Skip to main content
Erschienen in: European Journal of Plastic Surgery 4/2016

24.02.2016 | Case Report

Intralesional cryosurgery for the treatment of keloid scars following cochlear implant surgery and removal of cholesteatoma

verfasst von: Ariel Roitman, Michal Luntz, Yaron Har-Shai

Erschienen in: European Journal of Plastic Surgery | Ausgabe 4/2016

Einloggen, um Zugang zu erhalten

Abstract

The development of hypertrophic scars and keloids is a relatively common complication of different otologic procedures involving incision of the skin behind the ear. This case report aims to describe the successful treatment of keloids that developed following ear surgeries that have been performed via a retro-auricular approach (cochlear implantation and the removal of cholesteatoma) by an intralesional cryosurgery method. Two patients who were previously operated for an extensive pediatric cholesteatoma and one patient who underwent a cochlear implant surgery have developed large keloids at the radix helix. The keloids were treated under local anesthesia by the intralesional cryosurgery method. Over a 6-month period, the scars gradually flattened and became paler and the clinical symptoms of itchiness, pain, and tenderness have significantly been reduced. No complications were documented, and there were no recurrences in a follow-up period of 30 months. This case report demonstrates that intralesional cryosurgery provides the surgeon with an effective method to treat keloid scars following the removal of cholesteatoma or cochlear implantation, thus improving the quality of life and body image and enabling the patients to use the implanted device in an adequate and satisfactory way.
Level of Evidence: Level V, therapeutic study.
Literatur
1.
Zurück zum Zitat Ajalloueyan M, Amirsalari S, Yousefi J, Raeesi MA, Radfar S, Hassanalifard M (2011) A report of surgical complications in a series of 262 consecutive pediatric cochlear implantations in Iran. Iran J Pediatr 21:455–60 Ajalloueyan M, Amirsalari S, Yousefi J, Raeesi MA, Radfar S, Hassanalifard M (2011) A report of surgical complications in a series of 262 consecutive pediatric cochlear implantations in Iran. Iran J Pediatr 21:455–60
2.
Zurück zum Zitat Kempf HG, Johann K, Lenarz T (1999) Complications in pediatric cochlear implant surgery. Eur Arch Otorhinolaryngol 256:128–32CrossRefPubMed Kempf HG, Johann K, Lenarz T (1999) Complications in pediatric cochlear implant surgery. Eur Arch Otorhinolaryngol 256:128–32CrossRefPubMed
3.
Zurück zum Zitat Loochtan MJ, Yang S, Mantravadi AV, Marzo SJ (2014) Cochlear implant extrusion secondary to keloid formation. Cochlear Implants Int 15:276–8CrossRefPubMed Loochtan MJ, Yang S, Mantravadi AV, Marzo SJ (2014) Cochlear implant extrusion secondary to keloid formation. Cochlear Implants Int 15:276–8CrossRefPubMed
4.
Zurück zum Zitat Tunkel DE (2006) The Z-meatoplasty for modified radical mastoidectomy in children. Arch Otolaryngol Head Neck Surg 132:1319–1322CrossRefPubMed Tunkel DE (2006) The Z-meatoplasty for modified radical mastoidectomy in children. Arch Otolaryngol Head Neck Surg 132:1319–1322CrossRefPubMed
5.
Zurück zum Zitat Backer DC, Converse JM (1979) Correction of protruding ears: a 20-year retrospective. Aesthetic Plast Surg 3:29–39CrossRef Backer DC, Converse JM (1979) Correction of protruding ears: a 20-year retrospective. Aesthetic Plast Surg 3:29–39CrossRef
6.
Zurück zum Zitat Leist SD, Masson JK, Erich JB (1977) A review of 324 rhytidectomies emphasizing complications and patient dissatisfaction. Plast Reconstr Surg 59:525–529CrossRefPubMed Leist SD, Masson JK, Erich JB (1977) A review of 324 rhytidectomies emphasizing complications and patient dissatisfaction. Plast Reconstr Surg 59:525–529CrossRefPubMed
7.
Zurück zum Zitat Park TH, Chang CH (2015) Location of keloids and its treatment modality may influence the keloid recurrence in children. J Craniofac Surg 26:1355–1357CrossRefPubMed Park TH, Chang CH (2015) Location of keloids and its treatment modality may influence the keloid recurrence in children. J Craniofac Surg 26:1355–1357CrossRefPubMed
