Expression of human papilloma virus DNA in middle ear cholesteatoma

Basic research in chronic otitis media with cholesteatoma is very important as it may clarify the pathophysiology of the disease and explain the wide variation in clinical course. In the present study aggressive type cholesteatoma has histopathological findings characteristic of human papilloma virus induced-lesions [i.e. obvious koilocytosis] in 33.3% specimens. Moreover 50% of the aggressive cholesteatoma were stained positive for human papilloma virus [HPV] polymerase chain reaction [PCR]. Statistical correlations were established between hyper-proliferation [as revealed by MIB 1 high score] of the cholesteatoma and severe bone erosion [pave the way to major cholesteatoma complications] and also between hyperproliferation and middle ear inflammation [associated with more surgical difficulties and possible higher risk of recurrences]. These findings indicate a possible relationship between HPV with more aggressive cholesteatoma. It may arouse the cleavage, proliferation of cholesteatomatous epithelium and may also play a certain role in the recurrence of the disease following well performed surgical excision

Retrograde approach to the facial nerve in parotid gland surgery

The temporal branch of the facial nerve was examined in 8 cadaver dissections [4 right and 4 left]. A number of rami crossing the zygomatic arch and their location with respect to bone and soft-tissue landmarks were estimated. The temporal branch course follows a constant plane along the under surface of the temporoparietal fascia and it was found to be superficial as it crosses the zygomatic arch. Based on these relationships, a safe method of dissection within the temporal region was formulated. In five cases with retromandibular parotid neoplasms, the seventh cranial nerve was located through a retrograde exploration of its temporal branch. The decision to resort to the identification of the temporal branch is supported by its adequate calibre in its peripheral area, short course, and multiple rami crossing the zygomatic arch, which enable it to be easily located. Retrograde or centripetal approach to facial nerve has been found to be anatomically sound, simple to use and safe. It must be indicated when anterograde exploration is difficult

Diagnostic correlates in fenestral otosclerosis

The goal of this study was to investigate the relationship between the pre-operative audiometric levels and CT findings, and the pathological changes observed during stapes surgery. Thirty consecutive patients with clinical diagnosis of fenestral otosclerosis were evaluated with High-resolution computed tomography [CT] and audiological tests. Twenty-six were diagnosed as having this disorder by CT evidence of abnormal bony excrescence at the oval window. The diagnosis was made upon examination of 1 mm thick targeted sections obtained at 1-mm intervals in the semi-axial with 250 of forward tilting projection. Coronal section were also included. A direct relationship was found between the size of the fenestral focus and the air-bone gap. However, the degree and extent of bony footplate ankylosis could not be reliably predicted by the size of the air-bone gap

Retrograde approach to the facial nerve in parotid surgery

The temporal branch of the facial nerve was examined in eight cadaver dissections. Number of rami crossing the zygomatic arch and their location with respect to bone and soft-tissue landmarks were estimated. The temporal branch travelled in a constant plane along the under surface of the temporoparietal fascia and was superficial as it crossed the zygomatic arch. Based on these relationships, a safe method of dissection within the temporal region was formulated. In five cases with retromandibular parotid neoplasms, the seventh cranial nerve was located through retrograde exploration of its temporal branch. The decision to resort to the identification of the temporal branch is supported by its adequate calibre in its peripheral area, short course, and multiple rami crossing the zygomatic arch, which enable it to be easily located. Retrograde or centripetal approach to facial nerve has been found to be anatomically sound, simple to use and safe. It must be indicated when anterograde exploration is difficult

Bronchial reactivity in patients with nasal polyps before and after polypectomy

The surgical treatment of nasal polyps [in bronchial hyperreactive patients] is still controversial today because of the contradictory, in consisten. and unforeseen results reported in. the literature. 44 patients with nasal polyposis, with no prior history of polypectomy, were included in this study. Patients were studied with ventilatory function tests and metbacholine inhalation challenge [the provoking concentration.PD20, was assessed] before and 3 months after undergoing nasal polypectomy to determine the prevalence of bronchial hyperreactivity [BHR], and to assess the effect of polypectomy on bronchial reactivity. Patients with nasal polypi without asthma [23] 8 [34.8%] had no evidence of B.H.R. [PD20 > 4130 micro gm] while the other 15 patients [65.2%] had bronchial hyperreactivity not reaching the range of asthma [PD20 < 4130 but not reaching [600 micro gmj. After polypectomy of 15 non asthmatic hyper-reactive patients the mean increase in FVC, FEV1 and PD20 were statistically significant. In 8 non asthmatic non hypereactive patients the mean increase in FVC, FEV1, FVC / FEV1% were non significant and the mean PD20 was unchanged. In 21 asthmatic patients [PD20 [600 [gm] the mean increase in FVC, FEV1, FVC / FEV1% and PD20 were non significant Our study indicates that [1] bronchial hyperreactivity is common in nasal polyposis, [2] nasal polypectomy significantly decrease bronchial hyperreactivity in asymptomatic bronchial hyperreactive patients but not for the asthmatic one. Improvement of the asthmatic condition may be partly dependent upon a global toeatment of the patients. We recommended for proceeding with surgery in asymptomatic hyperreactive patients but in asthmatic patients when suffering from complete nasal obstruction

Meatoplasty versus meatoconchoplasty: in canal wall down [CWD] mastoidectomy

In managing patients by canal wall down mastoidectomy, we must ensure good ventilation of the depths of the mastoid cavity, which can be obtained only by a meatoplasty or a correct meatoconchoplasty. After a follow up period of six months duration for 20 cholesteatomatous patients managed by C.W.D. mastoidectomy with either meatoplasty or meatochoncoplasty. A/V ratio has a significant value in relation to the state of the mastoid cavity [dry or wet]. Neither area of meatal opening [A] nor volume of the mastoid cavity [V] is significant separately. Healing process reduces the area of meatoplasty or meatoconchoplasty by about 20%. No significant difference between healing ratio for meatoplasty and that for meatochoncoplasty. Meatoplasty or meatochoncoplasty opening tends to become more circular during healing. Simple scales and some suggestions for practical measuring of proper diameter for meatoplasty and meatochoncoplasty in order to achieve a dry cavity had been done