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Retraction pocket excision with cartilage grafting as a preventive surgery for cholesteatoma

Journal of Otology 2017年第3期12卷 112-116页

作者： Comacchio Francesco Mion Marta pedruzzi barbara Institute of Otolaryngology Department of Neurosciences Padova University Via Giustiniani 2 35121 Padova Italy Institute of Otolaryngology Ospedali Riuniti Padova Sud Via Albere 30 35043 Monselice Italy

Aims: The goal of the present study is to summarize our experience on surgical management of retraction pockets(RP) as a preventive tool against ***:Twenty-five ears have been followed up for a mean period of 6.16 ± 4.35 years(from 1 to 17 years). The sample presented a mean age of 47.56 + 19.11 years(from 16 to 73 years). All patients underwent cartilage graft surgery. Furthermore 10(40%) underwent tympanoplasty(TPL) type Ⅰ, 14(56%) TPL type Ⅱ and 1(4%) TPL type Ⅴ.Results: Eleven ears(44%) showed cholesteatoma: all these cases were stage Ⅲ according to Charachon staging, and stage Ⅳ or Ⅴ according to Gersdorff classification. Twelve patients(48%) showed erosion of the ossicular chain. Of these, five were associated with cholesteatoma and seven only with retraction. The recurrence rate of cholesteatoma was 12%. None of the patients with a stage Ⅱ or Ⅲ RP(according to Gersdorff classification) developed cholesteatoma. The recurrence of RP was 0%.In regards to literature review, seven references were selected. These studies showed a success rate ranging from 79.1% to 88%, while recurrences of RP varied from 6.4% to 13%. Only one study specified a recurrence rate of cholesteatoma of 28%.Conclusions: Surgical treatment of stages Ⅱ and Ⅲ RP is an effective tool to prevent cholesteatoma formation. The presence of keratin accumulation and cholesteatoma at the RP(stages Ⅳ and Ⅴ, according to Gersdorff) are the real predictors of poor prognosis.

关键词： Cartilage Cholesteatoma Graft Pockets Retraction

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Silent Sinus Syndrome: Clinical Findings and Differential Diagnosis

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Case Reports in Clinical Medicine 2014年第5期3卷 293-303页

作者： Paolo Bossolesi barbara pedruzzi Enzo Emanuelli U.O. di Otorinolaringoiatria Azienda ULSS 8 Asolo Ospedale di Castelfranco Veneto e Montebelluna (TV) Italy U.O.A. Chirurgia Endoscopica delle Vie Aeree Azienda Ospedaliera di Padova Padova Italy U.O.C. Otorinolaringoiatria e Otochirurgia Azienda Ospedaliera di Padova Padova Italy

The Silent Sinus Syndrome (SSS) is a rare condition that causes facial asymmetry, unilateral enophthalmos and diplopia. It is thought to be secondary to chronic maxillary sinus atelectasis (CMA) with reabsorbed bone and subsequent displacement of the orbital floor. Such anatomic modifications occur over time, and therefore it is possible to encounter different stages of the same disease with or without orbital displacement. Clinical findings can be unclear so it makes sense to recognize potentially evolving SSS while other disturbances have to be ruled out. Our purpose is to underline clinical findings for different diagnosis and proper management. We consider Functional Endoscopic Sinus Surgery (FESS) indicated in CMA and SSS to halt the progression of the disease. Nevertheless restitution treatment of enophtalmos due to orbital floor displacement involves plastic reconstruction of the floor of the orbit via transconjunctival approach. We report a case of SSS and discuss distinctive features of non-neoplastic lesions involving the maxillary sinus that should be considered for differential diagnosis.

关键词： Silent Sinus Syndrome SSS Unilateral Enophthalmos Diplopia Chronic Maxillary Sinus Atelectasis Displacement of the Orbital Floor Functional Endoscopic Sinus Surgery

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