Auris Nasus Larynx

SPIO Award 2011

2012-08-01

A perspective from magnetic resonance imaging findings of the inner ear: Relationships among cerebrospinal, ocular and inner ear fluids

2012-08-01

Abstract: Visualization of endolymphatic hydrops has been performed using magnetic resonance imaging (MRI) after intratympanic or intravenous gadolinium (Gd) injection. Our recent findings indicate that just as the prevalence of asymptomatic glaucoma is greater than that of symptomatic glaucoma, there are also many cases of asymptomatic endolymphatic hydrops. It is assumed that the asymptomatic endolymphatic hydrops that precedes Ménière's disease is found more frequently using MRI than with other techniques. Gd in the inner ear moves into the cerebrospinal fluid (CSF) via the internal auditory meatus. Gd enhancement is also recognized in the ocular fluid after the intravenous Gd administration. In this paper, the relationships between CSF, ocular fluid and inner ear fluid are reviewed. The central nervous system, eye and inner ear contain specialized extracellular fluids that are essential for maintaining their function: CSF, ocular fluid consisting of vitreous humor and aqueous humor, and inner ear fluid consisting of perilymph and endolymph. Abnormal accumulation of or pressure elevation in these fluids is associated with hydrocephalus, glaucoma and Ménière's disease, respectively. The dura mater and the arachnoid membrane of the optic nerve canal and inner ear meatus are very close to the eye and the inner ear, respectively. It has been reported that low CSF pressure is associated with glaucoma and endolymphatic hydrops. In glaucoma and Ménière's disease, nerve damage to ganglion cells rather than damage of the sensory cells is directly associated with progression of the disease. Retinal ganglion cells in glaucoma and spiral ganglion cells in Ménière's disease are targets of the abnormal accumulation of, or increased pressure in, the extracellular fluid, just as neurons are damaged in hydrocephalus. Studies on hydrocephalus, glaucoma and Ménière's disease as a group may deepen our understanding of each disease.

Transient low-tone air-bone gaps during convalescence immediately after canal plugging surgery for BPPV

2012-08-01

Abstract: Objectives: The aim of the present study was to elucidate the time course and frequency patterns of transient low-tone air-bone gaps (ABGs) after canal plugging for intractable BPPV.Methods: We investigated eight patients with intractable BPPV who underwent canal plugging. Four were cases with posterior type (pBPPV) and the other four were those with horizontal type (hBPPV). Pure-tone audiometries (PTAs) were performed before and 7 days, 1 month and 6 months after surgery. ABGs (+) were defined as the three-tone-average ≥20dB formulated by (a+b+c)/3, where a, b, and c are ABGs at 0.25, 0.5, and 1kHz, respectively.Results: The ratio of the number of patients with ABGs (+) at the post-operative 7th day and 1st month was 100.0% (8/8). The ratio at the post-operative 6th month was 0.0% (0/8). There were no significant differences in the time course or frequency patterns of the ABGs between pBPPV and hBPPV.Conclusions: We clearly demonstrated eight cases with intractable BPPV showing transient low-tone ABGs during convalescence immediately after canal plugging. During that period, patients also complained of motion-evoked dizziness. All these findings suggest that, during such a convalescence period, the plugged area might not be fixed yet and could still induce the dizziness and low-tone ABGs, as enlarged vestibular aqueduct syndrome and superior semicircular canal deficiency syndrome exhibit low-tone ABGs due to the third mobile inner ear window. More than one month after surgery, both the ABGs and dizziness could disappear according to fixation of the plugged area.

The mRNA of claudins is expressed in the endolymphatic sac epithelia

2012-08-01

Abstract: Objective: Claudins are a family of membrane proteins which localize to tight junctions (TJs). Recent studies have shown that claudins can form pores for ions in the TJs and regulate the permeability of epithelial paracellular ion transport. The endolymphatic sac (ES) is a part of the inner ear, absorbing the endolymphatic fluid. ES dysfunction may result in endolymphatic hydrops. In this study, we focused on the paracellular transport and examined claudin mRNA expression in the ES epithelia.Materials and methods: Total RNA was isolated from whole ES epithelia of rats by laser capture microdissection. RT-PCR was used to evaluate the expression of claudins. The expression of each claudin mRNA in the epithelial cells of rat ES was confirmed by in situ hybridization.Results: RT-PCR indicated the expression of cldn2, cldn4, cldn6, cldn7, cldn9, cldn11, cldn12, and cldn14. The expression of these claudin mRNAs in the epithelial cells of rat ES was confirmed by in situ hybridization.Conclusion: We demonstrated mRNA expression of multiple claudins in the rat ES epithelia. These results in the ES epithelia were consistent with a role of claudins in paracellular ion transport.

