Paul R. Lambert

Hearing results after primary cartilage tympanoplasty.

Objectives/Hypothesis Cartilage–perichondrium grafting of the tympanic membrane has been used in an effort to reduce recurrence or progression of middle ear disease. The rigidity of cartilage has obvious benefit in preventing tympanic membrane retraction, but concern has been raised regarding its sound conduction properties. Few studies in the literature address hearing results after cartilage tympanoplasty. The purpose of this study was to investigate the hearing results after primary cartilage tympanoplasty and compare them with results after primary tympanoplasty with temporalis fascia.

The canalith repositioning procedure for benign positional vertigo: A meta-analysis

Objective: To review the effectiveness of the canalith repositioning procedure (CRP) in the treatment of benign paroxysmal positional vertigo (BPPV) with a critical review of the literature and meta‐analysis.

Oral Mucoceles: A Clinicopathologic Review of 1,824 Cases, Including Unusual Variants

PURPOSE To review the clinicopathologic features of oral mucoceles, with special consideration given to unusual variants and exclusion of salivary duct cysts. MATERIALS AND METHODS This was a retrospective consecutive case review of all oral mucoceles diagnosed by the Medical University of South Carolina, Oral Pathology Biopsy Laboratory, from 1997 to 2006. The following data were recorded: patient demographics, clinical features (anatomic location, color, size, and consistency), clinical impression, history of trauma, history of periodic rupture, and occurrence of unusual mucocele variants. RESULTS During the study period, 1,824 oral mucoceles were diagnosed. Of these cases, 1,715 represented histopathologically confirmed cases that were not recurrences. There was no significant gender predilection, and the average age was 24.9 years. The most common locations were the lower labial mucosa (81.9%), floor of mouth (5.8%), ventral tongue (5.0%), and buccal mucosa (4.8%); infrequent sites included the palate (1.3%) and retromolar area (0.5%). The lesions most often were described as blue/purple/gray or normal in color. The mean maximum diameter was 0.8 cm (range, 0.1 to 4.0 cm). In 456 cases, a history of trauma was reported, and in 366 cases a history of periodic rupture was reported. Unusual variants included superficial mucoceles (n = 3), mucoceles with myxoglobulosis (n = 6), and mucoceles with papillary synovial metaplasialike change (n = 2). CONCLUSIONS Our results confirm the findings of previous investigators regarding the major clinicopathologic features of oral mucoceles. Special variants of oral mucoceles occur infrequently, although it is important to recognize these variants to avoid misdiagnosis.

Major Congenital Ear Malformations: Surgical Management and Results

Fifteen patients with major congenital aural atresia underwent operations using an anterior (trans-atretic bone) approach. Facial nerve monitoring was used in all cases and there were no instances of facial nerve injury. Postoperatively, two thirds of the patients had speech reception thresholds of 30 dB or better; the air conduction threshold (averaged for 500, 1,000, and 2,000 Hz) improved at least 25 dB in 80% of the patients and at least 30 dB in 60% of the patients (follow-up, 10 to 29 months). Minor revision surgery was necessary in three patients. On the basis of this series, several conclusions were made. First, one of the most important factors in proper patient selection is the degree of middle ear development on computed tomography, both in terms of size and ossicular formation. Second, every attempt should be made to keep the ossicular chain intact (versus use of a prosthesis), as this appears to optimize hearing results. Third, embryologic considerations and surgical experience predict a mobile stapes in the majority of major atresias. Lastly, facial nerve abnormalities are to be expected, especially in patients with significant microtia, but facial nerve monitoring will help minimize the risk of facial nerve injury.

Titanium versus Nontitanium Prostheses in Ossiculoplasty

Objectives/Hypothesis: To compare the hearing outcomes and complications observed using either titanium or nontitanium prostheses in a 7‐year consecutive series of ossiculoplasties performed by a single surgeon.

Oral and maxillofacial surgeons treating oral cancer: a preliminary report from the American Association of Oral and Maxillofacial Surgeons Task Force on Oral Cancer.

p d l h l p i r ral cancer (ie, cancer of the lip, tongue, floor of the outh, palate, gingiva, alveolar mucosa, buccal muosa, or oropharynx) accounts for approximately 2% f all cancers diagnosed annually in the United tates. In 2006, approximately 30,990 diagnoses f oral cancer were made and 7,430 persons died of he disease. Roughly 50% of the patients diagnosed ith oral cancer will die in the next 5 years. wenty-five percent will die of a second primary ancer, and 25% will die of comorbid conditions or nrelated illnesses. Approximately 90% of oral

Novel Radiographic Measurement Algorithm Demonstrating a Link between Obesity and Lateral Skull Base Attenuation

Objectives (1) To describe a validated algorithm for measuring tegmen thickness on computed tomography scans. (2) To compare the tegmen thickness in 3 groups: patients with spontaneous cerebrospinal fluid (CSF) leaks, obese controls, and nonobese controls. Study Design Retrospective review. Setting Patients with spontaneous CSF otorrhea often have highly attenuated tegmen plates. This is associated with obesity and/or idiopathic intracranial hypertension (IIH). No evidence exists, however, that objectively links obesity and/or IIH with skull base attenuation. Subjects and Methods This was a retrospective review from 2004 to the present. Patients with spontaneous CSF otorrhea and matched obese (body mass index [BMI] >30 kg/m2) and nonobese (BMI <30 kg/m2) controls were selected. Tegmen thickness was measured radiographically. Interrater validity was assessed. Results Ninety-eight patients were measured: 37 in the CSF group (BMI, 36.6 kg/m2), 30 in the obese group (BMI, 34.6 kg/m2), and 31 in the nonobese group (BMI, 24.2 kg/m2). The CSF group had a significantly thinner tegmen compared to both the obese control (P < .01) and nonobese control (P = .0004) groups. Obese controls had a thinner tegmen than nonobese controls (P < .00001). A significant inverse correlation was detected between skull base thickness and BMI. Signs/symptoms of IIH were most commonly found in the CSF group. Good to very good strength of agreement was detected for measures between raters. Conclusion This is the first study to (1) quantify lateral skull base thickness and (2) significantly correlate obesity with lateral skull base attenuation. Patients who are obese with spontaneous CSF leaks have greater attenuation of their skull base than matched obese controls. This finding supports theories that an additional process, possibly congenital, has a pathoetiological role in skull base dehiscence.

