Intramuscular hemangiomas are unusual tumors in the head and neck region that occur most frequently in the masseter muscle and are often confused with parotid neoplasms. Four cases are described and the literature reviewed. The diagnosis and management of these tumors are discussed in view of the fact that accurate preoperative diagnosis is unusual and tumor recurrence rates high. Increased awareness of the clinical presentation of intramuscular hemangiomas should enhance diagnostic accuracy and facilitate optimal treatment planning.
The formation of reparative granuloma as one of the causes for sensorineural hearing loss as a complication of stapedectomy has been reported previously.6,13,17 The purpose of this paper is to present our experiences with this problem and to show that this condition can be diagnosed and treated with good results in many cases.The incidence of sensorineural loss from all causes following stapedectomy was reported in several studies 8 ,9 ,l1 to range from 0.6 per cent to 3 per cent. Harris and Weiss, on the other hand, found six granulomas which were confirmed by surgery, in 119 stapedectomies for a 5 per cent incidence.We found ten granulomas from a total of 780 recent stapedectomies for an incidence of 1.3 per cent. Three of these granulomas occurred following 170 fat-wire implants and seven occurred after 610 Gelfoam®-wire implants. All of these granulomas were grossly and microscopically confirmed.The evidence indicates that reparative granuloma is a major cause of sensorineural hearing loss following stapedectomy. During the period of this study there was only one additional case of sensorineural hearing loss in this series of 780 stapedectomies. Tympanotomy in this case disclosed that a perilymph fistula occurred after a Gelfoarn-wire implant.
INITIAL SIGNS AND SYMPTOMSOf the ten cases of poststapedectomy granuloma, nine developed symptoms within the first six weeks (Table I). One patient experienced the onset of symptoms ten months following surgery.
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