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The use of the thoracodorsal nerve for facial nerve grafting
Otolaryngology– Head and Neck Surgery Volume 129 Number 2
P126 Loudness Discomfort Level for Normal Hearing Subjects: Is It a Reliable Test? Keila B Knobel (presenter); Tanit Ganz Sanchez MD PhD; Leopoldo N Pfeilsticker MD Campinas Brazil; Sao Paulo Brazil; Sao Paulo Brazil
Objectives: Loudness discomfort level (LDL) is usually used in patients with hearing loss during the hearing aid evaluation and fitting process. Recently, it has also been used to diagnose and follow-up patients with hypersensitivity to sound. As these patients may have normal hearing thresholds and there are no reference values established for this test, the objective of this study is to determine the range of values of LDL for normal listeners. Methods: The LDL was investigated in 64 normal listening young adults from 18 to 25 years old (34 females [53.1%] and 30 males [46.9%]). Both ears were evaluated in test and re-test situation for frequencies among 0.5 and 8 KHz. Pulsate pure tones were presented on ascendant way until the subject first complained of discomfort to the sound. Results: The median for all frequencies varied between 86 and 98 dBHL, with no differences between right and left ears nor on test and retest situation. Conclusion: The good reliability on test and re-test situation makes LDL a trustable test. However, the inter-subject differences pointed out in this study suggest that LDL should always be associated with a detailed anamnesis about hypersensitivity to sound before its interpretation. P127 The Use of the Thoracodorsal Nerve for Facial Nerve Grafting W Matthew White MD (presenter); Daniel G Deschler MD; Michael J McKenna MD Boston MA; Boston MA; Boston MA
Objectives: To present the use of the thoracodorsal nerve as an alternative for primary facial nerve interposition grafting in the setting of tumor resection. Methods: A 48-year-old male presented with a recurrent basal squamous cell carcinoma of the temporal bone. He had previously undergone numerous scalp resections, a left partial parotidectomy, bilateral radical neck dissections, and fullcourse radiation therapy. He presented with decreased facial nerve function at the time of his recurrence. Total parotidectomy was performed, sacrificing the facial nerve, followed by
P253
partial auriculectomy, lateral temporal bone resection, and intraoperative radiation therapy. All frozen section neural and soft tissue margins were negative. A pedicled latissimus dorsi flap was used to reconstruct the cervical defect. The thoracodorsal nerve was used as a primary interposition graft to the upper and middle facial nerve branches. Results: Complete flap survival was noted postoperatively. At 8 months postoperatively, the neck and temporal regions have completely healed. There is no evidence of recurrent disease. Facial nerve function to the grafted regions has returned to a House-Brackmann scale of IV/VI. Conclusion: The thoracodorsal nerve is an effective method of reconstituting facial nerve function in the setting where the thoracodorsal nerve would otherwise be sacrificed with harvest of the latissimus dorsi flap. Conversely, the latissimus dorsi flap may be chosen over other pedicled flap techniques if a nerve graft is required.
P128 The Case of Medullomyoblastoma of Cerebellopontine Angle Mimicking Acoustic Neuroma Sang-Yoo Park MD PhD (presenter); Tae-Hwan Kim MD; Ki-Taek Kim MD; Jae-Hong Park MD Wonju South Korea; Wonju South Korea; Wonju South Korea; Wonju South Korea
Objectives: Medulloblastoma is one of the commonly encountered malignant central nervous system neoplasms found mainly in the children. But in matter of the location of the tumor, medulloblastoma of the cerebellopontine angle is relatively unusual and about 10 cases have been reported in the literature. We report a case of the medullomyoblastoma, a rare variant of medulloblastoma, that occurred in the cerebellopontine angle. Methods: A 15-year-old boy presented sudden hearing loss in the left ear. Conservative medical treatment failed, and temporal MR imaging revealed a heterogenously enhancing mass at the left cerebellopontine angle cistern and in the internal auditory canal; therefore, the lesion was regarded as typical acoustic neuroma. Results: A few days before surgery, ipsilateral facial palsy developed and follow-up MR imaging showed rapid growth of the previous lesion. By an extended translabyrinthine approach, the surgical removal was possible. And under pathological diagnosis of malignancy, radiation therapy and series of chemotherapy were performed. Conclusion: Medullomyoblastoma is a unique variant of medulloblastoma, and it has histological characteristics of medulloblastoma which has a component of Desmin stain (⫹) smooth and striated muscle fibers. According to our knowledge, no previous case report documented the medullomyoblastoma of the cerebellopontine angle.
POSTERS
injury although it is not significant statistically. The procedure also has its cosmetic advantages. No recurrence occurred after partial and superficial parotidectomy in benign tumors. Conclusion: Partial parotidectomy might be the reliable option for the benign parotid tumors with the advantages of reduced risk to the facial nerve, reduced operating time, and no apparent risk of increased recurrence of benign tumors.