Does hyperandrogenism have an effect on hearing loss in patients with polycystic ovary syndrome?

Fatih Oghan, Hakan Coksuer — 2012-08-01

Abstract: Objective: Polycystic ovary syndrome (PCOS) is an endocrinopathy characterized by chronic anovulation and hyperandrogenism. Hormonal changes can affect hearing loss and inner ear functions. We evaluated hearing loss with audiometric tests in young patients with PCOS.Methods: Twenty-six women having PCOS and 25 normal individuals were enrolled in the study. Age ranges for PCOS and control groups were 20–35 years. Hormonal and biochemical values including LH, LH/FSH, E2, testosterone, fasting glucose and fasting insulin were calculated. Each subject was tested with low- (250–2000Hz) and high-frequency audiometry (4000–8000Hz). For each set of tests, mean values of air conduction at each frequency were measured for the PCOS and control groups and compared.Results: No difference was observed in speech frequencies on audiologic tests between the groups, however high-frequency hearing loss were significantly higher (p<0.05) in PCOS patients than in control women. Also, hearing thresholds were normal range in all of frequencies in PCOS and control subjects. PCOS patients showed high levels of LH, LH/FSH, testosterone and fasting insulin.Conclusion: Our findings suggest that patients diagnosed with PCOS should be advised audiologic evaluation especially in the high frequency.

Frequency of Alloicoccus otitidis, Streptococcus pneumoniae, Moraxella catarrhalis and Haemophilus influenzae in children with otitis media with effusion (OME) in Iranian patients

2012-08-01

Abstract: Objective: To determine the presence of common bacterial agents of otitis media with effusion (OME), together with investigation these agent in the adenoid tissue and antimicrobial susceptibility pattern of isolated bacteria in Iranian children with OME.Methods: Polymerase chain reaction (PCR) and bacterial culture methods were used for detection and isolation of Alloicoccus otitidis, Streptococcus pneumoniae, Moraxella catarrhalis and Haemophilus influenzae in 63 middle ear fluid samples and 48 adenoid tissues from 48 OME patients. Fifteen patients were bilaterally affected. Antimicrobial susceptibility of all bacterial isolates were determined by disk agar diffusion (DAD) method.Results: Bacteria were isolated from 47% (n=30) of the middle ear fluid samples and 79% (n=38) of the adenoid tissue specimens in OME patients. A. otitidis was the most common bacterial isolated from the middle ear fluid 23.8% by culture and 36.5% by PCR method. S. pneumoniae was the most prevalent pathogen (35.5% and 31.2% by culture and PCR) in the adenoid tissues. In 10 patients the same organisms were isolated from the middle ear fluid and adenoid tissue. Antimicrobial susceptibility pattern showed taht most isolates of bacteria were sensitive to ampicillin, Amoxicillin/Clavulanate and fluoroquinolones.Conclusion: The present study, being the first report on the isolation of A. otitidis by culture method in Iran and Asian countries, shows that A. otitidis is the most frequently isolated bacterium in Iranian children having otitis media with effusion. In this study A. otitidis, S. pneumoniae, H. influenzae and M. catarrhalis are the major bacterial pathogens in patients with OME and we found that ampicillin and Amoxicillin/Clavulanate have the excellent activity against bacterial agents in Iranian children with OME.

Anti-microbial and therapeutic effects of modified Burow's solution on refractory otorrhea

2012-08-01

Abstract: Objective: Burow's solution, which contains 13% aluminum acetate, has been shown to be effective against chronic otitis media. Since the preparation of Burow's solution is time-consuming, its rapid preparation method has been recently developed. In this study, we evaluated the therapeutic effects of the modified Burow's solution on refractory otorrhea in patients with chronic suppurative otitis and its anti-microbial activity in vitro.Methods: Fourteen ears of 12 patients with chronic otitis media, granular myringitis, otitis externa and postoperative mastoid cavity problems were treated topically with cotton swab/ball soaked with modified Burow's solution or its four-fold diluted ear drops once a week. We then examined the antimicrobial spectrum of modified Burow's solution against clinical bacterial isolates from otorrhea and laboratory bacterial strains in vitro.Results: In all ears, refractory otorrhea disappeared after 1–17 weeks treatment of modified Burow's solution with a mean of 5.4 weeks without apparent side-effects such as ototoxicity. Modified Burow's solution inactivated all Gram positive bacteria within 5min except Enterococcus species, all Gram negative bacteria including Pseudomonas aeruginosa within 30s and Candida albicans within 2min. In addition, modified Burow's solution inactivated MRSA completely within 5min, while 80.6% of MRSA survived even a 20-min contact with 0.3% ofloxacin.Conclusion: These findings indicate that modified Burow's solution, in addition to bearing a broad antimicrobial activity, is as effective as the original Burow's solution in the treatment of chronic suppurative otitis.

