Department of Ear, Nose and Throat, Royal Prince Alfred Hospital, Sydney, Australia.
Otol Neurotol. 2022 Jul 1;43(6):e658-e622. doi: 10.1097/MAO.0000000000003549.
To present a case of giant cholesteatoma and review of the contemporary literature.
A 61-year-old male presented with foul-smelling discharge from his right ear in the setting of a previous canal wall down mastoidectomy. Otomicroscopy demonstrated a mastoid cavity filled with infected keratinous debris. Neuro-imaging revealed soft tissue inflammatory changes in the mastoid cavity, with involvement of the temporomandibular joint (TMJ) and parotid gland and tegmen erosion. Biopsies showed evidence of desquamated epithelium consistent with cholesteatoma, with no malignant cells identified. Audiogram demonstrated a mean hearing loss of 65 dB on the right ear and an air-bone gap of 45 dB. Review of literature was also performed on giant cholesteatoma.
He underwent a modified Fisch Type B infratemporal fossa approach to completely remove the cholesteatoma and a vascularized free flap was utilized to fill the surgical defect.
Complete extirpation of choles-teatoma and resolution of otorrhoea.
Repeat imaging showed complete removal of cholesteatoma and clinically there was resolution of the otorrhea. Review of the literature has shown a lack of consensus around the definition of giant cholesteatoma. Most cases in the literature demonstrated extensive involvement of anatomical spaces beyond the confines of the temporal bone to qualify for the diagnosis of giant cholesteatoma.
Giant cholesteatoma should be suspected in cases of recurrent ear discharge following canal wall down mastoidectomy. The case we report add to the literature to benefit future patients in preoperative counseling and better inform management.
报告 1 例巨大胆脂瘤病例，并复习相关文献。
一名 61 岁男性，因先前施行完壁式乳突切除术（WCD）后右侧耳流脓伴臭味就诊。耳镜检查显示乳突腔充满感染性角化物。神经影像学显示乳突腔内软组织炎症改变，累及颞下颌关节（TMJ）和腮腺，以及鼓室盖侵蚀。活检显示有剥落的上皮组织，符合胆脂瘤表现，未见恶性细胞。听力图显示右侧平均听力损失 65dB，气骨导差 45dB。同时对巨大胆脂瘤进行了文献复习。
行改良 Fisch 型 B 型颞下窝入路，彻底清除胆脂瘤，并采用血管化游离皮瓣填充手术缺损。
胆脂瘤完全清除，耳流脓停止。
重复影像学检查显示胆脂瘤完全清除，临床耳流脓停止。文献复习表明，对于巨大胆脂瘤的定义尚无共识。文献中的大多数病例均表现为颞骨以外解剖空间的广泛受累，符合巨大胆脂瘤的诊断。
WCD 后反复发作耳流脓应怀疑巨大胆脂瘤。我们报告的病例为术前咨询和更好地指导管理提供了帮助，为未来的患者带来了更多的益处。
