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Acta Otorhinolaryngologica Italica :... Aug 2022
Topics: Ear Auricle; Humans; Perforator Flap; Plastic Surgery Procedures
PubMed: 36254656
DOI: 10.14639/0392-100X-N2036 -
The Journal of Craniofacial SurgeryDespite good surgical knowledge of the anatomy of parotid gland and meticulous surgical technique, the incidence of facial palsy in parotid surgeries is up to 26.7%...
INTRODUCTION
Despite good surgical knowledge of the anatomy of parotid gland and meticulous surgical technique, the incidence of facial palsy in parotid surgeries is up to 26.7% transient and 1.7% complete facial palsy(1). The risk of facial palsy increases further in malignant and revision cases.
METHOD
Superficial parotidectomy was done in 14 cadaveric hemi faces in 10 cadavers. Posterior auricular artery and its stylomastoid branch was dissected and facial nerve trunk was identified in all cases. The relationship of posterior auricular artery along with its stylomastoid branch with the facial nerve trunk was studied and recorded.
RESULT
Posterior auricular artery was found running inferior to the facial nerve trunk in 12 cadaveric dissection while the posterior auricular artery was found crossing below the main trunk of facial in 2 cadaver dissection. The average distance between PAA and facial nerve trunk was 7 mm (2-14 mm) Stylomastoid artery was found arising from Posterior auricular artery in 12 of 14 and it was found running medial to the facial nerve trunk in all the 8 cadavers.
CONCLUSION
Post auricular artery can be used as another landmark for identification of the main trunk of facial nerve in parotid surgeries.
Topics: Arteries; Cadaver; Facial Nerve; Feasibility Studies; Humans; Parotid Gland
PubMed: 33086304
DOI: 10.1097/SCS.0000000000007222 -
The Journal of Cardiovascular Surgery Feb 2023Data from literature confirmed the non-trivial risk associated with carotid revascularization. The purpose of this study is to evaluate carotid endarterectomy (CEA) via... (Observational Study)
Observational Study
BACKGROUND
Data from literature confirmed the non-trivial risk associated with carotid revascularization. The purpose of this study is to evaluate carotid endarterectomy (CEA) via a mini-invasive access (3-6 cm longitudinal) incision as a viable alternative to the traditional access via a cutaneous incision (˃6 cm) in terms of nerve sparing and neck pain/disability for patients.
METHODS
We performed a prospective, observational, cohort study on 796 consecutive patients who underwent CEAs. A number of 730 patients was included in the final analysis. Patients entered in two different cohorts: CEA with 3-6 cm incision was performed in N.=398 (Group A); CEA with>6 cm incision was performed in N.=398 (Group B). Entire data set is available from 382 in group A and 348 in group B. Adverse events were recorded at 30 days, 3 and 6 months after surgery. The primary purpose of this study was to identify the incidence of cranial nerve injuries and related pain (by Northwick Park Neck Pain Questionnaire [NPq]) in both groups. Differences between groups were exploratory, only, and considered significative for P≤0.05. Secondary objectives were: death, major and minor stroke, transient ischemic attack (TIA), myocardial infarction (MI) and main duration of operation.
RESULTS
The cumulative incidence of transient deficit of peripheral nerve in group A was 1.7% at 30 days and 19.4% in group B (RR: 0.10, 95% CI 0.07-0.1, P=0.0001) suggesting a possible benefit from mini-skin incision on nerve injuries reduction. Cranial nerve permanent injuries were identified in 0.17% of mini-incision group and 0.23% of standard group. Exploratory comparison did not demonstrate significative differences between the groups (RR: 0.72, 95% CI 0.19-2.71, P=0.63). The median NPq postoperative score was 40% in GROUP A and 79% in GROUP B (exploratory difference 39%, 95% CI 32.22-45.20%, P=0.0001, χ: 114.007). At 6 months, NPq was 20% and 42%, respectively; exploratory differences were still present. The need to prolong the mini-incision in GROUP A to preserve the surgical outcome was 1.3%, only.
CONCLUSIONS
According to these results the mini skin incision allows a sufficient vessels exposure for dissection, endarterectomy, reconstruction of carotid artery and shunt positioning, minimizing surgical invasiveness, decreasing the incidence of temporary cervical nerve dysfunction and improving the aesthetic result with significative less pain suffered by the patients. Transverse cervical and great auricular nerves sparing decreased postoperative hypo-paresthesia in the neck, improving patient's satisfaction. These data suggest that this procedure can be considered safe. Exploratory analysis suggested that it could possibly be considered a safety alternative to standard carotid endarterectomy. A randomized controlled trial is ongoing for definitive conclusions.
