Long-Term Results of Surgery for Temporal Bone Paraganglioma

The only way to resolve the dispute about the effectiveness of surgery versus radiation therapy for glomus tympanicum and jugulare tumors is adequate long-term studies. In a retrospective study with an average follow-up period of 15 years (range 11 to 23 years) we reassessed 11 patients with glomus tympanicum tumors and 11 patients with glomus jugulare tumors. Ten of 11 patients with glomus tympanicum tumor were tumor-free after surgery. A temporary facial palsy and an external meatal wall defect were the only surgical complications. The air-bone gap postoperatively closed to within 10 dB in three patients, to within 20 dB in six patients, and to more than 30 dB in one patient. Nine of 10 patients with glomus jugulare tumor receiving complete resection were tumor-free. Less than half the patients experienced new-onset cranial nerve function loss, and all made satisfactory recovery, eliminating the need for tracheostomy or gastrostomy. In two patients, the hearing could be preserved on the preoperative level, but the majority already presented with deafness. In the long-term, surgery remains a treatment of choice for glomus tympanicum tumors. It is also an extremely effective treatment with low morbidity for glomus jugulare tumors, including those with intracranial extension.     

Daptomycin‐Loaded Polymethylmethacrylate Bone Cement for Joint Arthroplasty Surgery

Antibiotic‐loaded acrylic bone cement has been frequently used as an infection prophylaxis or antibiotic‐loaded spacer in infected arthroplasty. In addition, daptomycin has been used recently against broad spectrum Gram‐positive organisms. The goal of this in vitro study is to investigate the bacteriacidal and mechanical properties of daptomycin‐incorporated polymethylmethacrylate (PMMA) bone cement and evaluate its feasibility for clinical use. Daptomycin (0.5, 1, or 2 g) was premixed with 40 g of PMMA bone cement powder before curing. The mechanical properties of the daptomycin‐loaded acrylic bone cement (DLABC) were estimated following standard guidance, and the release profile and kinetics of daptomycin from PMMA were analyzed. The antimicrobial efficacy of DLABC was determined with a zone of inhibition (ZOI) assay against Staphylococcus aureus, Staphylococcus epidermis, Enterococcus faecalis, and Enterococcus faecium, respectively. The results showed that the compressive strength, of PMMA bone cement, which was higher than 100 MPa in all groups, was sufficient according to ISO 5833 after incorporation of daptomycin. The encapsulated daptomycin was released for 2 weeks with a 9.59 ± 0.85%, 15.25 ± 0.69%, and 20.64 ± 20.33% released percentage on the first day in the low, mid, and high groups, respectively. According to the calculated release kinetics, incorporated daptomycin should be 3.3 times the original dose to double its release. Although all recipes of DLABC had a microbial inhibitory effect, the effect with a higher encapsulated amount of daptomycin was more significant. Therefore, we believe that daptomycin can be locally delivered from PMMA bone cement at the surgical site as a prophylactic or treatment for osteomyelitis against Gram‐positive organisms with intact cement function.     

Use of the LandmarX™ Surgical Navigation System in Lateral Skull Base and Temporal Bone Surgery

Despite the widespread availability of surgical navigation devices, their use in lateral skull base and temporal bone surgery has been limited. Problems with current systems include difficulty of use and inadequate accuracy. We present a series of cases using the LandmarXtrade mark surgical navigation system as an adjunct for lateral skull base and temporal bone procedures. This infrared emitting diodes (IRED)-driven system has a post that carries the IREDs and bypasses the need to place the patient in a Mayfield head holder. This configuration allows greater mobility of the surgical field. Registration of the patient can include a combination of fiducial and anatomic landmarks that significantly increase accuracy compared to fiducial calibration alone. We introduced the use of the lateral process of the malleus as a landmark, thereby increasing accuracy within the temporal bone to a range of 0.9 to 1.5 mm. We used the system on encephaloceles, glomus tumors, meningiomas, and schwannomas, and revision surgery for chronic otitis media. It decreased operating time, allowed more effective use of "keyhole" approaches, and increased safety. As the availability and flexibility of these systems increase, their use should become the standard of care in revision temporal bone and lateral skull base procedures.     

