查看更多>>摘要：Introduction:Medication-related osteonecrosis of the temporal bone is rare and has been reported to be associated with the use of anti-resorptive and biologic agents.Here,we present the first case of tyrosine-kinase inhibitor-related external auditory canal(EAC)osteonecrosis as well as two cases related to anti-resorptive therapies.Methods:A retrospective case series.Results:Case one:an 84-year-old female presented with chronic otitis externa and osteonecrosis of EACs bilaterally.She had a history of osteoporosis treated with denosumab and risedronic acid.She successfully underwent left EAC reconstruction using an inferiorly-based pedicle periosteal flap while the right ear canal was managed conservatively.Case two:a 69-year-old male presented with osteonecrosis of the right EAC.He had a history of osteoporosis treated with alendronic acid and zoledronic acid.His osteonecrosis is conservatively managed with local debridement and antibiotic application.Case three:a 60-year-old male presented with osteonecrosis of the right inferior EAC.He had a history of chronic myelogenous leukemia treated with a tyrosine-kinase inhibitor,imatinib.After failing conservative therapy,he underwent right ear canal reconstruction using a periosteal vascular pedicle flap without complication and experienced complete resolution to his symptoms.Conclusion:Anti-resorptive agents and/or tyrosine kinase inhibitors may lead to dysregulation of bone remodeling and result in rare cases of temporal bone osteonecrosis.When a local debridement and antibiotic therapy fail,definitive surgical excision of necrotic bone with subsequent reconstruction of the EAC may offer patients a possible resolution in symptoms.
查看更多>>摘要：Purpose:To report a rare variant of the posterior septal artery(PSA),which supplies blood to the posterior mucosa of the contralateral nasal septum.Case report:A 31-year-old female patient underwent suture removal 14 days after septoplasty and developed left-sided epistaxis 6h after suture removal.To safely and effectively relieve the patient from epistaxis,the cauterization of the left PSA was performed under general anesthesia.However,24 h after the first surgical hemostasis,the patient experienced epistaxis again in the right nasal cavity.We have reviewed the patient's sinus computed tomography again and found a rare variant of PSA,which is the right-sided PSA passing through a bony canal in the left-sided nasal septum.Discussion:The variant of PSA well explained the failure of the first hemostatic surgery.Therefore,we again performed a cauterization of the right-sided PSA,after which the patient recovered and no further epistaxis occurred.Conclusion:When cauterization of PSA is used to manage posterior epistaxis,it is necessary to pay attention to the possible variation in PSA.
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