Department of Otolaryngology-Head and Neck Surgery, Toronto General Hospital, University Health Network, University of Toronto, Canada.
Department of Otolaryngology-Head and Neck Surgery, Toronto General Hospital, University Health Network, University of Toronto, Canada.
Am J Otolaryngol. 2020 May-Jun;41(3):102407. doi: 10.1016/j.amjoto.2020.102407. Epub 2020 Jan 21.
To report our long-term results in surgical management of invasive intralabyrinthine cholesteatoma.
The study is a case series in a tertiary referral center. Retrospective chart review of all mastoid operations performed for chronic ear disease between 1994 and 2019 at University Health Network, Toronto. The type of surgery, intraoperative findings, hearing outcome, recurrence of disease and the need for revision surgery were evaluated.
10 cases of extensive petrous bone cholesteatoma medial to the otic capsule were identified in 616 mastoid surgeries. All but one patient with extensive petrous bone cholesteatoma who underwent an exteriorizing procedure to preserve cochlear function failed the first surgery. A second procedure was needed in all cases due to complications which included facial palsy, recurrent cholesteatoma or internal auditory canal (IAC) abscess. Hearing was not preserved in any patient. In contrast, 57 ears with cholesteatomatous labyrinthine fistula lateral to the otic capsule had matrix exteriorized and had very good long-term results.
We were rarely able to preserve hearing in massive petrous bone cholesteatoma. There should be no hesitation to remove the otic capsule to exteriorize diseases even under circumstances where residual cochlear and vestibular function is present if required to provide a safe ear.
报告我们在侵袭性内淋巴囊胆脂瘤的手术治疗中的长期结果。
本研究是多伦多大学健康网络中心在 1994 年至 2019 年间进行的一项三级转诊中心的病例系列研究。对所有因慢性耳部疾病而行乳突手术的病历进行回顾性图表审查。评估手术类型、术中发现、听力结果、疾病复发和需要再次手术的情况。
在 616 例乳突手术中，发现 10 例位于前庭囊内侧的广泛岩骨胆脂瘤病例。除 1 例外耳道成形术以保留耳蜗功能的广泛岩骨胆脂瘤患者外，所有患者首次手术均失败。由于面神经瘫痪、胆脂瘤复发或内听道（IAC）脓肿等并发症，所有患者均需要进行第二次手术。没有患者保留听力。相比之下，57 例位于前庭囊外侧的胆脂瘤迷路瘘管患者，将基质外置，取得了非常好的长期效果。
我们很少能在巨大的岩骨胆脂瘤中保留听力。如果需要为患者提供安全的耳朵，即使在残留耳蜗和前庭功能的情况下，也应毫不犹豫地切除前庭囊以将疾病外置。