Randomized clinical trial of single‐dose antibiotic prophylaxis for non‐reconstructive breast surgery. J. C. Hall P. C. Willsher J. L. Hall British Journal of Surgery 2006; 93: 1342–1346

The original article to which this Erratum refers was published in British Journal of Surgery 2006; 93: 1342–1346     

Middle Ear and Temporal Bone Papilloma: A Clinicopathologic Study and Comprehensive Literature Review of 57 Cases

Sinonasal papilloma (SP), formerly Schneiderian papilloma, represents a rare group of benign epithelial neoplasms, most commonly identified in the sinonasal tract, while less frequently identified in the pharynx, lacrimal sac, and middle ear. Within temporal bone sinonasal-type papilloma (TBSP), there seems to be a much higher recurrence and malignant transformation risk than those identified in the sinonasal tract. Based on this clinical report and a review of the cases reported in the English literature, 49% of the 57 cases developed in the setting of concurrent or antecedent sinonasal or nasopharyngeal SP. There is an equal sex distribution (26 females and 31 males), with a broad age range (19–81 years) at presentation (median 56 years; average 54 years). Three patients had bilateral disease. Symptoms include a mass lesion with hearing loss, otitis media, otorrhea, otalgia, and tinnitus, among others. Inverted SP was identified in 42 patients, oncocytic SP in six, and exophytic SP in four (undefined in the remainder). Recurrence was identified in 38 of 49 patients with follow-up (78%), often with multiple recurrences over time, with carcinoma developing in the temporal bone in 19 patients (33%), with males developing carcinoma by a 1.7:1 ratio over females. Surgery was the treatment of choice (radical mastoidectomy) with 6 patients (10%) dead of disease (median 30 months, mean 38 months), while 47 patients were alive at last follow-up: 31 without disease (mean 33 months); 7 with locally recurrent disease (mean 20 months); 9 patients alive but with unknown disease status; and 4 patients without follow-up. In conclusion, TBSP is frequently identified in the setting of concurrent sinonasal tract disease, showing similar histologic features to sinonasal tract counterparts. There is no sex predilection, with patients most commonly presenting in the sixth decade of life. Recurrences are common, with carcinoma developing much more frequently than in sinonasal tract papilloma (33%), but recognizing that carcinoma may be documented in either or both anatomic sites. Overall outcome is excellent, with long term clinical follow-up warranted to manage recurrence or malignant transformation.     

Enhanced Bone Bonding of the Hydroxyapatite/β‐Tricalcium Phosphate Composite by Electrical Polarization in Rabbit Long Bone

A review of the osteogenic cell activity and new bone growth in the regions bordering negatively charged surfaces of polarized Hydroxyapatite/β‐tricalcium phosphate (HA/TCP) composites implanted in the long bone in rabbits was conducted. Polarized and non‐polarized HA/TCP specimens were implanted into the right and left femoral condyle, respectively (each n = 10). After 3 and 6 weeks, five rabbits were sacrificed in each group, and histological analysis was administered. Large cuboidal‐shaped osteoblastic cells were predominantly observed lining the newly formed bone on the negatively charged surface (N‐surface) in the polarized HA/TCP implants. The TRAP‐positive multinucleated cells were observed extensively in the newly formed bone on the N‐surfaces compared with the 0‐surface and adhered directly to the HA/TCP composite. The bone area (B.Ar) value, newly formed bone area contacting the implant, and contact length (C.Le) value, percentage length of newly formed bone directly attaching to the implant, on both the 0‐ and N‐surface increased significantly with time in each group. Both the B.Ar and C.Le value on the N‐surface were significantly greater than those on the 0‐surface after 3 and 6 weeks. The number of TRAP‐positive cells/total length value on the N‐surface was significantly greater than that on the 0‐surface after 3 and 6 weeks postoperatively. It is hypothesized that electrical charge acquired by electrical polarization treatment may modify the biochemical and biophysical processes of the osteogenic cells, resulting in enhanced new bone formation and direct bonding between the recipient bone and implants.