Topics: Humans; Endarterectomy, Carotid; Carotid Stenosis; Neck Pain; Prospective Studies; Cohort Studies; Stroke; Treatment Outcome; Retrospective Studies; Risk Factors
PubMed: 36449023
DOI: 10.23736/S0021-9509.22.12532-2 -
Brazilian Journal of Otorhinolaryngology 2017Auricular Arteriovenous Malformation of the external ear is a rarely encountered disease; in particular, arteriovenous malformation arising from the auricle, with... (Review)
Review
INTRODUCTION
Auricular Arteriovenous Malformation of the external ear is a rarely encountered disease; in particular, arteriovenous malformation arising from the auricle, with spontaneous bleeding, has seldom been reported.
OBJECTIVE
In the current study, we report an unusual case of late-onset auricular arteriovenous malformation originating from the posterior auricular artery that was confirmed by computed tomographic angiography. The case was successfully managed by pre-surgical intravascular embolization followed by total lesion excision. Prompted by this case, we also present a scoping review of the literature.
METHODS
A case of a 60 year-old man with right auricular arteriovenous malformation treated in our tertiary care center, and 52 patients with auricular arteriovenous malformation described in 10 case reports and a retrospective review are presented. Auricular arteriovenous malformation can manifest as swelling of the ear, pulsatile tinnitus, pain, and/or bleeding. On physical examination, a pulsatile swelling and/or a tender mass is evident. When arteriovenous malformation is suspected, the lesions should be visualized using imaging modalities that optimally detect vascular lesions, and managed via embolization, mass excision, or auricular resection. Effectiveness of the various diagnostic methods used and the treatment outcomes were analyzed.
RESULTS
Various imaging modalities including Doppler sonography, computed tomographic angiography, magnetic resonance angiography, and/or transfemoral cerebral angiography were used to diagnose 38 cases reported in the literature. In another 15 cases, no imaging was performed; treatment was determined solely by physical examination and auscultation. Of the total of 53 cases, 12 were not treated (their symptoms were merely observed) whereas 20 underwent therapeutic embolization. In total, 32 patients, including 1 patient who was not treated and 10 with persistent or aggravated arteriovenous malformation after previous embolization, underwent mass excision or auricular resection depending on the extent of the lesion. No major postoperative complication was recorded. The postoperative follow-up duration varied from 1 month to 19 years, and only one case of unresectable, residual cervicofacial arteriovenous malformation was recorded.
CONCLUSION
Auricular arteriovenous malformation is a rarely encountered disease, but should be suspected if a patient presents with a swollen ear and pulsatile tinnitus. Appropriate imaging is essential for diagnosis and evaluation of the extent of disease. As embolization affords only relatively poor control, total surgical removal of the vascular mass is recommended.
Topics: Arteriovenous Malformations; Computed Tomography Angiography; Diagnosis, Differential; Ear Auricle; Embolization, Therapeutic; Humans; Male; Middle Aged; Retrospective Studies; Treatment Outcome
PubMed: 28277225
DOI: 10.1016/j.bjorl.2016.09.004 -
Wiener Klinische Wochenschrift Mar 2022Frank's sign (FS) was described in 1973 as an auricular marker for cardiovascular disease presenting as a crease of the auricular lobule. Since its first clinical... (Review)
Review
Frank's sign (FS) was described in 1973 as an auricular marker for cardiovascular disease presenting as a crease of the auricular lobule. Since its first clinical description, there have been multiple studies underlining the role of FS in a myriad of conditions, such as atherosclerosis, hypertension, cerebrovascular disease, peripheral artery disease, metabolic diseases as well as studies looking at physiological differences in the auricular shape that may mimic FS; however, a complex study to comprehensively analyze the clinical, gross, and histological findings of patients with FS has not yet been performed. Most studies focused on a specific system, mechanism of disease entry. This short review tries to summarize the current knowledge of FS in relation to diseases as well as its clinical classification, histology, and association with the recently described paired ear creases of the helix, as an attempt to reveal the dubious role of FS as a possible prognostic and predictive marker.
Topics: Atherosclerosis; Cardiovascular Diseases; Ear, External; Humans; Morbidity; Prognosis
PubMed: 34817665
DOI: 10.1007/s00508-021-01969-x -
Evidence-based Complementary and... 2022To investigate the effect of multimodal analgesia combined with auricular point therapy on physical and mental stress and rehabilitation quality of patients with...
Effects of Multimodal Analgesia Combined with Auricular Point Therapy on Physical and Mental Stress and Rehabilitation Quality of Patients with Meniscus Injury during the Perioperative Period.