Malignant paroxysmal positional vertigo

Alessandro De Stefano, Gautham Kulamarva, Francesco Dispenza — 2012-08-01

Abstract: Objective: An insidious percentage of paroxysmal positional vertigo appears to be intractable with canalith repositioning maneuver and also is not self-limiting. This type of positional vertigo is sustained by the action of intracranial tumors that mimics the clinical aspects of benign paroxysmal positional vertigo.Aim of this study is to clarify the features of these forms of positional vertigo, which we indicate as malignant paroxysmal positional vertigo.Methods: We retrospectively reviewed the clinical records of all the patients who presented with vertigo spells and were managed at our tertiary care referral centre over a three years period. Two hundred and eleven patients with diagnosis of positional paroxysmal vertigo were included in the final study.Results: Seven patients were affected by intracranial tumors causing a positional vertigo and were classified as malignant paroxysmal positional vertigo patients after radiological and histological diagnosis. These patients were affected by an internal auditory canal mass alone or with extension in the cerebello pontine angle that mimicked a benign positional vertigo.Conclusion: We can conclude that the clinician should keep in mind the differentiation between benign positional vertigo and malignant positional vertigo. When the patients with positional vertigo presents a strange behaviour of symptoms, nystagmus or response to the canalith repositioning maneuver a radiological investigation must be undertaken in every doubtful case.

Effect of the stapedotomy technique on early post-operative hearing results—Preliminary results

Tino Just, Ellen Guder, Hans Wilhelm Pau — 2012-08-01

Abstract: Objective: To compare three stapedotomy modalities used to fenestrate the stapes footplate in patients with primary otosclerosis.Materials: The non-randomized and unblinded one-center study included 48 patients with primary otosclerosis who underwent stapes surgery between May 2008 and April 2009. The patients were divided into three groups (single shot and two-shot CO2 laser stapedotomy, perforator) depending on the modality used for stapedotomy. Bone conduction (BC) and air conduction (AC) thresholds, air–bone gap (ABG), and the difference between mean pre-operative and 2- to 3-week post-operative BC thresholds were analyzed.Results: The temporary BC deterioration was most pronounced at 6 and 8kHz after 2-shot laser stapedotomy. A significant drop in AC or BC was not found in any of our 48 patients. Age, high-dose cortisone therapy, and ‘preoperative hearing’ did not influence the post-operative hearing results.Conclusion: Even though the number of patients presented here was small and statistical analysis was limited, the study showed a trend toward worse BC thresholds at 6 and 8kHz after a second shot CO2 application. Whenever possible, treatment should avoid a second laser shot on the already opened inner ear with the laser parameters used for the initial shot.

Heme oxygenase-1 expression in chronic rhinosinusitis with eosinophilic infiltration

2012-08-01

Abstract: Objectives: Chronic rhinosinusitis (CRS) with eosinophilic infiltration is a type of intractable rhinosinusitis often associated with asthma. The oxidants are well known to induce aggravate asthma. Heme oxygenase-1 (HO-1), a cytoprotective enzyme against oxidant, has been extensively studied in airway diseases. However, no study that observed HO-1 in both epithelial and subepithelial tissues of CRS has been reported.Methods: Part of each specimen derived from the nasal polyps of CRS with and without eosinophilic infiltration was promptly fixed for hematoxylin–eosin staining and immunohistochemical analysis for HO-1 and macrophages.Results: We found that the expression of HO-1 in the epithelial layers of CRS without eosinophilic infiltration was significantly enhanced as compared with that of CRS with eosinophilic infiltration. On the other hand, the number of macrophages with HO-1 positive reactions was significantly greater in CRS with eosinophilic infiltration compared with CRS without eosinophilic infiltration.Conclusions: Our study suggests that both a reduction of HO-1 expression in epithelial cells and an increase of infiltration of macrophages positive for HO-1 are related to the epithelial damage of CRS with eosinophilic infiltration.

