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Orphanet Journal of Rare Diseases Jul 2022Hearing loss (HL) has been sporadically described, but not well characterized, in Generalized Arterial Calcification of Infancy (GACI), a rare disease in which...
BACKGROUND AND IMPORTANCE
Hearing loss (HL) has been sporadically described, but not well characterized, in Generalized Arterial Calcification of Infancy (GACI), a rare disease in which pathological calcification typically presents in infancy.
OBJECTIVES
This study aims to describe the clinical audiologic and otologic features and potential etiology of hearing impairment in GACI and gain pathophysiological insight from a murine model of GACI.
DESIGN
Cross-sectional cohort study of individuals with GACI. Murine ossicle micromorphology of the ENPP1 mutant compared to wild-type.
SETTING
Clinical research hospital; basic science laboratory.
PARTICIPANTS
Nineteen individuals with GACI who met clinical, biochemical, and genetic criteria for diagnosis.
MAIN OUTCOMES AND MEASURES
Clinical, biochemical, and radiologic features associated with hearing status.
RESULTS
Pure-tone thresholds could be established in 15 (n = 30 ears) of the 19 patients who underwent audiological assessments. The prevalence of HL was 50% (15/30) of ears, with conductive HL in 80% and sensorineural HL in 20%. In terms of patients with HL (n = 8), seven patients had bilateral HL and one patient had unilateral HL. Degree of HL was mild to moderate for 87% of the 15 ears with hearing loss. Of those patients with sufficient pure-tone and middle ear function data, 80% (8/10) had audiometric configurations suggestive of ossicular chain dysfunction (OCD). Recurrent episodes of otitis media (ROM) requiring pressure-equalizing tube placement were common. In patients who underwent cranial CT, 54.5% (6/11) had auricular calcification. Quantitative backscattered electron imaging (qBEI) of murine ossicles supports an OCD component of auditory dysfunction in GACI, suggesting loss of ossicular osteocytes without initiation of bone remodeling.
CONCLUSIONS AND RELEVANCE
Hearing loss is common in GACI; it is most often conductive, and mild to moderate in severity. The etiology of HL is likely multifactorial, involving dysfunction of the ossicular chain and/or recurrent otitis media. Clinically, this study highlights the importance of early audiologic and otologic evaluation in persons with GACI. Novel findings of high rates of OCD and ROM may inform management, and in cases of unclear HL etiology, dedicated temporal bone imaging should be considered.
Topics: Animals; Cross-Sectional Studies; Hearing; Hearing Loss; Humans; Mice; Otitis Media; Vascular Calcification
PubMed: 35854274
DOI: 10.1186/s13023-022-02410-w -
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 -
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 -
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 -
The Cleft Palate-craniofacial Journal :... Sep 2023One of the most common complications of total auricular reconstruction is exposure of the ear framework. Various reconstruction methods have been reported depending on...
One of the most common complications of total auricular reconstruction is exposure of the ear framework. Various reconstruction methods have been reported depending on the location and size of exposed cartilage. This report describes a safe reconstruction method for each exposed part of the grafted ear framework. From January 2019 to August 2021, 2 cases (4 areas) of framework exposure were observed following autologous microtia reconstruction. The first case developed 2 small areas of skin necrosis on the anterior helix and lower antihelix to concha. The former was reconstructed with a temporal fascia flap and the latter with a local transposition flap. The second case also developed 2 small areas of skin necrosis on the posterior helix and lower antihelix to concha. The former was sutured directly and the latter with a local transposition flap. However, both wounds recurred due to flap necrosis and the cartilage was exposed again. The 3rd operation was performed by covering both wounds with a posterior auricular turnover flap and skin graft. In both cases, the exposed framework was completely covered with the flaps, and the reconstructed ears showed well-defined convolutions. Covering exposed cartilage with a local flap with a random pattern of blood circulation is convenient because no additional skin grafts are required. However, the blood circulation of the flaps is inadequate when an elongated flap is required; consequently, flap necrosis may occur. On the other hand, a temporal fascia flap and posterior auricular flap, which have axillary pattern blood circulation, are considered to be safer. We believe that it is safe to use a temporal fascia flap for cartilage exposure in the upper half of the auricle, and a posterior auricular turnover flap for the lower half.
Topics: Humans; Congenital Microtia; Surgical Flaps; Ear, External; Skin Transplantation; Postoperative Complications; Necrosis
PubMed: 35450440
DOI: 10.1177/10556656221095389 -
Folia Morphologica Nov 2023The anatomy of the posterior auricular artery (PAA) is highly variable and relevant in various plastic and reconstructive procedures.
BACKGROUND
The anatomy of the posterior auricular artery (PAA) is highly variable and relevant in various plastic and reconstructive procedures.