8.
Zurück zum Zitat Carvalho B, Ballin AC, Becker RV, Ribeiro TB, Cavichiolo JB, Ballin CR, Mocellin M (2012) Treatment of retroauricular keloids: revision of cases treated at the ENT service of HC/UFPR. Int Arch Otorhinolaryngol 16:195–200PubMedPubMedCentral Carvalho B, Ballin AC, Becker RV, Ribeiro TB, Cavichiolo JB, Ballin CR, Mocellin M (2012) Treatment of retroauricular keloids: revision of cases treated at the ENT service of HC/UFPR. Int Arch Otorhinolaryngol 16:195–200PubMedPubMedCentral
9.
Zurück zum Zitat Strohm M (2002) Acquired fibrotic atresia of external auditory canal. Laryngorhinootologie 81:8–13CrossRefPubMed Strohm M (2002) Acquired fibrotic atresia of external auditory canal. Laryngorhinootologie 81:8–13CrossRefPubMed
10.
Zurück zum Zitat Har-Shai Y, Amar M, Sabo E (2003) Intralesional cryotherapy for enhancing the involution of hypertrophic scars and keloids. Plast Reconstr Surg 111:1841–1852CrossRefPubMed Har-Shai Y, Amar M, Sabo E (2003) Intralesional cryotherapy for enhancing the involution of hypertrophic scars and keloids. Plast Reconstr Surg 111:1841–1852CrossRefPubMed
11.
Zurück zum Zitat Har-Shai Y, Dujovny E, Rohde E, Zouboulis CC (2007) Effect of skin surface temperature on skin pigmentation during contact and intralesional cryosurgery of keloids. J Eur Acad Dermatol Venereol 21:191–198CrossRefPubMed Har-Shai Y, Dujovny E, Rohde E, Zouboulis CC (2007) Effect of skin surface temperature on skin pigmentation during contact and intralesional cryosurgery of keloids. J Eur Acad Dermatol Venereol 21:191–198CrossRefPubMed
12.
Zurück zum Zitat Har-Shai Y, Brown W, Labbe D, Dompmartin A, Goldine I, Gil T, Mettanes I, Pallua N (2008) Intralesional cryosurgery for the treatment of hypertrophic scars and keloids following aesthetic surgery: the results of a prospective observational study. Int J Low Extrem Wounds 7:169–175CrossRefPubMed Har-Shai Y, Brown W, Labbe D, Dompmartin A, Goldine I, Gil T, Mettanes I, Pallua N (2008) Intralesional cryosurgery for the treatment of hypertrophic scars and keloids following aesthetic surgery: the results of a prospective observational study. Int J Low Extrem Wounds 7:169–175CrossRefPubMed
13.
Zurück zum Zitat Har-Shai Y, Mettanes I, Zilberstein Y, Genin O, Spector I, Pines M (2011) Keloid histopathology after intralesional cryosurgery treatment. J Eur Acad Dermatol Venereol 25:1027–1036CrossRefPubMed Har-Shai Y, Mettanes I, Zilberstein Y, Genin O, Spector I, Pines M (2011) Keloid histopathology after intralesional cryosurgery treatment. J Eur Acad Dermatol Venereol 25:1027–1036CrossRefPubMed
14.
Zurück zum Zitat Har-Shai Y, Sabo E, Rohde E, Hayms M, Assaf C, Zouboulis CC (2006) Intralesional cryosurgery markedly enhances the involution of recalcitrant auricular keloids—a new clinical approach supported by experimental studies. Wound Repair Regen 14:18–27CrossRefPubMed Har-Shai Y, Sabo E, Rohde E, Hayms M, Assaf C, Zouboulis CC (2006) Intralesional cryosurgery markedly enhances the involution of recalcitrant auricular keloids—a new clinical approach supported by experimental studies. Wound Repair Regen 14:18–27CrossRefPubMed
15.
Zurück zum Zitat Stromps J-P, Dunda S, Eppstein R-J, Babic D, Har-Shai Y, Pallua N (2014) Intralesional cryosurgery combined with topical silicone gel sheeting for the treatment of refractory keloids. Dermatol Surg 40:996–1003CrossRefPubMed Stromps J-P, Dunda S, Eppstein R-J, Babic D, Har-Shai Y, Pallua N (2014) Intralesional cryosurgery combined with topical silicone gel sheeting for the treatment of refractory keloids. Dermatol Surg 40:996–1003CrossRefPubMed
16.
Zurück zum Zitat Chopinaud M, Pham A-D, Labbe D, Verneuil L, Gourio C, Dompmartin A (2014) Intralesional cryosurgery to treat keloid scars: results from a retrospective study. Dermatology 229:263–270CrossRefPubMed Chopinaud M, Pham A-D, Labbe D, Verneuil L, Gourio C, Dompmartin A (2014) Intralesional cryosurgery to treat keloid scars: results from a retrospective study. Dermatology 229:263–270CrossRefPubMed
17.
