Otosclerosis is a congenital or spontaneous-onset disease characterized by abnormal bone remodeling in the inner ear. Often this causes the stapes to adhere to the oval window, which impedes its ability to conduct sound, and is a cause of conductive hearing loss. Clinical otosclerosis is found in about 1% of people, although it is more common in forms that do not cause noticeable hearing loss. Otosclerosis is more likely in young age groups, and females. Two common treatments are stapedectomy, the surgical removal of the stapes and replacement with an artificial prosthesis, and stapedotomy, the creation of a small hole in the base of the stapes followed by the insertion of an artificial prosthesis into that hole.
Clinical relevance
Stapes
Stapes | Clinical relevance
In the former the Stapes is replaced by artificial prosthesis whereas in the latter an artificial prosthesis is inserted by making a small hole in the base of the stapes Comparisons have shown stapedotomy to yield either as good or better results than stapedectomy  and to be less prone to complications. The creation of a small hole in the base of the stapes followed by the insertion of an artificial prosthesis into that hole The stapedotomy method is not applicable in those relatively rare cases that involve scleroris of the entire ossicular chain and it is preferred to stapedectomy in the absence of predictable complications.
what are the 3 smallest bones in the human body
user
Strapes is one of them
assistant
what is the size of this above bone?
user
Roughly 3 x 2.5mm
assistant
which part of the body is this located?
user
Middle ear of humans
assistant
besides the human, is this bony structure present in other living species in the animal kingdom?
user
It is one of three ossicles in mammals, in non-mammalian four-legged animals its homologous form is called the columella
assistant
what are the functions this bony structure serves?
user
It transmits sound vibrations from the incus to the oval window, a membrane-covered opening to the inner ear.
assistant
are there any variations of this bony structure?
user
It appears to be relatively constant in size in different ethnic groups
assistant
can this bony structure get affected or impaired?
user
Yes, its impairment causes conductive hearing loss
assistant
is there any remedy to solve this?
user
Two common treatments are stapedectomy and stapedotomy
assistant
how is the first treatment that you mentioned - carried out?
user
It is the surgical removal of the stapes and replacement with an artificial prosthesis
assistant
what are some of the complications involved?
user
Causes fibrosis-related damage to the base of the bone, or obliterative otosclerosis, resulting in obliteration of the base.
assistant
what does the term otosclerosis mean?
user
A condition where one or more foci of irregularly laid spongy bone replace part of normally dense enchondral layer of bony otic capsule in the bony labyrinth.
assistant
what is the main difference between the treatment we discussed versus stapedotomy?
user
There are various methods to treat otosclerosis. However the method of choice is a procedure known as stapedectomy. Early attempts at hearing restoration via the simple freeing of the stapes from its sclerotic attachments to the oval window were met with temporary improvement in hearing, but the conductive hearing loss would almost always recur. A stapedectomy consists of removing a portion of the sclerotic stapes footplate and replacing it with an implant that is secured to the incus. This procedure restores continuity of ossicular movement and allows transmission of sound waves from the eardrum to the inner ear. A modern variant of this surgery called a stapedotomy, is performed by drilling a small hole in the stapes footplate with a micro-drill or a laser, and the insertion of a piston-like prothesis.
Otosclerosis | Surgery
The success rate of either surgery depends greatly on the skill and the familiarity with the procedure of the surgeon. However, comparisons have shown stapedotomy to yield results at least as good as stapedectomy, with fewer complications, and thus stapedotomy is preferred in normal circumstances.
Otosclerosis | Surgery
Otosclerosis is a congenital or spontaneous-onset disease characterized by abnormal bone remodeling in the inner ear. Often this causes the stapes to adhere to the oval window, which impedes its ability to conduct sound, and is a cause of conductive hearing loss. Clinical otosclerosis is found in about 1% of people, although it is more common in forms that do not cause noticeable hearing loss. Otosclerosis is more likely in young age groups, and females. Two common treatments are stapedectomy, the surgical removal of the stapes and replacement with an artificial prosthesis, and stapedotomy, the creation of a small hole in the base of the stapes followed by the insertion of an artificial prosthesis into that hole.
Stapes | Clinical relevance
Surgery may be complicated by a persistent stapedial artery, fibrosis-related damage to the base of the bone, or obliterative otosclerosis, resulting in obliteration of the base.
Stapes | Clinical relevance
The results of this surgery are generally most reliable in patients whose stapes has lost mobility because of otosclerosis. Nine out of ten patients who undergo the procedure will come out with significantly improved hearing while less than 1% will experience worsened hearing acuity or deafness. Successful surgery usually provides an increase in hearing acuity of about 20 dB. That is as much difference as having your hands over both ears, or not. However, most of the published results of success fall within the speech frequency of 500 Hz, 1000 Hz and 2000 Hz; poorer results are typically obtained in the high frequencies, but these are normally less hampered by otosclerosis in the first place.
Stapedectomy | Introduction
A modified stapes operation, called a stapedotomy, is thought by many otologic surgeons to be safer and reduce the chances of postoperative complications. In stapedotomy, instead of removing the whole stapes footplate, a tiny hole is made in the footplate - either with a microdrill or with a laser, and a prosthesis is placed to touch this area, oval window. This procedure can be further improved by the use of a tissue graft seal of the fenestra, which is now common practice. Laser stapedotomy is a well-established surgical technique for treating conductive hearing loss due to otosclerosis. The procedure creates a tiny opening in the stapes (the smallest bone in the human body) in which to secure a prosthetic.
