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Query: UMLS:C0262471 (ENT)
 5,307 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Osseointegration describes direct contact between titanium and vital bone. The Branemark System uses this principle for bone anchorage of hearing aids and craniofacial prostheses. The experience made in the ENT Department of the University Hospital in Homburg/Germany with this procedure in the last 4 years is described. During this period, 40 patients have been operated and 119 titanium fixtures have been implanted. 30 patients got bone anchored prostheses (ear, nose or orbit) and 25 patients received bone anchored hearing aids. The large group of 15 patients with congenital ear malformation presented both indications. 100 out of 119 implants i.e. 84% caused no major problems. The most frequent complications were granulations (10 implants i.e., 8.4%). More severe problems as non-integration of three pillars or rejection of one pillar were rare. Our experience for 4 years in an important number of patients was very positive in the majority of cases and allows us to consider the bone anchorage of hearing aids and craniofacial prostheses as a major advance in craniofacial rehabilitation and audiology.
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PMID:[Bone-anchored epitheses and audioprostheses: 4 years' experience with the Branemark system in Germany]. 134 68

The purpose of this study was to compare hearing and understanding with a bone conduction hearing aid of a new type and with conventional models. The new instrument, BAHA (bone anchored hearing aid) is connected with the skull percutaneously rather than transcutaneously as with the conventional instruments. In the ENT department of Nijmegen University Hospital the understanding of speech with both types of hearing aid was evaluated thoroughly. The patients had a middle-ear loss with in addition an inner-ear loss of 60 dBHL at most. A conventional air conduction hearing aid (behind or inside the ear) was unsuitable for them because of, for instance, chronic runny ears or anomalies of the auditory meatus. A conventional bone conduction hearing aid containing a transducer pressing on the skin was rejected because of poor understanding or serious side effects such as headache and pressure pains. At the first session a titanium screw was implanted in the skull behind the ear. The percutaneous superstructure was put into place a few months later at a second session. In none of the patients were there peroperative problems or postoperative infections of any importance. Understanding of speech in silence and in noise was evaluated with the BAHA and with the conventional aid. Differences in understanding of speech were regarded as significant if they amounted to more than twice the known intra-individual standard deviation. As to understanding of speech in silence, 7 of the 15 patients were found to understand significantly better with the BAHA than with a conventional aid. In the other patients no difference was found.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A hearing aid anchored in the cranial bone for amplification of bone conduction]. 202 52

During the period February 1989-September 1991, 15 patients with absent or defective pinna were treated with a bone-anchored auricular prosthesis at the ENT-department, Rigshospitalet, Copenhagen. These patients were followed up from the hospital records and by means of a questionnaire. Altogether 40 titanium implants have been inserted, of which one implant was found not to be integrated at the time of the second-stage surgery. Five patients underwent additional surgery, one patient because of non-integration of a screw, and four patients on account of soft-tissue reactions. From the questionnaire replies it appears that all patients found the cosmetic result and the technique concerning mounting of the prosthesis very satisfactory. Nearly half the patients found that the care of the skin around the abutments caused considerable problems. Three patients had experienced unintended losses of the prosthesis. In conclusion, treatment with a bone anchored auricular prosthesis has considerable advantages compared to treatment with a prosthesis attached by adhesive. Furthermore the use of a bone-anchored prosthesis should be considered a viable alternative to surgical reconstruction because of the outstanding aesthetic result and because the surgical procedure puts less strain on the patient. The disadvantage of the method is the lifelong daily care of the skin and the dependence on the health services.
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PMID:[Bone-anchored auricular prosthesis]. 798 74

The case is described of mucocele of the right frontoethmoidal sinus with bilateral maxillary sinusitis and a large polyp in the right nasal cavity. The mucocele had determined erosion of the anterior and posterior walls of the frontal sinus and superomedial wall of the orbit. The patient was operated upon by a surgical team comprising ENT and maxillofacial specialists. Right maxillary sinusotomy (Caldwell-Luc procedure) was performed, and an osteoplastic flap was prepared, repositioned in the canine fossa and fixed with a titanium plate. Debris was removed from the left osteomeatal complex during endoscopy. To reach the mucocele, an external surgical approach was used, through a bitemporal coronal cutaneous incision, according to Unterberger. This approach was used in order to gain better access to the area of the lesion and in order to make reconstruction easier, with a view to achieving good functional results without untoward scarring. The scalp was detached down to the root of the nose to allow optimal visualisation of the anterior area of erosion determined by the mucocele, and, after excision and removal of the latter from the bony walls, of the posterior bony breach and underlying dura mater. Another bony breach involved the medial and superior walls of the orbit. The nasofrontal canal was obliterated with bone fragments and Tissucol; the posterior breach, with Surgical and Tissucol. The orbit wall was repaired with high-density porous polyethylene sheeting; the frontal sinus was filled with fat. The anterior wall of the frontal sinus was repaired with two split of calvarial bone grafts harvested from the parietal bone and fixed with a titanium microplate. The morphological outcome of reconstruction was satisfactory, with no recurrences, as confirmed at post-operative follow-up, including computed tomography scan, at 5 months. Ocular motility and patency of the tear drainage system were also normal. No diplopia, or inflammation occurred.
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PMID:Voluminous frontoethmoidal mucocele with epidural involvement. Surgical treatment by coronal approach. 1467 12