Scientific Posters
P126 Loudness Discomfort Level for Normal Hearing Subjects: Is It a Reliable Test? Keila B Knobel (presenter); Tanit Ganz Sanchez MD PhD; Leopoldo N Pfeilsticker MD Campinas Brazil; Sao Paulo Brazil; Sao Paulo Brazil
Objectives: Loudness discomfort level (LDL) is usually used in patients with hearing loss during the hearing aid evaluation and fitting process. Recently, it has also been used to diagnose and follow-up patients with hypersensitivity to sound. As these patients may have normal hearing thresholds and there are no reference values established for this test, the objective of this study is to determine the range of values of LDL for normal listeners. Methods: The LDL was investigated in 64 normal listening young adults from 18 to 25 years old (34 females [53.1%] and 30 males [46.9%]). Both ears were evaluated in test and re-test situation for frequencies among 0.5 and 8 KHz. Pulsate pure tones were presented on ascendant way until the subject first complained of discomfort to the sound. Results: The median for all frequencies varied between 86 and 98 dBHL, with no differences between right and left ears nor on test and retest situation. Conclusion: The good reliability on test and re-test situation makes LDL a trustable test. However, the inter-subject differences pointed out in this study suggest that LDL should always be associated with a detailed anamnesis about hypersensitivity to sound before its interpretation. P127 The Use of the Thoracodorsal Nerve for Facial Nerve Grafting W Matthew White MD (presenter); Daniel G Deschler MD; Michael J McKenna MD Boston MA; Boston MA; Boston MA
Objectives: To present the use of the thoracodorsal nerve as an alternative for primary facial nerve interposition grafting in the setting of tumor resection. Methods: A 48-year-old male presented with a recurrent basal squamous cell carcinoma of the temporal bone. He had previously undergone numerous scalp resections, a left partial parotidectomy, bilateral radical neck dissections, and fullcourse radiation therapy. He presented with decreased facial nerve function at the time of his recurrence. Total parotidectomy was performed, sacrificing the facial nerve, followed by
P253
partial auriculectomy, lateral temporal bone resection, and intraoperative radiation therapy. All frozen section neural and soft tissue margins were negative. A pedicled latissimus dorsi flap was used to reconstruct the cervical defect. The thoracodorsal nerve was used as a primary interposition graft to the upper and middle facial nerve branches. Results: Complete flap survival was noted postoperatively. At 8 months postoperatively, the neck and temporal regions have completely healed. There is no evidence of recurrent disease. Facial nerve function to the grafted regions has returned to a House-Brackmann scale of IV/VI. Conclusion: The thoracodorsal nerve is an effective method of reconstituting facial nerve function in the setting where the thoracodorsal nerve would otherwise be sacrificed with harvest of the latissimus dorsi flap. Conversely, the latissimus dorsi flap may be chosen over other pedicled flap techniques if a nerve graft is required.
P128 The Case of Medullomyoblastoma of Cerebellopontine Angle Mimicking Acoustic Neuroma Sang-Yoo Park MD PhD (presenter); Tae-Hwan Kim MD; Ki-Taek Kim MD; Jae-Hong Park MD Wonju South Korea; Wonju South Korea; Wonju South Korea; Wonju South Korea
Objectives: Medulloblastoma is one of the commonly encountered malignant central nervous system neoplasms found mainly in the children. But in matter of the location of the tumor, medulloblastoma of the cerebellopontine angle is relatively unusual and about 10 cases have been reported in the literature. We report a case of the medullomyoblastoma, a rare variant of medulloblastoma, that occurred in the cerebellopontine angle. Methods: A 15-year-old boy presented sudden hearing loss in the left ear. Conservative medical treatment failed, and temporal MR imaging revealed a heterogenously enhancing mass at the left cerebellopontine angle cistern and in the internal auditory canal; therefore, the lesion was regarded as typical acoustic neuroma. Results: A few days before surgery, ipsilateral facial palsy developed and follow-up MR imaging showed rapid growth of the previous lesion. By an extended translabyrinthine approach, the surgical removal was possible. And under pathological diagnosis of malignancy, radiation therapy and series of chemotherapy were performed. Conclusion: Medullomyoblastoma is a unique variant of medulloblastoma, and it has histological characteristics of medulloblastoma which has a component of Desmin stain (⫹) smooth and striated muscle fibers. According to our knowledge, no previous case report documented the medullomyoblastoma of the cerebellopontine angle.
POSTERS
injury although it is not significant statistically. The procedure also has its cosmetic advantages. No recurrence occurred after partial and superficial parotidectomy in benign tumors. Conclusion: Partial parotidectomy might be the reliable option for the benign parotid tumors with the advantages of reduced risk to the facial nerve, reduced operating time, and no apparent risk of increased recurrence of benign tumors.
Scientific Posters