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Workshop results with Dr. Ashesh Bhumkar(India) participation 13/11/2017-19/11/2017 Astana

Patient №1. Diagnosis. Bilateral atresia of the external ear canal. Bilateral microtia. Bilateral conductive hearing loss of second-third degree. Bilateral underdevelopment of temporomandibular joints.
During the workshop, 11 patients from the pediatric surgery and transplantology department №1 got the required consultations.

After doctor's examination three patients got the refusal for surgical treatment.

Patient №1. Diagnosis. Bilateral atresia of the external ear canal. Bilateral microtia. Bilateral conductive hearing loss of second-third degree. Bilateral underdevelopment of temporomandibular joints.

Doctor's decision: for the moment being there aren't any indications for surgery due to anatomical features-chest circumference less than 60 cm, absence of auditory bones in the middle ear. Another type of surgery (elective) is recommended for the patient: installation of the bone-anchored devices.

Patient №2. Diagnosis. Congenital atresia of the external ear canal on the right. Microtia on the right.

Doctor's decision: for the time being the operation is postponed due to the small weight of the child, the lack of auditory bones and the age of the child, surgical treatment is recommended in 2-3 years to reconstruct the ear auricle.

Patient №3. Diagnosis. Congenital atresia of the external ear canal on the right. Microtia on the right. Underdevelopment of temporomandibular joint on the right.

Doctor's decision: the operation is postponed due to the complexity of the anatomical structure of the mastoid bone - underdevelopment of antrum, mastoid cells and possible surgical injuries - facial nerve and temporal lobe injuries. Elective surgery, otoplasty, is recommended.
According to examination results, 4 patients were operated on, chosen by the Commission of the foreign treatment (UMC).

Patient №4. Date of birth 26.10.2010. Diagnosis. Congenital atresia of the external ear canal on the left, microtia on the left. Cholesteatoma on the left.

The surgery was performed - canaloplasty on the left with the excision of the cholesteatoma of the external ear canal. The operation was performed timely and medically indicated. During the operation, a cholesteatoma was found in the ear canal, spreading to the back wall of the ear canal.

Patient №5. Date of birth 01.06.2010. Diagnosis. Congenital atresia of the external ear canal on the left, microtia on the left. Conductive hearing loss of the third degree on the left. Condition after meatotympanoplasty on the left.

The surgery was performed – meatotympanoplasty with hearing aid on the left. The formation of the ear canal with the installation of a total prosthesis of the middle ear was done. The presence of scarring, the presence of granulation tissue and the technical difficulty of the operation due to the narrowness of the surgical area and the facial nerve presentation were registered.

Patient №6. Date of birth 26.01.2006. Diagnosis. Bilateral atresia of the external ear canal. Bilateral microtia. Condition after meatotympanoplasty on the right (2009).

The surgery was performed – otoplasty on the right using rib cartilage. Rough scar changes in the auditory canal were found intraoperatively. Conservation of the own ear lobe was done.

As the surgery was cancelled for the Patient №1, the surgery was performed for the Patient №7, date of birth 07.04.2006. Diagnosis: congenital atresia of the external ear canal on the right. Microtia on the right. Conductive hearing loss of the third degree on the right. The operation was performed due to the severity and complexity of the pathology, which tends to the development of cholesteatoma and complications – otitic meningitis, sinus thrombosis.

The surgery was performed – otoplasty using rib cartilage and opening the external ear canal on the right.
What is more, 4 patients, who were not chosen by the Commission of the foreign treatment (UMC), were operated on.

Patient №8. Date of birth 25.01.2012. Diagnosis. Congenital atresia of the external ear canal on the right. Microtia on the right. Conductive hearing loss of the third degree on the right.

These moments were stated after a computed tomography of the temporal bones: underdevelopment of the auditory bones of the middle ear, thickening of the facial nerve canal in the tympanic area, its presentation to the foot plate ??? of the stirrup. It can lead to the development of facial paresis.

The surgery was performed – meatotympanoplasty with hearing aid on the right. The formation of the ear canal with the installation of a total prosthesis of the middle ear was done. An open bone canal of the facial nerve in the tympanic cavity was found (CT data confirmed), fibrously altered mucous tissue was excised, the facial nerve was covered with fascia, which prevents the development of facial paresis.

After surgery, the child has improved hearing.

Patient №9. Date of birth 11.09.2008. Diagnosis. Congenital atresia of the external ear canal on the left. Microtia on the left. Condition after meatotympanoplasty on the left (2016). Conductive hearing loss of the third degree on the left. Since the presence of a permanent mucopurulent discharge, a long standing inflammatory process in the auditory passage, the ineffectiveness of conservative treatment, in connection with the threat of otogenic complications-meningitis and encephalopyosis, the surgery was performed in an urgent order.

The surgery was performed - revision of the external ear canal on the left with recanalization. The intraoperative debridement of the silicone element which caused otoblennorrhea was done. Plastic surgery in the purulent process is contraindicated.

Patient №10. Date of birth 06.05.2007. Diagnosis. Congenital atresia of the external ear canal on the left. Microtia on the left. Conductive hearing loss of the third degree on the left.

The surgery was performed – otoplasty on the right using rib cartilage.

There is a lack of auditory bones in the middle ear and presentation of the sigmoid sinus, which was a contraindication for canalplasty.

Patient №11.
Date of birth 14.01.2007. Diagnosis. Congenital atresia of the external ear canal on the right. Microtia on the right. Conductive hearing loss of the third degree on the right.

The surgery was performed – otoplasty using rib cartilage and opening the external ear canal on the right. This case is the most challenging from the technical and anatomical physiological point of view because rib cartilage had a porous structure and during the modeling of the auricle there was a danger of its injury.

This workshop showed that each patient requires an individual approach and sometimes solving the problem in several stages. The arrival of Ashesh Bhumkar is of utmost importance for the development of microtia - atresia in the Republic of Kazakhstan.
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