Extracranial carotid aneurysm resection
Sachinder Singh Hans, Alexander D Shepard, Mitchell R Weaver, Paul G Bove, Graham W Long in Endovascular and Open Vascular Reconstruction, 2017
The goal of surgical treatment is to remove the aneurysm and restore vessel continuity. Aneurysm resection can be challenging depending on size, inflammation, and location. In addition, the contents are vulnerable to embolization and must be removed completely. There are several operative techniques, all of which involve the standard oblique surgical incision and can extend from the sternal notch to the mastoid process. The internal jugular vein (IJV) and its branches are mobilized. Identification and protection of the vagus, hypoglossal, and glossopharyngeal nerves are necessary. Division of the posterior belly of the digastric muscle can assist in mobilization of the ICA near the skull base. The fragile branches of the IJV anterior to the ICA must be ligated for additional exposure. Other maneuvers to assist in dissection of the distal ICA include mandibular subluxation. Nasotracheal intubation is essential for this technique. Further exposure and control can be obtained by dividing the stylohyoid ligament and removing the styloid process. This higher mobilization requires dividing the styloglossus, stylopharyngeus, and stylohyoid muscles and avoiding injuring the glossopharyngeal nerve. Manipulation of the ICA at this level should be limited to prevent nerve injury.
Injuries in Children
Ian Greaves, Keith Porter, Jeff Garner in Trauma Care Manual, 2021
A meticulous examination of the injured child’s head is required, looking specifically for evidence of bruising, wounds, lacerations, abrasions and boggy swellings, as well as areas of tenderness that may indicate underlying fractures. Any lacerations should be carefully examined (but not probed) in order to exclude a depressed fracture. Signs of basal skull fractures should be excluded by checking for periorbital bruising, haemotympanum, bruising over the mastoid process and cerebrospinal fluid and blood leakage from the nasopharynx and ears. In infants, the tension of the anterior fontanelle should be assessed. The fundi should be examined in all children with head injury, especially in the setting of NAI, and specific findings are pathognomonic in the shaken baby syndrome. If suspected, this examination must be performed by an ophthalmologist as bilateral retinal haemorrhages strongly suggest NAI. If the child is under 5 years old, the modified version of the GCS should be used. Assessment of cranial nerves, peripheral nerves, motor function, posture and pupils may be possible only by observation alone, especially in the very young. The examination of the child’s head circumference as a baseline measurement is important, especially in infants.
Introduction to the clinical stations
Sukhpreet Singh Dubb in Core Surgical Training Interviews, 2020
A 9-year-old female presents to A/E after having a witnessed fall from a climbing frame at school, approximately 2 metres from the ground. She is fully conscious and stood up immediately, running to her mother after the fall but admits she may have been unconscious for a few seconds. Although teary the patient allows you to examine her head, you palpate a diffuse swelling over the right temporal bone and see a bruise situated over the right mastoid process. I had a bad habit of escalating too early to a senior in surgery. It's obviously important not to be gung-ho and act rashly, arrogantly or unsafely. However, there are important actions and interventions that you can do that help the patient, or make the seniors’ job more easy. After more revision and practice, I was able to formulate better management plans before handing over to a senior.
The value of ABR- and ASSR-based hearing estimation in young children with congenital monaural malformation (atresia)
Published in Acta Oto-Laryngologica, 2019
Xiangyu Zhang, Qin Sun, Long Sai, Huiqian Yu
The ABR thresholds were recorded under anaesthetized status (0.05 g/kg chloral hydrate, po.) in a double-walled sound-treated room. The hearing threshold was assessed with the use of the Bio-logic AEP evoked potential system to broadband click stimuli. The three electrodes (non-inverting, inverting, and grounding electrodes) were placed at the high forehead, ipsilateral mastoid process, and contralateral mastoid, respectively. The presence of the ABR waveform was identified as a replicable, visually detectable wave V. And the reproducibility was verified by two consecutive runs at least. Click stimuli were conveyed to each ear through a headphone with the stimulation rate of 10.13/s, and responses to 1024 click stimuli were averaged for each run. The presenting peak latency (PL) of wave I, III, V and wave interpeak latency (IPL) of I–III, III–V, I–V were identified at an initial intensity of 95 dB nHL.
The advantages of vestibular-evoked myogenic potentials induced by bone-conducted vibration in patients with otitis media
Published in Acta Oto-Laryngologica, 2022
Ying Cheng, Qing Zhang, Yuzhong Zhang, Zichen Chen, Weijun Ma, Min Xu
Clinical characteristics and parameters of a typical case with otitis media. (A) Endoscopic images showing evidence of otitis media (perforation of the tympanic membrane) in the left ear but not the right. Audiography revealed conductive deafness in the left ear, compared with the right ear. Left temporal bone computed tomography indicated granulation of the mastoid process, tympanic chamber, and tympanic sinus. (B) ACV-VEMPs could not be induced, while BCV-VEMPs were induced in both ears. The waveform was typical, and the repeatability was good. TM: tympanic membrane; PTA Left: average hearing threshold in the left ear; PTA Right: average hearing threshold in the right ear; ACS Left: air-conducted sound stimulation of the left ear; BCV Left: bone-conducted vibration stimulation of the left ear; BCV Right: bone-conducted vibration stimulation of the right ear.
Expression of endoplasmic reticulum stress mRNAs in otitis media
Published in Acta Oto-Laryngologica, 2021
Su Young Jung, Ki Jin Kwon, Hye Kyu Min, Dae Woong Kang, Dong Choon Park, Young Il Kim, Jeewon Ryu, Seung Geun Yeo
This study included 113 patients who underwent surgery in the otolaryngology department at our hospital from January 2014 to May 2019. OME was diagnosed by the presence of an amber-colored or opaque tympanic membrane or by an air-bubble or air-fluid level on the tympanic membrane, as determined by otoscopic or endoscopic examination, and by the presence on impedance audiometry of a B or C type tympanogram. Surgery was performed on patients who received medical treatment for 1 ∼ 2 weeks and showed no improvement after a 2 ∼ 3 month follow-up period; on patients who showed progressive retraction of the eardrum; and on those who experienced progressive hearing loss, as shown by an increase in pure tone threshold over 40 dB. Surgery was also performed when the parents or guardians of patients requested surgery. Patients with COM and CholeOM had otologic symptoms such as hearing loss, otorrhea, tinnitus, otalgia, or dizziness for longer than 3 months, and a lesion on the middle ear and mastoid process was identified on temporal bone computed tomography (TBCT). COM and CholeOM were differentiated by the results of a biopsy of inflammatory tissue in the middle ear during surgery. COM was diagnosed when a biopsy showed chronic inflammation or granulation tissue, and CholeOM when a biopsy showed cholesteatoma.