High-riding brachiocephalic (innominate) artery during surgical tracheostomy

Two cases of a high-riding innominate artery, which were found during routine surgical tracheostomy. A cartilage flap was applied to cover the significant vessel to prevent the life-threatening complications. These two cases were followed up for 2 months without any adverse events. We discussed the related vascular anatomy, imaging studies and brief literature review.

Endoscopic cochlear implantation: Call for caution

OBJECTIVES/HYPOTHESIS

To assess whether transcanal endoscopic access to the basal turn of the cochlea for cochlear implantation is appropriate.

STUDY DESIGN

Case series study.

METHODS

We reviewed 100 consecutive computed tomographic studies of the sinuses and temporal bone in our institution. We excluded studies that demonstrated evidence of congenital anomalies, chronic ear disease, or inadequate visualization of the cochlea. On axial sections, the angles of the basal turn of the cochlea and of the ear canal in reference to the sagittal plane were recorded as a function of age.

RESULTS

Eighty-four studies were included and 16 were excluded. There was significant variability in the relationship between the ear canal and the basal turn of the cochlea in reference to the sagittal plane. A clear majority of images demonstrated the basal turn of the cochlea to align with a more posterior angle than that of the ear canal.

CONCLUSION

The trajectory provided by posterior tympanotomy aligns more favorably with the basal turn of the cochlea than transcanal access. Endoscopic technique, primarily an ear canal intervention, may not be useful in cochlear implant surgery.

LEVEL OF EVIDENCE

4. Laryngoscope, 126:689-692, 2016.

Common cavity and custom-made electrodes: speech perception and audiological performance of children with common cavity implanted with a custom-made MED-EL electrode

OBJECTIVE

Few studies exist on children with common cavity, fewer still on their long-term audiological development after having received a cochlear implant. Our goal was to observe and report the long-term audiological progress of children with common cavity who were implanted with a custom-made electrode.

METHODS

In this longitudinal, multi-center study, 19 children were implanted with a MED-EL custom-made electrode via either single slit cochleostomy or double posterior labyrinthotomy. We observed their audiological development with a test battery consisting of Categories of Auditory Performance (CAP), Speech Intelligibility Rating (SIR), and Ling 6-Sounds tests. We tested the children 1 month prior to the surgery; at first fitting; at 1, 3, 6, 12, and 18 months post first-fitting; at 2 years after first-fitting; and, whenever possible, at 3, 4, and 5 years after first-fitting.

RESULTS

Children with common cavity tend to steadily and significantly improve their audiological skills over time. This development may, however, be highly individual; probably in part due to relatively high levels of additional needs. Parents should be counseled to establish realistic post-implantation expectations. Surgically, contrary to our expectations, we cannot confirm that double posterior labyrinthotomy reduces intracochlear electrode movement or that the MED-EL custom electrode leads to fewer incidences of intra- or post-implantation complications.

CONCLUSIONS

Cochlear implantation is a safe and effective treatment option in children with common cavity. The majority of children with CC derive significant audiological benefit from implantation. Intra- and post-surgical complications, while serious, and be dealt with effectively in most cases.

L’arthrodèse capitato-lunaire par hauban dans l’arthrose du poignet

PURPOSE OF THE STUDY

Treatment of degenerative osteoarthritis of the wrist is aimed at preserving wrist motion and force while reducing pain. Limitation of the degenerative processes to certain joints raises the possibility of intracarpal arthrodesis, e.g. capitolunate arthrodesis. We present results of this procedure with a tension band wire in patients with arthritic degenerative disease of the wrist.

MATERIAL AND METHODS

The series included 20 patients reviewed at mean 47 months. Mean age was 53.5 years. Pain was the main complaint. Wrist force and motion were decreased in all patients. All patients presented osteoarthritic disease of the wrist with preservation of the radiolunate space. The operation consisted in total scaphoidectomy and capitolunate arthrodesis maintained with a tension band wire. Force, pain (Mayo clinic score) and force (Jamar dynamometer) were recorded. The Cooney function score was determined and six patients completed the French Dash questionnaire. Radiolunate and capitolunate angles were noted as well as the index of carpal height measured preoperatively and at last follow-up.

RESULTS

Nineteen of the 20 arthrodeses fused. A revision graft was successful for the one nonunion. Pain was the only clinical factor which improved significantly (p<0.0001) in all patients. Lunatum extension (DISI) and capitatum flexion did not have any effect on functional outcome. Sixteen patients resumed their activities at the same level.

DISCUSSION

The results of this series are similar to those in the literature concerning four-way arthrodesis. Capitatolunate arthrodesis with partial arthrodesis of the carpus has been proposed for arthritic degeneration of the wrist with a preserved radiolunate space. We prefer this procedure to four-way arthrodesis because useful motion and wrist force are preserved with constant and effective significant pain relief.