Boko E, Morinière S, Lescanne E, Robier A
CHU de Lomé, Maître-Assistant Chef de Clinique, Service d'ORL, BP 30 006 Lomé, Togo.
Rev Laryngol Otol Rhinol (Bord). 2006;127(4):211-6.
Intrapetrous cholesteatoma can be recalled with regard of facial paralysis, mixed deafness, cholesteatoma visible under an otoscopy and some characteristic signs in imaging. Its treatment is a real dilemma between its complete exeresis and the preservation of the facial nerve.
We studied the diagnostic and therapeutic aspects of the 7 operated cases from 1994 to 2004.
We noted 5 men and 2 women with an average age of 37.29 years. One case was primitive. We observed 6 translabyrinthic lesions, 5 supralabyrinthic lesions and 2 infralabyrinthic lesions. The surgical approach was: translabyrinthic (1 case), translabyrinthic and suprapetrous (2 cases), suprapetrous (1 case), suprapetrous and petrectomy (1 case), petrectomy (2 cases). The diversion of the facial nerve was often associated. After the surgical operation the activity of the facial nerve was conserved in 4 patients and improved in 2 patients. The facial nerve paralysis that appeared on a patient after being operated on, totally recovered after 7 months. In spite of the appropriate surgical approach, the residual lesions were not rare (2 cases). This situation imposes a clinical and radiological follow-up for life.
Intrapetrous cholesteatoma is rare. The X-ray confirmed the diagnosis. The new MRI techniques allow to detect recurrences and residues. A second surgical operation can be necessary.
岩内胆脂瘤可通过面神经麻痹、混合性耳聋、耳镜下可见胆脂瘤以及影像学上的一些特征性表现来诊断。其治疗在完整切除与保留面神经之间是一个真正的两难选择。
我们研究了1994年至2004年7例接受手术治疗病例的诊断和治疗方面。
我们记录了5名男性和2名女性，平均年龄为37.29岁。1例为原发性。我们观察到6例经迷路病变、5例迷路上病变和2例迷路下病变。手术方式为：经迷路（1例）、经迷路和岩上（2例）、岩上（1例）、岩上和岩骨次全切除术（1例）、岩骨次全切除术（2例）。面神经改道常与之相关。手术后，4例患者面神经功能得以保留，2例患者面神经功能有所改善。1例患者术后出现面神经麻痹，7个月后完全恢复。尽管采用了合适的手术方式，残留病变并不少见（2例）。这种情况需要终身进行临床和影像学随访。
岩内胆脂瘤较为罕见。X线可确诊。新的MRI技术能够检测复发和残留情况。可能需要进行二次手术。
