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Barbara M, Covelli E, Monini S, Bandiera G, Filippi C, Margani V, Volpini L, Salerno G, Romano A, Bozzao A. Early non-EPI DW-MRI after cholesteatoma surgery. EAR, NOSE & THROAT JOURNAL 2024; 103:435-441. [PMID: 34846196 DOI: 10.1177/01455613211042946] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Middle ear cholesteatoma may lead to the erosion of the bony structures of the temporal bone, possibly causing intra- and extracranial complications. Surgical treatment is mandatory, and due to possible residual/recurrent disease, the use of reliable diagnostic methods is essential. Our study aimed to evaluate the reliability of non-EPI DW-MRI for the follow-up of cholesteatoma after surgery. METHODS In a study group including 53 consecutive patients who underwent surgery for cholesteatoma at a tertiary university hospital, an imaging protocol was applied, including non-echo planar diffusion-weighted imaging magnetic resonance (MR) at 1 month after surgery and then at 6 and 12 months after surgery. Based on the combination of preoperative assessment and intraoperative findings, the study group was divided into 3 subgroups: petrous bone (PB) cholesteatoma, complicated cholesteatoma and uncomplicated cholesteatoma. PB cholesteatoma patients were treated by a subtotal petrosectomy, whereas complicated and uncomplicated cholesteatoma patients were treated either by a canal wall up procedure or a retrograde (inside-out) canal wall down technique with bone obliteration technique (BOT). RESULTS The results show that patients who had positive findings on non-EPI DW-MRI scans 1 month after surgery consequently underwent revision surgery during which residual cholesteatoma was noted. All the patients who displayed negative findings on non-EPI DWI-MRI scan at 1 month after surgery did not show the presence of a lesion at the 6- and 12-month evaluations. The 6 patients who displayed residual cholesteatoma at the 1-month follow-up presented dehiscence/exposure of the facial nerve canal at the primary surgery, mostly at the level of the labyrinthine segment. CONCLUSION Non-EPI DW-MRI is a useful and reliable tool for follow-up cholesteatoma surgery, and when applied early, as was done in the protocol proposed in the present study, this tool may be used to detect the presence of residual cholesteatoma in some patients, prompting the planning of early revision surgery.
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Affiliation(s)
| | - Edoardo Covelli
- NESMOS Department, ENT Clinic, Sapienza University, Rome, Italy
| | | | | | - Chiara Filippi
- NESMOS Department, ENT Clinic, Sapienza University, Rome, Italy
| | - Valerio Margani
- NESMOS Department, ENT Clinic, Sapienza University, Rome, Italy
| | - Luigi Volpini
- NESMOS Department, ENT Clinic, Sapienza University, Rome, Italy
| | - Gerardo Salerno
- NESMOS Department, Laboratory Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Andrea Romano
- NESMOS Department, Neuroradiology Unit, Sapienza University, Rome, Italy
| | - Alessandro Bozzao
- NESMOS Department, Neuroradiology Unit, Sapienza University, Rome, Italy
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Facial Palsy Secondary to Cholesteatoma: A Case-Series of 14 Patients. Audiol Res 2023; 13:86-93. [PMID: 36648929 PMCID: PMC9844432 DOI: 10.3390/audiolres13010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/07/2023] [Accepted: 01/10/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND To evaluate patients with middle ear cholesteatoma presenting with facial palsy (FP). MATERIAL-METHODS A total of 14 subjects (10 males and 4 females), with a mean age of 42.5 years, were included in our study. The majority of patients presented with incomplete FP (House-Brackmann HB II-IV, 11 cases) and the remaining 3 patients had complete facial paralysis (HB V-VI). A canal wall down mastoidectomy was performed in all the patients, followed by partial facial nerve decompression. RESULTS At the one-year follow-up, eleven (78.5%) patients demonstrated satisfactory recovery to HB I-II. Facial function recovered to HB grade I-II in 9 (100%) patients who were surgically treated within one month, and in 2 (40%) patients who underwent surgery after one month. The tympanic segment of facial nerve was the most common site of involvement (8 patients). The multiple regression analysis showed that a higher preoperative HB grade combined with a gradual than sudden onset of FP more likely resulted in worse postoperative HB grade. CONCLUSION Early surgical removal of cholesteatoma associated with FP is more likely to result in good facial nerve recovery (78.5% of cases), when it is performed within one month from the onset of FP. According to the literature, the tympanic segment of the facial nerve was more frequently damaged (77.7%), followed by the mastoid segment (22.9%), labyrinthine segment (11.1%), and geniculate ganglion (11.1%). Labyrinthine fistula, mainly of the lateral semicircular canal, can be expected in cases of facial nerve dehiscence. The canal wall down mastoidectomy combined with partial decompression surgery was the most preferred surgical treatment for the FP secondary to cholesteatoma.