Stapedectomy | Stapedotomy
Comparisons have shown stapedotomy to yield either as good or better results than stapedectomy (measured by hearing improvement and reduction in the air-bone hearing gap, and especially at higher sound frequencies), and to be less prone to complications. In particular, stapedotomy procedure greatly reduces the chance of a perilymph fistula (leakage of cochlear fluid). Stapedotomy, like stapedectomy, can be successful in the presence of sclerotic adhesions (tissue growths abnormally linking the bones to the tympanic cavity), provided the adhesions are removed during surgery. However, the adhesions may recur over time. The stapedotomy method is not applicable in those relatively rare cases that involve scleroris of the entire ossicular chain.
Stapedectomy | Stapedectomy vs. stapedotomy
Otosclerosis is a condition where one or more foci of irregularly laid spongy bone replace part of normally dense enchondral layer of bony otic capsule in the bony labyrinth. This condition affects one of the ossicles (the stapes) resulting in hearing loss, tinnitus, vertigo or a combination of symptoms. The term otosclerosis is something of a misnomer. Much of the clinical course is characterized by lucent rather than sclerotic bony changes, so the disease is also known as otospongiosis.
Otosclerosis | Introduction
Occasionally the joints between the ossicles become rigid. One condition, otosclerosis, results in the fusing of the stapes to the oval window. This reduces hearing and may be treated surgically.
Ossicles | Clinical relevance
Complications of stapedectomy: When a stapedectomy is done in a middle ear with a congenitally fixed footplate, the results may be excellent but the risk of hearing damage is greater than when the stapes bone is removed and replaced (for otosclerosis). This is primarily due to the risk of additional anomalies being present in the congenitally abnormal ear. If high pressure within the fluid compartment that lies just below the stapes footplate exists, then a perilymphatic gusher may occur when the stapes is removed. Even without immediate complications during surgery, there is always concern of a perilymph fistula forming postoperatively.
Stapedectomy | Complications
A stapedectomy is a surgical procedure of the middle ear performed in order to improve hearing. If the stapes footplate is fixed in position, rather than being normally mobile, then a conductive hearing loss results. There are two major causes of stapes fixation. The first is a disease process of abnormal mineralization of the temporal bone called otosclerosis. The second is a congenital malformation of the stapes. In both of these situations, it is possible to improve hearing by removing the stapes bone and replacing it with a micro prosthesis - a stapedectomy, or creating a small hole in the fixed stapes footplate and inserting a tiny, piston-like prosthesis - a stapedotomy.
Stapedectomy | Introduction
If the mobility of the stapes is reduced due to otosclerosis, then stapedius muscle contraction does not significantly decrease the admittance. When acoustic reflex testing is conducted, the acoustic reflex thresholds (ART) cannot be determined when attempting to measure on the affected side. Also, a conductive pathology will attenuate the test stimuli, resulting in either elevated reflex thresholds or absent reflexes when the stimulus is presented in the affected ear and measured in the other ear.
Otosclerosis | Audiometry
Because it is a simpler and safer procedure, stapedotomy is normally preferred to stapedectomy in the absence of predictable complications. However, the success rate of either surgery depends greatly on the skill and the familiarity with the procedure of the surgeon. Furthermore, a major success factor in both surgeries is correctly determining the length of the prosthesis.
Stapedectomy | Stapedectomy vs. stapedotomy
In 1995, Glasscock et al. published a 25-year single-centre review of over 900 patients who underwent stapedectomy and stapedotomy and found complications rates as follows: reparative granuloma 1.3%, tympanic membrane perforation 1.0%, total sensorineural hearing loss 0.6%, partial sensorineural hearing loss 0.3%, and vertigo 0.3%. In this series, there was no incidence of facial nerve paralysis or tinnitus.
Stapedectomy | Complications
Jean-Bernard Causse, the reattachment of the stapedius muscle alongside the use of veinous grafts.
Stapedectomy | History
Tympanometry measures the peak pressure (TPP) and peak-compensated static admittance ("Y") of the middle ear at the eardrum. As the stapes is ankylosed in otosclerosis, the lateral end of the ossicular chain may still be quite mobile. Therefore, otosclerosis may only slightly reduce the admittance, resulting in either a shallow tympanogram (type A), or a normal tympanogram (type A). Otosclerosis increases in the stiffness of the middle-ear system, raising its resonant frequency. This can be quantified using multi-frequency tympanometry. Thus, a high resonant-frequency pathology such as otosclerosis can be differentiated from low resonant-frequency pathologies such as ossicular discontinuity. In the absence of a pathology, a loud sound (generally greater than 70 dB above threshold) causes the stapedius muscle to contract, reducing the admittance of the middle ear and softening the perceived loudness of the sound.
Otosclerosis | Audiometry
On radiographic images, the otic capsule is the most dense portion of the temporal bone. In otospongiosis, a leading cause of adult-onset hearing loss, the otic capsule is exclusively affected. This area normally undergoes no remodeling in adult life and is extremely dense. With otospongiosis, the normally dense enchondral bone is replaced by haversian bone, a spongy and vascular matrix that results in sensorineural hearing loss due to compromise of the conductive capacity of the inner ear ossicles. This results in hypodensity on CT, with the portion first affected usually being the "fissula ante fenestram".