Radiological analysis of the ethmoid roof in the Malaysian population

Sarmad Alazzawi, Rahmat Omar, Kartini Rahmat, Kasumawati Alli — 2012-08-01

Abstract: Objective: To ascertain the prevalence of the lateral lamella of the cribriform plate height according to Keros classification in the Malaysian population, and to find if there is any difference between the major ethnic groups in Malaysia (Malay, Chinese, Indian).Methods: Retrospective analysis of 150 CT scan studies of the paranasal sinuses.Results: The mean height of the lateral lamella of the cribriform plate (LLCP) in 300 sides was 2.64mm. Keros type I was seen in 240 sides (80%), while, Keros type II was seen in 60 sides (20%). There was no significant difference in the distribution of Keros classification among the major ethnic groups of Malaysia (Malay, Chinese, Indian). Keros type I was seen in 103 sides in males and 137 sides in females. Significant difference was observed in type II between the male and female (47 sides in males and 13 sides in female; p-value <0.001). When comparing the difference in the height of the LLCP in the same individual, asymmetry was observed in 139 patients. The LLCP height was higher on the left side in 71 patients and higher on the right in 68.Conclusion: The understanding of the anatomy of the ethmoid roof with its possible variation is crucial to give the surgeon the optimal information about the possible risk that one can face during the surgery.

Basaloid squamous cell carcinoma of the larynx—A systematic review

Krishnakumar Thankappan — 2012-08-01

Abstract: Objectives: This study pools all the cases of Basaloid squamous cell carcinoma of the larynx in the English literature to investigate the clinical course of this rare clinico-pathological disease entity.Methods: We found and analyzed 100 cases with individual patient data from 36 publications spanning 20 years.Results: It is a rare disease of the elderly with strong male predominance and more common in the supraglottis. Patients typically present with locoregionally advanced stage. Surgery alone or combined with radiotherapy is commonly reported. It has a worse survival outcome when compared to laryngeal cancers in general. Twenty-two percent eventually develop distant metastases with the lung being the predominant site.Conclusions: Given the rarity of this clinical condition and the lack of data from studies with adequate number of cases, this systematic literature analysis provides the best possible relevant evidence.

Treatment assessment based on computerized lymph node volume and ratio of necrotic area in tuberculous cervical lymphadenitis

Young-Hoon Joo, Se-Hwan Hwang, Jae-Hyun Seo, Jun-Myung Kang — 2012-08-01

Abstract: Objective: The objective of this study was to investigate the feasibility of computerized segmentation of lymph nodes to evaluate the relationship of treatment outcomes in tuberculous cervical lymphadenitis (TCL).Methods: The study included 52 subjects with TCL that had CT before standard medical treatment. The relationship between the medication treatment response, volume and ratio of necrotic area of the largest lymph node in patients with TCL was evaluated. The treatment outcome was defined as the ‘responder’ (n=35) and ‘non-responder’ (n=17) groups. Seventeen non-responder patients required surgery.Results: The average lymph node volumes and ratio of necrotic area were 58.59cm3 (range, 4.96–249.48cm3) and 0.30 (range, 0–0.59), respectively. There was a significant difference in the lymph node volumes (34.91±24.00cm3 vs. 107.04±69.12cm3, p<0.001) and ratio of necrotic area (0.26±0.12 vs. 0.40±0.14, p=0.001) between responders and non-responders. The receiver-operating-characteristic (ROC) curve analysis was used for differentiating responders from non-responders; it showed that the area under the curve for the lymph node volumes and ratio of necrotic area was 0.845 and 0.759, respectively. The cut-off value for the lymph node volumes and ratio of necrotic area was 44.15cm3 and 0.36 based on the ROC curve.Conclusions: A large lymph node volume and high ratio of necrotic area on the 3D reconstruction of CT images were associated with the response to medical treatment for TB. These findings might be useful for assessing treatment outcomes.

