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Zhang BY, Ho VWY, Tsai TY, Chan KC. An Early Report of Exoscope-assisted Otologic Surgery. J Chin Med Assoc 2023; 86:523-528. [PMID: 36854146 DOI: 10.1097/jcma.0000000000000907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Exoscope has been used in otoneurologic surgery in several reports. However, most ear surgeries are performed using either microscope or endoscopy today. The purpose of this study is to present our subjective and objective experience of using this instrument in our institution. METHODS 16 ears with different severity and condition in 15 consecutive patients were enrolled. A questionnaire with 12 questions was sent to different participants, including surgeons, residents, medical students, and scrub nurses in the operation room. The total score and average score of each item were calculated and analyzed. RESULTS Exclusive exoscopic operation was performed on 13 patients with 14 procedures. A combination of endoscopy-exoscope and microscope-exoscope was used in one patient, respectively. There were no complications. Hearing recovery or disease extirpation was achieved in most patients. Twenty participants in the operation room filled out the questionnaire. There was no significant difference between the different groups. High ratings were reported in terms of image quality, stereoscopic effects, magnification rate, and the same field of view as the surgeon. Worse ratings were reported in items related to limited working space, increase in eye strain by video observation, and focusing difficulty. CONCLUSION Exoscopic ear surgery is feasible, safe, and effective in managing various otologic conditions involving external ear, middle ear, mastoid, and lateral skull base. Its high-definition image quality, stereoscopic effects, sufficient magnification, reliability and teaching value made it a potential instrument in general ear surgeries. Further improvements to current drawbacks can be anticipated.
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Affiliation(s)
- Bang-Yan Zhang
- Department of Otolaryngology-Head and Neck Surgery, New Taipei Municipal Tucheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City, Taiwan, ROC
- School of Medicine, Chang Gung University, Taoyuan City, Taiwan, ROC
| | - Valerie Wai-Yee Ho
- Division of Head and Neck, Plastic and Reconstructive Surgery, Department of Surgery, Queen Mary Hospital, Hong Kong, China
| | - Tzong-Yun Tsai
- School of Medicine, Chang Gung University, Taoyuan City, Taiwan, ROC
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan, ROC
| | - Kai-Chieh Chan
- School of Medicine, Chang Gung University, Taoyuan City, Taiwan, ROC
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan, ROC
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Chan KC, Hu CY, Ho VWY, Lien KH. Merocel compression dressing: a novel modified surgical technique for treating auricular pseudocyst. Eur Arch Otorhinolaryngol 2021; 279:1633-1637. [PMID: 34704136 DOI: 10.1007/s00405-021-07152-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/20/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Auricular pseudocyst (AP) is a benign, noninflammatory swelling to the ear, located on either the front or side surface. Deroofing surgery with variable compression methods is considered the most effective method. However, post-operative wound pain is the main drawback following compression. We are introducing a novel painless surgical procedure which involves deroofing technique followed by Merocel® compression dressing. METHODS From 2015 to 2020, thirty-one patients with AP received this new surgical compression method in our university-affiliated tertiary hospital. Retrospective chart review and the analysis of the results were conducted. RESULTS All patients had unilateral lesions, with left side lesions (58.1%) predominant. The concha cymba (38.7%) and concha cavum (35.8%) were the most common sites. Previous aspiration or drainage had been performed for the cysts in eight patients (25.8%). Only one patient had the recurrence after post-operative 3 months and received the revised surgery without following recurrence and discomfort. Among all patients, 29 (93.5%) patients claimed minimal pain around 0 or 1 in numeric rating scale of pain score. Three patients had mild ecchymosis but recovered after conservative treatment. One patient had mild auricular deformity after surgery due to pre-treatment partial cartilage necrosis. All patients had follow-up for at least 6 months. CONCLUSION This novel Merocel® compression dressing technique to treat AP after deroofing is an effective procedure. Minimal pain, simple to do and easily acquired materials were the advantages of this novel procedure.
