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Published in: European Journal of Plastic Surgery 4/2016

01-08-2016 | Case Report

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

Authors: Ariel Roitman, Michal Luntz, Yaron Har-Shai

Published in: European Journal of Plastic Surgery | Issue 4/2016

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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.
Literature
1.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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
23.
go back to reference 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.
go back to reference 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.
go back to reference 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
Metadata
Title
Intralesional cryosurgery for the treatment of keloid scars following cochlear implant surgery and removal of cholesteatoma
Authors
Ariel Roitman
Michal Luntz
Yaron Har-Shai
Publication date
01-08-2016
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Plastic Surgery / Issue 4/2016
Print ISSN: 0930-343X
Electronic ISSN: 1435-0130
DOI
https://doi.org/10.1007/s00238-016-1183-9

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