Qotb Mohamed, Fawzy Tamer, Ragab Waleed
Department of Ear Nose and Throat, Fayoum University, Fayoum, Egypt.
J Int Adv Otol. 2017 Aug;13(2):181-185. doi: 10.5152/iao.2017.3311.
Removing the posterior canal wall or canal wall down mastoidectomy (CWDM) for the management of cholesteatoma remains controversial. We advocate partial removal of the posterior canal wall for complete eradication, followed by canal wall defect reconstruction to restore the normal anatomy and avoid the complications of CWDM.
Sixty-four patients with cholesteatoma (71 ears) were included. This study was conducted between 2009 and 2012. Single-stage mastoidectomy was performed by drilling the upper third of the posterior canal wall together with the attic, leaving the remaining lower two-thirds intact. Conchal cartilage was used to reconstruct the upper third of the posterior canal wall.
The mean±SD healing time was 7.5±2.3 (range, 4-14) weeks. The mean±SD preoperative and postoperative air bone gaps were 35.8±6.2 dB and 22.9±6.8 dB, respectively. Nearly 84.2% of the patients were followed up for at least 3 years and had dry healthy ears. Complications were noted and statistically examined.
Single-stage CWDM with reconstruction of the posterior canal wall, ossicular chain, and tympanic membrane is a safe and reliable technique with the advantages of Canal wall up Mastoidectomy (CWUM). Its recurrence rate is 4.2%. Longer follow-up durations are required.
采用后鼓室壁切除术或开放式乳突根治术（CWDM）治疗胆脂瘤仍存在争议。我们主张部分切除后鼓室壁以实现彻底根除，随后重建鼓室壁缺损以恢复正常解剖结构并避免CWDM的并发症。
纳入64例胆脂瘤患者（71耳）。本研究于2009年至2012年进行。通过磨除后鼓室壁上三分之一连同上鼓室进行一期乳突根治术，保留其余下三分之二完整。采用耳甲软骨重建后鼓室壁上三分之一。
平均愈合时间为7.5±2.3（范围4 - 14）周。术前和术后平均气骨导差分别为35.8±6.2 dB和22.9±6.8 dB。近84.2%的患者随访至少3年且耳内干燥健康。记录并发症并进行统计学检验。
一期CWDM联合后鼓室壁、听骨链及鼓膜重建是一种安全可靠的技术，具有完壁式乳突根治术（CWUM）的优点。其复发率为4.2%。需要更长的随访时间。
