Biomedical subjects
Publications and source records attributed to B R Roberts.
The giant cholesterol cyst is a clinical entity distinct from cholesterol granulomas and other destructive lesions of the petrous bone. Preoperative assessment by computed tomographic scan and magnetic resonance imaging is extremely helpful. Attempts at total resection of the lesion are not necessary. Adequate surgical drainage may be established through the mastoid or middle fossa.
Traditional therapeutic approaches for malignancies of the temporal bone have produced unacceptably low survival figures. The morbidity and mortality associated with temporal bone cancer justify extensive surgery. Total temporal bone resection can be performed successfully in the hands of an experienced skull-base surgical team. By circumscribing the tumor rather than transgressing it, this procedure follows generally accepted principles of oncologic surgery. This procedure also shows promise in resection of extensive, carefully selected, recurrent benign tumors. We believe this approach offers hope for improved survival in patients with malignancy of the temporal bone. Further refinements in technique are suggested by each new case. Additional experience and long-term follow-up are needed to assess the efficacy of this procedure. The interest, expertise, and active participation of the operating room nursing team are critical to the success of this surgery. Ideally, not only intraoperative participation but also preoperative assessment and postoperative support should be routine. Close cooperation and extensive communication among the surgeons and nurses are essential.
In the case presented, an intralabyrinthine schwannoma was discovered during translabyrinthine eighth nerve section. Analysis of this case and the 22 previously reported cases of intralabyrinthine schwannoma highlights the difficulty in preoperative diagnosis of this lesion. Concerns are raised about the frequency with which this diagnosis may be missed and its implication in neurotologic surgery for vertigo.
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Bilateral synchronous mixed tumors of the parotid glands are uncommon. In this case, they occurred in association with multiple benign tumors elsewhere in the body. The larger of the two parotid neoplasms was asymptomatic and undetected on physical examination, even after its presence had been established by computed tomographic scan.
Techniques for preservation of homografts for replacement of tympanic membranes, ossicles, closure of the oval window, and canalplasty remain controversial. Review of 300 articles reveals no evidence opposing the harvesting of grafts from living patients or cadavers, or the prolonged storage of these materials in antibacterial solutions. It appears to be important to store the grafting material long enough to reduce antigenicity. Numerous techniques and materials are being used with success. Additional research on antigens, histologic fate of grafts, long-term success, and complications is essential to determine ideal grafting materials, preservatives, and techniques.
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Fibrous dysplasia of the temporal bone is uncommon. When it does occur, surgery may be necessary because of cholesteatoma or chronic infection behind bony obstruction of the external auditory canal. Cosmetic surgery may also be performed because of bony deformity. When a surgical procedure is undertaken for hearing improvement, special problems may be encountered. The case presented illustrates middle ear pathologic changes found with fibrous dysplasia and specific surgical difficulties.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.