Haginomori Shin-ichi, Takamaki Atsuko, Nonaka Ryuzaburo, Takenaka Hiroshi
Department of Otolaryngology, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka 569-8686, Japan.
Arch Otolaryngol Head Neck Surg. 2008 Jun;134(6):652-7. doi: 10.1001/archotol.134.6.652.
To compare the incidence and localization of residual cholesteatomas in canal wall down tympanoplasty with soft-wall reconstruction with results with the canal wall down and open tympanoplasty or canal wall up tympanoplasty.
Retrospective case-series study.
Tertiary care university hospital.
Eighty-five patients (85 ears) with fresh extensive cholesteatomas who underwent canal wall down tympanoplasty with soft-wall reconstruction as first-stage surgery and a second operation after 1 year to confirm residual cholesteatomas and perform ossiculoplasty.
The incidence and localization of residual cholesteatomas in the middle ear were compared between surgery using the canal wall down and open tympanoplasty and canal wall up tympanoplasty. Possible technical causes of the residua were reviewed in a retrospective videotape analysis of the first-stage operations.
Of the 85 ears operated on, 18 had residual cholesteatomas, for an overall incidence of 21%, with 1 residuum per ear. Six cholesteatomas were located in the epitympanum (33%), 3 in the sinus tympani (17%), 3 in the antrum (17%), 2 on the stapes (11%), 2 on the tympanic membrane (11%), 1 on the tympanic portion of the facial canal (6%), and 1 just under the skin of the external auditory canal (6%). The retrospective videotape analysis revealed that the main cause of residual cholesteatomas in the epitympanum and sinus tympani was incomplete removal of the matrix under an indirect surgical view because of insufficient drilling. Residual matrix in a bony defect in the middle cranial fossa or facial canal was the cause of residual cholesteatomas in the antrum or facial canal. Inappropriate keratinizing epithelium rolling during tympanic membrane or external auditory canal reconstruction was the cause of residual cholesteatomas in the tympanic membrane or external auditory canal.
The incidence of residual cholesteatomas in patients who underwent canal wall down tympanoplasty with soft-wall reconstruction was similar to that in patients who underwent surgery involving the canal wall down and open tympanoplasty or canal wall up tympanoplasty. In terms of localization, with canal wall down tympanoplasty with soft-wall reconstruction, there is the possibility of residua not only in the tympanic cavity but also in the antrum or mastoid cavity, as with the canal wall up method. Results of this study suggest that in patients with extensive cholesteatoma, canal wall down tympanoplasty with soft-wall reconstruction should be followed by a second procedure to detect any residual cholesteatomas in the tympanic cavity, antrum, or mastoid cavity.
比较软壁重建的开放式鼓室成形术与开放式鼓室成形术或完壁式鼓室成形术相比，残余胆脂瘤的发生率及位置。
回顾性病例系列研究。
三级医疗大学医院。
85例（85耳）患有新鲜广泛性胆脂瘤的患者，他们接受了软壁重建的开放式鼓室成形术作为一期手术，并在1年后进行二次手术以确认残余胆脂瘤并进行听骨成形术。
比较开放式鼓室成形术和完壁式鼓室成形术手术中中耳残余胆脂瘤的发生率及位置。通过对一期手术的回顾性录像分析，探讨残余胆脂瘤可能的技术原因。
在接受手术的85耳中，18耳存在残余胆脂瘤，总体发生率为21%，每耳1处残余。6处胆脂瘤位于上鼓室（33%），3处位于鼓窦（17%），3处位于鼓室窦（17%），2处位于镫骨（11%），2处位于鼓膜（11%），1处位于面神经管鼓室段（6%），1处位于外耳道皮下（6%）。回顾性录像分析显示，上鼓室和鼓窦残余胆脂瘤的主要原因是间接手术视野下由于钻孔不足导致基质清除不完全。中颅窝或面神经管骨缺损处的残余基质是鼓室窦或面神经管残余胆脂瘤的原因。鼓膜或外耳道重建过程中角化上皮不适当的卷曲是鼓膜或外耳道残余胆脂瘤的原因。
接受软壁重建的开放式鼓室成形术患者的残余胆脂瘤发生率与接受开放式鼓室成形术或完壁式鼓室成形术手术的患者相似。就位置而言，采用软壁重建的开放式鼓室成形术，与完壁式手术一样，不仅鼓室，鼓室窦或乳突腔也有可能出现残余。本研究结果表明，对于广泛性胆脂瘤患者，采用软壁重建的开放式鼓室成形术后应进行二次手术，以检测鼓室、鼓室窦或乳突腔内的任何残余胆脂瘤。
