Congenital aural atresia.

Congenital aural atresia is an unusual anomaly that is difficult to surgically correct. Altered anatomical landmarks, especially of the facial nerve, and variability of the middle ear configuration, contribute to the difficulty of the procedure. In addition, the unpredictable healing process can make for variable outcomes. Choosing appropriate candidates for surgical repair minimizes risks and enhances patient care. This report reviews the outcome with evaluation and management of 17 patients with congenital aural atresia. Surgical techniques for repair, including use of a hydroxylapatite canal wall prosthesis to help reconstruct the posterior canal wall are described. As expected, patients with less severe anomalies had better postoperative hearing results. Lateralized tympanic membrane, canal stenosis, and meatal narrowing were complications encountered. The anatomy and embryology of the ear and facial nerve are reviewed to assist surgeons in safe, successful surgery.

Intraoperative facial nerve monitoring: a description of a unique system.

Intraoperative facial nerve monitoring has become an integral adjunct in facial nerve identification and preservation for patients undergoing cerebellopontine angle surgery. Since the first description of EMG monitoring of facial nerve activity intraoperatively, many systems have been developed. These systems often rely on unilateral monitoring of the facial nerve with auditory feedback to the surgeon, and it is difficult to distinguish between artifact and significant stimulation of the facial nerve. In this paper, we present the use of a bilateral, multialarm, facial nerve monitoring system that has multiple advantages over previous systems. Furthermore, we review our experience with this bilateral system, comparing a group of 50 monitored patients to a group of 50 unmonitored patients.

Proliferating cell nuclear antigen in the determination of growth rates in acoustic neuromas.

The growth rate of acoustic neuromas is difficult to predict clinically; however, the ability to do so would be of benefit to the clinician for patient prognostication. Laboratory studies utilizing flow cytometry and immunologic methods have been used to investigate growth rates of acoustic neuromas. The purpose of this pilot immunohistochemical study, using proliferating cell unclear antigen (PCNA) on 22 randomly selected vestibular schwannomas, was to compare the growth factors, determined immunohistochemically, with the growth rate in this class of lesions. Proliferating cell nuclear antigen is an antibody against DNA polymerase delta, which is expressed in late G1 through S phase of the cell cycle. The advantage of using PCNA is that standard archival formalin-fixed, paraffin-embedded tissues may be analyzed and that PCNA detect cells in G1 through S phase, allowing S-phase fractions, determined by flow cytometry. Results indicate that PCNA immunohistochemical analysis may potentially offer prognostic information relating to the growth potential of each tumor for individual patients with vestibular schwannomas. Further study with an expanded patient population is planned

Complications in stapes surgery. Options for prevention and management.

Although successful stapedectomy is very gratifying for both the patient and surgeon, complications can arise, often with disastrous results. Certain clues may alert the surgeon to risk prevention or possible complications, allowing early definitive management. This assumes critical importance today as fewer younger surgeons acquire extensive experience in stapedectomy. A thorough knowledge of possible problems and their management is mandatory for the otologist who undertakes this most challenging of operations.

Burkitt's lymphoma of the parapharyngeal space.

Burkitt's lymphoma is quite rare outside of Africa. It is even more uncommon for this nonendemic form of the disease to present in the head and neck region. To our knowledge, nonendemic Burkitt's lymphoma has not been previously reported arising from the parapharyngeal space. We review the case of a 10-year-old boy who presented with an asymptomatic mass at the angle of the mandible several weeks after blunt trauma to that area. We discuss the evaluation of this mass, including the results of computed tomography and magnetic resonance imaging, along with the findings of histopathologic and cytogenetic studies. We also discuss the differential diagnosis of parapharyngeal lesions, paying particular attention to the workup and management of Burkitt's lymphoma. Since Burkitt's lymphoma has the highest growth rate of any tumor in man, rapid diagnosis and immediate treatment are important and likely to improve outcome.