Surgical Atlas of pediatric otolaryngology - part 2 pptx

72 Surgical Atlas of Pediatric Otolaryngology • The tympanomeatal flap is replaced. A tympanostomy tube is inserted into the tympanic membrane if eustachian tube function is still poor in order to prevent middle-ear effusion or another portion of the tympan- ic membrane from retracting (Figure 3–48). • A layer of Gelfoam is placed over the tympanic membrane and graft. Two strips of Adaptic gauze impregnated with antibiotic ointment are inserted into the external canal. Postoperative Care • The postoperative care is the same as that described in Chapter 2 under Postauricular Approach. Figure 3–48 A tympanostomy tube is inserted into the tympan- ic membrane. Myringoplasty and Tympanoplasty 73 REFERENCES 1. Saito H, Kazama Y, Yazawa Y. Simple maneuver for closing traumatic eardrum perforation by micropore strip tape patching. Am J Otol 1990;11:427–30. 2. Paparella MM. Otologic surgery in children. Otolaryngol Clin North Am 1977;10:145–51. 3. Sheehy JL, Anderson RG. Myringoplasty: a review of 472 cases. Ann Otol Rhinol Laryngol 1980;89:331–4. 4. Koch WM, Friedman EM, McGill TJI, et al. Tympanoplasty in children. The Boston Children’s Hospital Experience. Arch Otolaryngol Head Neck Surg 1990;116:35–40. 5. Smyth GD. Tympanic reconstruction. Otolaryngol Clin North Am 1972;5:111–25. 6. Shih L, de Tar T, Crabtree JA. Myringoplasty in children. Otolaryngol Head Neck Surg 1991;105:74–7. 7. Tos M, Orntoft S, Stangerup SE. Results of tympanoplasty in children after 15 to 27 years. Ann Otol Rhinol Laryngol 2000;109:17–23. 8. Vrabec JT, Deskin RW, Grady JJ. Meta-analysis of pediatric tympanoplasty. Arch Otolaryngol Head Neck Surg 1999;125:530–4. 9. Bluestone CD, Klein JO. Otitis media in infants and children. WB Saunders; 2001. p. 313–7. 10. Potsic WP, Winawer MR, Marsh RR. Tympanoplasty for the anterior-superior perforation in children. Amer J Otol 1996;17:115–8. 11. Lempert J. Endaural, antauricular surgical approach to the temporal bone: principles involved in this new approach. Summary report of 1,780 cases. Arch Otolaryngol Head Neck Surg 1937;27:555–87. 12. Blaney SPA, Tierney P, Bowder DA. The surgical management of the pars tensa retraction pock- et in the child—results following simple excision and ventilation tube insertion. Int J Pediatr Otorhinolaryngol 1999;50:133–7. 13. Palva T, Johnsson L-G, Ramsey H. Attic aeration in temporal bones from children with recur- ring otitis media: tympanostomy tubes did not cure disease in Prussak’s Space. Am J Otol 2000;21:485–93. 14. Hasebe S, Takahashi H, Honjo I, Sudo M. Organic change of effusion in the mastoid in otitis media with effusion and its relation to attic retraction. Int J Pediatr Otorhinolaryngol 2000;53:17–24. 15. Gerber MJ, Mason JC, Lambert PR. Hearing results after primary cartilage tympanoplasty. Laryngoscope 2000;110:1994–9. 16. Bluestone CD. Definitions, terminology, and classification. In: Bluestone CD, Rosenfeld RM, editors. Evidence-based otitis media. Hamilton, Ontario: B C Decker Inc; 1999. p. 94–6. 17. Khanna SM, Tonndorf J. Tympanic membrane vibration in cats studied by time-averaged holography. J Acoust Soc Am 1972;51:1904–20. 18. Chan KC, Sculerati N, Casselbrant ML, et al. Comparison of eustachian tube function tests between children with cholesteatoma/retraction pocket and those with chronic otitis media with effusion. In: Tos M, Thomsen J, Peitersen E, editors. Cholesteatoma and Mastoid Surgery; 1989; Amsterdam: Kugler & Ghedini; 1989. p. 485–7. [...]... cholesteatoma developed in 38% of cases and 23 % of those cholesteatomas were detected at the time of the “second look” procedure.4 1 02 Surgical Atlas of Pediatric Otolaryngology Residual or recurrent disease was significantly associated with ossicular erosion at the time of the original surgery, in direct proportion to the number of ossicles involved In a Japanese review of children operated on for cholesteatoma,... Laryngoscope 1979;89:108–14 21 Colletti V, Fiorino FG Malleus to footplate prosthetic interposition: experience with 26 5 patients Otolaryngology Head Neck Surg 1999; 120 :437–44 22 Bellucci RJ Dual classification of tympanoplasty Laryngoscope 1973;83:1754–8 23 Black B Ossiculoplasty prognosis: the SPITE method of assessment Am J Otol 19 92; 13:544–51 24 Mills RP The influence of pathological and technical... 