Ann Oto Rhinol Laryn
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Ann Oto Rhinol Laryn · Jun 2004
Case ReportsEcthyma gangrenosum: a rare cutaneous manifestation of a potentially fatal disease.
Ecthyma gangrenosum is a cutaneous lesion frequently associated with Pseudomonas aeruginosa bacteremia, although it may develop in the absence of bacteremia and may originate from other bacterial and fungal organisms. Ecthyma gangrenosum most often occurs in patients with neutropenia and other immunocompromised hosts. ⋯ Tissue and blood cultures were positive for P aeruginosa. This clinical entity should be considered when otolaryngologists are asked to evaluate necrotic cutaneous lesions of the head and neck.
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Ann Oto Rhinol Laryn · Apr 2004
Enlarged translabyrinthine approach for the management of large and giant acoustic neuromas: a report of 175 consecutive cases.
The translabyrinthine approach was once considered inadequate for the removal of acoustic neuromas (ANs), but that theory has few proponents today. Over the years, the translabyrinthine approach has been modified into the enlarged translabyrinthine approach, with experience and technical refinements leading to a wider access. Between April 1987 and December 2001, the Gruppo Otologico of Piacenza-Rome was able to remove 175 ANs 3 cm or larger in size from the cerebellopontine angle by adopting this modified surgical technique. ⋯ The preoperative ipsilateral hearing was already compromised in 119 of the 175 cases (68%; class C/D according to the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery, 1995). From our results, we can conclude that the use of the enlarged translabyrinthine approach in AN surgery is not dependent on tumor size. On the contrary, the advantages of a low rate of morbidity and a short hospital stay are ample proof that this is the best approach for the removal of large ANs.
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Ann Oto Rhinol Laryn · Feb 2004
Case ReportsHearing preservation after modified translabyrinthine approach performed to remove a vestibular schwannoma.
Hearing preservation after surgical removal of a vestibular schwannoma by a modified translabyrinthine approach was initially reported by McElveen et al in 1991. We report the case of a 46-year-old man from whom a vestibular schwannoma (grade I) was removed by this approach. ⋯ To the best of our knowledge, this is the first case with satisfactory and long-standing hearing preservation. However, further experimental studies are needed to determine the mechanisms of hearing preservation in order to develop a reliable technique for this approach before using it as an alternative in the management of vestibular schwannoma.
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Every critical advancement in direct laryngoscopic surgical technique has enhanced its precision. Among the most notable was Killian's seminal description of suspension laryngoscopy 90 years ago, which allowed for bimanual direct laryngoscopic surgery. Because of the technical difficulties encountered while performing suspension laryngoscopy, Brünings and Seiffert designed fulcrum laryngoscope holder-stabilizers for spatula laryngoscopes from Killian's original instrument design. ⋯ The applied vector forces on the mandible, maxilla, oral cavity, pharynx, and larynx associated with suspension laryngoscopy are preferable to those associated with holder-stabilizers. A prospective assessment of 120 cases revealed effective use of suspension laryngoscopy in all. We believe that only a minority of surgeons has actually seen true suspension laryngoscopy and that its merits are worthy of reexamination.