Comparing postoperative quality of life in children after microdebrider intracapsular tonsillotomy and tonsillectomy

2012-08-01

Abstract: Objective: To evaluate postoperative quality of life in patients undergoing microdebrider intracapsular tonsillotomy and adenoidectomy (PITA) in comparison with traditional adenotonsillectomy (AT) and to assess PITA's efficacy in solving upper-airway obstructive symptoms.Methods: 29 children with adenotonsillar hyperplasia referred for AT were included. Patients were divided into two groups: Group 1 (underwent PITA) included 14 children (age 5.1±1.8 years) affected by night-time airway obstruction without a relevant history of recurrent tonsillitis; Group 2 (underwent AT) included 15 children (age 5.2±1.7 years) with a history of upper-airway obstruction during sleep and recurrent acute tonsillitis. Outcomes measures included the number of administered pain medications, time before returning to a full diet, Obstructive Sleep Apnea survey (OSA-18), parent's postoperative pain measure questionnaire (PPPM) and Wong–Baker Faces Pain Rating Scale (WBFPRS).Results: Postoperative pain was significantly lower in the PITA group, as demonstrated by PPPM and WBFPRS scores and by a lower number of pain medications used. PITA group also resumed a regular diet earlier (P<0.001). OSA-18 scores proved that both PITA and AT were equally effective in curing upper-airway obstructive symptoms.Conclusion: PITA reduces post-tonsil ablation morbidity and can be a valid alternative to AT for treating upper-airway obstruction due to adenotonsillar hyperplasia.

Otologic complications caused by hearing aid mold impression material

Dong Hoon Lee, Hyong-Ho Cho — 2012-08-01

Abstract: We report two extremely rare cases of otologic complications caused by hearing aid mold impression material. The symptoms of patients with retained impression material are characteristic of the length of time the impression material is retained. In case 1 had a chronic discharge and granulation tissue of the middle ear, while case 2 presented with acute pain and dizziness. The management for retained impression material may require surgical interventions, which can be safely accomplished by standard otologic techniques.

Reversing the polarity of a cochlear implant magnet after magnetic resonance imaging

Ju Hyun Jeon, Mi Ran Bae, Jae Won Chang, Jae Young Choi — 2012-08-01

Abstract: The number of patients with cochlear implant (CI) has been rapidly increasing in recent years, and these patients show a growing need of examination by magnetic resonance imaging (MRI). However, the use of MRI on patients with CI is restricted by the internal magnet of the CI. Many studies have investigated the safety of performing 1.5T MRI on patients with CI, which is now being practiced in a clinical setting. We experienced a case in which the polarity of the cochlear implant magnet was reversed after the patient was examined using 1.5T MRI. The external device was attached to the internal device oppositely. We could not find displacement of the internal device, magnet, or electrode upon radiological evaluation. We came up with two possible mechanisms by which the polarity of the magnet reversed. The first possibility was that the magnetic field of MRI reversed the polarity of the magnet. The second was that the internal magnet was physically realigned while interacting with the MRI. We believe the second hypothesis to be more reliable. A removable magnet and a loose magnet boundary of a CI device may have allowed for physical reorientation of the internal magnet. Therefore, in order to avoid these complications, first, the internal magnet must not be aligned anti-parallel with the magnetic polarity of MRI. In the Siemens MRI, the vector of the magnetic field is downward, so implant site should be placed in facing upwards to minimize demagnetization. In the GE Medical Systems MRI, the vector of the magnetic field is upward, so the implant site should be placed facing downwards. Second, wearing of a commercial mold which is fixed to the internal device before performing MRI can be helpful. In addition, any removable internal magnets in a CI device should be removed before MRI, especially in the trunk. However, to ultimately solve this problem, the pocket of the internal magnet should be redesigned for safety.

Brown tumor mimicking maxillary sinus mucocele as the first manifestation of primary hyperparathyroidism

Liviu-Adelin Guldfred, Søren Daugaard, Christian von Buchwald — 2012-08-01

Abstract: We describe the first case of brown tumor mimicking a maxillary sinus mucocele as the first manifestation of the patient's primary hyperparathyroidism. A 34-year old woman presented with a 14 days history of elevation of the right orbit, retrobulbar pain and cheek anesthesia. The CT and MR evaluation showed a mass, initially described as mucocele of the right maxillary sinus. The laboratory studies revealed hyperparathyroidism. The patient underwent acute surgery, and the mass appeared clinically as mucocele. The histological examination of the resected lesion revealed changes representing either giant cell granuloma or brown tumor. The finding of hyperparathyroidism confirmed the diagnosis of brown tumor. To our knowledge, this is the first report of cystic brown tumor mimicking a mucocele of the maxillary sinus.

A huge chondromyxoid fibroma of the nasal cavity in a newborn baby

Young Tae Yoo, Joo Hyun Park, Woong Sang Sunwoo, Chae-Seo Rhee — 2012-08-01

Abstract: Chondromyxoid fibroma is a rare benign tumor that usually occurs in the long bones. A 2-month newborn presented with huge masses in the both nasal cavities, which turned out to be chondromyxoid fibroma. The masses originated from both inferior turbinates. Total turbinectomy on the left side and submucosal mass excision on the right side were performed. No recurrence or new lesion was observed during the 2 years of follow up. We report here on a rare case of nasal cavity chondromyxoid fibroma in a neonate and we review the relevant literature.