1993;18 :20 2–5 25 Smyth GD, Patterson CG Results of middle ear reconstruction: do patients and surgeons agree? Am J Otol 1985;6 :27 6–9 26 Browning G Clinical Otology and Audiology London, England: Butterworths; 1986 27 Sellari-Franceschini S, Piragine F, Bruschini P, Berrettini S TORPS and PORPS: causes of failure Am J Otol 1987;8:551 2 28 Silverstein H, McDaniel AB, Lichtenstein R A comparison of PORP,... results of an airbone gap < 20 dB were noted in 54% of cases with an extrusion rate of 13% Tos and Lau31 evaluated autografts and homografts in children and found 58% had hearing results of an air-bone gap < 20 dB which remained stable Due to the lack of long-term use of middle-ear prostheses in children, autograft materials are primarily used to reconstruct the ossicular chain whenever possible. 32 The... Laryngoscope 1986;96:159–65 29 Sheehy JL Cholesteatoma surgery in children Am J Otol 1985;6:170 2 30 Kessler A, Potsic WP, Marsh RR Total and partial ossicular replacement prostheses in children Otolaryngol Head Neck Surg 1994;110:3 02 3 31 Tos M, Lau T Stability of tympanoplasty in children Otolaryngol Clin N Am 1989 ;22 :15 28 32 Bluestone CD, Stool SE, Kenna M Pediatric Otolaryngology 3rd ed Philadelphia:... Presence or absence of chronic suppurative otitis media and mastoiditis • Presence or absence of suppurative or nonsuppurative complications • Anatomy of the temporal bone and the middle-ear cleft • Status of eustachian tube function • Age and general health of the child • Findings of CT scans • Availability of postoperative follow-up care As stated above, the long-standing goals of cholesteatoma surgery... rate of recurrent and chronic middle-ear disease and poor eustachian tube function in the pediatric population Of the 199 procedures performed for acquired cholesteatoma (or cholesteatoma of uncertain etiology) at Children’s Hospital of Pittsburgh from 1973 to 1990, 28 % involved only a middle-ear procedure, 20 % were canal wall–up tympanomastoidectomies, 25 % were modified mastoidectomies, and 28 % were... tympani (Figure 5 21 ) • The posterosuperior portion of the canal wall scutum is removed with a curette to further visualize the cholesteatoma (Figure 5 22 ) Alternatively, a microdrill can be used • Cholesteatoma in the facial recess is removed, and visualization of the sinus tympani is enhanced with the aid of a 2. 7-mm 70˚ Hopkins rod-lens telescope (Hopkins-Karl Storz, Endoscopy-America Inc, Culver... quadrant of the intact tympanic membrane 108 Surgical Atlas of Pediatric Otolaryngology • The tympanomeatal flap is replaced (Figure 5–18) A defect, if present, is repaired using a medial fascia graft as described in Chapter 2 • If the endaural approach was used, the incision is closed with 2- 3 absorbable sutures Postoperative Care • The postoperative care is dependent on the approach used (see Chapter 2) ... evaluated short- and long-term outcomes of ossiculoplasty in children, the surgeon must have some guidelines for procedure timing A useful rule of thumb is that eustachian tube function may be considered adequate for ossiculoplasty when there has 88 Surgical Atlas of Pediatric Otolaryngology been no otitis media (in an ear with an intact tympanic membrane) for at least four consecutive seasons ( 12 months) . footplate is available. 78 Surgical Atlas of Pediatric Otolaryngology ADVANCEMENT FLAP Indications • Lateralized tympanic membrane following any method of tympanoplas- ty, but more often following the. B, The sculpted incus is inserted between the malleus and head of the stapes. A B 82 Surgical Atlas of Pediatric Otolaryngology PARTIAL OSSICULAR REPLACEMENT PROSTHESIS (PORP) Indications • Ossicular. Placement of a total ossicular replacement prosthesis (TORP). A, Surgeon’s view of TORP in place. B, Lateral view of the TORP positioned on the stapes footplate. B 84 Surgical Atlas of Pediatric Otolaryngology •