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Cartilage tympanoplasty: Indications, techniques, and outcomes in A 1,000-patient series

THE LARYNGOSCOPE, Issue 11 2003
John Dornhoffer MD
Abstract Objectives/Hypothesis: The purpose of this study was to analyze the anatomical and audiologic results in more than 1,000 cartilage tympanoplasties that utilized a logical application of several techniques for the management of the difficult ear (cholesteatoma, recurrent perforation, atelectasis). Our hypothesis was that pathology and status of the ossicular chain should dictate the technique used to achieve optimal outcome. Study Design: Retrospective clinical study of patients undergoing cartilage tympanoplasty between July 1994 and July 2001. A computerized otologic database and patient charts were used to obtain the necessary data. Methods: A modification of the perichondrium/cartilage island flap was utilized for tympanic membrane reconstruction in cases of the atelectatic ear, for high-risk perforation in the presence of an intact ossicular chain, and in association with ossiculoplasty when the malleus was absent. A modification of the palisade technique was utilized for TM reconstruction in cases of cholesteatoma and in association with ossiculoplasty when the malleus was present. Hearing results were reported using a four-frequency (500, 1,000, 2,000, 3,000 Hz) pure-tone average air-bone gap (PTA-ABG). The Student t test was used for statistical comparison. Postoperative complications were recorded. Results: During the study period, cartilage was used for TM reconstruction in more than 1,000 patients, of which 712 had sufficient data available for inclusion. Of these, 636 were available for outcomes analysis. In 220 cholesteatoma cases, the average pre- and postoperative PTA-ABGs were 26.5 ± 12.6 dB and 14.6 ± 8.8 dB, respectively (P < .05). Recurrence was seen in 8 cases (3.6%), conductive HL requiring revision in 4 (1.8%), perforation in 3 (1.4%), and postand intraoperative tube insertion in 11 (5.0%) and 18 ears (8.2%), respectively. In 215 cases of high-risk perforation, the average pre- and postoperative PTA-ABGs were 21.7 ± 13.5 dB and 11.9 ± 9.3 dB, respectively (P < .05). Complications included recurrent perforation in 9 ears (4.2%), conductive HL requiring revision in 4 (1.9%), postoperative and intraoperative tube insertion in 4 (1.9%) and 6 ears (2.8%), respectively. In 98 cases of atelectasis, the average pre- and postoperative PTA-ABGs were 20.2 ± 10.9 dB and 14.2 ± 10.2 dB, respectively (P < .05). Complications included 1 perforation (1.0%), conductive loss requiring revision in 2 cases (2.0%), and post- and intraoperative tube insertion in 7 (7.1%) and 12 ears (12%), respectively. In 103 cases to improve hearing (audiologic), the average pre- and postoperative PTA-ABGs were 33.6 ± 9.6 dB and 14.6 ± 10.1 dB, respectively (P < .05). Complications included 1 perforation (1.0%), conductive loss requiring revision in 11 (11%), and post- and intraoperative tube insertion in 6 (5.8%) and 2 (1.9%), respectively. Conclusions: Cartilage tympanoplasty achieves good anatomical and audiologic results when pathology and status of the ossicular chain dictate the technique utilized. Significant hearing improvement was realized in each pathological group. In the atelectatic ear, cartilage allowed us to reconstruct the TM with good anatomic results compared to traditional reconstructions, which have shown high rates of retraction and failure. In cholesteatoma, cartilage tympanoplasty using the palisade technique resulted in precise reconstruction of the TM and helped reduce recurrence. In cases of high-risk perforation, reconstruction with cartilage yielded anatomical and functional results that compared favorably to primary tympanoplasty using traditional techniques. We believe the indications for cartilage tympanoplasty (atelectatic ear, cholesteatoma, high-risk perforation) were validated by these results. [source]

Twenty years of experience with Krzeski's cystovaginoplasty for vaginal agenesis in Mayer-Rokitansky-Küster,Hauser syndrome: anatomical, histological, cytological and functional results

