Benign osteoblastoma of the temporal bone: case report and literature review.

We report a case of benign osteoblastoma of the temporal bone and a review of the literature. Osteoblastoma is a rare bony tumor that usually develops in the long bones or in the vertebral column. To our knowledge, this is the fourth reported case of benign osteoblastoma confined to the temporal bone, and it is the second such reported case to include facial paralysis as the initial symptom. Result of computed tomography scan, magnetic resonance imaging scan, and angiography are reported. The diagnosis and management of this type of lesion are also discussed.

Cerebrospinal fluid leak after acoustic neuroma surgery.

BACKGROUND: CSF rhinorrhea is a common complication of acoustic neuroma surgery. METHODS: Twenty cases of persistent cerebrospinal fluid rhinorrhea, 2 of transient leaks, and 2 of late meningitis occurring in a series of 156 posterior fossa acoustic neuroma removals were studied. Prophylaxis of leaks was usually attempted by filling opened air cells in the drilled internal auditory canal (IAC) with bone wax. Communications were repaired by rewaxing the IAC, or by fat packing of either the mastoid or the eustachian tube, middle ear, and mastoid. RESULTS: Most leaks were diagnosed within 1 week of surgery, although 1 occurred 4 years postoperatively. Those seen later were usually recurrences of a previously repaired leak or cases of meningitis. Leaks were more common later in the series when a more lateral unroofing of the IAC was used. The communication usually occurred through air cells opened while unroofing the canal, but two were via the vestibule and oval window. Treatment failed in 38% of cases in which canal rewaxing was used. There were no failures when the communication was sealed by fat obliteration of the eustachian tube, middle ear, and mastoid. CONCLUSIONS: Leaks are more common with a more lateral unroofing of the IAC. A leak may occur into the middle ear via the oval window. Optimal treatment is packing of the middle ear and mastoid with fat.

Plasma cell granuloma of the middle ear and mastoid. Case report.

We present the case of a 37-year-old man with plasma cell granuloma affecting the middle ear and mastoid. At magnetic resonance imaging scan, the lesion appeared as a homogeneously enhancing mass of soft tissue replacing the majority of the mastoid bone and causing vascular compression. After surgical resection, microscopic examination showed predominantly plasmacytes, and histochemical studies confirmed a polyclonal origin consistent with nonneoplastic plasma cell granuloma. We believe this is the first case report of plasma cell granuloma affecting the middle ear and mastoid.

Infiltration of epinephrine in tonsillectomy: a randomized, prospective, double-blind study.

A variety of hemostatic agents and techniques have been used in an attempt to reduce intraoperative blood loss and postoperative bleeding in tonsillectomy. The efficacy of most of these substances and techniques has been judged primarily on clinical impressions. Because of the paucity of prospective studies, a randomized, prospective, double-blind study, using the patients as their own controls, was conducted. Ninety-two patients were injected before tonsillectomy in a random, double-blind fashion with normal saline solution in one tonsil and 1:100,000 epinephrine in the other. The blood loss, time of dissection, and postoperative bleeding were recorded separately for each tonsil. Cardiac manifestations were also monitored. The tonsils injected with epinephrine had a statistically significant reduction in blood loss and dissection time when compared with those injected with normal saline. Subjectively, dissection was easier on the epinephrine-injected side. There was no difference in the incidence of postoperative hemorrhage. Cardiac manifestations of epinephrine were minimal and transient. This study demonstrates that epinephrine is useful in reducing hemorrhage during tonsillectomy and can be used safely with the appropriate inhalation anesthetics.