Effectiveness and Safety of Attic Exposition-Antrum Exclusion versus Canal Wall-Up in Patients with Acquired Stage Ib and II Cholesteatoma Affecting the Attic and Tympanic Cavity.

This study aims to test the effectiveness and safety of exteriorization surgery comprising atticotomy and obliteration of the additus ad antrum, also referred to as attic exposition-antrum exclusion (AE-AE) surgery. This surgery combines otoendoscopy with surgical microscopy for the treatment of acquired pars flaccida cholesteatoma in stages Ib and II (according to the classification of the Japan Otological Society) present in the attic and the tympanic cavity. We reviewed a historical cohort of 65 patients. Of the total, 21 were treated with canal wall-up tympanomastoidectomy (CWU). Patients in whom the AE-AE technique was performed had residual and recurrence rates of 0% and 9.1%, respectively, compared with 28.6% and 9.5%, respectively, for those treated with CWU. In the AE-AE procedure, surgery is performed in one stage compared with the two stages in CWU, to address the risk of residual cholesteatoma. Auditory thresholds were higher in the CWU group compared with the AE-AE group in the pre-surgery (53 ± 16 vs. 44 ± 15 dB; p = 0.039) and post-surgery (52 ± 18 vs. 42 ± 16 dB; p = 0.042) evaluations but not in pre-post-surgery comparisons for either the AE-AE technique (p = 0.89) or the CWU technique (p = 0.96). We conclude that AE-AE is an effective and safe technique for the treatment of acquired stage Ib and II cholesteatoma present in the attic and tympanic cavities.

Quilting sutures compared with sponge packing in septolplasty and turbinoplasty.

INTRODUCTION: There is a lack of consensus regarding the need for nasal packing after a septoplasty. The use of nasal packing has been proposed to reduce bleeding, synechiae and haematomas. Despite these advantages evidence is scant to support postoperative packing. Furthermore, packing is not an innocuous procedure and can cause complications. OBJECTIVE: The purpose of this study was to investigate the efficacy of quilting sutures compared with sponge nasal packing on haemostasis, haematomas and wound healing following septoplasty. MATERIAL AND METHODS: Seventy-six patients with nasal septum deviation requiring septoplasty and turbinoplasy with radiofrequency were included. Following surgery, fifty patients were selected randomly for septoplasty with one quilting suture. And twenty-six patients had sponge nasal packing. Haemostatic properties, formation of haematomas, formation of synechiae, the patients' pain and bleeding on removal of the packing were evaluated. RESULTS: Both techniques were equally effective in the control of postoperative bleeding, haematoma and synechiae formation following septoplasty. Sponge packing was associated with significant pain and bleeding on removal. CONCLUSION: The use of quilting sutures like sponge packing is efficient in controlling bleeding, synechiae and haematomas after septoplasty and turbinoplasty.

Comparación entre una sutura transfixiante y el taponamiento nasal en la septoplastia y turbinoplastia / Quilting sutures compared with sponge packing in septolplasty and turbinoplasty

Introducción: No existe un consenso sobre la necesidad del taponamiento nasal después de una septoplastia. El uso de los taponamientos ha sido propuesto con el fin de reducir las hemorragias, sinequias o hematomas después de este procedimiento. A pesar de estas ventajas la evidencia del uso de un taponamiento nasal es baja. Adicionalmente este procedimiento no es agradable para el paciente y puede tener complicaciones.ObjetivoEl propósito de este estudio es investigar la eficacia de la sutura transfixiante o transeptal comparada con el taponamiento nasal. Analizar el control de la epistaxis, hematomas y sinequias después de una septoplastia.Material y métodosSetenta y seis pacientes con indicación de septoplastia y turbinoplastia con radiofrecuencia fueron incluidos en el estudio. Pseudoaleatoriamente se utilizó una sutura transfixiante en 50 pacientes y taponamiento nasal en 26 pacientes después de la cirugía. En los 2 grupos se comparó el porcentaje de epistaxis, hematomas y sinequias. Además, el dolor y la epistaxis de los pacientes al retirar el taponamiento nasal.ResultadosTanto la sutura transfixiante como el taponamiento nasal tienen resultados similares en cuanto al control de las epistaxis, sinequias y hematomas después de la septoplastia con radiofrecuencia de cornetes. Los pacientes con taponamiento nasal presentaron dolor y epistaxis autolimitada en el momento de retirar el taponamiento nasal.ConclusiónEl uso de la sutura transfixiante después de una septoplastia y turbinoplastia con radiofrecuencia es igual de eficaz que el taponamiento nasal para el control de epistaxis, sinequias y hematomas. (AU)