Bony labyrinth | Introduction
Otologists and neurotologists have specialized in otolaryngology and then further specialized in pathological conditions of the ear and related structures. Many general otolaryngologists are trained in otology or middle ear surgery, performing surgery such as a tympanoplasty, or a reconstruction of the eardrum, when a hole remains from a prior ear tube or infection. Otologic surgery includes treatment of conductive hearing loss by reconstructing the hearing bones, or ossicles, as a result of infection, or by replacing the stapes bone with a stapedectomy for otosclerosis. Otology and neurotology encompass more complex surgery of the inner ear not typically performed by general otolaryngologists, such as removal of complex cholesteatoma, labyrinthectomy, surgery of the endolymphatic sac for meniere's disease and cochlear implant surgery.
Neurotology | Introduction
Fixation of the stapes within the oval window causes a conductive hearing loss. In pure-tone audiometry, this manifests as air-bone gaps on the audiogram (i.e. a difference of more than 10 dB between the air-conduction and bone-conduction thresholds at a given test frequency). However, medial fixation of the ossicular chain impairs both the inertial and osseotympanic modes of bone conduction, increasing the bone-conduction thresholds between 500 Hz and 4 kHz, and reducing the size of air-bone gaps. As 2 kHz is the resonant frequency of the ossicular chain, the largest increase in bone-conduction threshold (around 15 dB) occurs at this frequency – the resultant notch is called "Carhart's notch" and is a useful clinical marker for medial ossicular-chain fixation.
Otosclerosis | Audiometry
The world's first stapedectomy is credited to Dr. John J.Shea Jr. who performed it in May 1956 on a 54-year-old housewife who could no longer hear even with a hearing aid. Significant contributions to modern stapedectomy techniques were then made by the late Dr. Antonio De La Cruz of the House Ear Institute in Los Angeles; by the late Professor Henri André Martin of the Hôpital Edouard Herriot in Lyon, France, including calibrated platinotomy (stapes footplate rather than whole surgery) and trans-footplate piston surgery that also paved the way for modern stapedotomy; and by the late Dr. Jean-René Causse of the eponymous clinic in Béziers, France, who pioneered the use of Teflon piston prostheses (also critical progress for stapedotomy) and, with his late son Dr.
Stapedectomy | History
A Cochrane review sought to compare the effectiveness of fornix-based versus limbal-based conjunctival flaps for patients undergoing trabeculectomy. There were no statistically significant differences between the two procedures in regards to surgery failure rate, mean intraocular pressure at follow-up, and postoperative complications. Currently, there are no published trials which compare the efficacy and safety of ab interno trabeculectomy with Trabectome with other procedures for treating glaucoma.
Trabeculectomy | Research
A scaphocephaly that is diagnosed and treated later in life requires a more extensive secondary operation than one which is treated before five months. A major focus in craniosynostosis reconstruction is maintaining normalized aesthetics of temporal region, and avoiding temporal hollowing. Despite attempts to avoid temporal hollowing by employing overcorrection techniques, autologous fat transfer, and bone grafts, up to 50% of patients still present with depression in the temporal fossa post-operatively.
Craniofacial surgery | Surgical procedures
In both the classic and vascular form, the treatment is surgical. A partial styloidectomy is the preferred approach. Repair of a damaged carotid artery is essential in order to prevent further neurological complications. Regrowth of the stylohyoid process and relapse being a common occurrence is debatable. Medical management may include the use of pain and anti-inflammatory medications, antidepressants, and/or corticosteroids. The overall success rate for treatment (medical or surgical) is about 80%.
Eagle syndrome | Treatment
A specific form of conjunctivoplasty may help somewhat.
Nevus of Ota | Treatment
The Stenström technique or method is otoplastic surgery (otoplasty) for pinning protruding ears. The method belongs together with the Mustardé technique and the Converse technique to the traditional or conventional otoplasties.
Stenström technique | Introduction
CHL in otosclerosis is caused by two main sites of involvement of the sclerotic (or scar-like) lesions. The best understood mechanism is fixation of the stapes footplate to the oval window of the cochlea. This greatly impairs movement of the stapes and therefore transmission of sound into the inner ear ("ossicular coupling"). Additionally the cochlea's round window can also become sclerotic, and in a similar way impair movement of sound pressure waves through the inner ear ("acoustic coupling"). Conductive hearing loss is usually concomitant with impingement of abnormal bone on the stapes footplate. This involvement of the oval window forms the basis of the name fenestral otosclerosis.
Otosclerosis | Pathophysiology
In cases when all conservative treatment fails, surgical therapy may be necessary. In a bursectomy the bursa is cut out either endoscopically or with open surgery. The bursa grows back in place after a couple of weeks but without any inflammatory component.
Bursitis | Treatment
The recovered long bones lack inner cavities, like in "Paleoparadoxia" and "Desmostylus", and the trabecular pattern is different from that in "Behemotops".
Ashoroa | Introduction
Blood supply and innervation The superficial temporal and posterior auricular arteries preserve the arterial blood supply of the external ear. The sensory innervation involves the front and back (anterior and posterior) branches of the greater auricular nerve, and is reinforced by the auricular temporal and lesser occipital nerves. The auricular branch of the vagus nerves supplies a portion of the posterior wall of the external auditory canal. Otoplastic praxis The support framework of the reconstructed pinna must be more rigid than the natural cartilage framework of a normal ear, in order for it to remain of natural size, proportion, and contour.