OBJECTIVE
To investigate the effect of multimodal analgesia combined with auricular point therapy on physical and mental stress and rehabilitation quality of patients with meniscus injury during the perioperative period.
METHODS
148 patients in our hospital from October 2019 to October 2021 who were scheduled to undergo meniscus surgery were selected and grouped according to the order of file establishment, with 74 cases in each. The control group was given routine analgesia, and the observation group was given multimodal analgesia combined with auricular point therapy. The pain level (visual analogue scale (VAS)), physical and mental stress (heart rate (HR), mean arterial pressure (MAP), depression scale (PHQ-9), and anxiety scale (GAD-7)), complications, rehabilitation quality, and analgesia satisfaction were observed.
RESULTS
The VAS scores of pain in the observation group were lower than those in the control group at 6 hours before operation and at 6 hours, 24 hours, and 72 hours after operation ( < 0.05). The MAP, HR, PHQ-9, and GAD-7 scores of the observation group were lower than those of the control group 6 hours before operation ( < 0.05). There was no significant difference in MAP, HR, PHQ-9, and GAD-7 scores between the two groups at 6 hours and 24 hours after operation ( > 0.05). The analgesic satisfaction of the observation group was better than that of the control group ( < 0.05). The incidence of complications in the observation group was 8.11% compared with 12.16% in the control group, which was not statistically significant ( > 0.05). The first exhaust, getting out of bed, and hospital stay in the observation group were shorter than those in the control group ( < 0.05).
CONCLUSION
Multimodal analgesia combined with auricular acupuncture therapy is effective in perioperative patients with meniscus injury. It can reduce perioperative pain, reduce physical and mental stress, and promote early postoperative recovery through a variety of analgesic mechanisms.
PubMed: 36034956
DOI: 10.1155/2022/3130956 -
Microsurgery Sep 2017There is a limited availability of suitable microvascular free flap options for the reconstruction of small to medium-sized facial and intraoral defects. The purpose of...
BACKGROUND
There is a limited availability of suitable microvascular free flap options for the reconstruction of small to medium-sized facial and intraoral defects. The purpose of this report is to present a new free temporal artery based posterior auricular skin (TAPAS) flap in facial and intraoral reconstruction.
PATIENTS AND METHODS
Four patients were deemed suitable for TAPAS flap reconstruction and consisted of two males and two females with a mean age of 43 years (range 22-66). Defect aetiology and location comprised of post-traumatic lower eyelid scarring, late lower lip scarring post tumour resection, and floor of mouth and tongue defects following tumour resection. The dimensions of the resultant defects ranged from 25 × 50 mm (smallest) to 40 × 70 mm (largest). All patients underwent microvascular reconstruction using a free fasciocutaneous TAPAS flap raised from the retroauricular region based on the superficial temporal vessels.
RESULTS
The maximal pedicle length was 60 mm and the maximum flap size measured 40 mm by 70 mm. The latter patient required skin grafting of the postauricular donor site. Postoperatively, there was one case of mild transient venous congestion that spontaneously resolved after 2 days and one case of minor partial flap dehiscence that required re-suturing. Follow-up time ranged from 6 to 14 months. Overall, all flaps survived with good aesthetic and functional outcome.
CONCLUSION
The TAPAS flap is a small flap with exceptional qualities and may be a useful addition to the armamentarium of free flaps in facial and oral reconstructions. © 2016 Wiley Periodicals, Inc. Microsurgery 37:525-530, 2017.
Topics: Adult; Aged; Facial Injuries; Female; Follow-Up Studies; Free Tissue Flaps; Graft Survival; Head and Neck Neoplasms; Humans; Male; Microsurgery; Middle Aged; Quality of Life; Plastic Surgery Procedures; Risk Assessment; Sampling Studies; Skin Transplantation; Temporal Arteries; Wound Healing; Young Adult
PubMed: 27159873
DOI: 10.1002/micr.30069 -
Acta Neurochirurgica Apr 2020Skull base paragangliomas are highly vascular tumors that are often embolized before surgical resection; however, the safety and efficacy of preoperative embolization...
BACKGROUND
Skull base paragangliomas are highly vascular tumors that are often embolized before surgical resection; however, the safety and efficacy of preoperative embolization using an ethylene vinyl alcohol copolymer (Onyx; Medtronic, Dublin, Republic of Ireland) in these tumors is unknown. This retrospective cohort study evaluated patient outcomes after preoperative embolization of skull base paragangliomas using Onyx.