BJU INTERNATIONAL, Issue 11 2008
Andrzej Borkowski
OBJECTIVE To evaluate the long-term anatomical results using the original method of vaginal reconstruction with a pedicled bladder flap (Krzeski's cystovaginoplasty, CVP) in women with Mayer-Rokitansky-Küster,Hauser syndrome (MRKHS) and the evaluation of radiological, histological, cytohormonal and functional results of CVP. PATIENTS AND METHODS Between 1981 and 2000, 38 patients (mean age 22.5 years, range 18,40) with MRKHS underwent CVP. A physical examination was used to evaluate the anatomical results, 27 patients had vaginography, and biopsies of the neovaginal wall and cytohormonal smears were taken in two. Functional sexual and urinary results, and opinions on CVP, were evaluated by an inventory mailed to 37 patients in 2000. RESULTS The anatomical result was good in 37 patients during a mean (range) follow-up of 9 (0.25,19) years; the result was good in 30 patients, but seven developed vaginal stenosis that was successfully repaired. There were two cases of post-coital vesicovaginal fistula (VVF) at 18 months after CVP. Vaginal biopsies showed epithelialization of the posterior vaginal wall and gradual metaplastic changes from urothelium to stratified nonsquamous epithelium. Cytological smears showed a normal biphasic pattern and neovaginal susceptibility to hormonal milieu. In all, 27 patients (73%) responded to the questionnaire. All had sexual partners and started sexual intercourse at a mean of 14 months after CVP; 89% experience orgasms and in 48% the vagina was the source; 40% sometimes used lubricants and seven (26%) used vaginal dilators. Lower urinary tract symptoms (LUTS) after CVP were reported by 19 (66%) of the women and in six the LUTS were persistent. One patient was not satisfied with the functional and anatomical result of CVP, 89% declared that it improved sexual life, 93% would undergo CVP again and in 92% the quality of their sexual life was improved. All patients, when asked, stated that they would recommend CVP to another patient with MRKHS. CONCLUSIONS Vaginal reconstruction by CVP is characterized by good anatomical and functional results, sustained by long-term observation. The resultant epithelium is very similar to that of the native vagina in histology and function. All vaginas are functional and the level of patient satisfaction was high. The level of complications was acceptable, but in some patients LUTS can persist. [source]

Anatomical and functional outcome in brilliant blue G assisted chromovitrectomy

ACTA OPHTHALMOLOGICA, Issue 5 2010
Paul B. Henrich
Abstract. Purpose:, To evaluate the potential of brilliant blue G (BBG) for intraoperative staining of the inner limiting membrane (ILM) with respect to staining properties and surgical outcome. Methods:, In a retrospective, non-comparative clinical case series, we analysed 17 consecutive chromovitrectomy interventions for surgery of macular holes, ERMs, vitreoretinal traction syndromes and cystoid macular oedema. Following complete posterior vitreous detachment, BBG was injected into the vitreous cavity at a concentration of 0.25 mg/ml, followed by immediate washout. Main outcome measures were staining properties, visual acuity, central visual field testing and optical coherence tomography (OCT) measurements over a mean follow-up period of 3 months. Results:, ILM staining was somewhat less intensive for BBG than for average indocyanine green (ICG) chromovitrectomy. However, the ILM was removed successfully without additional ICG in 15/17 patients. Postoperative visual acuity was improved in 16/17 patients and remained unchanged in one patient. Central retinal OCT thickness showed a postoperative reduction, with values ranging from +7 to ,295 ,m (median ,89 ,m). Neither visual field defects nor any other adverse events were recorded. Conclusion:, BBG permits sufficient staining for safe ILM removal. In this short-term study, good anatomical and functional results were achieved and no adverse events were observed. [source]

The first keratoprosthesis implantation 1n 1955

ACTA OPHTHALMOLOGICA, Issue 2009
MF DE LA PAZ
Purpose to describe the Barcelona experience with the different types of keratoprosthesis for end-stage cicatricial corneal disease. Methods We present 6 cases showing various types of keratoprosthesis which we have used at the Barraquer Eye Center from the 1950´s up to the present. Results We describe the first keratoprosthesis ever implanted in Spain, on a case of severe chemical burn on a young lady. We implanted a Dorzee acrylic keratoprosthesis in 1955. 5 years later she had extrusion of the prosthesis and superior retinal detachment. The second case describes the Dorzee-Barraquer-Cardona acrylic implant implanted in 1958 on a patient with end-stage glaucoma. Patient had good anatomical retention until his death in 1970. The third case describes the use of the Cardona keratoprosthesis in 1960. Patient had good anatomical and functional results for 8 years until suffering from an acute endophthalmitis. The fourth case demonstrates the expulsion of a Teflon-supported keratoprosthesis designed by Girard. The fifth case describes the first implantation of an osteo-odontokeratoprosthesis designed by Strampelli on a blast injury showing good results for 10 years. The last case shows our experience on the Boston keratoprosthesis which we started using in 2006. Finally, we present our technique of the osteo-odontokeratoprosthesis and a summary of our clinical results from 1970´s to the present. Conclusion Our clinical experience for more than 50 years on the use of keratoprosthesis shows that while the surgical technique, design and post-operative treatment of both biological and non-biological keratoprosthesis have improved thru the years, the anatomical and functional success remains a challenge for the KPro surgeon. [source]