Eustachian tube teratoma and its terminological correctness.

Teratomas are germ cell tumours usually found in the young and are characteristically composed of tissue foreign to the place where they arise. Two teratomas of the middle ear were first described in 1866 and since then, and to the best of our knowledge, 19 additional cases have been reported in the literature under different terms such as hairy congenital polyps, epidermoid cysts, dermoid cysts, hamartoma, cutaneous teratoma and teratomas. The difficulty in classifying germ cell tumours may explain the different terminologies encountered in the literature. The authors describe a case of teratoma of the eustachian tube presenting as a mass in the middle and external ear of a 10-week-old girl. Using this case, a review of the literature is performed in light of the new classification of germ cell tumours proposed by the World Health Organization (WHO). It is of note that most of the teratomas that present in the middle ear arise from, or involve, the eustachian tube.

Cavernous haemangioma of the facial nerve.

Facial nerve haemangiomas are probably the most frequent benign tumours involving the facial nerve in its intratemporal portion. Usually facial nerve dysfunction is present when these tumours are of extremely small size, the average tumour being less than 10 mm. We present a case of a 15 mm diameter cavernous haemangioma of the geniculate region, with histological findings of nerve infiltration, without facial nerve symptoms. The atypical clinical presentation justifies the report and subsequent literature review.

Applied embryology and post-natal morphology of the human tympanic membrane.

This article deals with the morphological as well as histological changes of the tympanic membrane and bone from early embryological life until mature age. An overview of the continuous changes is given with reference to pertinent clinical implications.

Normal and metastatic melanin in the temporal bone.

PURPOSE: Malignant melanoma is known to metastasize to the temporal bone. However, melanocytes exist in the normal inner ear and may be difficult to distinguish from metastatic melanotic cells. This study describes distribution of normal melanin in the ear and metastatic melanoma to the temporal bone. MATERIALS AND METHODS: Normal melanin distribution is described in 48 temporal bones from White (18), Native-American (19), and African-American (11) individuals and metastatic melanoma to the temporal bone is described in four cases (seven temporal bones). Temporal bones were removed at autopsy, fixed in 10% buffered formalin, and processed for routine celloidin embedding. Sections were cut at a thickness of 20 microns and every tenth section was stained with hematoxylin-eosin for light microscopic evaluation. RESULTS: Normal melanin was found in the inner ear, mainly around terminal neural structures and blood vessels, and occurred in greater quantities in African-American individuals. Metastatic melanotic cells reached the temporal bone by hematological dissemination, and by neural invasion from the central nervous system. No correlation was found between histopathological findings and clinical symptoms of patients. CONCLUSIONS: Metastatic melanoma to the temporal bone may be seen in the same areas as normal melanin. They may also be observed in bone marrow cells of the petrous bone and along the course of nerves of the internal auditory canal and cochlear vestibular labyrinth, either by following neural sheaths or blood vessels that run along the nerve. Metastatic disease to the temporal bone is often asymptomatic, or it may present with uncharacteristic symptoms that may delay diagnosis.

Overall view and rationale for surgical alternatives for incapacitating peripheral vertigo.

This article describes an overall view and the rationale for the different surgical alternatives available for treating incapacitating peripheral vertigo. The authors emphasize that the number of patients requiring surgery is very small, and that the surgical procedures available do not provide 100% relief nor are they free of risks. A need for individualized attention to patients and a careful selection of the most appropriate surgical procedure for each particular case are strongly stressed.

Mechanisms of retraction pocket formation in the pediatric tympanic membrane.

The epidemiological nature of acquired cholesteatoma in children has shown that it occurs more often in the posterosuperior quadrant of the pars tensa and in the pars flaccida. This type of cholesteatoma is rarely seen before the age of 3 years, and serous otitis media is the most important risk factor for its occurrence. In an attempt to present a pathological rationale for these clinical findings, tympanic membranes from 11 temporal bones with purulent otitis media and 13 with serous otitis media were evaluated light microscopically and compared with 14 temporal bones without disease. Ages ranged from newborn to 3 years 6 months. The persistence of mesenchyme and greater inflammatory reaction observed in the pars flaccida and the posterosuperior quadrant of the pars tensa and changes in collagen and elastin observed in purulent otitis media and serous otitis media may represent a pathological rationale for the epidemiological nature of cholesteatoma in children.

