Felix tympanoplasty: functional results of a single surgeon's technique in the scope of a literature review on influencing factors.

Felix tympanoplasty: functional results of a single surgeon's technique in the scope of a literature review on influencing factors. OBJECTIVE: The outcome of myringoplasties may be affected by local, general or epidemiologic factors. We reduced the variability of the surgical procedure to a minimum, in order to better evaluate the role of these factors on the functional results. To accomplish this, a single surgical procedure performed by a single surgeon was analysed in this retrospective study. The analysis was performed on a cohort study of patients who underwent the Felix tympanoplasty as their only operation. METHODS: Thirty-nine patients were included in the study from January 2001 to January 2011. Postoperative changes from preoperative levels of air-bone gaps were compared according to patient characteristics using linear regression models. We evaluated the following conditions: sex, age, rural or urban living, smoking, alcohol consumption, frequent infantile otitis, frequent adult recurrent otalgia, frequent adult recurrent otorrhoea, contralateral chronic otitis, tympanic membrane perforation size, tympanosclerosis, otorrhoea and inflammatory tympanic membrane at the time of the operation. RESULTS: Evidence of a larger air-bone gap reduction was detected for patients with a history of frequent otorrhoea and with a perforation size >50% of the area of the tympanic membrane. In contrast, there was evidence of a lower air-bone gap reduction detected for patients with tympanosclerosis. The impact on hearing of all other variables did not reach statistical significance. Conlusion: Patients with a history of frequent ear discharge and those with large tympanic membrane perforations had better chances of obtaining greater improvement to their hearing postoperatively. The presence of preoperative tympanosclerosis decreased the mean change from preoperative to postoperative air-bone gaps.

Ten years' experience with Felix tympanoplasty: analysis of anatomical and functional results.

OBJECTIVE: This paper presents our 10 years' experience with Felix tympanoplasty. This surgical procedure is designed to repair large perforations of unhealthy tympanic membranes, providing good graft stability without blunting of the anterior tympanomeatal angle. METHODS: From January 2001 to December 2011, 64 Felix tympanoplasties were performed, conducted as the only surgical procedure. This paper describes the surgical technique and analyses the functional results. RESULTS: Graft take was achieved in 61 ears (95.31 per cent). There was air-bone gap improvement in 84.6 per cent of cases. CONCLUSION: Felix tympanoplasty was effective in repairing unhealthy tympanic membranes with large perforations; the avoidance of blunting at the anterior tympanomeatal angle achieved good functional results.

Angiosarcoma of the larynx. Case report and review of the literature.

Angiosarcoma of the larynx is a rare malignant tumour of vascular origin, accounting for less than 1% of all malignant tumours of the larynx. Angiosarcoma involves, in particular, the head and neck in areas such as the scalp and face. The causes are unknown, even if, in some cases, it is believed to be radiation-induced. The case is described of a patient with hypopharyngolaryngeal angiosarcoma, which became manifest with dysphagia, dysphonia and a palpable right latero-cervical mass about 7 cm in length. The patient underwent total pharyngolaryngectomy, right hemithyroidectomy, and bilateral neck dissection. Histological examination of the surgical specimen revealed a large haemorrhagic lesion involving the right pyriform sinus and homolateral hemilarynx. Right radical neck dissection revealed 9 metastatic lymph nodes, 1 of which with capsular invasion. Upon complete recovery the patient, underwent adjuvant post-operative radiotherapy. Six months later she is still alive with no clinical or radiological signs of disease. A careful review of the literature produced very few reports of such cases, only 6 of which in the last 30 years. Survival rate is very low, even if feasible average can be advanced, in view of the paucity of the case reports. Histological diagnosis is not always straightforward, as this neoplasm may be misdiagnosed as other vascular tumours (Kaposi's sarcoma, haemangiopericytoma), as non-neoplastic lesions (granulomas secondary to intubation) and as poorly differentiated squamous cell carcinoma. Immunohistochemical evaluation by means of markers, such as vimentin and factor VIII, offers a significant contribution to the diagnosis of angiosarcoma. The treatment of choice for laryngeal angiosarcoma is surgical excision, ample and radical, whenever possible, followed by adjuvant post-operative radiotherapy.

Is pressure dressing necessary after ear surgery?

