Cholesterol Granuloma Petrous Apex Revision

Contributors: Ravi N. Samy, M.D., F.A.C.S (University of Cincinnati / CCHMC) and  Shawn Stevens, M.D.

Cholesterol granuloma recurrence at the petrous apex.   The patient had a prior surgery performed without stenting. Revision surgery at UC performed with double-barrel stent placement.

External Related Links: www.cisurgeon.org    www.youtube.com/user/cisurgeon

DOI: http://dx.doi.org/10.17797/vvmrb6t77g

Editor Recruited By: Ravi N. Samy, MD, FACS

Transcanal Endoscopic Infracochlear Approach for a Petrous Apex Cholesterol Granuloma

This video demonstrates a transcanal endoscopic infracochlear approach to the petrous apex in a patient with a large cholesterol granuloma. The patient presented with a history of profound left sensorineural hearing loss, hemifacial spasm, and House Brackmann Grade 2 facial function. Preoperative imaging demonstrated a T1 and T2 hyperintense heterogenous lesion in both petrous apices with the left being larger than the right on magentic resonance imaging. A computed tomography scan (CT) of the temporal bones demonstrates extension of the left petrous apex lesion into the internal auditory canal and cochlea.

Dr. Isaacson has had 2 patients who have had significant recovery of their bone line after using an infracochlear approach. In the unlikely event that the patient experiences hearing loss in the other ear, their cochlea is preserved for a possible CI. However, the patients hearing loss is likely secondary to the 8th nerve involvement of cholesterol granuloma erosion into IAC.

The patient in this surgical video has been monitored for a year. One year postop CT shows aeration of the apex. This patient’s facial spasm has resolved. Dr. Isaacson has used stents in the past, but in this case felt the opening was large enough that he could forego it. Patient did not recover their hearing.

DOI: http://dx.doi.org/10.17797/1wq11j68wa

Translabyrinthine Approach for Vestibular Schwannoma (Acoustic Neuroma) Resection

Contributors: Bruce E. Mickey and  J. Walter Kutz

This video highlights key steps to the translabyrinthine approach for vestibular schwannoma resection. It emphases identification of the facial nerve and the benefit of facial nerve monitoring in lateral skull base surgery.

DOI#: https://doi.org/10.17797/4w83z6uxam

Mandibular Distraction for Micrognathia in a Neonate

Introduction

Patients with Pierre-Robin Sequence (PRS) suffer from micrognathia, glossoptosis, and upper airway obstruction, which is sometimes associated with cleft palate and feeding issues.  To overcome these symptoms in our full-term male neonate patient with PRS, mandibular distraction osteogenesis was performed.

Methods

The patient was intubated after airway endoscopy.  A submandibular incision was carried down to the mandible. A distractor was modified to fit the osteotomy site that we marked, and its pin was pulled through an infrauricular incision.   Screws secured the plates and the osteotomy was performed.  The mandible was distracted 1.8 mm daily for twelve days.

Results

During distraction, the patient worked with speech therapy.  Eventually, he adequately fed orally.  He showed no further glossoptosis or obstruction after distraction was completed.

Conclusion

In our experience, mandibular distraction is a successful way to avoid a surgical airway and promote oral feeding in children with PRS and obstructive symptoms.

By: Ravi W Sun, BE

Surgeons:

Megan M Gaffey, MD

Adam B Johnson, MD, PhD

Larry D Hartzell, MD

Department of Otolaryngology – Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
Arkansas Children’s Hospital, Little Rock, AR, USA

Recruited by: Gresham T Richter, MD

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