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Biomedical subjects

J E Benecke

Publications and source records attributed to J E Benecke.

At least 19 recordsLinked to original sources
PubMed1995

Myringoplasty: the lateral graft technique with fascia.

Grafting the tympanic membrane can be successfully accomplished by a number of techniques. The otologic literature is replete with descriptions of methods, materials, and results in myringoplasty. It is generally agreed that whatever method and materials are used to graft the tympanic membrane, the graft take-rate should be at least 90%. The key to obtaining a 90% take rate is not the technique employed, but how well the surgeon performs the technique. This article describes the lateral graft technique with fascia. This is the author's preferred myringoplasty procedure. When properly implicated, the lateral graft technique provides reproducible results in any pathologic condition. Excellent hearing and morphologic results can be obtained with few complications.

Fascia↗
PubMed1992

Anatomic importance of the retrofacial air tract.

The retrofacial air tract is a constant and relevant anatomic landmark for the temporal bone surgeon. By purposefully dissecting this space, one is able to safely identify the facial nerve, endolymphatic sac, and jugular bulb. The retrofacial air tract also provides access to the petrous apex. Forty temporal bones of varying degrees of pneumatization were dissected in order to study the retrofacial air tract. A well-developed air tract was easily identified in all specimens. We describe our anatomic findings and discuss the surgical relevance and important of the retrofacial air tract.

Ear, Inner↗
PubMed1991

Intraoperative facial nerve monitoring: prognostic aspects during acoustic tumor removal.

Intraoperative facial nerve monitoring with electrical stimulation (IFNMES) has become an integral part of acoustic tumor surgery. We reviewed the records of fifty-six patients who underwent translabyrinthine acoustic tumor removal with IFNMES. There was excellent correlation between intraoperative facial nerve activity and immediate postoperative facial nerve function (24 hours after surgery and at hospital discharge). Our data would suggest that patients who exhibit less than 500 microvolts of ongoing EMG activity during surgery, and who yield at least a 500-microvolt contraction when stimulated with 0.05 milliamps at the brainstem after tumor removal, can expect an excellent immediate facial nerve result (grade I or II).

Ear Neoplasms↗
PubMed1991

Association of facial paralysis with HIV positivity.

Facial paralysis, although a rare complication of AIDS related complex (ARC) or AIDS, may well be the presenting symptom of HIV positivity. A case report of facial paralysis followed closely by discovery of HIV positivity is described, along with a pertinent and extensive literature review. Seroconversion to HIV-positive status should be suspected in any high-risk patient presenting with idiopathic facial paralysis. HIV testing should be included in the evaluation of Bell's palsy and other idiopathic forms of facial paralysis in the at-risk patient.

Facial Paralysis↗
PubMed1990

Intraoperative facial nerve monitoring. Technical aspects.

Intraoperative facial nerve monitoring (FNM) is widely used as a method of assessing the anatomic and physiologic integrity of the facial nerve during procedures in which the nerve may be in jeopardy. The doctors of the Otologic Medical Group use intraoperative FNM during all neurotologic procedures. This technique can also be used for congenital ear surgery and complicated revision chronic ear surgery. On the basis of experience gained from more than 200 cases in which FNM has been used, definitive conclusions can be made in regard to technical aspects. This article will discuss indications for intraoperative FNM, electrode design, visual and auditory feedback, and the particulars about stimulators.

Facial Nerve↗
PubMed1990

Consequences of middle ear bone dust during neurotologic surgery.

Most otologists are cautioned at some point in their training that if bone dust is allowed to enter the middle ear while the mastoid is being drilled, there may be adverse consequences. Two cases of ossicular fixation and conductive hearing loss after retrolabyrinthine vestibular nerve section prompted us to examine the issue of bone dust in the middle ear. In a study of 13 temporal bones that had undergone neurotologic surgery, we found 11 that showed evidence of viable bone dust in the middle ear, and three that had ossicular fixation. Viable bone dust was always encased in a mucous membrane lining. These findings suggest that bone dust that enters the middle ear may indeed remain viable and cause ossicular fixation. The surgeon should therefore take every precaution to prevent bone dust from entering the middle ear during neurotologic procedures in which conservation of hearing is attempted.

Bone and Bones↗
PubMed1990

Chondrogenic potential of tragal perichondrium: a cause of hearing loss following stapedectomy.

Tragal perichondrium is a widely used tissue seal in the oval window following stapes surgery. Autogenous and easily accessible, it is a suitable substance to cover the vestibule in total stapedectomy, and to seal around the prosthesis in small-fenestra stapedotomy. The incidence of complications from the use of perichondrium in this manner is exceedingly low. We report a case where tragal perichondrium in the oval window resulted in the proliferation of cartilage. The cartilage displaced the stapes prosthesis, resulting in a conductive loss. Although the chondrogenic potential of perichondrium is known, we are not aware of other reports implicating this as a cause of failure in stapes surgery. The pertinent clinical and experimental literature regarding chondrogenesis is reviewed. This information suggests that the formation of cartilage from perichondrium in the oval window might be influenced by mechanical trauma and tissue orientation.

