Techniques of the Tympanomastoidectomy with Reconstruction of the Posterior Bone Wall of the External Auditory Canal.

A combined tympanoplasty method, the mobile-bridge tympanoplasty, has been applied at the Clinic for Ear, Nose and Throat Diseases in Novi Sad since 1998. Mobile-bridge tympanoplasty is performed at our Clinic by applying Feldmann's procedure utilizing a microsurgical oscillating saw. It is a combination of closed and open techniques for surgical treatment of middle ear diseases. In addition to this technique, a method for reconstruction of the posterior bone wall of the external auditory canal was introduced. This procedure is applied in cases of damage or impairment of the bony ear canal wall using mastoid cortical temporal bone graft or modeled cartilage of the concha. Maintenance of general anatomical relations in the middle ear enables good ventilation of pneumatic spaces of the middle ear and Eustachian tube permeability, thus providing good conditions for ossicular chain reconstruction. The incidence of recurrent cholesteatoma in combined mobile-bridge tympanoplasty and tympanoplasty with reconstruction of the posterior bone wall was 6% in total. The incidence values for the recurrent cholesteatoma in closed tympanoplasty and in cases of open techniques were 10%. Mobile-bridge tympanoplasty and reconstruction of the posterior bone wall of external auditory canal are methods of choice in surgical treatment of middle ear cholesteatoma that progressed to the attic space, sinus tympani and facial recess.

Complications in Cochlear Implantation at the Clinical Center of Vojvodina.

INTRODUCTION: The first modern cochlear implantation in Serbia was performed on November 26, 2002 at the Center for Cochlear Implantation of the Clinic for Ear, Nose and Throat Diseases, Clinical Center of Vojvodina. OBJECTIVE: The aim of the paper is the analysis of intraoperative and postoperative complications. Major complications include those resulting in the necessity for revision surgery, explantation, reimplantation, severe disease or even lethal outcomes. Minor complications resolve spontaneously or can be managed by conservative therapy and do not require any prolonged hospitalization of the patient. METHODS: In the 2002-2013 period, 99 patients underwent surgical procedures and 100 cochlear implants were placed. Both intraoperative and postoperative complications were analyzed in the investigated patient population. RESULTS: The analysis encompassed 99 patients, the youngest and the oldest ones being one year old and 61 years old, respectively. The complications were noticed in 11 patients, i.e. in 10.5% of 105 surgical procedures. The majority of procedures (89.5%) were not accompanied by any post-surgical complications. Unsuccessful implantation in a single-step procedure (4.04%) and transient facial nerve paralysis can be considered most frequent among our patients, whereas cochlear ossification (1.01%) and transient ataxia (2.02%) occurred rarely. Stimulation of the facial nerve (1.01%), intraoperative perilymph liquid gusher (1.01%), device failure and late infections (1.01%) were recorded extremely rarely. CONCLUSION: Complications such as electrode extrusion, skin necrosis over the implant or meningitis, which is considered the most severe postoperative complication, have not been recorded at our Center since the very beginning. Absence of postoperative meningitis in patients treated at the Center can be attributed to timely pneumococcal vaccination of children.

Carcinoma developing in a branchial cyst.

INTRODUCTION: The malignant transformation of the branchial cysts epithelium is rare and it represents separate entity called branchiogenic carcinoma. CASE REPORT: A 55-year-old male with fluctuating mass localized on the right side of the neck, was admitted to the Department of Maxillofacial Surgery, General hospital in Vrbas where cystic tumor 3 cm in its greatest dimension with friable, dark red wall below the front edge of the sternocleidomastoid muscle was revealed. The wall of the tumor was composed of lymphoid tissue with germinal centers. The internal surface of the cyst was lined with thin layered squamous epithelium that showed a transition from the normal, followed by the atypical epithelium, and the in situ carcinoma to the part corresponding to a poor differentiated invasive squamous carcinoma. Following the diagnosis of suspected branchiogenic carcinoma a radical neck dissection was performed. No elements of the tumor had been found in the sampled materials taken from striated muscle tissue, salivary gland tissue and reactive lymph nodes (n = 24). The patient was presented to Oncology Consilium, and radiotherapy was implemented. CONCLUSION: The definitive diagnosis must be based on histological features. A five-year monitoring of the patient is necessary to rule out cervical metastasis of this tumor. It is necessary for a five-year follow-up to rule out cervical metastasis of the tumor.

Functional hearing results in patients with otosclerosis before and after stapedotomy.

Surgical treatment of otosclerosis with stapedotomy leads to the improvement of subjective and objective problems in patients with otosclerosis. A prospective study included patients who had been treated surgically at the Department for Ear, Nose and Throat in Novi Sad in the period from September 2006 to September 2007. On the basis of the appropriate diagnostic procedures, 33 patients were diagnosed with otosclerosis. Functional hearing was assessed before and after surgery by means of pure tone audiometry. The comparison of functional results before and after surgery revealed no changes in pure tone average of bone conduction threshold (average hearing threshold for hearing range), whereas pure tone average of air conduction and pure tone average of the gap showed statistically significant improvement. The results of this study demonstrated the applicability of stapedotomy as a method for successful management of otosclerosis. This way of examination offers a new perspective on patients' health, which should be defined as a physical, psychosocial and social well-being, and not only the absence of a disease itself.