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[Osteoma and exostosis of the external auditory meatus: a clinical diagnosis].

Proliferative osseous lesions usually found in the external ear are exostoses and osteomata. In other sites they are clearly different entities, but in this location histopathologic differential features are not so reliable in the study of the specimens. An occlusive osteomata is shown, with the typical clinical presentation demonstrated in a multiplanar CT. Microscopically, the lesion consisted of mature bone trabeculae, separated by medular spaces with fibrovascular tissue, characteristic features of osteomata. However, in the most superficial areas, lines of bone apposition, like those in exostoses, were found. A literature review confirms the lack of specificity of the histopathologic study, so diagnosis is based on clinical data.

Aged↗

Microtia: total reconstruction of the auricle in one single operation.

A one-stage method of total reconstruction of the external ear in microtic patients is described. The auricular framework is fashioned from autogenous rib cartilage. Cover is provided by a vascular pedicle of the conchal area and by the aponeurotic layer which protects the posterior surface supplemented by a full-thickness skin graft. The surgical technique is described and the indications for the operation are indicated.

Cartilage↗

A study on the prevalence of accessory auricle anomaly in Turkey.

OBJECTIVE: Accessory auricular anomaly is a small elevation of skin containing a bar of elastic cartilage localized most commonly just anterior to the tragus or ascending crus of the helix. The anomaly may exist isolated or may be associated with other congenital anomalies of the first arch. The purpose in this study is to detect prevalence of accessory auricle in Turkey and find out whether it is associated with other craniofacial anomalies or hearing loss. METHODS: The study was performed on 850 children from the age of 7 to 9 during a screening program in primary schools. Complete otolaryngologic examination and acoustic reflectometry measurements were performed on all the children. Full physical examination, tympanometric and audiometric evaluation and EEG measurements were added to the cases with accessory auricle anomaly. RESULTS: Among 850 children examined, four had accessory auricle anomaly and prevalence of the anomaly was calculated as 0.47% (95% confidence interval (CI), 0.13-1.20%). Children were developmentally normal, and no other congenital craniofacial or systemic anomaly was detected in any of the cases. Further, tympanometric, audiometric evaluations and EEG tests were in normal limits. CONCLUSIONS: In this study, the prevalence rate of the condition was calculated as 0.47%. Although one study from China reported this prevalence as 0.22%, the difference between the reported prevalances was not statistically significant. Further, although external ear anomalies may present together with cranifacial anomalies and neurologic disorders like epilepsy, neuromotor retardation and EEG disorders, in our cases, mental and motor development was normal and epilepsy history or abnormal EEG patterns do not exist. On the other hand, no hearing loss was found to be associated with accessory auricles.

Child↗

CHARGE syndrome. Part II. Hearing loss.

CHARGE is a mnemonic for a syndrome with multiple congenital anomalies that occurs with normal chromosomes. The unique external ear anomalies have been described in CHARGE Syndrome Part I in this journal. This report describes the distinctive middle ear and sensorineural losses that occur in the syndrome, both of which can be progressive and, in most cases, are moderate to severe. There is evidence to indicate that these losses are due to congenital ossicular anomalies, eustachian tube dysfunction from craniofacial malformation, and cochlear involvement that is greatest for high frequencies.

Abnormalities, Multiple↗

Human immunodeficiency virus--associated non-Hodgkin's lymphoma presenting as an auricular perichondritis.

AIDS-related NHL is an aggressive neoplasm, usually of high or intermediate grade, frequently extranodal at initial treatment, and often the first manifestation of AIDS. Although complete remissions have been reported, they occur in only a minority of patients. We describe a patient with NHL of the external ear that masqueraded as an auricular perichondritis. This is the first case reported in which AIDS-related NHL first appeared in the ear, and this should alert physicians who treat patient with AIDS to be aware of the protean manifestations of this disease.

Adult↗

Anthelix-conchal reconstruction with postauricular "revolving door" island flap.

The postauricular "revolving door" island flap is commonly used to reconstruct the conchal area after ablative surgery. This procedure may also be used to reconstruct the anthelix-conchal area after surgical removal of a squamous cell carcinoma of the external ear. The technique is simple and safe, and it can be performed as a one-stage procedure; moreover, excellent aesthetic results can be achieved.

Aged↗

Reconstruction of extensive defects of the parotid region: experience with the pectoralis major and free latissimus dorsi flaps.