Adolescent↗
PubMed1990

Adenomatous tumors of the middle ear and mastoid.

Adenomatous tumors of the middle ear and mastoid have been called adenoma or adenocarcinoma. The clinical and pathologic distinction between the two has been difficult. The resultant pathologic ambiguity makes it difficult to decide whether conservative or radical management is appropriate. The Otologic Medical Group's (OMG) experience with glandular tumors of the middle ear and mastoid over the past 27 years was reviewed. Thirteen cases were found and analyzed with respect to signs and symptoms at presentation. Extensive histopathologic review with light and electron microscopy was performed on tumor specimens. Two distinctive histopathologic and clinical patterns were identified. The mixed type of tumor was always confined to the middle ear and mastoid, was commonly misdiagnosed as chronic otitis media, and rarely demonstrated otic capsule or facial nerve involvement. The papillary pattern always had extension to the petrous apex and frequently involved the middle and/or posterior cranial fossa. Papillary tumors were more frequent in females and usually involved the facial nerve. On the basis of the findings in this review as well as information from the literature, we have come to the following conclusions: 1. The correct general pathologic heading be Adenomatous Tumors of the Middle ear and Mastoid with each tumor then being subclassified into Mixed or Papillary tumor and adenocarcinoma when warranted by histology. 2. There is a high rate of local recurrence. 3. Long-term follow-up (at least 10 years) for all adenomatous tumors is necessary. 4. Primary surgical treatment is required.

Adenocarcinoma↗
PubMed1989

Management of osteomyelitis of the skull base.

Osteomyelitis of the skull base is the most severe form of malignant otitis externa. As a result of having treated 13 patients with skull base osteomyelitis over a 4-year period, we have developed a method of staging and monitoring this malady using gallium and technetium scanning techniques. Stage I is localized to soft tissues, stage II is limited osteomyelitis, and stage III represents extensive skull base osteomyelitis. All stages are treated with appropriate antipseudomonal antibiotics. The duration of therapy depends upon the clearing of inflammation as shown on the gallium scan. Each case must be looked at independently and not subjected to an arbitrary treatment protocol.

Aminoglycosides↗
PubMed1988

Vertigo caused by basilar artery compression of the eighth nerve.

Vascular compression syndromes in the posterior cranial fossa have become well described clinical entities, especially for the fifth and seventh cranial nerves. Jannetta has proposed vascular compression of the eighth nerve as the etiology of hearing loss, tinnitus, and vertigo in some patients. The case that follows illustrates a clear-cut example of vestibular symptoms arising from vascular compression of the eighth nerve. The patient involved had disabling peripheral vertigo refractory to medical management. Magnetic resonance imaging documented a tortuous basilar artery compressing the eighth nerve on the involved side. This was confirmed at surgery, and a selective section of the vestibular nerve provided complete relief of disabling symptoms and preservation of hearing. The authors describe the details of this case and the enigma of eighth nerve symptoms due to vascular compression.

Basilar Artery↗
PubMed1988

Giant cholesterol granuloma producing brainstem compression.

Cholesterol granuloma of the petrous apex is an unusual clinical entity that has received much attention in the recent literature. Not considered to be a life-threatening lesion, cholesterol granuloma usually presents with a variety of cranial nerve findings. A case of brainstem compression caused by a giant cholesterol granuloma is presented. This lesion prompted emergency surgical intervention with dramatic relief of neurologic symptoms. The unusual nature of this case is compared with the more common presentation of cholesterol granuloma.

Adult↗
PubMed1987

Facial nerve monitoring during acoustic neuroma removal.

As the surgeon's ability to perform total acoustic tumor removal without major neurologic deficit has reached a pinnacle, preservation of facial nerve function has assumed a higher priority. Satisfactory postoperative facial function depends upon an anatomically and physiologically intact facial nerve. Precise localization of the facial nerve is the first step toward preservation of function. Intraoperative facial nerve (FN) stimulation allows the surgeon to safely locate the facial nerve. Monitoring evoked electromyographic activity with an audio speaker provides direct, ongoing information regarding trauma to the nerve during dissection. Intraoperative FN monitoring was used in 18 consecutive translabyrinthine acoustic tumor removals. Seventeen patients had an excellent facial nerve result (Grade I or II using the House 6-point scale). The authors conclude that intraoperative FN stimulation and monitoring during acoustic tumor removal is a safe and reliable method of locating and protecting the facial nerve during cerebellopontine angle surgery.

Electric Stimulation↗