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Affiliation(s)
- Kai-Chieh Chan
- Division of Otology, Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, 5, Fuxing St., Guishan Dist., Taoyuan, 33305, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Yu Hu
- Division of Otology, Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, 5, Fuxing St., Guishan Dist., Taoyuan, 33305, Taiwan
| | - Valerie Wai-Yee Ho
- Division of Head and Neck, Plastic and Reconstructive Surgery, Department of Surgery, Queen Mary Hospital, Hong Kong, China
| | - Kuang-Hsu Lien
- Division of Otology, Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, 5, Fuxing St., Guishan Dist., Taoyuan, 33305, Taiwan. .,School of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Chen SL, Huang SF, Ho VWY, Chuang WY, Chan KC. Clinical characteristics and treatment outcome of adenoid cystic carcinoma in the external auditory canal. Biomed J 2020; 43:189-194. [PMID: 32389593 PMCID: PMC7283548 DOI: 10.1016/j.bj.2019.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 05/19/2019] [Accepted: 07/30/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND This study reviewed the clinical manifestations, pathological findings, and treatment outcomes of adenoid cystic carcinoma (ACC) in the external auditory canal (EAC). METHODS This was a retrospective review of 12 patients with a diagnosis of ACC in the EAC seen in a single institution over a 30-year period. Data on the demographics, clinical presentation, treatment strategy, and outcome, as well as the pathological features of ACC, were reviewed and analyzed. RESULTS The male-to-female ratio was 1:3 and the mean patient age was 55.9 years. The most common clinical presentation was otalgia (75%). Ten patients underwent surgical interventions, including radical mastoidectomy in five patients, wide excision in three, and lateral temporal bone resection in two. Adjuvant radiotherapy or concurrent chemoradiotherapy (CCRT) was performed in case of incomplete resection. Two patients underwent non-surgical treatments: radiotherapy in one and CCRT in the other. Microscopic perineural invasion was not associated with otalgia or histological subtype. The mean follow-up period was 84.6 months. Local recurrence occurred in 33% of patients. One-quarter of patients had distant metastasis, and all had lung metastasis. The 5-year overall survival rate for these patients was 82.5%. CONCLUSION EAC ACC should be included in the differential diagnosis when a patient presents with otalgia and a mass in EAC for more than 6 months, particularly if the patient is a middle-aged female. Otalgia might not be associated with perineural invasion or histological subtype. The lung is the most common site of distant metastasis in patients with EAC ACC. Further studies should determine the optimal treatment protocol for this rare malignancy.
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Affiliation(s)
- Shih-Lung Chen
- Department of Otolaryngology & Head and Neck Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shiang-Fu Huang
- Department of Otolaryngology & Head and Neck Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Valerie Wai-Yee Ho
- Division of Head and Neck, Plastic and Reconstructive Surgery, Department of Surgery, Queen Mary Hospital, Hong Kong, China
| | - Wen-Yu Chuang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Anatomic Pathology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Kai-Chieh Chan
- Department of Otolaryngology & Head and Neck Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Chan KC, Wallace CG, Wai-Yee Ho V, Wu CM, Chen HY, Chen ZC. Simultaneous auricular reconstruction and transcutaneous bone conduction device implantation in patients with microtia. J Formos Med Assoc 2019; 118:1202-1210. [DOI: 10.1016/j.jfma.2019.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/07/2018] [Accepted: 01/21/2019] [Indexed: 10/27/2022] Open
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Chan KC, Kuo HT, Wai-Yee Ho V, Chuang WY, Chen ZC. A modified supra-auricular approach with helix cartilage suture for surgical treatment of the preauricular sinus. Int J Pediatr Otorhinolaryngol 2018; 114:147-152. [PMID: 30262354 DOI: 10.1016/j.ijporl.2018.08.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/31/2018] [Accepted: 08/31/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Several surgical techniques and modifications have been described to reduce the high recurrence rate after excision of preauricular sinus (PAS). This study was designed to evaluate the surgical outcomes of PAS excision using a new modified supra-auricular approach (SAA) and to assess the predisposing factors for recurrence. METHODS A total of 175 (158 patients) PAS excision procedures were performed from 2007 to 2016 in a single institute using this modified SAA with helix cartilage suture to obliterate the dead space. The specimens were assessed to measure the closest distance between the squamous tract and the excised auricular cartilage (sinocartilaginous distance). We also evaluated the surgical outcomes and investigated the predisposing factors for recurrence, including gender, lesion laterality, etiology (primary or revised), anesthesia methods (general or local), history of infection, and history of incision and drainage (I&D) for abscess. RESULTS Patients were followed up for a median duration of 45 months (range from 6 months to 10 years). There was a 2.3% (4 ears) recurrence rate and a 1.7% (3 ears) complication rate in our series. The average sinocartilaginous distance was 0.44 mm (median distance, 0.3 mm) and this value was less than 0.5 mm in 66% of cases. Recurrence was not significantly affected by gender, lesion laterality, etiology of surgery, anesthesia method, or a history of infection or preoperative I&D for abscess. CONCLUSIONS Surgical PAS excision using the modified SAA with cartilage suture of dead space yielded low overall recurrence and complication rates in this series. Cosmesis was maintained due to a smaller incision. No significant predisposing factors for recurrence were identified. Thus, the modified technique described in the present study can be regarded as a simple, effective and reproducible surgical treatment for PAS.
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Affiliation(s)
- Kai-Chieh Chan
- Division of Otology, Department of Otolaryngology, Chang Gung Memorial Hospital, Linkou, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Han-Tse Kuo
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Valerie Wai-Yee Ho
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Kwong Wah Hospital, Kowloon, Hong Kong, China
| | - Wen-Yu Chuang
- School of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Pathology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Zung-Chung Chen
- School of Medicine, Chang Gung University, Taoyuan, Taiwan; Craniofacial Research Center, Division of Craniofacial Surgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
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