An atypical stapedial artery.

The persistence of the stapedial artery is a rare vascular anomaly. It is mostly asymptomatic but sometimes cause conductive hearing loss, pulsatile tinnitus, or vertigo. The estimated prevalence of this rare postembryonic persistence ranged from 0.02% to 0.48%. Four different anatomical forms have been identified, and their preoperative diagnostic is essential. We report the case of an incidental discovery of pharyngo-hyo-stapedial artery, the most uncommon form of persistent stapedial artery. Its per-operative finding has become rare because tomodensitometry is performed in case of conductive hearing loss. The continuous improvement of imagery resolution will probably help to revise the incidence of this malformation.

Vestibular information is necessary for maintaining metric properties of representational space: evidence from mental imagery.

The vestibular system contributes to a wide range of functions, from postural and oculomotor reflexes to spatial representation and cognition. Vestibular signals are important to maintain an internal, updated representation of the body position and movement in space. However, it is not clear to what extent they are also necessary to mentally simulate movement in situations that do not involve displacements of the body, as in mental imagery. The present study assessed how vestibular loss can affect object-based mental transformations (OMTs), i.e., imagined rotations or translations of objects relative to the environment. Participants performed one task of mental rotation of 3D-objects and two mental scanning tasks dealing with the ability to build and manipulate mental images that have metric properties. Menière's disease patients were tested before unilateral vestibular neurotomy and during the recovery period (1 week and 1 month). They were compared to healthy participants tested at similar time intervals and to bilateral vestibular-defective patients tested after the recovery period. Vestibular loss impaired all mental imagery tasks. Performance varied according to the extent of vestibular loss (bilateral patients were frequently the most impaired) and according to the time elapsed after unilateral vestibular neurotomy (deficits were stronger at the early stage after neurotomy and then gradually compensated). These findings indicate that vestibular signals are necessary to perform OMTs and provide the first demonstration of the critical role of vestibular signals in processing metric properties of mental representations. They suggest that vestibular loss disorganizes brain structures commonly involved in mental imagery, and more generally in mental representation.

A middle ear implant with a titanium canal wall prosthesis for a case of an open mastoid cavity.

OBJECTIVE: Open mastoid cavity rehabilitation should focus on both anatomical and functional aspects. We hereby report the technique and results of a combined strategy to reconstruct the external ear canal using a titanium wall implant and the middle ear using a fully implantable active middle ear device. METHODS: A fully implantable active middle ear implant was used to rehabilitate the mixed hearing loss of a 63-year-old woman, and a titanium posterior canal wall prosthesis was used to reconstruct the external ear canal during the same procedure. The middle ear implant was placed directly on the footplate. The auditory results were compared to the preoperative unaided thresholds and to the amplification of a conventional hearing aid. RESULTS: Following the procedure, there was an anatomically normal external ear canal with a healed tympanic membrane separating the external from the middle ear spaces. The postoperative auditory gains were on average 31.8 dB on pure-tone audiometry, and 20 dB on speech reception threshold. No complications occurred. CONCLUSION: The rehabilitation of the external ear canal in an open mastoid cavity allows for clinical follow-up of the patient, and the implantation of an active middle ear implant provides appropriate auditory gains both in pure tones and in speech reception thresholds.

Accidental Removal of a Carotid Endovascular Stent during Oropharyngeal Mass Biopsy.

A 54-year-old male patient, with a history of a right mandibular adenocarcinoma, previously excised, and treated with post operative chemo- and radio-therapy, presented with a right oropharyngeal necrotic mass of several months duration. His history is pertinent for a right internal carotid endovascular stenting 2 years prior to presentation. During biopsy of his oropharyngeal lesion, a specimen of tissue was retrieved, with the carotid stent within. There was no bleeding. To the best of our knowledge, there is no such case reported in the literature. We present this case as a reminder on the importance and risks of radiation-induced necrosis and its distortion of the surrounding anatomy, especially in the presence of foreign bodies or protheses.

Laser cordotomy for the treatment of bilateral vocal cord paralysis in infants.

OBJECTIVE: Vocal cord paralysis is the second cause of neonatal stridor. Several surgical treatments are proposed in order to avoid tracheotomy or to decanulate patients. Laser posterior partial cordotomy is supposed to be a minimal invasive procedure. The purpose of the study is to share our experience in management of laryngeal paralysis with this technique in infants and appreciate its role in avoiding tracheotomy in infants. DESIGN: Retrospective study. PATIENTS: The charts of 0-2-year-old patients treated for vocal cord paralysis from 1996 to 2007 are reviewed. Eleven infants with bilateral laryngeal paralysis in adduction presented severe dyspnoea. Tracheotomy was performed in four out of them, proposed in five others. One infant out of 11 underwent long-term intubation, and one presented with progressive dyspnoea. RESULTS: The laser posterior partial cordotomy allowed the decanulation after one session (n=2) or avoided tracheotomy (n=5), one patient had significant improvement of his respiratory function. Two patients needed a second session of laser cordotomy and were decanulated. The functional results for the voice and swallowing qualities were subjectively satisfactory. One patient had pejorative evolution. CONCLUSION: Posterior partial cordotomy is an effective, minimal invasive technique which can be proposed to avoid tracheotomy in infants with bilateral adduction vocal cord paralysis. No functional sequelae were observed.

Ear canal keratinocyte culture: clinical perspective.

HYPOTHESIS: Autologous epidermal sheets obtained by cultivating keratinocytes of the external auditory meatus can be used to repair cutaneous defects of the ear canal. The Rheinwald and Green method has been used to know whether the produced epidermal layer preserves its specificities after the culture. BACKGROUND: Using a split-thickness skin graft during a functional ear atresia surgery does not allow for the restitution of external auditory canal self-cleaning. Some authors cultivated external auditory meatus keratinocytes and showed migration capacities of these colonies. METHODS: Samples of preauricular skin and of the bony part of the external auditory canal were harvested from 10 patients. Keratinocytes were extracted and cultured until an epidermal sheet was obtained. The output, the keratinocyte plating efficiency, and the production delay were measured during the culture. Culture product sections and biopsy sections were examined using optical microscopy after standard coloration and indirect immunohistochemistry. RESULTS: Nine epidermal layers from 10 biopsies were obtained in each group. A significant difference between external auditory meatus and preauricular keratinocyte plating efficiency was highlighted. The average production delay of 23 cm2 external auditory canal and preauricular epidermal layers was 21 days. There was no difference in the cytokeratine expression between external auditory canal and preauricular skin, nor between external auditory canal and preauricular culture products. All cultures expressed the cytokeratine 5 characteristic of stratifying epithelium. CONCLUSION: The Rheinwald and Green keratinocyte culture method allows the production of ear canal-stratified epidermal sheets, which can be used for external ear reconstruction.