Chu F W, Jackler R K
Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco 94143.
Laryngoscope. 1988 Mar;98(3):274-9. doi: 10.1288/00005537-198803000-00007.
Epitympanic cholesteatoma may involve the facial nerve at several anatomic locations resulting in functional impairment. The most common site of nerve compression is the middle-ear segment where the nerve is frequently devoid of bony covering. In five patients with facial palsy due to epitympanic cholesteatoma, a characteristic pattern of growth was recognized in which the cholesteatoma traversed the anterior epitympanum rather than taking the more common posterior route. Extension anteromedial to the head of the malleus leads to compression of the facial nerve in the region of the geniculate ganglion at the level of the middle cranial fossa floor. The most probable pathogenesis of this lesion is extension of disease along the embryologic course of either the saccus anticus or the anterior saccule of the saccus medius. Management of these lesions is surgical and may require, in addition to mastoidectomy with anterior and/or posterior atticotomy, middle fossa craniotomy and/or partial removal of the labyrinth for complete excision.
上鼓室胆脂瘤可在几个解剖位置累及面神经，导致功能障碍。神经受压最常见的部位是中耳段，该段神经常常缺乏骨质覆盖。在5例因上鼓室胆脂瘤导致面瘫的患者中，识别出一种特征性的生长模式，即胆脂瘤穿过上鼓室前部，而非走更常见的后部路径。向锤骨头前内侧延伸会导致面神经在颅中窝底水平的膝状神经节区域受压。该病变最可能的发病机制是疾病沿前袋或中袋前囊的胚胎学路径蔓延。这些病变的治疗是手术治疗，除了进行乳突切除术加前和/或后鼓室切开术外，可能还需要进行中颅窝开颅术和/或部分切除迷路以完全切除病变。
