of the rearfoot. (J Am Podiatr Med Assoc 95(1): 34–41, 2005)

Diagnostic accuracy and complication rate of image-guided percutaneous transthoracic needle lung biopsy for subsolid pulmonary nodules: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Junghoon Kim ◽  
Choong Guen Chee ◽  
Jungheum Cho ◽  
Youngjune Kim ◽  
Min A Yoon
Keyword(s):  
Diagnostic Accuracy ◽  
Complication Rate ◽  
Needle Biopsy ◽  
Meta Analysis ◽  
Pulmonary Nodules ◽  
Major Complication ◽  
Needle Aspiration ◽  
Fine Needle ◽  
Major Complication Rate ◽  
Higher Sensitivity

Objectives: To determine the diagnostic accuracy and complication rate of percutaneous transthoracic needle biopsy (PTNB) for subsolid pulmonary nodules and sources of heterogeneity among reported results. Methods: We searched PubMed, EMBASE, and Cochrane libraries (until November 7, 2020) for studies measuring the diagnostic accuracy of PTNB for subsolid pulmonary nodules. Pooled sensitivity and specificity of PTNB were calculated using a bivariate random-effects model. Bivariate meta-regression analyses were performed to identify sources of heterogeneity. Pooled overall and major complication rates were calculated. Results: We included 744 biopsies from 685 patients (12 studies). The pooled sensitivity and specificity of PTNB for subsolid nodules were 90% (95% confidence interval [CI]: 85–94%) and 99% (95% CI: 92–100%), respectively. Mean age above 65 years was the only covariate significantly associated with higher sensitivity (93% vs  85%, p = 0.04). Core needle biopsy showed marginally higher sensitivity than fine-needle aspiration (93% vs  83%, p = 0.07). Pooled overall and major complication rate of PTNB were 43% (95% CI: 25–62%) and 0.1% (95% CI: 0–0.4%), respectively. Major complication rate was not different between fine-needle aspiration and core needle biopsy groups (p = 0.25). Conclusion: PTNB had acceptable performance and a low major complication rate in diagnosing subsolid pulmonary nodules. The only significant source of heterogeneity in reported sensitivities was a mean age above 65 years. Advances in knowledge: This is the first meta-analysis attempting to systemically determine the cause of heterogeneity in the diagnostic accuracy and complication rate of PTNB for subsolid pulmonary nodules.

Learning curve for robot-assisted Ivor Lewis esophagectomy

2021 ◽  
Author(s):  
Yu Han ◽  
Yajie Zhang ◽  
Wentian Zhang ◽  
Jie Xiang ◽  
Kai Chen ◽  
...  
Keyword(s):  
Learning Curve ◽  
Complication Rate ◽  
Major Complication ◽  
Robot Assisted ◽  
Ivor Lewis ◽  
Initial Learning ◽  
Cusum Analysis ◽  
Technical Proficiency ◽  
Major Complication Rate ◽  
Two Phases

Summary This study aimed to demonstrate the learning curve of robot-assisted minimally invasive esophagectomy (RAMIE). A retrospective analysis of the first 124 consecutive patients who underwent RAMIE with intrathoracic anastomosis (Ivor Lewis) by a single surgeon between May 2015 and August 2020 was performed. An risk-adjusted cumulative sum (RA-CUSUM) analysis was applied to generate a learning curve of RAMIE considering the major complication rate, which reflected the technical proficiency. The overall 30-day morbidity rate was 38.7%, while the major complication rate was 25.8%. The learning curve was divided into two phases based on the RA-CUSUM analysis: phase I, the initial learning phase (cases 1–51) and phase II, the proficiency phase (cases 52–124). As we compared the proficiency phase with the initial learning phase, significantly decreased trends were observed in relation to the major complication rate (37.3% vs. 18.7%, P = 0.017), total operation time (330.9 ± 55.6 vs. 267.3 ± 39.1 minutes, P &lt; 0.001), and length of hospitalization (10 [IQR, 9–14] days vs. 9 [IQR, 8–11] days, P = 0.034). In conclusion, the learning curve of RAMIE consisted of two phases, and at least 51 cases were required to gain technical proficiency.