Otoplasty | Surgical anatomy of the external ear
Because of the fluid egress the iris will partially prolapse through the sclerostomy and is usually therefore grasped to perform an excision called iridectomy. This iridectomy will prevent future blockage of the sclerostomy. The scleral flap is then sutured loosely back in place with several sutures. The conjunctiva is closed in a watertight fashion at the end of the procedure.
Trabeculectomy | Procedure
The CO laser allows the surgeon to create very small, precisely placed holes without increasing the temperature of the inner ear fluid by more than one degree, making this an extremely safe surgical solution. The hole diameter can be predetermined according to the prosthesis diameter. Treatment can be completed in a single operation visit using anesthesia, normally followed by one or two nights' hospitalization with subsequent at-home recovery time a matter of days or weeks.
Stapedectomy | Stapedotomy
Recurrent otitis media is common, and many patients required the placement of PE tubes. Small ear canals are also fairly common, but not as much as in 18q-.
Tetrasomy 18p | ENT
Surgical otoplasty techniques Depending upon the auricular (pinna) defect, deformity, or reconstruction required, the surgeon applies these three otoplastic techniques, either individually or in combination to achieve an outcome that produces an ear of natural proportions, contour, and appearance:
Otoplasty | Surgical procedures
Then the graft is attached to the overlying host stroma pneumatically (Fig 3E,F). Air fluid pressure is maintained inside the chamber for 60 seconds and then minimal air is released. The wound is closed with 10-0 monofilament suture and subconjunctival antibiotic steroid injection is given.
Pre-Descemet's Endothelial Keratoplasty | Graft Injection into Host Bed
Moseley and coworkers studied the effect of arthroscopic surgery for osteoarthritis of the knee establishing two treatment groups and a sham-operated control group. They found that patients in the treatment arms did no better than those in the control group. The fact that all three groups improved equally points to the placebo effect in surgical interventions. In a recent study it was found, that arthroscopic partial meniscectomy does not offer any benefit over sham (or fake) surgery in relieving symptoms of knee locking or catching in patients with degenerative meniscal tears. A randomised controlled trial was carried out to investigate the effectiveness of shoulder surgery to remove an acromial spur (bony protuberance on x-ray) in patients with shoulder pain.
Sham surgery | Orthopedic diseases
The approach used for each individual person is based on several factors such as tumor size, location, skill and experience of the surgeon, and whether hearing preservation is a goal. Each of the surgical approaches has advantages and disadvantages in terms of ease of tumor removal, likelihood of preservation of facial nerve function and hearing, and post-operative complications.
Vestibular schwannoma | Surgery
The endoscopic patients showed a higher recurrence rate. In another case study on CRAs, they showed similar results with the CSF leaks being more of a problem in endoscopic patients. Open procedure patients showed a higher rate of post operative seizures as well. Both of these studies still suggest that despite the CSF leaks, that the endoscopic technique is still an appropriate and suitable surgical option. Otologic surgery, which is traditionally performed via an open approach using a microscope, may also be performed endoscopically, and is called Endoscopic Ear Surgery or EES.
Endoscopic endonasal surgery | Endoscopic techniques vs open techniques
The revival of the stapes mobilization operation by Rosen, in 1953, made the use of the microscope mandatory, although it was not used by the originators of the technique, Kessel (1878), Boucheron (1888) and Miot (1890). Mastoidectomies began to be performed with the surgical microscope and so were the tympanoplasty techniques that became known in the early 1950s. The stapes mobilization operation had varying results and was soon replaced by stapedectomy, first described by John Shea, Jr.; this was an operation that was always performed with the microscope. Today neurosurgeons are very proud to use microscopes in their procedures. But it was not always so: many prestigious centers did not accept that idea and it had to be developed in relative isolation.
Microsurgery | History
The stapes appears to be relatively constant in size in different ethnic groups. In 0.01-0.02% of people, the stapedial artery does not regress, and persists in the central foramen. In this case, a pulsatile sound may be heard in the affected ear, or there may be no symptoms at all. Rarely, the stapes may be completely absent.
Stapes | Variation
This approach is in a slightly different incision location and is utilized primarily for the purpose of hearing preservation in patients with small tumors, typically confined to the internal auditory canal. A small window of bone is removed above the ear canal to allow exposure of the tumor from the upper surface of the internal auditory canal, preserving the inner ear structures.
Vestibular schwannoma | Middle fossa approach
The words myringotomy, tympanotomy, tympanostomy, and "tympanocentesis" overlap in meaning. The first two are always synonymous, and the third is often used synonymously. The core idea with all of them is cutting a hole in the eardrum to allow fluid to pass through it. Sometimes a distinction is drawn between myringotomy/tympanotomy and tympanostomy, in parallel with the general distinction between an -otomy (cutting) and an -ostomy (creating a stoma with some degree of permanence or semipermanence). In this distinction, only a tympanostomy involves tympanostomy tubes and creates a semipermanent stoma. This distinction in usage is not always made. The word "tympanocentesis" specifies that centesis (aspiration for sampling) is being done.
Myringotomy | Nomenclature
The Mustardé technique is an otoplastic surgery (otoplasty) for pinning protruding ears. The method belongs together with the Stenström and Converse methods to the traditional otoplasties. It is antihelix plastic surgery performed with the suturing technique.