Sclerosing sweat duct carcinoma of the nose with multiple cervical lymph node metastasis

Mi-Jin Moon, Kyu-Sup Cho, Yoon-Se Lee, Su-Bong Nam — 2012-08-01

Abstract: Sclerosing sweat duct carcinoma (SSDC) in the nose, a rare occurrence with no specific symptoms, is frequently confused with rhinophyma or other inflammatory disease. In this report, we describe a 64-year-old woman who presented with a mass on her nasal dorsum for 1 year. Initially, the tumor had been misdiagnosed as a rhinophyma and followed-up for 1 year. She was referred due to a persistent nasal and neck mass. Deep incisional biopsy was performed to produce sufficient tissue and the histopathologic results showed SSDC. We performed wide local excision and reconstruction using radial forearm musculocutaneous free flaps with a costal cartilage framework followed by bilateral neck dissection. SSDC is seldom recognized and is frequently clinically confused with benign syringoma prior to pathologic diagnosis. Wide and deep incisional biopsy is necessary for the correct diagnosis and successful treatment of SSDC.

Surgical management of tongue cancer during pregnancy

2012-08-01

Abstract: There are ethical dilemmas in managing head and neck cancers during pregnancy. Diagnostic and treatment modalities need to be carefully determined. We herein describe 3 cases of tongue cancer during pregnancy. The details of the management would contribute to the daily practices for head and neck cancers.All three patients were Japanese female patients, two of them were 29 years old and one was 26 years old. All patients were admitted to the Nippon Medical School Hospital during pregnancy, complaining of oral pain and/or discomfort. Case 1 was diagnosed as tongue cancer stage T3N0M0, however, the tumor was superficial and controllable by partial glossectomy. Case 2 was stage T2N0M0 with deep invasion with ulcer, and the hemi-glossectomy with neck dissection and the reconstruction was thought to be the standard modality. However, she underwent partial glossectomy in order to reduce the stress of the fetus. Case 3 could not be diagnosed on admission by biopsy and she underwent partial glossectomy after delivery. In case 3, the pathological diagnosis was pT1 tongue cancer. In case 1 and case 3, the patient and baby were healthy. In case 2, however, the patient died of recurrence at the primary site.In decision making of the strategy, the most important factors are not only oncological evaluation but also ethical and emotional factors.

Intravestibular space occupying lesions of lipoma and schwannoma

Jeong-Seok Choi, Young Hyo Kim, Chang Dok Han, Kyu-Sung Kim — 2012-08-01

Abstract: Intravestibular lipoma (IVL) and intravestibular schwannoma (IVS) are rare tumors occupying the intravestibular space. Patients with IVL or IVS complain of hearing impairment, tinnitus or recurrent rotatory vertigo. Therefore, the clinical practitioner could misdiagnose them as sudden sensorineural hearing loss or Meniere's disease. Since delayed diagnosis and treatment could lead to more severe and refractory symptoms, clinicians should have a high index of suspicion for early diagnosis. Recent advancements in imaging diagnostic tools such as computed tomography and magnetic resonance imaging have facilitated the correct diagnosis of these intravestibular tumors without surgical removal. Presently, we report two different kinds of intravestibular tumors of lipoma and schwannoma which manifest different clinical course and treatment strategies.

Transoral robotic surgery for neurogenic tumors of the prestyloid parapharyngeal space

Hyoung Shin Lee, Jinna Kim, Hyun Jin Lee, Yoon Woo Koh, Eun Chang Choi — 2012-08-01

Abstract: The parapharyngeal space is a difficult area for a surgical approach due to anatomical complexity. We performed a minimally invasive and precise surgical technique to remove neurogenic tumors of the prestyloid parapharyngeal space using transoral robotic instrumentation. The mass was successfully removed in the two cases with three-dimensional visualization providing an excellent view of the resection margin and the dissection plane preserving the vital structures. An adequate resection margin was acquired, and no violation of the tumor capsule occurred. No significant complications were noted. Transoral robotic surgery was feasible for neurogenic tumors of the prestyloid parapharyngeal space, providing a sufficient resection margin and delicate dissection through excellent surgical views and instrumentation.