The RetroX is a new semi-implantable hearing aid which does not occlude the external ear canal. It consists of an electronic unit that plugs into a titanium tube which is implanted under the pinna so as to connect the retroauricular sulcus with the inside lumen of the external ear canal. Implantation requires minor surgery which can be performed under local anesthesia. Moreover, a pre-implant simulator exists and allows patients to try the device before deciding on definite implantation. The RetroX auditory implant is indicated in case of high-frequency sensorineural hearing loss with a steep slope (ski-slope audiogram). We implanted 25 adults suffering from such a hearing loss, and we report their hearing measured after 2.5 to 15 months of use. Four patients developed a persistent granulomatous reaction which disappeared after explantation. Two patients complained of acoustic feedback and needed supplementary fitting. Twenty three of our 25 subjects are satisfied or even extremely satisfied with the hearing improvement provided by the RetroX; they wear the implant daily, from morning until evening. Audiometrically, we observed a statistically significant improvement of the pure-tone thresholds at 1, 2, 4 and 8 kHz. In quiet, the speech reception thresholds decreased by 10 dB SPL and in noise, speech intelligibility increased by 15% for signal-to-noise ratios between -5 dB and +5 dB. Up till now, our patients were implanted monaurally because of financial considerations and our initial inexperience with this new implant. The overall results, however, are promising and nowadays, we advise bilateral implantation for patients who tolerate the first implant. By doing so, we hope to improve hearing in noise and spatial sound perception.
B-ENT 2005
PMID:Rehabilitation of high-frequency hearing loss with the RetroX auditory implant. 1599 71

Endoscopic forehead lifting is a widely accepted treatment for brow ptosis. The procedure safely and effectively corrects horizontal forehead rhytids, brow ptosis, upper eyelid dermatochalasis and periorbital crow's feet. The result is a refreshed and more open facial expression. A thorough understanding of basic facial anatomy is the key to successful cosmetic surgery. The procedure is based on a subperiostal and preperiosteal mobilisation of the temporal and frontal soft tissues and a detachment of the periosteum of the orbital rim. An upper eyelid blepharoplasty and selective incomplete or complete myotomies of the corrugator and procerus muscles may be incorporated in the operation. Most surgeons prefer to fixate the elevated soft tissue planes to the calvarium by sutures, titanium or resorbabale polyglactid anchors. While initial enthusiasm for this procedure seems to be declining in several countries, few ENT-surgeons are familiar with this technique in Europe. This article reviews the surgical anatomy of the forehead and temporoparietal region by means of cadaver dissection and describes the surgical procedure for German speaking readers.
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PMID:[Endoscopic forehead lifting: surgical anatomy and technique]. 1729 46

This study designs and evaluates a mechatronic system to assist ENT surgery, taking as an example a navigation controlled shaver as used in paranasal sinus surgery. The on/off status of the shaver is regulated automatically, depending on the current position of the shaver tip. The working space for the navigation controlled shaver is planned preoperatively as a three-dimensional model and is based on the individual patient's CT data. Within this area the shaver reacts to signals from the surgeon. If the tip of the shaver moves outside the predefined working space, the shaver's automatic drive control is interrupted by an electrical pulse. The planning software was evaluated using CT data sets from 32 patients. The accuracy of the registration was analysed on an anatomical model with the aid of 451 measurements on titanium screws attached endonasally, whilst the implementation of the working space was evaluated on 5 technical models. The average time taken for segmenting the working space was found to be 4.23 minutes. The average accuracy of the shaver registration was 1.08 mm. The selected cavity was to be resected without any restrictions. The preoperatively determined working space was implemented with a mean deviation of 3.1 mm over all levels. The study proves the feasibility of a mechatronic assistance system taking as an example the navigation controlled shaver used in paranasal sinus surgery. In contrast to isolated CAS solutions, this conceptual approach provides for the redundancy of the surgeon and eases their cognitive burden. We can foresee numerous applications in ENT surgery of the future following the principle presented here, in the control systems of power tools such as cutters, high frequency scalpels and lasers.
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PMID:Navigated control in functional endoscopic sinus surgery. 1751 88

