- Percutaneous Threshold of Facial Nerve Stimulation Predicts Facial Canal Dehiscence. [Journal Article]
- NJNeurodiagn J 2019; 59(2):91-103
- Iatrogenic facial nerve (FN) injury is one of the most feared complications of otologic surgery. Dehiscence of the bony covering of the FN within the temporal bone increases FN vulnerability to accid…
Iatrogenic facial nerve (FN) injury is one of the most feared complications of otologic surgery. Dehiscence of the bony covering of the FN within the temporal bone increases FN vulnerability to accidental injury. High-resolution computed tomography (HRCT) of the temporal bone is used preoperatively to assess middle ear and mastoid anatomy; however, it is unreliable for detecting facial canal dehiscence. In this study, our aim was to determine if preoperative percutaneous FN stimulation could predict middle ear facial canal dehiscence. Between January 2015 and February 2017, we performed preoperative HRCT and percutaneous FN stimulation on adult patients who underwent otologic surgery at our institution. Stimulation was performed with a monopolar probe placed on the skin over the stylomastoid foramen. Electrical stimuli ranged from 0 to 40 milliamperes (mA). Recordings were made from ipsilateral facial muscles. Dependent variables included threshold to compound muscle action potential (CMAP), threshold to maximum amplitude of CMAP, and maximum amplitude of CMAP for each muscle. A retrospective chart review was performed. Seventy patients met inclusion criteria. Of the 24 with an intraoperatively confirmed dehiscence, 10 were identified preoperatively by the attending surgeon on HRCT. Averages of the lowest recorded threshold to CMAP (5.1mA v. 9.1mA), and an average of the threshold to CMAP (8.9 mA. 11.8 mA) of dehiscent versus non-dehiscent nerves were significantly different (p < .05). In conclusion, percutaneous FN stimulation is a simple and cost-effective tool that can give the surgeon important preoperative information about FN anatomy.
- Comparative analysis of four morphometric methods for sex estimation: A study conducted on human skulls. [Journal Article]
- LMLeg Med (Tokyo) 2019 Jun 03; 39:29-34
- The pelvis and skull are the regions of the human skeleton that most clearly show sexual dimorphism, with the pelvis being superior to the skull for sex estimation owing to reproductive and hormonal …
The pelvis and skull are the regions of the human skeleton that most clearly show sexual dimorphism, with the pelvis being superior to the skull for sex estimation owing to reproductive and hormonal factors. However, as many skeletons are found incomplete, it is important to be able to determine sex from analyzing the skull as well as the pelvis. This study was aimed at validating and evaluating the effectiveness of four morphometric methods for sex estimation using the human skull. One hundred human Brazilian skulls belonging to identified but unclaimed skeletons were used after all legal and administrative requirements for exhumation were satisfied. Four dimensions were analyzed: the facial triangle; the bimastoid triangle; the mastoid triangle; and finally, the occipital triangle. These dimensions were used to calculate the triangle areas. Descriptive analysis was used to verify the mean, standard deviation, and confidence interval of all variables and discriminant analysis with cross-validation was used to verify the percentage of correctness of the sex estimation methods. Individual analysis of the areas of the facial, right mastoid, left mastoid, bimastoid, and occipital triangles, and sum of the mastoid triangle areas, produced average accuracies of 63.0%, 81.8%, 77.8%, 71.4%, 64.0%, and 80.8%, respectively. Combinations of triangles resulted in higher mean accuracy percentages, with only 75.6% accuracy recorded when the left and right mastoid triangle areas were removed. All average values of analyzed triangles were higher in males than in females. Analyses of the cranial triangles were useful for sex estimation in the population studied.
- Clinicoradiologic characteristics of endolymphatic sac tumors. [Journal Article]
- EAEur Arch Otorhinolaryngol 2019 Jun 13
- CONCLUSIONS: CT and MRI findings of ELSTs are associated with clinical features. Imaging tests should be performed to identify ELSTs early and ensure greater potential for hearing preservation in patients with cochleovestibular symptoms.