MATERIALS AND METHODS
The results of 55 consecutive patients who underwent head and neck computed tomography angiography (CTA) were analyzed. A total of 78 hemifaces were evaluated. The analysis has been performed in 19 categories.
RESULTS
Median PAA length was found to be 47.59 mm (LQ = 32.75; HQ = 56.16). The median PAA diameter (at its origin) was established at 2.55 mm (LQ = 2.29; HQ = 2.90). Moreover, the median PAA cross-sectional area (at its origin) was set to be 3.22 mm (LQ = 2.49; HQ = 4.13). Sexual dimorphism regarding all of the measured parameters was also evaluated. Statistically significant differences (p ≤ 0.05) were found in 13 of the measured categories.
CONCLUSIONS
The present study demonstrated the complete anatomy of the PAA. The most frequent origin of the said artery was from the ECA, and its mean length was 45.07 mm; which did not differ between males and females significantly (p>0.05). Moreover, we have provided surgeons with tools to localize this artery pre- and intraoperatively using simple landmarks, namely the apex of the mastoid process and the center of the external acoustic meatus. The exact position of the origin of the PAA was also demonstrated by a heat map of the auricular region. Our findings have the potential to assist surgeons in developing a mental visualization of the arterial anatomy of the retroauricular region. This visualization can be instrumental in precisely identifying the location of the PAA during reconstructive surgeries, thereby minimizing complications and enhancing surgical outcomes.
PubMed: 37957932
DOI: 10.5603/fm.96993 -
Renal Failure Nov 2019The aim of this study was to evaluate and compare the severity of acute kidney injury (AKI) induced by iodine contrast agent injection via the renal artery, ear vein,...
OBJECTIVES
The aim of this study was to evaluate and compare the severity of acute kidney injury (AKI) induced by iodine contrast agent injection via the renal artery, ear vein, and femoral artery in a rabbit model.
METHODS
Blood oxygenation level-dependent (BOLD) magnetic resonance (MR) scans were performed at 24 h prior to contrast injection and 1, 24, 48, and 72 h after injection. Iodixanol injection dose was 1.0, 1.5, 2.0, and 2.5 g iodine/kg, respectively. Hypoxia-inducible factor-1α (HIF-1α) expression was determined, and the BOLD-MRI parameter R2* was used to express tissue oxygenation. Increases in R2* levels reflect reductions in tissue oxygenation. Analyses including R2* value, dose response, histology, and HIF-1α were conducted.
RESULT
Injection of 1.0 g iodine/kg into the left renal artery resulted in significant increases in renal R2* values after 24 h. This was equivalent to the change of R2* after 2.0 g iodine/kg femoral artery injection. Renal injury scores and HIF-1α expression scores were significantly increased at 24 h. The R2* values exhibited a positive linear correlation with histological injury scores. The maximum effects occurred 24 h after iodixanol injection and returned to baseline levels within 72 h.
CONCLUSIONS
The renal injury induced by 1.0 g iodine/kg iodixanol through renal artery injection was more significant than that caused by the same dose of femoral artery and auricular vein injection, while similar to that caused by 2.0 g iodine/kg femoral artery injection.
Topics: Acute Kidney Injury; Animals; Contrast Media; Disease Models, Animal; Ear Auricle; Femoral Artery; Humans; Hypoxia-Inducible Factor 1, alpha Subunit; Injections, Intra-Arterial; Injections, Intravenous; Kidney; Magnetic Resonance Imaging; Male; Oxygen; Rabbits; Renal Artery; Severity of Illness Index; Triiodobenzoic Acids
PubMed: 31057054
DOI: 10.1080/0886022X.2019.1604382 -
Journal of Neuroendovascular Therapy 2022We treated a case of scalp arteriovenous malformation (sAVM) by transvenous embolization using Onyx.
OBJECTIVE
We treated a case of scalp arteriovenous malformation (sAVM) by transvenous embolization using Onyx.
CASE PRESENTATION
We describe the case of a 17-year-old woman with a pulsatile mass at the right temporal area. DSA identified sAVM with the venous pouch between the right occipital artery (OA) and the right two occipital veins (OVs), which was also fed by multiple branches of the right posterior auricular artery (PAA) and superficial temporal artery (STA). The shunts were completely occluded by the reverse pressure cooker technique (RPCT), which involves navigating the balloon catheters just distal to the shunt point in the OVs approaching from the right external jugular vein (EJV) and injecting Onyx to each feeder retrogradely with balloons inflated.
CONCLUSION
This technique may be useful for treating sAVM with venous angioarchitecture enabling a transvenous approach.
PubMed: 37502025
DOI: 10.5797/jnet.tn.2020-0175