Synthetic mesh placement - modality of choice in spontaneous intercostal pleural herniation: a case report

Hernia is defined as protrusion of a viscus or its part from the wall covering it and in some rare cases due to increased intercostal space there is spontaneous herniation of pleura and lung also known as extrathoracic lung hernia. A 48 year gentleman was admitted in our centre for chest wall swelling which has developed spontaneously 1 year back, painless, with cough impulse, further investigations like chest x-ray revealed nothing , subsequently CT thorax showed intercostal pleural hernia. He underwent surgery which diagnosed it as a case of intercostal pleural hernia having defect between 8th and 9th rib. Subsequently primary repair of defect was done with placement of monofilament mesh over it and then approximation of intercostal space was done with monofilament suture placed over 8th and 9th ribs. Post operatively patient had no complications and no recurrence of hernia. Spontaneous pleural herniation is a usually caused by coughing, heavy weight lifting, weakness of thoracic muscles by smoking, obesity etc. Ideal management is to treat the aetiology along with repair of the defect to prevent recurrence. In the present case the hernia developed after a bout of cough due to increased intercostal space between 8th and 9th ribs and also due to obesity leading to weak musculature. Intercostal pleural hernia repair can be achieved by primary repair of defect but it is advisable to use synthetic materials such as knitted monofilament polypropylene (Marlex) mesh to provide addition support to prevent recurrence.

Soft tissue lesion of the ear canal – Now you see it, now you don’t

Spontaneous herniation of the temporomandibular joint along a bony defect in the external auditory canal is an uncommon condition that may lead to otologic symptoms. A 43-year-old gentleman presented with otalgia and an external auditory canal soft tissue lesion, which flattens upon opening of the jaw. Computed tomography scan of the temporal region confirmed the presence of a soft tissue lesion that herniated through an external auditory canal wall defect. This condition should be included in the differential diagnoses of an external auditory canal mass, despite infrequently encountered. It is important to inspect the external auditory canal during movement of the jaw when a soft tissue lesion is noted, so as not to miss this diagnosis.

Bilateral Spontaneous Temporomandibular Joint Herniation: A Case Report and Literature Review

In this article we report the case of a 41-year-old man with bilateral aural fullness and hearing loss. On examination he was found to have bilateral, dehiscent anterior canal walls with herniation of the mandibular condyle. This herniation partially obstructed the canals and contributed to his symptoms. To the best of our knowledge, this is only the third reported case of bilateral spontaneous temporomandibular joint herniation, and only 28 cases of unilateral spontaneous herniation can be found in the English language literature. While it is a rare phenomenon, it should be considered when evaluating a patient with fluctuating ear symptoms.

Spontaneous herniation of the spinal cord: operative technique and follow-up in 10 cases

Object The authors report on a series of 10 patients with spontaneous thoracic cord herniation, provide the longterm follow-up, and propose a surgical strategy. Methods All 10 patients had a defect in the ventral dura mater. They were all treated surgically with wide excision of the dura around the defect, repositioning of the cord, and reconstruction with a ventral patch. Five patients were followed up for > 4 years. Results Surgery improved motor power in 4 patients and pain in 2 patients, although sensory disturbances remained unchanged in all but 1 patient. One patient's condition deteriorated secondarily due to edema and syringomyelia. Conclusions Microsurgical treatment may halt the exacerbation of neurological symptoms and should be performed with progressive deficits. Long-term results are good regarding the motor function.