Compressive bandages carry intrinsic risks and complications. The purpose of this study was to assess whether compressive head bandages are necessary after ear surgery to prevent complications such as hematoma or wound infection. A prospective, randomized, controlled study was conducted from August 1, 1993, to June 1, 1999. We randomly assigned 420 consecutive middle ear or mastoid operations to either a pressure bandage group or to a no-pressure bandage group. A careful follow-up was planned, and complications were recorded. In the pressure bandage group, 3 patients had bruising over the pinna and 70 patients had minor skin erythema when the dressing was removed. No patient had bruising or erythema in the no-pressure bandage group. No patient had hematoma, wound infection, or any other wound complication in either group. As a result of this study, we have decided to abandon the use of compression bandages after uncomplicated ear surgery.

Pectoralis major myocutaneous flap: analysis of complications in difficult patients.

The purpose of this study was to assess and discuss the effects of old age and systemic diseases on complications related to the use of a pectoralis major myocutaneous flap (PMMF) for reconstruction in head and neck surgery. Eighty-four consecutive patients, operated on between January 1992 and December 1998, were included in the study. Of these patients, 47 were in relatively good condition, while 37were old and frail or affected by systemic diseases. Patients were monitored for complications during a follow-up of 2 years. All patients included in the study had very advanced squamous cell carcinomas (T3-T4) and reconstruction with PMMF was performed after a commando procedure, a total laryngectomy with partial pharyngectomy, or a composite resection. Necrosis of skin island was the most frequently encountered complication, but no surgical intervention was needed. Overall, complications occurred more frequently in patients with underlying pathologies, the risk ratio adjusted for age and sex being 2.94, but 95% confidence intervals were 0.99-8.65 and all complications were minor. In summary, we recommend the use of PMMF for immediate repair in difficult patients who have large oropharyngo-laryngeal excisions and radical neck dissections and who suffer concomitantly with various medical problems known to increase complication rates. PMMF proved to be suitable to give these patients good chances of a quick recovery with satisfactory aesthetic and functional results.

Twenty years of experience with Marullo's supraglottic laryngectomy.

We present a follow-up study of 142 patients on whom we performed supraglottic laryngectomy (SL) with an anterior subperichondral approach using Marullo's technique, which was described in 1975. Between January 1976 and December 1992, 142 patients (age range, 35-73 years) with squamous cell carcinoma of the supraglottic larynx were treated with SL or extended SL (ESL) and ipsilateral or bilateral neck dissections with or without postoperative radiotherapy. All cases were staged according to the 1997 UICC TNM classification. Survival was defined by the Kaplan-Meyer method and showed an overall survival of 77% and a local control rate of 78%. Regarding functional rehabilitation, the mean nasogastric tube-removal time was 16 days (range, 10-39 days) for SL and 23 days (range, 11-102 days) for ESL. Voice quality was very satisfactory after SL, while the voice was often harsh or breathy after ESL with postoperative radiotherapy. The overall oncologic and functional results obtained with Marullo's SL were very similar to those obtained with the classic Alonso's operation and demonstrated that this technique makes it possible to reach "en bloc" supraglottic sites and the hyothyroepiglottic space. We consider the operation to be safe and simple to perform, provided the sub-perichondral plane is correctly identified. This approach allows the surgeon easily to reach the correct transverse level above the anterior commissure of the vocal cords. Inferiorly, the resection cuts through the floor of the ventricle and is considered to be the safe oncologic plane for pure supraglottic lesions. This technique has also been used successfully in extended resections to treat tumors involving the base of the tongue, pyriform sinus and one arytenoid.

Superficial siderosis of the central nervous system: an underestimated cause of hearing loss.

Superficial siderosis of the central nervous system (CNS) is a rare disease resulting in the accumulation of haemosiderin in the meninges, the brain surface, the spinal cord and the cranial nerves. The pigment is deposited as a result of chronic bleeding in the subarachnoid space. This produces a clinical picture of deafness, ataxia, cranial nerve deficits and in the latest stages dementia. In some cases the source of bleeding can be identified, whilst in others it can not. Despite its rarity the disease should be considered in the differential diagnosis of sensorineural deafness, particularly as it is a progressive and in some cases curable disease which is easily diagnosed by magnetic resonance imaging (MRI). In this case report the haemosiderin was derived from an ependymoma of the fourth ventricle with extension into the cerebello-pontine angle. The first symptom was a worsening sensorineural hearing loss.