Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Tottori University, Yonago, Japan.
Kunimoto ENT Clinic, Yonago, Japan.
Ear Nose Throat J. 2024 Apr;103(4):234-240. doi: 10.1177/01455613211048575. Epub 2021 Oct 1.
Few reports discuss the characteristics of repeated recidivism of cholesteatoma. We describe the clinical characteristics of patients with cholesteatoma who experienced at least two recidivism episodes after initial surgery for cholesteatoma requiring canal wall reconstruction.
We reviewed the medical records of 11 patients who underwent surgery for cholesteatoma with canal wall reconstruction at our department between April 2008 and March 2018 and subsequently experienced two relapses that necessitated revision surgery involving tympanomastoidectomy with canal reconstruction. Patient age at the time of the first surgery ranged from 6 to 56 (mean, 25.7) years. Seven (63.6%) of the 11 patients were male. These 11 patients were classified according to the type of recidivism, and their characteristics (pathology, operation date, operation method, pattern of relapse, and position of recurrence) were investigated.
Four cases involved secondary residual cholesteatoma, with the mean interval between the first revision surgery and the second revision surgery being 23.8 (range, 11-39) months. Secondary residual sites included the anterior tympanic cavity, tympanic sinus, and anterior end of the reconstructed cartilage of the canal wall. The other seven cases involved secondary recurrence, with the mean interval between the first and the second revision surgery being 26.1 (range, 12-57) months. The sites of recurrence were at the edges of the reconstructed cartilage. One notable case involved the cartilage junction, leading us to hypothesize that retraction of the temporal muscle flap and the patulous Eustachian tube was the underlying cause.
For residual cholesteatoma, strict measures are necessary to maintain the operation under clear view, and more careful follow-up is necessary in patients who have had previous surgery at another hospital. For recurrent cholesteatoma, it was recognized that Eustachian tube function must be ascertained in advance, and careful observation of the reconstructed cartilage edge is necessary.
鲜有报道探讨胆脂瘤多次复发的特征。我们描述了经历初次胆脂瘤手术后至少两次复发，且需要行鼓室成形并重建外耳道后壁术的胆脂瘤患者的临床特征。
我们回顾了 2008 年 4 月至 2018 年 3 月在我科行胆脂瘤手术并重建外耳道后壁，随后因复发而再次行乳突根治术和重建外耳道后壁术的 11 例患者的病历资料。初次手术时患者年龄 6-56 岁，平均 25.7 岁。7 例（63.6%）为男性。根据复发类型对这 11 例患者进行分类，并调查其特征（病理学、手术日期、手术方法、复发模式和复发部位）。
4 例为继发性残余胆脂瘤，初次翻修术和再次翻修术的平均间隔时间为 23.8（11-39）个月。继发性残余部位包括前鼓室、鼓窦和重建的外耳道后壁软骨的前端。另外 7 例为继发性复发，初次翻修术和再次翻修术的平均间隔时间为 26.1（12-57）个月。复发部位在重建软骨的边缘。有一例很显著的病例涉及到软骨交界部位，我们推测这与颞肌瓣的退缩和咽鼓管的开张过度有关。
对于残余胆脂瘤，有必要采取严格措施确保手术在清晰视野下进行，并且对于曾在其他医院行手术的患者，有必要进行更仔细的随访。对于复发性胆脂瘤，有必要事先确定咽鼓管功能，并仔细观察重建的软骨边缘。
