Postauricular periosteal-pericranial flap for mastoid obliteration and canal wall down tympanomastoidectomy.

OBJECTIVE: To describe an effective technique for mastoid cavity obliteration in canal wall down tympanomastoidectomy for chronic otitis media and review its efficacy in producing a dry, low-maintenance, small mastoid cavity. DESIGN:: Retrospective clinical study of a consecutive series of procedures from 1995 to 2000. SETTING: Tertiary referral center and institutional academic practice in otology and neurotology. PATIENTS: Sixty consecutive procedures for active chronic otitis media with a minimum follow-up of 12 months (mean, 31 mo; range, 12-80 mo). INTERVENTION: All patients had canal wall down mastoidectomy with simultaneous tympanoplasty including split-thickness skin grafting. An inferiorly pedicled, periosteal-pericranial flap was used in conjunction with autologous bone pate to obliterate the mastoid cavity. The additional length provided by the pericranial extension of the flap permitted it to reach superior to the lateral canal and into the sinodural angle, with improved coverage of bone pate and better reduction of cavity size. OUTCOME MEASURES: The primary outcome measure was control of suppuration and creation of a dry, low-maintenance mastoid cavity, which was assessed using a previously developed semiquantitative scale. This scale includes a temporal dimension to assess control of infection. Secondary outcome measures included postoperative complications (i.e., hematoma, infection, flap necrosis, and meatal stenosis) and incidence of recurrent or residual cholesteatoma. RESULTS: Forty-nine ears (82%) maintained a small, dry, healthy mastoid cavity. Five ears (8%) had intermittent otorrhea easily controlled by topical treatment. Six ears (10%) had suboptimal control of otorrhea, of which four had meatal stenosis. There were no residual or recurrent cholesteatomas. Outcomes remained stable over progressively longer follow-up, up to 80 months. CONCLUSION: Obliteration of a canal wall down mastoid cavity by a postauricular periosteal-pericranial flap with autologous bone pate is a reliable and effective technique that results in a dry, trouble-free mastoid cavity in 90% of patients with active chronic otitis media.     

Postauricular cerebellar encephalocoele secondary to chronic suppurative otitis media and mastoid surgery

Cerebellar herniation into the mastoid through the posterior aspect of the temporal bone as a result of chronic suppurative otitis media and mastoid surgery is a rare event. A case is reported in which such a hernia presented subcutaneously behind the pinna; its repair is discussed.     

An unusual case of congenital choleasteatoma in the mastoid with epidural abscess and cutaneous fistula

A unique case of congenital choleasteatoma within the mastoid region of the temporal bone is described. The patient presented with a cutane ous fistula into the external auditory canal and epidural abscess. The clinical, radiological, histopathological and operative findings are discussed. A review of the literature shows only one report of a similar case.     

Postauricular subcutaneous leiomyosarcoma

Superficial leiomyosarcomas are rare soft tissue tumors, most frequently involving the lower extremity. Leiomyosarcomas which could be misdiagnosis or delayed are very rare in the head and neck region. In this report, a 46-year-old man with postauricular leiomyosarcoma was presented. The tumor was totally excised with 3 cm margins. Immunohistochemically, the specimen showed reactivity for smooth muscle actin, vimentin, and desmin. No complications developed in the postoperative period and the patient was free of recurrence at the 26 months follow-up. Immunohistopathological examination is essential for an accurate histological diagnosis. The ENT surgeon should pay attention to superficial leiomyosarcoma with its specific behavior and treatment while evaluating the lesions in the head and neck region.     

Persistent cutaneous fistula in the neck.

A cutaneous fistula may develop from an infected tooth. The lesion usually arises without dental symptoms and for this reason is often incorrectly diagnosed. For correct diagnosis intraoral radiographs and essential. Elimination of the infectious process and curettage of the periapical lesion are indicated. Usually no further treatment is warranted.     

Facial cutaneous fistula due to a foreign body in Wharton's duct

An extremely rare case of a cutaneous fistula of the submandibular salivary gland is presented. The etiology of the fistula was a foreign body in Wharton's duct. We describe the clinical course, management and histo-pathological findings.     

耳后原发性皮肤隆突性纤维肉瘤1例

患者,男,26岁。因发现左耳后包块5个月余,手术切除术后11d,于2009年12月28日收住院。2009年7月患者无意中触摸到左耳后近乳突处一约绿豆粒大小圆形肿物,高出皮肤,表面不光滑,呈结节状。当时无红肿、触痛及瘙痒,未引起注意。此后该肿物渐增大至花生粒大小,质韧而较实,与皮肤紧连,可推动,表面呈淡紫色,皮肤无破溃,亦无触痛、红肿及瘙痒。同年12月17日就诊于当地     

Day-case paediatric mastoid surgery

OBJECTIVE: Children have traditionally been kept in hospital overnight after mastoid surgery, but evidence from the US in adults suggests that a substantial number of patients may be suitable for discharge on the day of surgery. We sought to ascertain the proportion of our children having mastoid operations between February 1994 and December 2000 who were suitable for same-day discharge. We also evaluated some of the factors that prevented discharge the same day. METHODS: A standard proforma was used to record relevant data in 35 children (mean age 10 years 6 months) undergoing consecutive mastoid operations at Mayday University Hospital, London, UK. Operative findings, duration of anaesthesia and time back on ward were recorded as well as details regarding admission, follow-up findings and complications. A bed was booked preoperatively but there was intent to discharge the patient if feasible. RESULTS: Nine out of twelve patients (75%) operated between 1998 and 2000 were suitable for discharge on the day of surgery. The pre-1998 discharge rate was 20%. Only one of the former group of patients underwent a modified radical mastoidectomy in comparison with ten such procedures pre-1998. There was a significant relationship between extent of surgery and in-patient admission. The outcomes of day-case mastoid surgery, in terms of complications rates and overall success rates, were comparable with surgery performed on an in-patient basis. Using correlation analysis, no relationship could be found between duration of anaesthesia and time of arrival back on the ward and in-patient admission. CONCLUSION: Children can undergo mastoid procedures safely and effectively on a day-case basis but should still have a bed booked pre-operatively as the majority will require admission. The main factor related to admission was the mastoid procedure performed. With improvements in surgical and anaesthetic techniques and other advances, operations such as atticotomy may become standard day-case procedures in paediatric patients.     

Osteoma of the mastoid

We present herein a rare case of osteoma mixtum of the mastoid. The main features of the osteoma were demonstrated clearly by preoperative tangential X-ray projection. Histological studies revealed the osteoma to be composed of multiple small foci of ossification on the outer layer with a large single inner mass. Subsequent examinations revealed that the osteoma had arisen from the parietosquamosal suture.