Mustardé technique | Introduction
An initial pocket is created under the conjunctiva and Tenon's capsule and the wound bed is treated for several seconds to minutes with mitomycin C (MMC, 0.5–0.2 mg/ml) or 5-fluorouracil (5-FU, 50 mg/ml) soaked sponges. These chemotherapeutics help to prevent failure of the filter bleb from scarring by inhibiting fibroblast proliferation. Alternatively, non-chemotherapeutic adjuvants can be implemented to prevent super scarring by wound modulation, such as the ologen collagen matrix implant. Some surgeons prefer "fornix-based" conjunctival incisions while others use "limbus-based" construction at the corneoscleral junction which may allow easier access in eyes with deep sulci. A partial thickness flap with its base at the corneoscleral junction is then made in the sclera after careful cauterization of the flap area, and a window opening is created under the flap with a Kelly-punch to remove a portion of the sclera, Schlemm's canal and the trabecular meshwork to enter the anterior chamber.
Trabeculectomy | Procedure
Trigonocephaly seems to be the most compliant form of craniosynostosis for surgery. Because of standardization of current surgical approaches there is no surgical mortality and complications are few to none. The simple suturectomy is presently insufficient to adjust the complicated growth restrictions caused by metopic synostosis. On the other hand, the fronto-supraorbital advancement and remodelling and the 'floating forehead technique' create sufficient space for brain growth and result in a normal horizontal axis of the orbits and supraorbital bar. The fronto-supraorbital advancement and remodelling is the most used method nowadays. Over the past few years distraction osteogenesis has been gradually acknowledged since it has a positive effect on hypotelorism.
Trigonocephaly | Surgical
This is done by reflecting the mucoperiosteal flap in order to expose the extended bone for complete excision. This bone will then be sent for histopathological examination to differentiate from benign to malignant neoplastic processes. Routine post-operative instructions are given to the patient and occasionally antibiotics may be prescribed. The patient will then be recalled after 1 week in order to remove the sutures and often after a few months for post-operative follow up.
Buccal exostosis | Management
Both are medications used to treat fungal infections. Based on magnetic resonance imaging and cerebrospinal fluid (CSF) analysis 8 months after the surgery, the male Boxer’s outcome was considered excellent.
Phaeohyphomycosis | Treatment
The bone flap is then propped open using small wedges or pieces of bone such that the enlarged spinal canal will remain in place. This technique contrasts with vertebral laminectomy in the amount of bone and muscle tissue that has to be removed, displaced, or dissected in the procedure.
Laminoplasty | Introduction
Thoracotomy is used to surgically correct this pathology.
Trilogy of Fallot | Treatment
Surgery is needed to prevent the closing of the coronal sutures from damaging brain development. In particular, surgeries for the LeFort III or monobloc midface distraction osteogenesis which detaches the midface or the entire upper face, respectively, from the rest of the skull, are performed in order to reposition them in the correct plane. These surgeries are performed by both plastic and oral and maxillofacial (OMS) surgeons, often in collaboration.
Apert syndrome | Craniosynostosis
The skin wound on the back of the ear is sutured and finally a bandage is applied for 1 or 2 weeks, or longer in exceptional cases. The hollows of the ear on the front (anterior) side of the ear (cavum conchae, scapha) are modelled with ointment-containing swabs for several days and supported this way. According to the opinion of Weerda this method is not suitable for older patients due to the limited elasticity of the cartilage.
Stenström technique | Surgical method
Otology is a branch of medicine which studies normal and pathological anatomy and physiology of the ear (hearing and vestibular sensory systems and related structures and functions) as well as their diseases, diagnosis and treatment. Otologic surgery generally refers to surgery of the middle ear and mastoid related to chronic otitis media, such as tympanoplasty, or ear drum surgery, ossiculoplasty, or surgery of the hearing bones, and mastoidectomy. Otology also includes surgical treatment of conductive hearing loss, such as stapedectomy surgery for otosclerosis. Neurotology, a related field of medicine and subspecialty of otolaryngology, is the study of diseases of the inner ear, which can lead to hearing and balance disorders.
Otology | Introduction
Lumbar sympathectomy is still being offered as a treatment for plantar hyperhidrosis, or as a treatment for patients who have a bad outcome (extreme 'compensatory sweating') after thoracic sympathectomy for palmar hyperhidrosis or blushing; however, extensive sympathectomy risks hypotension.
Endoscopic thoracic sympathectomy | History
(2013), "Ohranlegung ohne Hautschnitt (Incisionless otoplasty. A review). "J Aesthet Chir, 6, 203-208 16. Tramier, H. Personal approach to treatment of prominent ears. In: Plastic and Reconstructive Surgery. 99, Number 2, 562–565, . 17. Vecchione, T.R. 1979 Needle scoring of the anterior surface of the cartilage in otoplasty. In: Plastic and Reconstructive Surgery. 64, Number 4, 568, . 18. Fritsch, M.H. (1995). "Incisionless Otoplasty". Laryngoscope. 105, 1-11
EarFold | References
The main elements of metopic suture closure involve a low volume of the anterior cranial fossa, the metopic ridging and hypotelorism. These problems are all addressed during the surgical intervention. The volume is increased by placing the frontal bones and the supraorbital rim further forward. This is done by excision of the bones after which they are reshaped with greenstick fracturing. Replacement of the bones provides a possibility for the correction of the hypotelorism at the same time. A bone graft is placed in between the two halves of the supraorbital bars, thereby increasing the width between the orbits. The metopic ridge can then be corrected with a (simple) burring.