Middle ear dimensions in congenital aural atresia and hearing outcomes after atresiaplasty

Objective: To determine if middle ear dimensions in congenital aural atresia (CAA) patients can predict early postoperative audiometric outcomes in order to establish specific parameters that facilitate stratification of surgical candidates. Study Design: Retrospective case review. Setting: Tertiary referral center. Patients: Twenty-five patients with CAA (28 atretic ears and 22 nonatretic ears) and 12 controls (24 ears). Intervention: Primary repair of congenital aural atresia. Main Outcome Measures: Measure and compare middle ear dimensions in controls, atretic ears, and nonatretic ears in unilateral CAA. Determine correlations between the dimensions and best speech reception threshold during the first postoperative year (SRT-1). Results: The epitympanic depth, medial canal diameter, and the mesotympanic height, area, and estimated volume measurements in atretic ears differ significantly with those in control ears. The mesotympanic length, area, and estimated volume measurements each correlate significantly with SRT-1. Atretic ears with a mesotympanic volume estimate measurement greater than or equal to 42 mm3 are 24 times more likely to have an SRT-1 of 25 dB or better than those measuring less than 42 mm3 (odds ratio = 24.5; 95% confidence interval, 2.826-212.4; Fishers exact test, p = 0.0022). Conclusion: Middle ear measurements in appropriately selected patients may help predict successful early hearing outcomes after atresiaplasty, thus offering a valuable tool for the surgical decision-making process.

Association between Lateral Skull Base Thickness and Surgical Outcomes in Spontaneous CSF Otorrhea

Objectives (1) Correlate skull base thickness with perioperative outcomes for spontaneous cerebrospinal fluid (CSF) otorrhea. (2) Augment perioperative counseling of patients with abnormally thin skull bases. Study Design Case series with chart review. Setting Tertiary center. Patients with spontaneous CSF otorrhea have thin skull bases. This is associated with obesity and/or idiopathic intracranial hypertension. The influence of skull base thinning on perioperative outcomes is unknown. Subjects and Methods A retrospective review was conducted from 2004 to 2014. Forty-eight cases of spontaneous CSF otorrhea met the inclusion criteria of primary surgery by the senior authors: preoperative dedicated temporal bone computed tomography, absence of other leak etiologies, and follow-up >6 months. Patients were stratified into thin (<0.9 mm) and thick (>0.9 mm) groups based on computed tomography measures of their tegmen. Primary outcomes measures were as follows: postoperative meningitis, recurrent leak, second site leak (contralateral ear/anterior fossa), and permanent shunt placement. Hearing outcomes were not assessed in this study. Results Thirty and 15 patients composed the thin and thick groups, respectively. Both the incidence (P < .0001) and the rate (P = .005) of adverse outcomes were significantly higher in the thin group. Only 2 patients in the thick group experienced an adverse outcome. Eleven patients underwent multiple procedures for spontaneous leaks. The recurrence rate was 14.5%. All but 1 recurrence occurred in the thin group. Conclusions An abnormally thin tegmen was significantly associated with adverse perioperative outcomes in cases of spontaneous CSF otorrhea. A thick skull base and the presence of an encephalocele may be protective against recurrence. The effect of untreated intracranial hypertension on the results is unknown.

Bilateral inverted papilloma of the middle ear with intracranial involvement and malignant transformation: First reported case

Inverted (Schneiderian) papilloma (IP) is a benign but locally aggressive tumor that is typically located in the sinonasal tract. Middle ear involvement and intracranial extension are rare. We present a patient with a history of a completely resected right nasal cavity IP that returned 7 months later with hearing loss, bilateral aural fullness, and right‐sided facial weakness. Work‐up revealed middle ear IP, and the patient underwent bilateral mastoidectomies. On both sides, the disease caused erosion of the tegmen and was adherent to the underlying dura. There was dehiscence of the carotid canal wall on the left. On the right, the tumor was discovered to have recurred 3 months after initial resection, resulting in complete facial nerve paralysis and trigeminal paresthesias. A right temporal bone resection was undertaken along with neurosurgery. The IP was discovered to have invaded through the dura of the temporal lobe, incase the internal carotid artery, and infiltrate the trigeminal nerve. The facial and vestibulocochlear nerves were sacrificed on the right. Pathology of the right temporal bone revealed malignant transformation to squamous carcinoma. The patient was referred to radiation oncology for postoperative therapy. To our knowledge, this is the first case of bilateral IP of the middle ear with intracranial involvement and malignant transformation. Discussion points include: 1) management of middle ear IP, 2) carotid canal wall dehiscence in erosive middle ear disease, 3) aggressive surgical excision in locally destructive middle ear tumors, and 4) the role of radiation therapy in malignant transformation of IP.