- Iatrogenic facial nerve exposure in cochlear implant surgery: incidence and clinical significance in the absence of intra-operative nerve monitoring. [Journal Article]
- CICochlear Implants Int 2019 Jun 12; :1-5
- CONCLUSIONS: The incidence of iatrogenic facial nerve exposure during cochlear implantation may be relatively high. However, no additional risk of post-operative facial nerve paralysis was found, provided that the integrity of the neural sheath was preserved, even with the lack of intra-operative monitoring.
- [The infracochlear approach for diagnostic petrous apicotomy]. [Review]
- HNOHNO 2019 Jun 11
- Diagnostic and therapeutic approaches to the petrous apex involve sub-/transtemporal, retrosigmoidal, infratemporal and-lesser invasive-e. g. infracochlear, infralabyrinthine or under favourable anat…
Diagnostic and therapeutic approaches to the petrous apex involve sub-/transtemporal, retrosigmoidal, infratemporal and-lesser invasive-e. g. infracochlear, infralabyrinthine or under favourable anatomic conditions, transsphenoidal surgical pathways. For diagnostic purposes, minimally invasive approaches should be preferred due to their lesser morbidity. This article illustrates the infracochlear approach to the petrous apex in the case of a diagnostic indication in a patient with an incidental, asymptomatic tumorous lesion of the right petrous apex with bony erosion. After the bone of the floor of the ear canal and the hypotympanum was removed, the carotid artery and the jugular bulb were identified using a diamond burr. The route to the petrous apex is triangled by the cochlea superiorly, the jugular bulb posteriorly, and the carotid artery anteriorly. After opening the petrous apex lesion, biopsies were taken. The defect in the floor of the ear canal and the hypotympanum was reconstructed with cartilage and temporalis fascia. The patient recovered quickly from surgery without vertigo or hearing loss. Histological evaluation showed a chondrosarcoma. The patient opted for primary radiation therapy (C12, 63 Gy). The infracochlear approach is minimally invasive and can offer access to the petrous apex with minimal morbidity. The pathway, however, is narrow and deep and bounded by the jugular bulb and the carotid artery. The available space can be estimated from preoperative CT scans and, if possible, with 3D reconstructions. Navigation can additionally enhance safety.
- Histomorphological study on hypocellularity in mastoid processes from archaeological human skeletons. [Journal Article]
- IJInt J Paleopathol 2019 Jun 07; 26:27-36
- CONCLUSIONS: Using histomorphology, in vivo processes resulting in different types of mastoid hypocellularity can be assessed, even in bones that have undergone some degree of diagenesis.The study provides methods to evaluate the etiology of histomorphological changes of the mastoid process, which potentially provides insight into the presence of infection and inflammation in past populations.Diagenetic modifications of archaeological bone can hinder assessment of histomorphological change, requiring careful evaluation during analysis.
- Ipsilateral Hypertrophy of the Mastoid Process in Surgical Cases of Congenital Muscular Torticollis. [Journal Article]
- CPCleft Palate Craniofac J 2019 Jun 09; :1055665619853966
- CONCLUSIONS: We showed ipsilateral hypertrophy of the mastoid process in patients with CMT and demonstrated that the volumetric asymmetry increased with age.
- Primary Extracranial Meningioma of Mastoid in a Patient With History of Skin Squamous Cell Carcinoma, Lung Adenocarcinoma and Prostatic Carcinoma. [Case Reports]
- ARAnticancer Res 2019; 39(6):3197-3201
- CONCLUSIONS: To the best of our knowledge, primary mastoid meningioma clinically mimicking a cholesteatoma presenting in a patient with a history of multiple primary carcinomas has not been previously reported. The pathogenesis, diagnosis and treatment of this entity are discussed.
- An innovative method to visualise mastoiditis using a hand-held X-ray system. [Journal Article]
- IJInt J Paleopathol 2019 Jun 05; 26:22-26
- CONCLUSIONS: This method was found to be an effective, convenient, and versatile non-destructive alternative to sectioning and traditional radiographic imaging.This is the first project to adapt a hand-held X-ray system for imaging and diagnosis of mastoiditis and this approach encourages future analyses of this infection.The cost of the imaging system is limiting and there are few comparative images taken in the same plane.
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- Endomeatal approach in cochlear implant surgery in a patient with small mastoid cavity and procident lateral sinus. [Journal Article]
- BCBMJ Case Rep 2019 Jun 06; 12(6)