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Gulotta G, Visconti IC, Pace A, Iannella G, Rossetti V, Mastino P, Vicini C, Salzano F, Artico M, Greco A, Magliulo G. Facial nerve dehiscence and cholesteatoma: Pediatrics vs adults. Int J Pediatr Otorhinolaryngol 2020; 138:110260. [PMID: 32705993 DOI: 10.1016/j.ijporl.2020.110260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES the aim of this paper is to study the incidence of facial canal dehiscence (FCD) in pediatric and non-pediatric patients, analyzing eventual differences in frequency, localization, primary or revision surgery and duration of the disease. METHODS 527 patients suffering from chronic otitis media with acquired cholesteatoma, divided into two groups, those aged 18 years or over (470 patients), and those aged below 18 years (57 patients). RESULTS Total incidence of FCD in adult population was 25,7% (121/470) and 7% (4/57) in pediatric one. Globally higher values were found in revision surgery, 43,5% (40/92) in adults and 16,7% (1/7) in children. Diseases longer than 5 years have been correlated to higher incidence of FCD in adults, 29,9% (109/364), than in pediatrics, 7,3% (3/41). No statistical significant difference has been found in those with a disease shorter than 5 years: 11,3% in adults (12/106) and 6,2% in children (1/16). The majority of patients, both adults and pediatrics, had a dehiscence in the tympanic tract of facial nerve. No statistical correlation regarding concomitant semicircular canal fistula and FCD has been found due to the absence of data in children. CONCLUSIONS Incidence of FCD is higher in adult population than in pediatric. Adults have a higher incidence in primary surgery than children. No statistical significant difference has been found in adults and pediatrics with a less than 5 years disease, while diseases longer than 5 years expose adults to higher risk of FCD. Middle tract of tympanic segment is the most involved site of dehiscence in both populations.
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Affiliation(s)
- Giampiero Gulotta
- Department of "Organi di Senso", Sapienza University of Rome, Rome, Italy
| | | | - Annalisa Pace
- Department of "Organi di Senso", Sapienza University of Rome, Rome, Italy
| | | | - Valeria Rossetti
- Department of "Organi di Senso", Sapienza University of Rome, Rome, Italy
| | - Pierluigi Mastino
- Department of "Organi di Senso", Sapienza University of Rome, Rome, Italy
| | - Claudio Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Francesco Salzano
- Department of Otorhinolariyngology, University of Salerno, Salerno, Italy
| | - Marco Artico
- Department of "Organi di Senso", Sapienza University of Rome, Rome, Italy
| | - Antonio Greco
- Department of "Organi di Senso", Sapienza University of Rome, Rome, Italy
| | - Giuseppe Magliulo
- Department of "Organi di Senso", Sapienza University of Rome, Rome, Italy.
