扩大的耳廓组织瓣游离移植修复鼻基底细胞癌术后缺损

目的:探讨应用扩大的耳廓复合组织瓣修复鼻部基底细胞癌扩大切除术后缺损创面的手术方法及适应证。方法:根据患者病理确诊后实施鼻部基底细胞癌扩大切除术,依据缺损范围,采用单侧或双侧扩大耳廓复合组织瓣游离移植进行修复。术中彻底切除癌组织,病理证实切缘(-),将耳廓复合组织瓣游离,楔形植入鼻部缺损区,适度加压包扎固定,术后2周拆线。结果:本组18例患者,均移植成功,外形满意。修复创面面积约2.0~2.5cm,随访患者3~6个月,移植初期创面组织高出鼻部周缘,后期均发生不同程度回缩,与周缘组织融合自然,外形基本满意。结论:通过病理学证实肿物性质,确保周缘阴性,形成扩大创面,选用扩大耳廓复合组织瓣游离移植修复,通过对移植组织块精细缝合和适度加压固定技术,使创面得以修复,外形自然,供区隐蔽。本术式是较理想修复鼻部较大创面的术式选择。     

Hyperacusis and stapes surgery: An observation in fifty patients after stapedotomy

Objective:To assess hyperacusis after stapedotomy and its possible influencing factors.Study design:Prospective,interventional,and longitudinal study.Setting:A tertiary referral center.Patients:Fifty consecutive patients(35 females,mean age=46.8 years).Intervention:All patients underwent stapedotomy.The validated Portuguese version of the“Hyperacusis Questionnaire”(HQ)was administered before and two weeks and one month after surgery.Results:No hyperacusis was reported by any patient before surgery.At two weeks after surgery,all patients experienced hyperacusis,with a mean HQ at 16.88±6.54(range 4e25).One month after surgery,hyperacusis had already resolved in most patients.Gender,preoperative presentation or surgeon had no influence on HQ scores(p>0.05).Patients with previous contralateral stapedotomy showed lower HQ scores(p=0.001).Audiological parameters improvement measured at one month after surgery(PTA,SRT and contralateral SRT)were associated with HQ higher scores.Conclusion:This study confirms that hyperacusis is a common complaint after stapedotomy that usually resolves in one month after surgery.The HQ highest scores were registered among patients with the highest audiological gain after surgery.This suggests that hyperacusis may be a positive prognostic factor for audiological success after stapedotomy.     

Prevalence of middle ear disease in Chilean natives and the impact of development over 14 years

IntroductionThe prevalence of middle ear disease and its risk factors have been the subject of multiple studies. High prevalence of middle ear disease has been described among North American natives, especially chronic otitis media. Such studies have not been carried out in South America.ObjectiveTo describe the prevalence of middle ear pathology and risk factors in native schoolchildren from southern Chile who belong to the Mapuche ethnic group, as well as the impact of socio-economic and demographic changes after 14 years of development.Material and methodsTwo otologic evaluations with an interval of 14 years were performed in schoolchildren with a percentage of indigenous population above 85%. Socioeconomic and demographic data were collected from national official statistical data.ResultsA total of 1067 schoolchildren were examined. Many described risk factors for ear pathology were found. An overall prevalence of 0.19% for tympanic membrane perforation, 5.6% for pars tensa retraction pockets, 1.5% for pars flaccida retraction pockets and 11.1% of otitis media with effusion was found. There were several socioeconomic improvements after 14 years. The difference between the prevalence of symptoms and the presence of otitis media with effusion was statistically significant (p < 0.001).ConclusionsDespite the presence of several risk factors for middle ear disease, this study population showed a low prevalence of middle ear disease. The ethnic-racial factor seems to be a protective factor.     