Large defects of the parotid region resulting from excision of malignant tumours, or necrotic tissue due to radiotherapy, should not always be closed with local tissue, for several reasons. Occasionally, myocutaneous flaps are indicated, giving better results. We describe the problems of such tissue defects and our experience over a 10-year period using 2 different flap reconstruction techniques. A total of 28 cases, 25 with malignant tumours of the parotid or the external ear, 2 with extensive radionecrosis of the parotid region and 1 with a burn, were evaluated. The defects were restored with a pectoralis major flap in 21 cases and with a free latissimus dorsi flap in 7 cases. The follow-up ranged from 18 to 60 months. The flaps were successful in achieving stable wound healing, restoration of tissue volume and in helping patients to return to normal life activities. There were complications in 28.5% of the cases. There were 2 early deaths due to encephalitis. Two pectoralis major flaps (9.5%) failed partially. All latissimus dorsi flaps survived. The pectoralis major proved to be useful, especially in older and medically compromised patients, whereas the latissimus dorsi fared well in younger female patients and in cases of a hemifacial resection defect. Numerous technical points in both methods are emphasized.

Adult↗

Cancer patients with large defects. Reconstructional options: a case study.

We report a case of a seventy-five years old male patient with a squamous cell carcinoma (SCC) originated from the right external ear four years ago. He was undergone surgical removal of the lesion with a combination of modified neck dissection and reconstruction with the use of pectoralis major flap. Furthermore, he had radiotherapy with 6000 rads of the right temporal region. Two months ago the patient showed an extended recurrence concerning the temporal muscle and bone, the lithoid bone, the masseter and the pterygoid muscles, the right part of the mandible, the parotid gland with the facial nerve, and the superior bulb of the internal jugular vein. He had a surgical removal of the lesion in extended healthy margins and functional and esthetic reconstruction of the defect with a combination of metal fixed prosthesis of the condyle and the right mandible and the use of myocutaneous trapezius flap. This is a case report of the reconstruction options we have nowadays to provide quality of life in cancer patients.

Aged↗

Angiolymphoid hyperplasia of the head and neck.

Angiolymphoid hyperplasia is a rare benign condition affecting the skin and subcutaneous tissue of the head and neck. Superficial (intradermal) lesions frequently affect the external ear and such a case presenting to an otolaryngologist is described. Clinically the disease is characterized by single or multiple plum-coloured nodules or plaques which are often itchy and may bleed with mild trauma. Histologically the lesions are composed of proliferating capillary vessels associated with a heavy inflammatory infiltrate including eosinophils and mast cells. The cause remains obscure. The lesions often persist for many years and may regress spontaneously. Several forms of treatment have been used, including cryosurgery, curettage and diathermy, radiotherapy and intralesional steroid injections. In this case the Argon laser was employed.

Adult↗

Quelprud's nodule: a post-auricular cartilaginous nodule.

A number of minor variations to the configuration of the external ear are well recognized. This paper brings attention to one entity which is characterized by a small cartilaginous nodule or prominence arising from the posterior surface of the pinna and which we have named Quelprud's nodule. A prospective clinical survey of 208 patients attending an ENT clinic revealed that nearly one-third of the population studied possess this nodule. There was an equal sex incidence. The Quelprud's nodule was identified within families in a distribution which suggests an autosomal dominant inheritance with variable expressivity.

Adolescent↗

Lateral temporal bone resection for extensive pinnal malignancy. Has anything changed in forty years?

This paper offers an account of the contemporary surgical approach to advanced tumours of the external ear based on a series of 11 patients. There were eight squamous, two basal cell carcinomas and one mucoepidermoid tumour. The traditional method of excision was slightly modified by performing microsurgical dissection of the lateral part of the temporal bone rather than chisel osteotomies, and then including it en bloc with the involved soft tissues. The defect was then closed using a scalp or myocutaneous flap and this combination of otological and reconstructive expertise has proved satisfactory. Four patients are alive with no evidence of disease a mean of 4.2 (range 1.0-7.0) years from surgery: two patients who remained free of disease have subsequently died of unrelated conditions 12 and 24 months post-operatively, and in three cases death from recurrent disease occurred a mean of 1.4 (range 0.9-2.1) years after our surgery. There were two post-operative deaths. Based on the actuarial survival of 36 per cent and a successful disease clearance rate of 54 per cent, our conclusion is that the outlook of this condition has not dramatically improved since the original descriptions of the management of this problem first appeared, although intervention remains justifiable because of the potential curability and relief of symptoms.

Aged↗

The distribution of different molecular species of collagen in fibrous, elastic and hyaline cartilages of the pig.