Zurück zum Zitat Mirmovich O, Gil T, Lavi I, Goldine I, Mettanes I, Har-Shai Y (2012) Pain evaluation and control during and following the treatment of hypertrophic scars and keloids employing contact and intralesional cryosurgery—a preliminary study. J Eur Acad Dermatol Venereol 26:440–447CrossRefPubMed Mirmovich O, Gil T, Lavi I, Goldine I, Mettanes I, Har-Shai Y (2012) Pain evaluation and control during and following the treatment of hypertrophic scars and keloids employing contact and intralesional cryosurgery—a preliminary study. J Eur Acad Dermatol Venereol 26:440–447CrossRefPubMed
18.
Zurück zum Zitat Froelich K, Staudenmaier R, Kleinsasser N, Hagen R (2007) Therapy of auricular keloids: review of different treatment modalities and proposal for therapeutic algorithm. Eur Arch Otorhinolaryngol 264:1497–1508CrossRefPubMed Froelich K, Staudenmaier R, Kleinsasser N, Hagen R (2007) Therapy of auricular keloids: review of different treatment modalities and proposal for therapeutic algorithm. Eur Arch Otorhinolaryngol 264:1497–1508CrossRefPubMed
19.
Zurück zum Zitat Fraccalvieri M, Bogetti P, Salomone M, Di Santo C, Ruka E, Bruschi S, Cryotreatment of keloids: a single Italian institutional experience. Eur J Plast Surg. doi:10.1007/s00238-015-1170-6, Published online November 2015. Fraccalvieri M, Bogetti P, Salomone M, Di Santo C, Ruka E, Bruschi S, Cryotreatment of keloids: a single Italian institutional experience. Eur J Plast Surg. doi:10.​1007/​s00238-015-1170-6, Published online November 2015.
20.
Zurück zum Zitat Keveton JF (2004) Revision mastoidectomy. In: Haberman RS (ed) Middle ear and mastoid surgery, Chapter 11. Thieme New York, New York, p 76 Keveton JF (2004) Revision mastoidectomy. In: Haberman RS (ed) Middle ear and mastoid surgery, Chapter 11. Thieme New York, New York, p 76
21.
Zurück zum Zitat Berman B, Perez OA, Konda S et al (2007) A review of the biologic effects, clinical efficacy, and safety of silicone elastomer sheeting for hypertrophic and keloid scar treatment and management. Dermatol Surg 33:1291–1303PubMed Berman B, Perez OA, Konda S et al (2007) A review of the biologic effects, clinical efficacy, and safety of silicone elastomer sheeting for hypertrophic and keloid scar treatment and management. Dermatol Surg 33:1291–1303PubMed
22.
23.
Zurück zum Zitat Ray J, Gibson W, Sanli H (2004) Surgical complications of 844 consecutive cochlear implantation and observations on large versus small incisions. Cochlear Implants Int 5:87–95CrossRefPubMed Ray J, Gibson W, Sanli H (2004) Surgical complications of 844 consecutive cochlear implantation and observations on large versus small incisions. Cochlear Implants Int 5:87–95CrossRefPubMed
24.
Zurück zum Zitat Glasscock ME 3rd (2011) Expenses keep cochlear implants out of reach for millions of individuals with profound hearing loss in poor and emerging countries. Otol Neurotol 32:893–894CrossRefPubMed Glasscock ME 3rd (2011) Expenses keep cochlear implants out of reach for millions of individuals with profound hearing loss in poor and emerging countries. Otol Neurotol 32:893–894CrossRefPubMed
25.
Zurück zum Zitat Ajalloueyan M, Amirsalari S, Radfar S, Tavallaee A, Khoshini S (2012) Flap outcome using “C” shaped and “new” incisions in pediatric cochlear implantation. Iran Red Crescent Med J 14:218–221PubMedPubMedCentral Ajalloueyan M, Amirsalari S, Radfar S, Tavallaee A, Khoshini S (2012) Flap outcome using “C” shaped and “new” incisions in pediatric cochlear implantation. Iran Red Crescent Med J 14:218–221PubMedPubMedCentral
Metadaten
Titel
Intralesional cryosurgery for the treatment of keloid scars following cochlear implant surgery and removal of cholesteatoma
verfasst von
Ariel Roitman
Michal Luntz
Yaron Har-Shai
Publikationsdatum
24.02.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
European Journal of Plastic Surgery / Ausgabe 4/2016
Print ISSN: 0930-343X
Elektronische ISSN: 1435-0130
DOI
https://doi.org/10.1007/s00238-016-1183-9

Weitere Artikel der Ausgabe 4/2016

European Journal of Plastic Surgery 4/2016 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.