Korner's septum; clinical, radiological and cadaveric studies

To describe the anatomy of the Korner's septum [KS] or petrosquamosal suture [PSS], its incidence, variations in normal and inflamed middle ears, and to evaluate its clinical importance. Review of 100 CT scans temporal bones were done to determine the degree of visualization of Korner's septum [KS]. Cadaveric dissection of 100 temporal bones were done in temporal bone dissection laboratory of Ain Shams University Specialzied hospital in addition to 100 mastoidectomies performed in the ENT inpatient department. KS or PSS is not only a bony plate dividing the mastoid cells at the level of the antrum, but is also a lamina starting from the posterior aspect of the glenoid fossa that extends above the middle ear cavity and courses inferiorly lateral to facial canal and proceeds to mastoid apex. Korner's septum was seen radiologically in 26% of CT scans of temporal bones, and in 25% of temporal bone specimens. Clinically "KS" was seen in [29%] of cases with COM and in [24%] in cases without COM with a total incidence of [28%]. Frequently there was a hidden cholesteatoma or cholesterol graunloma behind the septum. Rarely the cog [anterior part of the septum] may extend to fix the ossicels. KS is an imporatn anatomic observation in patients with chronic otitis media, it may contribute to middle ear infection and it may hide cholesteatoma or cholesterol granunloma behind it which may be missed if superficial compartment was sclerosed

Role of endoscopic control with canal wall down [CWD] in decreasing cholesteatoma recidivism

To evaluate the role of otoendoscope in conjunction with conventional otomicroscopic surgery of canal wall down technique; to inspect hidden areas and decrease rate of recidivism in cholesteatoma surgery. Also, to assess the role of partial obliteration of mastoid [leaving open attic] to decrease cavity problems of open technique. This study was conducted on 25 patients with cholesteatoma. Initial CWD technique was done for all cases in a trial to reduce recidivism. After complete removal of cholesteatoma matrix, otoendoscoy was used to inspect hidden areas, the incidence and sites of discovered cholesteatoma were recorded. Reconstruction of hearing mechanism and partial obliteration of mastoid were done. Follow up was done for 2 to 4 years and a C.T. scan was made after 1 to 2 years for every patient and a second look mastoidoscopy was carried out when needed. The incidence and site of recidivism was reported, and compared with the C.T. scan results. The use of otoendoscope after removal of cholesteatoma by otomicroscopic surgery lead to discover of residual cholesteatoma matrix in 9 patients [36%]. The highest incidence was in sinus tympani and facial recess and the least was in hypotympanum and round window niche. After partial obliteration of mastoid, cavity problems were encountered only in one patients [4%] and was successfully managed by local treatment. The second look mastoidoscopy revealed recidivism only in 1 patient [4%]. Otoendoscopy in cholesteatoma surgery improved visualization of hidden areas and decreased rate of recidivism. Also partial obliteration of lower mastoid in CWD technique lead to decrease complications of cavity problems

Extracranial meningiomas

Extrcranial meningiomas involving nose, paranasal sinuses, orbit and neck are uncommon. This series describes the clinical presentations, radiographic findings, and implications for surgical treatment of extractranial meningiomas. Egypt patients [median age 41.8 years] underwent resection of extractranial meningioma. In five cases [62.5%] meningioma extended to adjacent structures and the surgical approach for resection is tailored according to the extension. Preoperative neuroradiologic imaging is crucial for preoperative and postoperative evaluation of cases. Preoperative radiographic assessment showed meningioma associated with anterior cranial fossa erosion in one case [12.5%], cavernous sinus involvement and clival erosion in one case [12.5%], and olfactory groove erosion in one case [12.5%]. Histological examination of the bones from anterior cranial fossa and clivus were positive in two cases [25%]. Meningioma extended to the nasopharynx, invading the mucosa in one patient and another one patient suffered from orbital involvement and extension to optic nerve. Understanding the pertinent clinical and morphological aspects of extracranial meningioma is essential to surgical treatment of patients with this condition