Over the past decade, surgical navigation systems have found widespread use in ENT-surgery. Navigational accuracy highly depends on the registration process. The objective of this study was to assess the accuracy in the paranasal sinuses and lateral skull base after surface laser registration using the navigation system VectorVisionCompact (BrainLab, Heimstetten, Germany). Repeated measurements were performed on two cadaver heads. Sixteen titanium screw fiducials per head were placed in facial bones, the paranasal sinuses and the lateral skull base, thereby serving as exactly identifiable measurement points. The respective influence on measurement accuracy depending on the localization and conformation of the registration area was evaluated by performing symmetrically bilateral as well as strictly unilateral registrations. The resulting overall accuracy for a symmetrically bilateral surface laser registration was 1.13 +/- 0.53 mm, ranging from 0.77 (sinus frontalis) to 1.76 (petrous bone) mm, and thus proved to be clinically sufficient. Increasing distance between target point and registration area went along with a decline in accuracy. Navigational accuracy was significantly influenced by the choice of the registration area. Best accuracy was detected after symmetrically bilateral registration.
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PMID:Surface laser registration in ENT-surgery: accuracy in the paranasal sinuses--a cadaveric study. 1808 21

The Kraus K-Helix Crown and Piston prostheses are novel, newly designed, MRI compatible, titanium ossicular replacement prostheses that have received U.S. Food and Drug Administration clearance in March of 2008 for ossiculoplasty. Reconstruction is indicated to restore sound conduction of the ossicular chain during tympanoplasty in chronic and non-chronic ears. The prostheses have been specifically developed for reconstruction of an eroded or absent long process of the incus and an eroded or absent stapes superstructure. They may be used with or without glass-ionomer cement. The prostheses may be implanted incus-to-stapes or malleus-to-stapes (K-Helix Crown) or may be implanted incus-to-footplatelneo-membrane or malleus-to-footplate/neo-membrane (K-Helix Piston). The K-Helix Piston is useful during revision stapedectomy when an eroded long process of the incus is encountered. By coating the K-Helix prostheses with glass-ionomer cement, it is possible to perform "endoskeletal ossicular reconstruction" which greatly enhances long-term prosthesis stability and avoids contact with the tympanic membrane. The prostheses may be custom-fit to reconstruct each individual patient's anatomy. Preliminary hearing results in a small cohort of patients at one year indicate very satisfactory hearing results with closure of the air-bone gap in the majority of patients. The ENT OR nurse plays a role in the use of specialized, adjunctive OR equipment that is used with the technology, is required for the preparation of glass-ionomer cement, and provides patients with important educational information concerning reconstructive otologic procedures.
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PMID:Endoskeletal ossicular reconstruction using the Kraus K-Helix Crown and Piston middle ear prostheses. 2119 83

Computed tomography is currently the standard in preoperative evaluation of facial fractures, but cone beam computed tomography (CBCT) or digital volume tomography (DVT) offers potential advantages. Intraoperative imaging may facilitate adequate fracture reduction, optimising fracture repair. The aim of this article is to demonstrate the potential benefits of a new mobile CBCT system in a series of patients with complex facial fractures. Intraoperative imaging was performed with the xCAT ENT portable CBCT system. Images were provided in three planes and in a three-dimensional reconstruction. This system was used for intraoperative imaging of 46 consecutive facial trauma patients. The impact of intraoperative CBCT on the management of these cases is described and two select cases are presented to illustrate the potential benefits of this technique. Intraoperative CBCT was successfully performed in all patients and has led to immediate consequences in 12 (26%) cases. In 5 cases, fracture reduction turned out to be insufficient and was further optimized and in 5 other cases the titanium implant (orbital mesh) was not placed in the optimal position and the position was corrected. Bony fragments were detected and removed in 2 cases. Intraoperative imaging provides a number of advantages over post-therapeutic imaging in the management of facial fractures.
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PMID:Intraoperative cone beam computed tomography in the management of facial fractures. 2278 54


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