Craniosynostosis | Metopic synostosis/trigonocephaly
A full thickness flap is usually elevated to a point apical to the desired area to be contoured, and according to the amount of bone needed to be removed, a bone file, or a bone rongeur, or a burr under copious irrigation can be used to provide the desired contour. Taking in consideration that lack of irrigation can lead to bone necrosis. When finished, the flap is repositioned and sutured. The alveolar mucosa covering bone should have uniform thickness, density and compressibility to evenly distribute the masticatory forces to the underlying bone.
Alveoloplasty | Clinical Procedure
Lids should be separated by excision of adhesions between the lid margins and kept apart during the healing process. When adhesions extend to the angles, epithelial grafts should be given to prevent recurrences.
Ankyloblepharon | Treatment
For example, the lower branch of the squamosal bone is shortened to offset the tall dorsal process of quadratojugal which connects to it. On the other hand, the rear branch jugal bone lengthens to fill some of the space left by the shortening of the anterior process of the quadratojugal. In archosauriforms, the jugal even re-encloses the lower temporal fenestra. The stapes are long, thin, and solid, without a perforating hole (stapedial foramen) present in the more robust stapes of other reptiles.
Archosauromorpha | Skull
Since this lesion is usually a complication of long standing otitis media, it is important to use an appropriate antibiotic therapy regimen. If the patient fails first line antibiotics, then second-line therapies should be employed, especially after appropriate culture and sensitivity testing. Surgery may be required if there is extension into the mastoid bone, or if a concurrent cholesteatoma is identified during surgery or biopsy. In general, patients have an excellent outcome after appropriate therapy.
Otic polyp | Management
Asymptomatic patients do not require therapy. Symptomatic patients should undergo arthroscopic or surgical removal of intra-articular bodies. Patients who have recurrent intra-articular bodies or in whom the entire synovial lining is metaplastic require total synovectomy.
Synovial osteochondromatosis | Treatment
Myringosclerosis seems to be more common than tympanosclerosis. Most research has not been conducted upon the general, healthy population, but rather those with otitis media or patients who have had tympanostomy tubes in prior procedures. Of the children studied who had 'glue ear', and who were treated with tympanostomy tubing, 23-40% of cases had tympanosclerosis. One study suggested that people with atherosclerosis were more likely to have tympanosclerosis than otherwise healthy individuals.
Tympanosclerosis | Epidemiology
Surgical treatment in the presence of planovalgus deformity can be of two types: Both techniques provide for a thirty-day subsequent protection with a plastered knee-high without load.
Planovalgus deformity | Treatment
Recently, some success has been claimed with a second such treatment, bisphosphonate medications that inhibit bone destruction. However, these early reports are based on non-randomized case studies that do not meet standards of clinical trials. There are numerous side-effects to both pharmaceutical treatments, including occasional stomach upset, allergic itching, and increased joint pains which can lead to arthritis. In the worst case, bisphosphonates may lead to osteonecrosis of the auditory canal itself. Finally, neither approach has been proven to be beneficial after the commonly preferred method of surgery has been undertaken.
Otosclerosis | Medical
Research to treat ORN at a molecular level has increased with progress in the field of medicine. The pharmacological methods to treat ORN listed below were developed to treat the etiologic factors.
Osteoradionecrosis | Therapeutic approach
A wide range of treatments are possible, including rest, surgery and casting.
Trapezoid bone | Clinical Significance
Arthroscopic surgery (or open joint surgery) is an effective treatment. Joint replacement surgery may be necessary in the case of severe pain or substantial joint restriction. Prominent trabeculae. * Normal sacro-iliac joints and symphysis pubis.
Protrusio acetabuli | Treatment
If the reconstructed pinna framework were as structurally delicate as the cartilage framework of a natural pinna, its anatomic verisimilitude as an ear would gradually be eroded by a combination of the pressure of the tight skin-envelope in the temporal region of the head, and of the pressure of the progressive contracture of the surgical scar(s).
Otoplasty | Surgical anatomy of the external ear
In bone surgery, a corticotomy is a cutting of the bone that may or may not split it into two pieces (bone fracture) but involves cortex only, leaving intact the medullary vessels and periosteum. Corticotomy is particularly important in distraction osteogenesis or Surgically Facilitated Orthodontic Therapy.
Corticotomy | Introduction
The pathophysiology of otosclerosis is complex. The key lesions of otosclerosis are multifocal areas of sclerosis within the endochondral temporal bone. These lesions share some characteristics with Paget's Disease, but they are not thought to be otherwise related. Histopathological studies have all been done on cadaveric temporal bones, so only inferences can be made about progression of the disease histologically. It seems that the lesions go through an active "spongiotic" or hypervascular phase before developing into "sclerotic" phase lesions. There have been many genes and proteins identified that, when mutated, may lead to these lesions. Also there is mounting evidence that measles virus is present within the otosclerotic foci, implicating an infectious etiology (this has also been noted in Paget's Disease).
Otosclerosis | Pathophysiology
This approach makes a surgical corridor from the frontal sinus to the sphenoid sinus. This is done by the complete removal of the ethmoid bone, which allows a surgeon to expose the roof of the ethmoid, and the medial orbital wall. This procedure is often successful in the removal of small encephaloceles of the ethmoid osteomas of the ethmoid sinus wall or small olfactory groove meningiomas. However, with larger tumors or lesions, one of the other approaches listed above is required.
