Schmerber S, Baguant A, Fabre C, Quatre R
Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital, Grenoble Alpes, France; INSERM UMR1205 Brain Tech Lab, University, Grenoble Alpes, France.
Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital, Grenoble Alpes, France.
Eur Ann Otorhinolaryngol Head Neck Dis. 2021 Sep;138(4):279-282. doi: 10.1016/j.anorl.2020.11.004. Epub 2020 Dec 9.
Middle ear cholesteatoma is a destructive lesion that can potentially erode the bone. Cholesteatoma is a clinical diagnosis in the vast majority of cases. Patients must be systematically investigated for the presence of signs suggestive of complications, the most common of which is labyrinthine fistula. However, the clinical features of labyrinthine fistula are inconstant and the fistula sign may sometimes be negative. CT scan of the petrous temporal bone is performed systematically to specify the site and extension of the cholesteatoma, and to assess the extent of osteolysis that can result in exposure of the membranous labyrinth. Surgical treatment has three main objectives: complete resection of the cholesteatoma, which is the only way to avoid residual cholesteatoma, prevention of recurrence by an adapted, preferably one-step, technique, and restoration of good quality hearing. Hydrodissection of the cholesteatoma matrix in the presence of labyrinthine fistula is a simple technique that can achieve the three main general objectives of cholesteatoma surgery.
中耳胆脂瘤是一种具有潜在骨质侵蚀性的破坏性病变。在绝大多数情况下，胆脂瘤是一种临床诊断。必须对患者进行系统检查，以确定是否存在提示并发症的体征，其中最常见的是迷路瘘管。然而，迷路瘘管的临床特征并不恒定，瘘管征有时可能为阴性。需系统地进行颞骨岩部CT扫描，以明确胆脂瘤的部位和范围，并评估可能导致膜迷路暴露的骨质溶解程度。手术治疗有三个主要目标：彻底切除胆脂瘤，这是避免残留胆脂瘤的唯一方法；采用合适的、最好是一步法的技术预防复发；恢复良好的听力。在存在迷路瘘管的情况下，对胆脂瘤基质进行水分离是一种简单的技术，可实现胆脂瘤手术的三个主要总体目标。
