Matthew L. Wong

Vascularized Hyoid Interposition for Subglottic and Upper Tracheal Stenosis

Chronic subglottic and upper tracheal stenosis can be treated successfully with lumenal augmentation using a vascularized hyoid-sternohyoid muscle interposition into the stenotic area. Successful decannulation was achieved in eight of nine patients. Follow-up periods varied from 6 months to 36 months. Concomitant laryngeal stenosis and vocal cord paralysis were treated successfully at the same time. The major complication was occasionally delayed but successful decannulation due to granulation tissue. Minimal wound and peritracheal stoma infections probably accounted for the granulation tissue.

Head and Neck Manifestations of Malignant Osteopetrosis

Malignant osteopetrosis is the autosomal recessive form of osteopetrosis. Besides anemia, hepatosplenomegaly, and the osteopetrotic bone seen on roentgenogram, the head and neck manifestations are important to the diagnosis and clinical course of this disease. Eye, ear, nose, face, teeth, mandible, maxilla, central nervous system structures, and cranial nerves are often involved.

Lipoma of internal auditory canal.

Lipoma of the internal auditory canal is a rare tumor. Clinically, it presents like an acoustic tumor. The diagnosis can be made with the use of a magnetic resonance imaging showing a high intensity on T1- and low intensity on T2-weighted image with no enhancement. Pathologically, this is a soft, smooth, yellow tumor with some fat in it that can resemble grossly any acoustic tumor. The lipoma is intermixed with the eighth nerve and can be adherent to adjacent structures. The growth of a lipoma can be slower than an acoustic tumor. A patient diagnosed with lipoma of the internal auditory canal can often have quite good hearing. As an alternative to surgical removal, another therapeutic option is to watch the growth of the lipoma with periodic magnetic resonance imaging, probably on a yearly basis initially.

Virtues and vagaries of high-resolution CT air cisternography in the diagnosis of acoustic neuromas.

A series of 125 consecutive, bilateral, high-resolution, computerized tomographic (CT) air cisternograms was prospectively reviewed and analyzed. Emphasis was placed on identifying problems encountered in performing the study and potential sources of error in interpretation. In two patients there was difficulty in transporting the air bolus because spinal cord tumors coexisted with bilateral acoustic neuromas. Potential false-positive results were avoided in four patients by persistent efforts to fill the internal auditory canal. Later reexaminations were recommended for four patients whose examinations were suspicious or suggestive of tiny acoustic neuromas. Unilateral Mondini malformation was incidentally diagnosed in one patient. Six patients required therapy for persistent headache after lumbar puncture. High-resolution CT air cisternography is believed to be the method of choice for investigating the nonenhancing or small acoustic neuroma. However, this method is not without potential problems, some of which are discussed.

Chapter 10 – Imaging of the Postoperative Middle Ear, Mastoid, and Internal Auditory Canal

Interpretation of CT or MR imaging examinations performed on patients with a history of middle ear, mastoid, or neurotologic surgery can be challenging. This is greatly simplified by knowing the surgical procedures used. Knowledge of the expected normal versus abnormal postoperative appearance is the key to recognizing complications or recurrent disease. This chapter initially discusses the surgical approaches to the middle ear and mastoid (transcanal, retroauricular, endaural) and the procedures facilitated by these (meatoplasty, canaloplasty, myringoplasty, tympanoplasty, ossiculoplasty, stapedectomy, mastoidectomy). Imaging findings indicative of recurrent disease are then discussed to include MR imaging for the detection of cholesteatoma. The chapter concludes with a discussion of surgical approaches to the internal auditory canal and otic capsule (retrosigmoid, middle cranial fossa, translabyrinthine, transmastoid) for the management of tumors and superior semicircular canal dehiscence.