Comparison of endoscopic transcanal and microscopic approach in Type 1 tympanoplasty

IntroductionEndoscopic tympanoplasty is a minimally invasive surgery that may be performed via a solely transcanal approach. The use of endoscopes in otologic procedures has been increasing worldwide. The endoscopic approach facilitates the transcanal tympanoplasty, even in patients having the narrow external ear canal with an anterior wall protrusion.ObjectivesThe present study aimed to compare the surgical and audiological outcomes of endoscopic transcanal and conventional microscopic approach in Type 1 tympanoplasty.MethodsThe graft success rates, hearing outcomes, complications, and duration of surgery in patients who underwent endoscopic and microscopic tympanoplasty between October 2015 and April 2018 were retrospectively analysed.ResultsGraft success rates were 94.8 per cent and 92.9 per cent for the endoscopic and microscopic group, respectively (p > 0.05). Postoperative air-bone gap values were improved significantly in both groups (p < 0.001). The average duration of surgery was significantly shorter in the endoscopic group (mean 34.9 min) relative to the microscopic group (mean 52.7 min) (p < 0.05). The average hospitalization period was 5.2 h (range 3–6 h) in Group I whereas it was 26.1 h (range 18–36 h) in Group II (p < 0.05).ConclusionThe endoscopic transcanal tympanoplasty approach is a reasonable alternative to conventional microscopic tympanoplasty in the treatment of chronic otitis media, with comparable graft success rates and hearing outcomes.     

Congenital Middle Ear Malformation with Common Deafness Gene Mutation Analysis: A Review of 813 Profound Sensorineural Hearing Loss Child Patients

Deafness gene variants play a key role in inner ear malformations. However, the relationship between congenital middle ear malformations and common deafness genes (GJB2, SLC26A4, and mtDNA) in profound sensorineural hearing loss (SNHL) child patients remains poorly investigated. Here we showed that there was no statistical significance in the total mutation frequency of the three common deafness genes in the middle ear malformation group (21.2%, 41/193) in comparison with the normal middle ear and inner ear group (21.0%, 116/553) (χ² = 0.0061, p = 0.940). Moreover, the mutation ratio of GJB2 and SLC26A4 in the middle ear malformation group (18.7%, 36/193; 2.6%, 5/193) was not significantly different from that in the normal middle ear and inner ear group (17.7%, 98/553; 2.4%, 13/553) (χ² = 0.084, p = 0.772; χ² = 0.0000, p = 1.000). The mutation ratio of GJB2 235delC and GJB2 79G>A in the middle ear malformation group (8.8%, 17/193; 8.8%, 17/193) was almost the same to that in the normal middle ear and inner ear group (8.6%, 48/553; 6.7%, 37/553) (χ² = 0.0030, p = 0.957; χ² = 0.9556, p = 0.328). The high jugular bulb subgroup analysis also showed the same results. Our findings suggested that GJB2, SLC26A4, and mtDNA mutations might not be related to the middle ear malformations in profound SNHL child patients. Anat Rec, 303:594–599, 2020. © 2019 American Association for Anatomy     

Accuracy of the Dentaport ZX apex locator for working length determination when retreating molar root canals

The aim of this study was to evaluate the accuracy of the Dentaport ZX apex locator for working length determination during root canal retreatment of mandibular molars. Fifteen extracted mandibular first molars with separate mesial canals and apical foraminae and one distal canal were selected. The mesiobuccal and distal canals were investigated; the length with the file tip at the major diameter was defined as the tooth length (TL). The canals were prepared with ProTaper files to 1 mm short of this and filled with gutta‐percha and AH Plus sealer. One week later, the root fillings were removed using ProTaper retreatment files. Tooth length was remeasured and recorded as the retreatment tooth length (RTL). Then electronic measurements were taken at the major (electronic apex locator (EAL) major) and minor (EAL minor) foraminae as suggested by the instrument display. These lengths were compared with RTL and measurements 0.5 and 1 mm short of this distance. For both canals, no significant difference was found between RTL and EAL major, and 0.5 mm short of RTL and EAL minor (P > 0.05). There were significant differences found between all other readings. The Dentaport ZX could not detect the minor foramen accurately but was able to indicate the major foramen in molars undergoing a root canal retreatment procedure.