Mobashir Mohammad Kamal, Basha Waleed M, Mohamed Abd ElRaof Said, Elmaghawry Mohammed Elsayed
Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Auris Nasus Larynx. 2018 Apr;45(2):254-260. doi: 10.1016/j.anl.2017.05.020. Epub 2017 Jul 20.
The main goal of surgery in acquired middle ear cholesteatomas is the complete eradication of the disease with an ear free of discharge. This can be performed either by open or closed techniques with their benefits and drawbacks. We present the technique of reposition of the posterior canal wall for the management of cholesteatoma cases and its results and outcome.
This study included 31 patients with primary acquired middle ear cholesteatoma. The surgical technique included complete cortical mastoidectomy, wide posterior tympanotomy, dividing the bony posterior meatal wall with a micro-sagittal saw and its removal, dissection and eradication of cholesteatoma, and repositioning the canal wall segment in its anatomical site.
No significant intraoperative complication occurred. An injury to the dura occurred in one patient. Damage of the bony posterior canal wall occurred in two patients during saw cutting. Residual cholesteatoma was found in two patients. No dislocation or necrosis of the reconstructed posterior canal wall was noted and the new reconstructed external ear canal appeared to be of near normal size, shape, and contour.
This technique provides optimal surgical exposure and access to areas that are difficult to reach by CWU approach, allows removal of the cholesteatoma without intraoperative complications, decreases the rate of residual cholesteatoma, restores near-normal anatomy of the external auditory canal, and avoids the sequelae of the open mastoid cavity. Therefore, it would be a feasible alternative to the standard CWU and CWD procedures.
后天性中耳胆脂瘤手术的主要目标是彻底根除疾病且耳部无分泌物。这可以通过开放式或封闭式技术来实现，两种技术各有优缺点。我们介绍后鼓室壁复位技术在胆脂瘤病例治疗中的应用及其结果和疗效。
本研究纳入31例原发性后天性中耳胆脂瘤患者。手术技术包括完整的皮质乳突切除术、广泛的后鼓室切开术、用微型矢状锯切开并去除骨性外耳道后壁、解剖并根除胆脂瘤，以及将鼓室壁段复位至其解剖位置。
术中未发生重大并发症。1例患者硬脑膜受损。2例患者在锯切过程中发生骨性后鼓室壁损伤。2例患者发现有残余胆脂瘤。未发现重建的后鼓室壁脱位或坏死，新重建的外耳道大小、形状和轮廓接近正常。
该技术提供了最佳的手术视野，能够到达经传统开放式乳突根治术（CWU）方法难以到达的区域，可在无术中并发症的情况下切除胆脂瘤，降低残余胆脂瘤的发生率，恢复外耳道接近正常的解剖结构，并避免开放乳突腔的后遗症。因此，它将是标准CWU和开放式乳突根治术（CWD）手术的一种可行替代方案。
