Chemically Assisted Dissection by Means of Mesna in Cholesteatoma Surgery

Vincenti, Vincenzo; Magnan, Jacques; Saccardi, Maria Silvia; Zini, C

doi:10.1097/mao.0000000000000514

Cited by 19 publications

(14 citation statements)

References 19 publications

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“…Vincenti et al . 14 conducted a retrospective study on Mesna topical application in canal wall up mastoidectomy. They included 214 patients: 108 underwent operation with the ancillary use of Mesna (chemically assisted dissection group), and 106 were treated with the traditional mechanical technique alone (no chemically assisted dissection group).…”

Section: Resultsmentioning

confidence: 99%

“…17 In recent years, there has been an increase in indications for Mesna as a support tool for surgical dissection especially in the ENT field. 14 With the hypothesis that the physiological and pathological adhesions between different layers are rich in disulphide bonds, and bearing in mind that some drugs already in use have the ability to break these bonds, Zini et al . 8 developed a research project entitled ‘chemically assisted dissection’ and, among various substances, chose Mesna for this purpose.…”

Section: Discussionmentioning

confidence: 99%

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A ‘chemical help’ in middle-ear surgery? A systematic review on sodium 2-mercaptoethanesulfonate

et al. 2021

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Objective Sodium 2-mercaptoethanesulfonate (Mesna) has been proposed as a chemical aid in any surgical procedure, including cholesteatoma surgery. This review investigated the benefits and safety of Mesna during surgical management of cholesteatoma and adhesive otitis media. Method A systematic literature review was performed to identify clinical studies evaluating topical Mesna application during ear surgery (cholesteatoma or atelectasis). A qualitative analysis based on data extracted was conducted. Results From 27 articles, 5 retrospective studies were selected for a full analysis for a total of 607 patients (aged 5 to 72 years). Three studies evaluated cholesteatoma recidivism after Mesna application during cholesteatoma surgery, one study evaluated the surgical success rate of Mesna application for the treatment of atelectatic ears and adhesive otitis media, and one study evaluated potential ototoxicity of Mesna during cholesteatoma surgery. All the studies showed overall improvement in recurrence and residual cholesteatoma disease after Mesna application during surgery. Sensorineural hearing loss was not encountered after Mesna application. Conclusion Mesna application in cholesteatoma surgery could represent a valid and safe support tool during surgical treatment carried out both with microscopy and endoscopy. More studies are required to confirm these promising results.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A ‘chemical help’ in middle-ear surgery? A systematic review on sodium 2-mercaptoethanesulfonate

et al. 2021

View full text Add to dashboard Cite

show abstract

“…It has been reported that application of MESNA dissects tissue layers during cholestea-toma or atelectatic ear surgeries by breaking the disulfide bonds of the matrix. MESNA has also been reported to increase success rates of surgery and decrease rates of residual cholesteatoma formation 33,34 . In this study, there was no residual cholesteatoma in the MESNA group, while there was one in the non-MESNA group.…”

Section: Discussionmentioning

confidence: 99%

Mastoid Cavity Obliteration With Cartilage Graft; Evaluation of 35 Patients

Kalcıoğlu¹,

Özerk²,

Eğilmez³

et al. 2019

MMJ

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Objective: Cartilage is a rigid material that is highly resistant to infection and retraction and is tolerated well by the middle ear. The purpose of this study was to review retrospectively the results of cases of mastoid cavity obliteration with cartilage performed after canal wall down (CWD) mastoidectomy and to discuss the literature. Method: Of 983 patients who underwent surgery for chronic otitis media between January 2000 and June 2012, 54 patients who underwent CWD mastoidectomy plus mastoid cavity obliteration with cartilage and who were followed up regularly were selected from the database and invited for re-evaluation. All patients who came for a follow up after the invitation were examined and their data were evaluated retrospectively. Results: Thirty-five of the patients who accepted the invitation were included in the study. All of the patients in the study underwent mastoid cavity obliteration with conchal and/or tragal cartilage grafts. The duration of follow up ranged from 21 to 41 months (average, 27.3 months). Epithelization occurred in all patients with dry cavity, except one who had residual cholesteatoma and underwent revision surgery. Conclusion: The results of this study indicate that cartilage can be preferred for obliteration of mastoid cavity after CWD mastoidectomy.

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“…Among methods facilitating removal of the matrix from the fistula laser [21], special techniques, e.g., underwater ear surgery [22] and mesna [23] are described. We do not have experience with the first mentioned method, but we appreciate significant role of mesna in atraumatic LF clearance.…”

Section: Discussionmentioning

confidence: 99%

“Sandwich technique” enables preservation of hearing and antivertiginous effect in cholesteatomatous labyrinthine fistula

Bartochowska

Pietraszek

Wierzbicka

et al. 2021

Eur Arch Otorhinolaryngol

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Purpose The aim of the study was to assess hearing, surgical and clinical results of the treatment in patients with cholesteatomatous labyrinthine fistula (LF) focusing on the different techniques and materials used in the management. Methods Study group included 465 patients. Cases with LFs discovered or confirmed during surgical procedure were thoroughly analyzed. Results LFs were noted in 11.4% of all cases. Thirty-eight patients, with all follow-up data available, were included into the further analysis. Most LFs were located in the lateral semicircular canal (87%). LFs were assessed as small in 2 cases, as medium in 24 patients while 12 were described as large. Based on Dornhoffer and Milewski classification, 50% of LFs were classified as IIa, 24% as IIb, 6 LFs were very deep (type III), while 4—superficial (type I). The size and type of LF did not influence postsurgical complaints (p = 0.1070, p = 0.3187, respectively). Vertigo was less frequent in LFs treated by “sandwich technique”, especially those with opened endosteum. In 30 (79%) patients, hearing improved or did not change after surgery. Hearing outcomes were significantly better in the ears operated by means of CWU technique (p = 0.0339), in LFs with intact membranous labyrinth (p = 0.0139) and when “sandwich technique” was performed (p = 0.0159). Postsurgical bone conduction thresholds levels were significantly better in LFs covered by “sandwich method” (p = 0.0440). Conclusion “Sandwich technique” (temporal fascia–bone pate–temporal fascia) enables preservation of hearing as well as antivertiginous effect in patients with cholesteatomatous labyrinthine fistula.

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Chemically Assisted Dissection by Means of Mesna in Cholesteatoma Surgery

Abstract: This study showed that chemically assisted dissection by using mesna represents a valid support in reducing the frequency of residual disease in cholesteatoma surgery.

Cited by 19 publications

References 19 publications

A ‘chemical help’ in middle-ear surgery? A systematic review on sodium 2-mercaptoethanesulfonate

A ‘chemical help’ in middle-ear surgery? A systematic review on sodium 2-mercaptoethanesulfonate

Mastoid Cavity Obliteration With Cartilage Graft; Evaluation of 35 Patients

“Sandwich technique” enables preservation of hearing and antivertiginous effect in cholesteatomatous labyrinthine fistula

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