Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Department of Otolaryngology, Inner Mongolia People's Hospital, Hohhot, China.
Cancer Biother Radiopharm. 2021 Apr;36(3):260-267. doi: 10.1089/cbr.2020.3786. Epub 2020 Jul 28.
To explore more refined classification methods of congenital middle ear cholesteatoma (CMEC) based on two existing staging systems. This study involved a retrospective data review of 57 patients (61 ears involved) with CMEC requiring the surgical treatment. Patients were classified into different stages according to Nelson, Potsic, and Modified Nelson staging system. Preoperative data and intraoperative findings were recorded. The mean age at operation was 15 ± 15.04 years with a median of 10 years. The main clinical manifestation was hearing loss (72.13%). CMEC mass was mainly located in the posterior portion of the tympanic cavity (65.57%). No patient was classified into Potsic stage II. The erosion of incus happened in all cases. Patients with Nelson type 2 and type 3 had erosions to the structures out of middle ear, such as dura mater, lateral semicircle canal, and facial canal. Postoperative follow-up time was more than 24 months. Recurrence occurred in four patients (6.56%), all of them in Nelson type 2, who had received canal wall down mastoidectomy (three cases) and canal wall up mastoidectomy (one case). Nelson staging system was more suitable for advanced CMEC patients than Potsic staging system. The rare case of Potsic stage II restricted the application of Potsic staging system. Moreover, since both of two staging systems do not distinguish the type of involved ossicles, the authors recommended to subdivide Nelson type 2 into type 2a and type 2b based on the erosion of the ossicular chain, as well as subdivide Nelson type 3 into type 3a and 3b based on the erosion of structures out of middle ear, which was named as Modified Nelson staging system.
为了基于现有的两种分期系统探索更为精细的先天性中耳胆脂瘤（CMEC）分类方法。本研究回顾性分析了 57 例（61 耳）接受手术治疗的 CMEC 患者的临床资料。根据 Nelson、Potsic 和改良 Nelson 分期系统对患者进行分期。记录患者的术前资料和术中所见。手术时的平均年龄为 15±15.04 岁，中位数为 10 岁。主要临床表现为听力损失（72.13%）。CMEC 肿块主要位于鼓室后份（65.57%）。无一例患者被归入 Potsic Ⅱ期。所有病例均有砧骨破坏。Nelson Ⅱ型和 Ⅲ型患者的中耳外结构有破坏，如硬脑膜、外半规管和面神经管。术后随访时间超过 24 个月。4 例患者（6.56%）复发，均为行完壁式乳突切除术（3 例）和开放式乳突切除术（1 例）的 Nelson Ⅱ型患者。Nelson 分期系统比 Potsic 分期系统更适用于晚期 CMEC 患者。Potsic Ⅱ期的罕见病例限制了 Potsic 分期系统的应用。此外，由于两种分期系统均未区分受累听小骨的类型，作者建议根据听小骨链的破坏将 Nelson Ⅱ型进一步分为 2a 型和 2b 型，根据中耳外结构的破坏将 Nelson Ⅲ型进一步分为 3a 型和 3b 型，命名为改良 Nelson 分期系统。