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Gulotta G, Pace A, Iannella G, Visconti IC. Facial Nerve Dehiscence and Cholesteatoma: A Comparison between Decades. J Int Adv Otol 2020; 16:367-372. [PMID: 33136018 DOI: 10.5152/iao.2020.8395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To evaluate the incidence of facial canal dehiscence (FCD) and other intraoperative findings over the last 20 years as well as correlation with the Japanese Otological Society/European Academy of Otology and Neurotology classification in patients with cholesteatoma. MATERIALS AND METHODS A total of 469 patients operated from 1998 to 2018 were selected and divided into 2 groups of 10 years each. RESULTS Dehiscence was significantly higher in patients with a history of pathology longer than 5 years (22.7%). Higher values were observed in revision surgery, 44.4% in the first period and 41.7% in the second. The tympanic segment was the one most frequently involved, affecting 92% of patients in the first period and 97% of patients in the second. Dehiscence occurred significantly more often in patients with a semicircular canal fistula, 14.8% in the first decade and 8.8% in the second. The incidence of FCD was significantly higher in patients with primary cholesteatoma (especially in those with combined pars tensa-flaccida) than in those with a secondary acquired one, 31.5% vs 7.4% in the first period, 21.1% vs 7.4% in the second, and in those with a stage III disease, 42% in the first period, 33.3% in the second. CONCLUSION Patients with a shorter history of cholesteatoma as well as those not previously operated had a lower incidence of FCD. The tympanic tract of the facial nerve remains the most frequent site of dehiscence, while the association between dehiscence and fistula of the semicircular canal remains strong. Patients with combined pars tensa-pars flaccida and stage III cholesteatoma have a higher incidence of FCD.
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Affiliation(s)
- Giampiero Gulotta
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Annalisa Pace
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Giannicola Iannella
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
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Sahin MM, Cayonu M, Dinc ASK, Boynuegri S, Barut FE, Eryilmaz A. Cautionary Findings for the Presence of Facial Canal Dehiscence During Cholesteatoma Surgery. EAR, NOSE & THROAT JOURNAL 2019; 99:327-330. [PMID: 31203653 DOI: 10.1177/0145561319856886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Our aim was to investigate the relationship between facial canal dehiscence (FCD) and surgical findings and procedures in patients with cholesteatoma. A total of 186 patients (118 males, 39.2 ± 15 years) who underwent surgery for advanced cholesteatoma between 2013 and 2018 were included in the study. The relationship between FCD and surgical findings was investigated via the surgical registries. The prevalence of FCD was 36.6% (68/186). The prevalence of FCD was 44%, and 13.2% for the patients who underwent canal wall down mastoidectomy (62/141) and canal wall up mastoidectomy (6/45), respectively (P < .001). Facial canal dehiscence was detected in 73.9% of the 23 patients who had a lateral semicircular canal (LSCC) defect (P < .001), in 61.9% of 21 patients who had a tegmen tympani defect, and in 58.1% of the 31 patients who had erosion on the posterior wall of the external auditory canal (EAC; P < .05). The prevalence of FCD was 3.1% in patients with isolated incus erosion, 59.1% in patients with erosion of malleus and incus, 60.7% in patients with erosion of stapes suprastructure and incus, and 43.2% in patients with whole ossicular chain deformation (P < .001). The defects on LSCC, EAC, tegmen tympani, and malleus and incus might be cautionary findings for the presence of FCD during cholesteatoma surgery.
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Affiliation(s)
- Muammer Melih Sahin
- Department of Otorhinolaryngology-Head and Neck Surgery, Ankara Numune Training and Research, Hospital, Ankara, Turkey
| | - Melih Cayonu
- Department of Otorhinolaryngology-Head and Neck Surgery, Ankara Numune Training and Research, Hospital, Ankara, Turkey
| | - Ayse Secil Kayalı Dinc
- Department of Otorhinolaryngology-Head and Neck Surgery, Ankara Numune Training and Research, Hospital, Ankara, Turkey
| | - Suleyman Boynuegri
- Department of Otorhinolaryngology-Head and Neck Surgery, Ankara Numune Training and Research, Hospital, Ankara, Turkey
| | - Fulya Eker Barut
- Department of Otorhinolaryngology-Head and Neck Surgery, Ankara Numune Training and Research, Hospital, Ankara, Turkey
| | - Adil Eryilmaz
- Department of Otorhinolaryngology-Head and Neck Surgery, Ankara Numune Training and Research, Hospital, Ankara, Turkey
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