The distribution of type II collagen, considered to be characteristic of cartilaginous tissues, was determined in various specialized cartilages of the mature pig. The tissues examined were: (1) fibrocartilage of the semilunar meniscus of the knee; (2) elastic cartilage of the external ear; (3) hyaline cartilage of (a) the synovial joint (b) the thyroid plate of the larynx, and (c) the nasal septum. The predominant species of collagen in each tissue, whether type I or type II, was appraised semi-quantitatively by analysis of purified collagen solubilized by pepsin and of peptide fragments produced by cyanogen bromide. Cyanogen bromide-derived peptides were characterized by column chromatography on CM-cellulose and by electrophoresis in sodium dodecyl sulphate-polyacrylamide gels. The proportion of each type of collagen was determined precisely by isolating the homologous small peptides alpha1(II)CB6 [nomenclature of Miller (1973) Clin. Orthop. 92, 260-280], by column chromatography on phosphocellulose and determining their relative proportions by amino acid analysis. Thus collagen of the fibrocartilage of the meniscus proved to be all type I; type II was not detected. In contrast, collagen of elastic cartilage of the outer ear, after rigorous exclusion of perichondrium, was type II. Similarly, type II was the only collagen detected in all the mature hyalline cartilages examined.

Amino Acids↗

Bilateral auricular squamous cell carcinomas with perineural invasion.

BACKGROUND: Bilateral squamous cell carcinoma (SCC) of the external ears is a rare phenomenon, and we are unaware of instances of bilateral perineural involvement. OBJECTIVE: To describe bilateral auricular SCCs, each with perineural invasion. METHODS: Case report and literature review. RESULTS: Histopathologic examination revealed perineural invasion in both tumors. CONCLUSION: This appears to be an unusual presentation of bilateral auricular SCCs with perineural invasion in an elderly immunocompromised patient.

Aged↗

Accessory tragus: report of two cases and review of the literature.

Accessory tragus is a fairly common congenital malformation of the external ear. In the vast majority of cases it is an isolated developmental defect not associated with other abnormalities. However, the remote possibility exists that it could be associated with other abnormalities of the first and second branchial arch. Accessory tragus is a consistent feature of the oculoauriculovertebral syndrome (Goldenhar syndrome). When correctly identified, surgical excision of accessory tragus is quite simple and rarely results in any complications.

Child, Preschool↗

Surgery of the auricle.

Auricular reconstruction is a unique area of facial plastic surgery where a wide array of reconstructive options often must be considered. The external ear is unique in its aesthetic role where the normal auricle often goes unnoticed; yet even a small irregularity can stand out and become conspicuous. The reconstruction of large or total auricular defects is a combination of science and art. Two forms of auricular reconstruction are discussed: (1) those for a congenitally abnormal shape but no acquired tissue deficiency, that is, otoplasty, and (2) repairs requiring a reconstruction of discrete loss of tissue. A general algorithm is presented that can assist with flap selection and covers the techniques for grafts, framework repair, local and pedicled flaps, temporoparietal facial flaps, and auricular prostheses.

Cartilage↗

Technical devices in otoplasty to obtain a natural appearance.

This article outlines the importance given by plastic surgeons to correcting the external ear malformations. The objective is to create ears with a normal appearance. Despite more than 200 methods proposed by different authors, a procedure for otoplasty that gives constant and lasting surgical results has not yet been found. Following some critical remarks, both anatomical and surgical, the author proposes a method that, in his experience, gives good results, more natural and reliable, and is free from failures.

Ear Cartilage↗

Assisted retention of a hearing device in an implant-retained auricular prosthesis.

The use of bone-anchored hearing aids is not possible for all patients who wear an implant-retained auricular prosthesis. For some patients, the external ear canal cannot be occluded with a conventional hearing device. Currently manufactured hearing aids may not readily fit the contours of an implant-retained auricular prosthesis. This article describes a technique that allows a modular hearing aid device to be inserted into a custom "sleeve." With this device, the patient can take advantage of binaural cues.

Acrylic Resins↗

Articular chondromatosis and chrondroid metaplasia in transgenic TAg mice.

The C3(1)/SV40 T antigen transgenic mouse model for which rapid mammary and prostate tumor development has been documented uses the FVB/N mouse as a background strain. In this study, where the background strain used was the C57BL/6J mouse, neither mammary nor prostate tumors developed over periods of up to 40 weeks. However, a disturbance of hyaline cartilage in joints was observed similar to that found in synovial chondromatosis in humans. In addition, cartilage thickening in the external ears and cartilaginous metaplasia of the ascending aorta also occurred. This suggests that rearrangement of the transgene occurred in breeding on the C57BL background, thus modifying its expression. It raises the possibility that the genetic changes induced by the SV40 T antigen transforming sequence are important in cartilage homeostasis.

Animals↗