Avoiding mastoid cavity problems: mastoid obliteration using bioactive glass

The aim of this study was to evaluate bioactive glass as an ideal material for the purpose of mastoid cavity elimination after mastoid surgery to avoid mastoid cavity problems. In 20 patients diagnosed as cholesteatoma or chronic unsafe ear, we used different surgical techniques according to pathology and situation during surgical exploration, basically adhering to standard principles of eradicating disease in chronic unsafe ear. After performing the canal wall down [CWD] or the canal wall up [CWU] technique, mastoidectomy was followed by obliteration of mastoid cavity by particulate form Bioglass. Cases were divided according to operative procedures, type of reconstruction and material used into 3 groups A- Canal wall up mastoidectomy followed by obliteration of mastoid cavity by particulate form Bioglass. B- Canal wall down mastoidectomy followed by reconstruction of posterior meatal wall and obliteration of mastoid cavity by particulate form Bioglass. C- Canal wall down mastoidectomy followed by reconstruction of posterior meatal wall by conchal cartilage and obliteration of mastoid cavity by Bioglass. Bioactiveglass paste is very effective for mastoid obliteration in the three groups with good integration to the surrounding tissues either connective tissue, bone, meninges or lateral dural sinus without any adverse reaction on the dura even with contact to Bioglass. Infection was seen in 2 cases [10%], however was readily controlled by topical application of antibiotics daily for one week. In both cases no extrusion of the material occurred. The successful formation of bone with elimination of mastoid cavity problems proved that using Bioglass is appropriate for performing clinical mastoid obliteration

Laryngeal nerves monitoring versus non-monitoring in thyroid surgery

Thyroid surgery is the most common cause of recurrent nerve [RLN] injury. Deliberate identification of the RLN minimizes the risk of injury. When the nerve is identified and dissected, the reported RLN injury rate during thyroidectomy is 0-2.1%. Continuous intra-operative nerve monitoring during surgery remains a controversial issue. The basic technique involves a skin surface electrode or muscle electrode used to make electromyography [EMG] recordings, which have an audible alarm to alert the surgeon if passive [e.g.stretch during traction] or active nerve stimulation has occurred. We aim to evaluate the use of intra-operative nerve monitoring [IONM] to preserve the laryngeal nerves that may be at risk for injury during thyroid surgery and show the merits of using electrophysiologic laryngeal nerve monitoring during thyroid surgery. This study was conducted as a prospective study on 28 patients whom are thyroidectomy candidates; we elected 14 thyroidectomy candidates in whom we don't use NIM during surgery [Control group A]. These patients were chosen to be evenly matched with another 14 thyroidectomy candidates to monitor the recurrent laryngeal [RLN] and external branch of superior laryngeal [EBSLN] throughout thyroidectomy procedures [NIM group B] to compare the laryngeal nerves risk of injury with and without the use of nerve monitor. Four patients [2 patients in-group A and 2 patients in-group B] were dysphonic after operation. Laryngoscopy revealed unilateral recurrent laryngeal nerve palsy in all except one bilateral in group A. There were no significant differences in RLN paralysis, paresis, or total injury rates between both groups. The number of patients in the presented study was limited to draw a statistical conclusion for significance. The routine application of IONM cannot prevent or reduce recurrent laryngeal nerve injury. However the study signifies the trend towards the use of INOM in expectedly difficult cases and in revision surgery with distorted anatomical relationships and fibrous adhesions