Miman Murat Cem, Aydin N Engin, Oncel Semih, Ozturan Orhan, Erdem Tamer
Department of Otorhinolaryngology, Inonu University Medical Faculty, 44300, Malatya, Turkey.
Auris Nasus Larynx. 2002 Apr;29(2):133-9. doi: 10.1016/s0385-8146(01)00148-1.
The choice of the graft in ossicular chain reconstruction during middle ear surgery for cholesteatoma is a subject still discussed on. In order to clarify the discussion of reuse of the autologous ossicles obtained during middle ear surgery for cholesteatoma, we evaluated the probability of residual disease histologically and the safety of the ossicles after autoclavization, the most promoting alternative method to eradicate residual cholesteatoma and infection on them.
The specimens used in this study were eroded twenty-seven ossicles (22 incuses, 5 malleoli) which were removed from the 27 consecutive patients operated because of cholesteatomatous middle ear disease. They were grouped as follows: Group 1, Fifteen ossicles examined histopathologically directly. Group 2, Five ossicles autoclaved for 20 min at 134 degrees C and then examined histopathologically. Group 3, Five ossicles autoclaved for 20 min at 134 degrees C after mechanical surface cleaning by a fine diamond drill, examined histopathologically. Group 4, Two ossicles removed from two different patients were placed in their mastoid cavities in order to be examined after access in the second-look operation. While one ossicle was only autoclaved, the other was mechanically cleaned by a drill before autoclavization (for 20 min at 134 degrees C). The ossicles were examined histopathologically after the removal at the second stage operation performed 12 months later.
In Group 1, all ossicles showed evidence of periosteal thickening. Additional findings were surface cholesteatoma or epithelia in 13 ossicles, surface inflammation in 12 ossicles, granulation tissue in 10 ossicles, osteitis in six ossicles. In Group 2, all five ossicles had preserved their lamellar structure but, no vital cells were seen. The lacunes that had the osteocytes was almost completely empty. The inflammatory cells were eliminated from the ossicles. In Group 3, ossicles were found well preserved with their lamellar structures and contours, with empty lacunes and eliminated inflammatory cells. In Group 4, in two ossicles of this group the lacunes were replaced by the new migrated viable osteocytes with evidence of new bone formation and neovascularisation. No new inflammatory focus or epithelia were found on the surfaces of the ossicles. The shape and the contour of the ossicles remained unchanged.
In cholesteatoma surgery, ossicles with minimal erosion and adequate thickness can be used after autoclavization. In this study, it was observed histopathologically that the autoclaving autologous ossicles before ossiculoplasty in cholesteatomatous middle ear is a safe and reliable method.
在胆脂瘤型中耳炎中耳手术中，听骨链重建移植物的选择仍是一个备受讨论的话题。为了阐明在胆脂瘤型中耳炎中耳手术中获取的自体听骨再利用的相关讨论，我们从组织学角度评估了残留疾病的可能性以及高压灭菌后听骨的安全性，高压灭菌是根除残留胆脂瘤及其感染的最常用替代方法。
本研究使用的标本是从27例因胆脂瘤型中耳疾病接受手术的连续患者中取出的27块被侵蚀的听骨（22块砧骨，5块锤骨）。它们被分为以下几组：第1组，15块听骨直接进行组织病理学检查。第2组，5块听骨在134℃下高压灭菌20分钟，然后进行组织病理学检查。第3组，5块听骨在通过细金刚石钻头进行机械表面清洁后，于134℃下高压灭菌20分钟，进行组织病理学检查。第4组，从两名不同患者身上取出的2块听骨被放置在他们的乳突腔中，以便在二次探查手术取出后进行检查。其中一块听骨仅进行高压灭菌，另一块在高压灭菌（134℃下20分钟）前用钻头进行机械清洁。在12个月后进行的第二阶段手术取出后，对听骨进行组织病理学检查。
在第1组中，所有听骨均显示骨膜增厚迹象。其他发现包括13块听骨有表面胆脂瘤或上皮，12块听骨有表面炎症，10块听骨有肉芽组织，6块听骨有骨炎。在第2组中，所有5块听骨均保留了其板层结构，但未见活细胞。含有骨细胞的腔隙几乎完全空了。听骨中的炎性细胞被清除。在第3组中，发现听骨的板层结构和轮廓保存良好，腔隙为空，炎性细胞被清除。在第4组中，该组的2块听骨中，腔隙被新迁移的有活力的骨细胞取代，有新骨形成和新生血管的证据。在听骨表面未发现新的炎症灶或上皮。听骨的形状和轮廓保持不变。
在胆脂瘤手术中，侵蚀最小且厚度足够的听骨在高压灭菌后可以使用。在本研究中，从组织病理学观察到，在胆脂瘤型中耳炎鼓室成形术前对自体听骨进行高压灭菌是一种安全可靠的方法。