Introduction: There is a lack of consensus regarding the need for nasal packing after a septoplasty. The use of nasal packing has been proposed to reduce bleeding, synechiae and haematomas. Despite these advantages evidence is scant to support postoperative packing. Furthermore, packing is not an innocuous procedure and can cause complications.ObjectiveThe purpose of this study was to investigate the efficacy of quilting sutures compared with sponge nasal packing on haemostasis, haematomas and wound healing following septoplasty.Material and methodsSeventy-six patients with nasal septum deviation requiring septoplasty and turbinoplasy with radiofrequency were included. Following surgery, fifty patients were selected randomly for septoplasty with one quilting suture. And twenty-six patients had sponge nasal packing. Haemostatic properties, formation of haematomas, formation of synechiae, the patients’ pain and bleeding on removal of the packing were evaluated.ResultsBoth techniques were equally effective in the control of postoperative bleeding, haematoma and synechiae formation following septoplasty. Sponge packing was associated with significant pain and bleeding on removal.ConclusionThe use of quilting sutures like sponge packing is efficient in controlling bleeding, synechiae and haematomas after septoplasty and turbinoplasty. (AU)

Quilting sutures compared with sponge packing in septolplasty and turbinoplasty. / Comparación entre una sutura transfixiante y el taponamiento nasal en la septoplastia y turbinoplastia.

INTRODUCTION: There is a lack of consensus regarding the need for nasal packing after a septoplasty. The use of nasal packing has been proposed to reduce bleeding, synechiae and haematomas. Despite these advantages evidence is scant to support postoperative packing. Furthermore, packing is not an innocuous procedure and can cause complications. OBJECTIVE: The purpose of this study was to investigate the efficacy of quilting sutures compared with sponge nasal packing on haemostasis, haematomas and wound healing following septoplasty. MATERIAL AND METHODS: Seventy-six patients with nasal septum deviation requiring septoplasty and turbinoplasy with radiofrequency were included. Following surgery, fifty patients were selected randomly for septoplasty with one quilting suture. And twenty-six patients had sponge nasal packing. Haemostatic properties, formation of haematomas, formation of synechiae, the patients' pain and bleeding on removal of the packing were evaluated. RESULTS: Both techniques were equally effective in the control of postoperative bleeding, haematoma and synechiae formation following septoplasty. Sponge packing was associated with significant pain and bleeding on removal. CONCLUSION: The use of quilting sutures like sponge packing is efficient in controlling bleeding, synechiae and haematomas after septoplasty and turbinoplasty.

Facial canal dehiscence in patients with cholesteatoma: concordance between intraoperative inspection, computed tomography and neurophysiological findings.

OBJECTIVES: To assess the diagnostic capacity of intraoperative neurophysiological monitoring with respect to "gold standard" microscopic findings of facial canal dehiscence in middle ear cholesteatoma surgery. STUDY DESIGN, PATIENTS AND SETTING: We carried out a retrospective cohort study of 57 surgical interventions for cholesteatoma between 2008 and 2013 at Hospital Universitario de Canarias, Spain. DIAGNOSTIC INTERVENTIONS: Each patient underwent preoperative computed tomography (CT), intraoperative neurophysiological monitoring and intraoperative inspection of the facial nerve during microsurgery. Diagnostic concordance on the presence/absence of facial canal dehiscence was assessed in 54 surgical interventions. MAIN OUTCOME: Presence of facial canal dehiscence. RESULTS: Of 57 interventions, 39 were primary surgeries; 11 (28.2%) showed facial canal dehiscence. and 18 were revision surgeries; 6 (33.3%) showed facial canal dehiscence. The facial nerve was not damaged in any patient. Facial canal dehiscence was observed in 17 (29.82%) interventions. We used intraoperative microscopic findings as the gold standard. Neurophysiological study showed a sensitivity of 94.1, specificity 97.3, positive predictive value (PPV) 57.8 and negative predictive value of 97.2. CT showed a sensitivity of 64.7, specificity 78.4, PPV 57.8 and negative predictive value of 82. CONCLUSIONS: Our neurophysiological study showed greater sensitivity and higher PPV than CT for the detection of facial canal dehiscence. We found no relationship between disease progression time and the presence of facial canal dehiscence.

Meningioma primario extracraneal de senos paranasales / Intracranial meningiomas of the paranasal sinuses

Los meningiomas extracraneales son poco frecuentes y es rara su localización en los senos paranasales. Presentamos el caso de un paciente con un meningioma primario de senos paranasales. Describimos el abordaje quirúrgico realizado y revisamos la literatura actual al respecto (AU)

Extracraneal meningiomas are infrequent and their localization in the paranasal sinuses is rare. We present the case of a patient with a primary meningioma of the paranasal sinuses. We describe the surgical approach and review the current literature (AU)

[Extracranial meningiomas of the paranasal sinuses]. / Meningioma primario extracraneal de senos paranasales.

Extracraneal meningiomas are infrequent and their localization in the paranasal sinuses is rare. We present the case of a patient with a primary meningioma of the paranasal sinuses. We describe the surgical approach and review the current literature.