METHODS
We retrospectively analyzed data from all patients with skull base paragangliomas who underwent preoperative Onyx embolization at our institution (January 01, 2005-December 31, 2017). Patient, tumor, embolization, and outcomes data were extracted by reviewing inpatient and outpatient clinical and imaging records.
RESULTS
Seven patients were studied (5/7 [71%] female), 6 with glomus jugulares and 1 with a glomus vagale. The median age was 52 years, and the most common presenting symptom was cranial neuropathy (6/7 [86%]). The tumor vascular supply was from the ascending pharyngeal artery in all 7 cases (100%) with additional feeders including the occipital artery in 5 (71%); internal carotid artery in 3 (43%); middle meningeal, vertebral, and internal maxillary artery each in 2 (29%); and posterior auricular artery in 1 (14%). The median postembolization tumor devascularization was 80% (range, 64-95%). The only postembolization complication was a facial palsy in 1 patient.
CONCLUSION
Preoperative embolization with Onyx affords excellent devascularization for the majority of skull base paragangliomas, and it may facilitate resection of these hypervascular lesions. The advantages provided by Onyx with respect to penetration of intratumoral vessels must be weighed against the risk of cranial neuropathy.
Topics: Child; Cranial Nerve Diseases; Embolization, Therapeutic; Female; Humans; Male; Middle Aged; Paraganglioma; Polyvinyls; Retrospective Studies; Skull Base Neoplasms; Treatment Outcome; Young Adult
PubMed: 31919599
DOI: 10.1007/s00701-019-04127-5 -
Annals of Plastic Surgery Mar 2019The superficial temporal artery (STA) flap is a versatile flap for head and neck defect reconstruction. It can be based on the frontal branch of the STA and an islanded... (Review)
Review
The superficial temporal artery (STA) flap is a versatile flap for head and neck defect reconstruction. It can be based on the frontal branch of the STA and an islanded 360-degree rotation arc for various defects on the scalp, cheek, and auricular region. It provides a nonmicrosurgical option for reconstructing such defects, which is itself relatively easy to perform. However, venous congestion is a problem than often can cause worry to the clinician and hence preclude its use. In this review, we revisit this flap in head and neck reconstruction, with case examples used for reconstruction of defects on the scalp, maxilla, lip, ear, and retroauricular area. The STA flap in our review can be used either as a fasciocutaneous flap or with its fascia alone. The main issue with the STA flap is that it is generally a high-inflow flap with variable outflow. Venous congestion is frequently encountered in our practice, and adequate management of the venous drainage in the postoperative period is crucial in ensuring its success as a versatile and viable option for head and neck reconstruction.
Topics: Aged; Female; Follow-Up Studies; Graft Rejection; Graft Survival; Head and Neck Neoplasms; Humans; Male; Middle Aged; Neck Dissection; Quality of Life; Plastic Surgery Procedures; Surgical Flaps; Temporal Arteries; Treatment Outcome; Wound Healing
PubMed: 30211739
DOI: 10.1097/SAP.0000000000001602 -
Plastic and Reconstructive Surgery.... Dec 2016The retroauricular tissues have been used for a long time for ear reconstruction, but the anatomical bases of flaps of this region are not completely clear. The aim of...
BACKGROUND
The retroauricular tissues have been used for a long time for ear reconstruction, but the anatomical bases of flaps of this region are not completely clear. The aim of this study was to estimate blood supply area and location of this on the skin and fascia retroauricular dependent of posterior auricular artery (PAA) to establish safe margins to design flaps for auricular reconstruction.
METHODS
Dissection under magnification (×3.5) of the PAA through a cervical approach; injection of methylmethacrylate in the PAA as a staining technique; retroauricular approach to identify the territory of irrigation of PAA in the retroauricular skin and fascia; measuring and location of the stained area; and report of 2 cases of ear reconstruction with fasciocutaneous and fascia flaps based on PAA, designed according to the anatomical study.
RESULTS
In a sample of 10 cadaveric specimens, the PAA irrigated an area of the retroauricular skin and fascia of 10.7 cm length × 7.07 cm wide equivalent to 60.44 cm (95% CI, 37.07-83.81), with a distribution posterior to external auditory canal of 7.15 cm (95% CI, 5.53-8.77) and posterior to the helix insertion of 6.12 cm (95% CI, 4.89-7.35). In the 2 patients treated with fascia and fasciocutaneous flaps based on the PAA, these were good options for ear reconstruction.
CONCLUSION
A fascia or fasciocutaneous flap from the retroauricular region based on PAA within the dimensions and location found in this study will be a safe option for reconstruction of the ear.
PubMed: 28293515
DOI: 10.1097/GOX.0000000000001165