scholarly journals Comparison of quality of life outcomes following different mastoid surgery techniques

2015 ◽  
Vol 129 (9) ◽  
pp. 835-839 ◽  
Author(s):  
J Joseph ◽  
A Miles ◽  
S Ifeacho ◽  
N Patel ◽  
A Shaida ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Response Rate ◽  
Chronic Otitis Media ◽  
Postal Survey ◽  
Life Outcomes ◽  
Subjective Change ◽  
Glasgow Benefit Inventory ◽  
Significant Difference ◽  
Mastoid Surgery

AbstractBackground:Mastoid surgery carried out to treat chronic otitis media can lead to improvement in objective and subjective measures post-operatively. This study investigated the subjective change in quality of life using the Glasgow Benefit Inventory relative to the type of mastoid surgery undertaken.Method:A retrospective multicentre postal survey of 157 patients who underwent mastoid surgery from 2008 to 2012 was conducted.Results:Eighty-three questionnaire responses were received from patients who underwent surgery at one of three different hospitals (a response rate of 53 per cent). Fifty-seven per cent of patients had a Glasgow Benefit Inventory score of 0, indicating no change in quality of life post-operatively. Thirty-five per cent scored over 50, indicating significant improvement. The only significant difference found was that women fared worse after surgery than men.Conclusion:The choice of mastoid surgery technique should be determined by clinical need and surgeon preference. There is no improvement in quality of life for most patients following mastoid surgery.

scholarly journals Fixation of Ankle Fractures

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0008
Author(s):  
Andrew Molloy ◽  
Samantha Whitehouse ◽  
Lyndon Mason
Keyword(s):  
Complication Rate ◽  
Major Complication ◽  
Ankle Fractures ◽  
Complication Rates ◽  
Junior Staff ◽  
System Changes ◽  
Major Complication Rate ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Category: Trauma Introduction/Purpose: Ankle fractures are one of the most common fractures. Historically these have been frequently treated by non-specialists and junior staff. In 2011 we presented high malunion rates, which have been mirrored in other departments work. We present the results of system changes to improve the results of ankle fracture fixation Methods: Image intensifier films were reviewed on PACS and scored based on the criteria published by Pettrone et al. At least two blinded assessors assigned scores independently. Patients clinical data was collected from medical records. In 2011 we presented the results of fixation in 94 consecutive patients (Group 1) from 2009. Following this there was period of education in the department to allow change. 68 patients (Group 2) were then reviewed from a 7 month period in 2014 Multiple system changes were introduced in the department including; new treatment algorithms, dedicated foot and ankle trauma lists and clinics, and next day review of all intra-operative radiographs by independent attending. Prospective data was collected on 205 consecutive cases (Group 3) from 01/01/15 – 09/30/16 Results: Patients in group 1 had a malreduction rate of 33%. The major complication rate in this group was 8.5% (8 patients); with only one of these occurred in a correctly reduced fracture. These complications included 4 revision fixations, 2 deep infections and 1 amputation. Following the period of re-education, in Group 2, the mal-reduction rate deteriorated to 43.8%. In this group the major complication rate was 10.9%; including 6 revision fixations and 1 ankle fusion. In Group 3, following overall system changes, the malreduction rate was 2.4%. This result is statistically significant. The major complication rate fell to 0.98%; 1deep infection and 1 amputation (in a polytrauma patient with vascular injury). This result is again statistically significant. Conclusion: Our initial results show that very poor results are a consequence when sufficient attention is not given to what are frequently considered to be ‘simple’ fractures. In group 2 we demonstrated that soft educational changes (eg presentations, emails) are ineffective in improving results. We have demonstrated that hard (institutional system) changes in our department provided statistically significant improvements. These changes allowed the correct surgeon for the fracture in both determining the treatment plan and operating. With these changes, malreduction rates fell from 43.8% to 2.4% and major complication rates from 10.9% to 0.98%

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