Endoscopic endonasal surgery | Transethmoidal approach
Adult osteopetrosis typically does not require treatment, but complications of the condition may require intervention. Surgery may be needed for aesthetic or functional reasons (such as multiple fractures, deformity, and loss of function), or for severe degenerative joint disease.
Osteopetrosis | Treatment
The neck of the femur is usually removed at the same time as the head. This prevents the post operative complication of bone rubbing on bone and continued pain. This has led to the procedure often also called "Femoral head and neck ostectomy". Animals who have had the operation are required to maintain a lower weight to compensate for the loss of skeletal integrity, and typically have excellent functional outcomes with appropriate physical therapy.
Femoral head ostectomy | Procedure
The mainstay of treatment is surgical excision. Two adjuvant therapeutic strategies are Stereotactic surgery (SRS) and fractionated convention radiotherapy (FCRT). Both are highly effective means of treatment.
Central neurocytoma | Treatment
Imaging is usually not pursued in those with uncomplicated conductive hearing loss and characteristic clinical findings. Those with only conductive hearing loss are often treated medically or with surgery without imaging. The diagnosis may be unclear clinically in cases of sensorineural or mixed hearing loss and may become apparent only on imaging. Therefore, imaging is often performed when the hearing loss is sensorineural or mixed. A high-resolution CT shows very subtle bone findings. However, CT is usually not needed prior to surgery. Otosclerosis on CT can be graded using the grading system suggested by Symons and Fanning.
Otosclerosis | CT imaging
In severe cases, amputation may even be necessary to prevent the further spread of infection. Following surgical intervention, antibiotic therapy is continued and adjusted based on the results of the fluid culture.
Tenosynovitis | Treatment
The stapes is one of three ossicles in mammals. In non-mammalian four-legged animals, the bone homologous to the stapes is usually called the columella; however, in reptiles, either term may be used. In fish, the homologous bone is called the "hyomandibular", and is part of the gill arch supporting either the spiracle or the jaw, depending on the species. The equivalent term in amphibians is the "".
Stapes | Animals
The treatment for cholesteatoma is surgery.
Ear | Vertigo
MISS is more time-consuming than conventional surgery. Operating on the muscles through the tunnel is more demanding on the surgeon. The keyhole cuts may tear in older patients. If the tear involves Tenon's capsule, a visible scar may result. An excessive bleeding that cannot be stopped makes an enlargement of the cuts necessary to cauterize the vessel. Usually, a conversion to a limbal opening as in classical strabismus surgery can be avoided. There are few reports, though, on complications that are unique to MISS.
Minimally invasive strabismus surgery | Disadvantages and potential complications
An ostectomy is a procedure involving the removal of bone. Examples include: In dentistry, ostectomy refers specifically to the removal of bone surrounding a tooth in an attempt to eliminate an adjacent periodontal pocket.
Ostectomy | Introduction
There are three modalities of surgical treatment (excision) depending on where the anatomical location of the incision to access the tumor is made: retrosigmoid (a variant of what was formerly called suboccipital), translabyrinthine, and middle fossa. The goals of surgery are to control the tumor, and preserve hearing as well as facial nerves. Especially in the case of larger tumors, there may be a tradeoff between tumor removal and preservation of nerve functionality. There are different defined degrees of surgical excision, termed 'subtotal resection', 'radical subtotal resection', 'near-total resection', and 'total resection' in order or increasing proportion of tumor removed.
Cerebellopontine angle syndrome | Surgical
The corrective goal of otoplasty is to set back the ears so that they appear naturally proportionate and contoured without evidence or indication of surgical correction. Therefore, when the corrected ears are viewed, they should appear normal, from the: (i) Front perspective. When the ear (pinna) is viewed from the front, the helical rim should be visible, but not set back so far (flattened) that it is hidden behind the antihelical fold. (ii) Rear perspective. When the pinna is viewed from behind, the helical rim is straight, not bent, as if a "letter-C" (the middle-third to flat), or crooked, as if a hockey stick" (the earlobe is insufficiently flat).
Otoplasty | Surgical otoplasty
If the periosteum or underlying muscles (frontalis, occipitalis, temporalis) are intact, secondary closure by granulation is possible. Before surgical intervention this was the only option available, as used to treat Robert McGee in 1864. Considering modern aesthetic standards, a better option is the use of split-thickness or full-thickness skin grafts, which is also quicker. When bulk is needed for a better contour a free flap is used, or as shown in the pictures, a regional flap.
Scalp reconstruction | Soft tissue defects
After obtaining the informed consent from the patient, local anesthesia is given. Anterior chamber entry (eye entry) is made by a blade in the superior corneo-limbus area. Descemet's membrane along with endothelium in the patient is removed mechanically by reverse Sinskey hook by controlled stripping on the endothelial side (Fig 3A-C).
Pre-Descemet's Endothelial Keratoplasty | Host Bed Preparation
Data on long-term outcomes is limited. However, it appears that cancer recurrence and death are similar when compared to standard treatments (radical hysterectomy and radiation). Death and cancer recurrence rates (associated with the procedure) are approximately 3% and 5% respectively.
Cervicectomy | Trachelectomy compared to other treatments
In MISS the operating microscope rather than magnifying glasses should be used by the surgeon. Instead of one large opening of the conjunctiva as is done in conventional strabismus surgery, several small cuts are placed where the main surgical steps, usually suturing, have to be performed. Openings are placed as far away from the corneal limbus as possible to minimize postoperative discomfort. Between two of these incisions, called keyhole openings, there is a "tunnel" used by the surgeon to insert the instrument for the treatment of the eye muscles. At the end of the operation, the keyhole openings are closed with resorbable sutures.