Paediatric otoscopy--clinical and histological correlation.

Otoscopy is a subjective clinical method. Its subjectively has led physicians to verify its accuracy through correlations with findings of otomicroscopy, pneumatic otoscopy, tympanometry, and myringotomy. In the very young population, however, the interpretation of otoscopic findings become more difficult. To improve the interpretation of normal otoscopy in young children, an otoscopic-histological correlation was attempted in children up to nine years of age. Twenty-one temporal bones from 15 children aged from two days to nine years who had no evidence of otological disease or congenital anomalies were examined under light microscopy; the thickness of the pars flaccida, posterior superior quadrant, and umbo were measured. Twenty-five eardrums of 15 healthy children without past or present history of otological disease were examined using otoscopy; a photograph of each eardrum was obtained. Our study demonstrates that structural changes in the tympanic membrane during these years of childhood have a good correlation with otoscopic findings. Understanding normal histological changes in the paediatric eardrum may improve our interpretation of otoscopic findings.

Otitis media: the pathogenesis approach. General surgical approach based on pathogenesis. An overall approach.

The authors present an overall approach and fundamental concepts based on pathogenesis. They advocate an open-minded approach, tailoring the treatment to each individual patient rather than fitting patients into preestablished classifications.

Age-related morphologic changes in the human tympanic membrane. A light and electron microscopic study.

To our knowledge, the normal changes that occur in the tympanic membrane after birth have not been described, despite several reports that their otoscopic appearance in healthy, full-term infants is different from that in adults. To provide such a description, the tympanic membranes of 54 temporal bones that had no pathologic evidence of otologic diseases, from patients aged 33 weeks' gestation to 91 years, were examined with light or electron microscopy. The changes encountered in thickness, cellularity, vascularity, collagen, and elastin indicated beyond the first year of life and into old age.

Recurrent pleomorphic adenomas of the parotid gland.

Twenty-seven patients with recurrent pleomorphic adenomas of the parotid gland were seen. This study confirms that superficial parotidectomy with identification and dissection of the facial nerve greatly decreases the incidence of recurrent benign pleomorphic adenoma, and, in the small number that recur, are easier to cure. All lumps in the parotid area should be approached in the same manner, with the surgeon prepared to isolate the facial nerve and perform superficial parotidectomy. This technique is successful because it avoids dissection near the tumor capsule, which is the major cause of recurrence. The procedure recommended for treatment of patients to remove the first recurrent tumor is total parotidectomy and excision of the previous scar. This vigorous approach is dictated by the increasing difficulty of removing further recurrent tumors. Only 67% of patients with recurrent tumors ultimately achieve a tumor-free status. Experienced surgeons can preserve the facial nerve even after multiple operations.

Obstructing tumors of the subglottic larynx and cervical trachea: airway management and treatment.

A series of 11 patients presenting with airway obstruction secondary to tumors involving the subglottic larynx and cervical trachea was treated with either carbon dioxide or neodymium:yttrium aluminum garnet laser tumor ablation. Choice of ventilation varied according to the site of airway obstruction: Venturi jet with ventilation laryngoscope for glottic and subglottic tumors and a specially designed ventilation laser fiber tracheoscope for tumors obstructing the cervical trachea. All patients subsequently had definitive treatment of the tumor and were relieved of the compromised airway. No complications associated with ventilation and treatment techniques were recorded.

Treatment of severe recurrent aphthous stomatitis with colchicine.

Recurrent aphthous stomatitis (RAS) is characterized by necrotizing ulcers of the oral mucosa that persist, remit, and recur for variable periods of time. Despite the benign nature of the disease, persistent pain and ulceration may disable patients from performing their daily activities. We describe three patients with long-standing active RAS treated with oral colchicine. All patients experienced a marked decrease in symptoms and a remission of the disease. Recurrences, however, occurred within three days of discontinuation of the therapy. In one patient, colchicine therapy was discontinued because of persistent diarrhea. In another, a second remission was more difficult to achieve on the same regimen. The literature on the subject is reviewed, and the beneficial effects of colchicine therapy are discussed in relation to the immunopathogenesis of this disease. We conclude that colchicine therapy should be considered as an alternative in the treatment of the major or persistent form of RAS.