I listened to Lloyd Minor, the guy who first described Superior semi-circular Canal Dehiscence syndrome, giving a talk in Kyoto recently, on surgical correction of SCD via middle fossa approach, and that was precisely why I am intrigued by this simpler mastoidectomy approach described so elegantly in this new paper from Spain (M. Crovetto, E. Areitio, J. Elexpuru, F & Aguayo:Auris Nasus Larynx 35 (2008) 247–249) that is also well illustrated

Editor’s choice :  Transmastoid scd surgery …?

...?

Utricle, ESC Therapy & hearing loss...?

The quest for cell regeneration has driven the interests in inner ear embryonic stem cell therapy, and to overcome the challenge of preserving the delicate cochlear membrane during invivo ESC transplantation, this paper from Germany (Mark Praetorius;  Ignacio Vicario b; &Thomas Schimmang, Acta Oto-Laryngologica, Volume 128, Issue 7 2008 , pages 720 - 723) built on earlier one by Sekiya T et al , 2006 (Exp Neurol. 2006 Mar;198(1):12-24 ) that utilized the auditory nerve & cochlear duct for same purpose, by introducing the ESC transplants into the utricule, with reported good stem cell diffusion.

June 29 2008

Vol 8 No 6

Otorhinolaryngology news

In this issue

· Transmastoid SCD Surgery…?

· Utricle, ESC therapy & Hearing loss…?

· Residual NPC, Prognosis  Surgical Approach..?

· Case of The week

Journal Watch: Early onset otitis media: risk factors and effects on the outcome of chronic suppurative otitis media. Lasisi, Olayemi & Irabor, 2008

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 Till Next Week,

 Biodun

Residual npc, prognosis & surgical approach ...?

Abstract: 

OBJECTIVE: To investigate whether the approach used to the nasopharynx to perform a salvage nasopharyngectomy for recurrent or residual nasopharyngeal carcinoma influences survival. STUDY DESIGN: A retrospective case series. SUBJECTS AND METHODS: Eighty patients underwent a nasopharyngectomy via a transpalatal, maxillary swing, or midfacial degloving approach. Local progression-free, locoregional progression-free, and overall survival rates were calculated for each approach. RESULTS: For the whole group (N
80), there were no significant differences in the survival rates between the three approaches. For the subgroup of patients with recurrent T1 and T2 tumors (n
68), the local progression-free and locoregional progression-free survival rates were significantly better when a maxillary swing approach was used than when a midfacial degloving approach was used. CONCLUSION: The maxillary swing approach is associated with significantly better survival rates than the midfacial degloving approach when used to perform a salvage nasopharyngectomy for residual or recurrent T1 and T2 nasopharyngeal carcinoma

Extract:

Mastoid approach begins with a wide mastoidectomy, one should try to preserve the largest possible fragment of mastoid cortical bone. Mastoidectomy must be enlarged until both the superior and posterior semicircular canals and

their common crux are exposed; taking, at the same time, extreme care not to open them (Fig. 2). Although it is not

necessary to exposed completely the dehiscence, drilling should be carried on until opening the base of the middle

cranial fossa in the vicinity of the upper arch of the Superior Semicircular Canal has been achieved (Fig. 2). Followingthis, a pouch is created between the osseous surface of the arcuate eminence and the dura mater covering it (Fig. 3).

This pouch is extended posteriorly between the dura mater and the tegmen of the antrum until wide enough to

accommodate the bone graft. Mastoid cortical bone, previously harvested, is now drill-carved to match the convex shape of the arcuate eminence. The shaped bone graft is inserted through the orifice drilled in the tegmen and

interposed between the dura mater and the osseous surface of the arcuate eminence, as a button going through a buttonhole (Figs. 4 and 5) ...

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Abstract:

Conclusion. Cell transplantation into the utriculus provides an efficient and non-invasive route to introduce embryonic stem (ES) cells into the vestibular and cochlear portions of the inner ear. Objective. The transfer of stem cells into the inner ear for therapeutic purposes is an important approach to cure damage to the cochlea and vestibulum. A key issue is to provide an entry point for cell transplants into the inner ear that does not affect its physiologic functions. The aim of this study was to examine the feasibility of transferring ES cells into the inner ear via the utriculus. Materials and methods. ES cells were injected via utriculostomy into the mouse inner ear. The distribution of the injected cells was determined using a beta-galactosidase marker gene expressed by the ES cells. Results. Injected ES cells were found within the perilymph of the scala tympani and vestibuli. Moreover, ES cells were detected close to the cochlear sensory epithelium and spiral limbus.