Minimally invasive strabismus surgery | Principle
Surgery to repair a tear in the tracheobronchial tree can be successful even when it is performed months after the trauma, as can occur if the diagnosis of TBI is delayed. When airway stenosis results after delayed diagnosis, surgery is similar to that performed after early diagnosis: the stenotic section is removed and the cut airway is repaired.
Tracheobronchial injury | Treatment
The procedure involves minimal bleeding and is usually done using local anesthesia. The amount of tissue removed during the surgery can vary with respect to the pain.
Vestibulectomy | Procedure
The configuration of the stapes is intermediate between non-amniote tetrapods and amniotes. On the one hand, its connection to the otic notch is unusual, since true reptiles and other amniotes have lost an otic notch, forcing the tympanum and stapes to shift downwards towards the quadrate bone of the jaw joint. On the other hand, the thin, sensitive structure of "Seymouria"'s stapes is a specialization over most non-amniote tetrapods, which have a thick stapes useless for hearing yet useful for reinforcing the skull. The inner ear of "Seymouria baylorensis" retains a cochlear recess located behind (rather than below) the vestibule, and its anterior semicircular canal was likely encompassed by a cartilaginous (rather than bony) supraoccipital.
Seymouria | Skull
The variation in technique in cholesteatoma surgery results from each surgeon's judgment whether to retain or remove certain structures housed within the temporal bone in order to facilitate the removal of cholesteatoma. This typically involves some form of mastoidectomy which may or may not involve removing the posterior ear canal wall and the ossicles. Removal of the canal wall facilitates the complete clearance of cholesteatoma from the temporal bone in three ways: Thus removal of the canal wall provides one of the most effective strategies for achieving the primary aim of cholesteatoma surgery, the complete removal of cholesteatoma. However, there is a trade-off, since the functional impact of canal wall removal is also important.
Cholesteatoma | Surgery
There is a 5% chance of failure of coronectomy, the root will become mobilized during transection. In 5% of the cases, follicle remnants will form deep periodontal pockets which will lead to infection.
Coronectomy | Disadvantages
Due to the spectrum of symptoms present within caudal duplication, there is no uniform surgical treatment in relieving symptoms. The type and severity of surgical intervention is often dependent upon the type and complexity of symptoms presented. Thus, the primary goal of surgical treatment for the syndrome is to relieve symptoms, not to restore normal anatomy, and hence, potentially life-threatening malformations are addressed first and often followed by other anatomic or aesthetic reconstructions in later stages. After the medical treatment, the patients are periodically monitored.
Caudal duplication | Spinal and lower limb tract
The choice of surgical versus non-surgical treatments for osteochondritis dissecans is controversial. Consequently, the type and extent of surgery necessary varies based on patient age, severity of the lesion, and personal bias of the treating surgeon—entailing an exhaustive list of suggested treatments. A variety of surgical options exist for the treatment of persistently symptomatic, intact, partially detached, and completely detached OCD lesions. Post-surgery reparative cartilage is inferior to healthy hyaline cartilage in glycosaminoglycan concentration, histological, and immunohistochemical appearance. As a result, surgery is often avoided if non-operative treatment is viable.
Osteochondritis dissecans | Surgery
Imaging is important and is diagnostic. Visualizing the styloid process on a CT scan with 3D reconstruction is the suggested imaging technique. The enlarged styloid may be visible on an orthopantogram or a lateral soft tissue X ray of the neck.
Eagle syndrome | Diagnosis
Treatment is difficult, often requiring a joint replacement. Spontaneous improvement occasionally happens and some juxta-articular lesions do not progress to collapse. Other treatments include immobilization and osteotomy of the femur. Cancellous bone grafts are of little help.
Dysbaric osteonecrosis | Treatment
This is a minor surgical procedure where the affected soft tissue covering and surrounding the tooth is removed. This leaves an area that is easy to keep clean, preventing plaque buildup and subsequent inflammation. Sometimes operculectomy is not an effective treatment. Typically operculectomy is done with a surgical scalpel, electrocautery, with lasers or, historically, with caustic agents (trichloracetic acid)
Pericoronitis | Operculectomy
5–6 years of age) or non-surgical correction (tissue molding) is required to achieve an ear of normal proportions, contour, and appearance.
Otoplasty | Indications
An excision of the flattened occipital bone with release of the fused suture tends to correct the cranial vault deformity.
Craniosynostosis | Unilateral lambdoid synostosis/posterior plagiocephaly
Hence, the underlying tissues have an increased available volume to expand into, preventing further tissue injury or functional compromise.
Escharotomy | Overview
Except for the columellar incision, the technical and procedural approaches of open rhinoplasty and of closed rhinoplasty are similar; yet closed rhinoplasty procedure features:
Rhinoplasty | Procedural differences
At, or above, the age of 7, a child or adult could treat their prominent ears with a minimally invasive technique using earFold implants to remold the cartilage in their ears in a simple procedure which can be performed under local anaesthesia.
Otoplasty | Adults
A labyrinthectomy is a procedure used to decrease the function of the labyrinth of the inner ear. This can be done surgically or chemically. It may be done to treat Ménière's disease.
Labyrinthectomy | Introduction