Prasad K C, Vyshnavi V, Abhilasha K, Prathyusha K, Anjali P K, Varsha G Indu
Department of Otorhinolaryngology and Head and Neck Surgery, RL Jalappa Hospital, Kolar, Karnataka India.
Indian J Otolaryngol Head Neck Surg. 2022 Aug;74(Suppl 1):184-189. doi: 10.1007/s12070-020-01948-0. Epub 2020 Jul 9.
To document the clinical presentation, complications, management strategy and post-operative outcomes of extensive cholesteatomas. Cholesteatoma is a well demarcated cystic lesion derived from an abnormal growth of keratinizing squamous epithelium in the temporal bone. Cholesteatomas commonly involve the middle ear, epitympanum, mastoid antrum and air cells and can remain within these confines for a considerable period. Bony erosion is present confined to ossicular chain and scutum initially, but as the cholesteatoma expands, erosion of the otic capsule, fallopian canal and tegmen can occur. Erosion of the tegmen tymapani or tegmen mastoideum may lead to development of a brain hernia or cerebrospinal fluid leakage. Invasion of jugular bulb, sigmoid sinus, internal carotid artery are noticed in extensive cholesteatoma and are quite challenging and requires expertise. Neurosurgical intervention should be considered along with the otological management in the same sitting in all possible cases. A retrospective review of 12 patients were carried out to assess the clinical presentation, complications, surgical management and postoperative outcomes of extensive cholesteatomas presenting at our centre between January 2017 and December 2019. CT or MRI findings, extent of cholesteatoma intra-operatively along with the status of major neurovascular structures and disease clearance, and the post-operative outcomes including morbidity and mortality were noted. All patients underwent canal wall down mastoidectomy with or without ossiculoplasty. Post operatively all patients were treated with intravenous antibiotics and if required intravenous steroids. Amongst the 12 patients of extensive cholesteatoma (EC), all of them (100%) presented with foul smelling, purulent ear discharge. 9 (75%) patients presented with otalgia. 4 (33.33%) patients had temporal headache. 10 (83.33%) patients complained of hard of hearing. 7 (58.33%) patients gives history of vertigo at the time of presentation. In 8 (66.66%) patients there was tegmen plate erosion noticed in CT scan. In 3 (25%) patients, the disease was invading the sigmoid sinus and in 1 (8.33%) patient jugular bulb was involved. In 3 (25%) cases of EC, blind sac closure was performed. In two patients who developed cerebellar abscess, drainage procedure was performed. 2 (16.66%) patients developed sigmoid sinus thrombosis, 1 (8.33%) patient had petrositis.
记录广泛性胆脂瘤的临床表现、并发症、治疗策略及术后结果。胆脂瘤是一种界限清晰的囊性病变，由颞骨中角化鳞状上皮异常生长形成。胆脂瘤通常累及中耳、上鼓室、乳突窦和气房，并可在这些范围内持续相当长一段时间。起初，骨质侵蚀局限于听骨链和鼓盾，但随着胆脂瘤扩大，可出现内耳囊、面神经管和鼓室盖的侵蚀。鼓室盖或乳突盖的侵蚀可能导致脑疝或脑脊液漏。广泛性胆脂瘤可出现颈静脉球、乙状窦、颈内动脉受累，极具挑战性，需要专业知识。在所有可能的情况下，应在同一次手术中同时考虑神经外科干预和耳科治疗。对12例患者进行回顾性研究，以评估2017年1月至2019年12月在本中心就诊的广泛性胆脂瘤的临床表现、并发症、手术治疗及术后结果。记录CT或MRI检查结果、术中胆脂瘤范围以及主要神经血管结构的状况和疾病清除情况，以及包括发病率和死亡率在内的术后结果。所有患者均接受了开放式乳突根治术，部分患者同时进行了听骨成形术。术后所有患者均接受静脉抗生素治疗，必要时使用静脉类固醇。在12例广泛性胆脂瘤（EC）患者中，所有患者（100%）均有恶臭、脓性耳漏。9例（75%）患者有耳痛。4例（33.33%）患者有颞部头痛。10例（83.33%）患者主诉听力减退。7例（58.33%）患者就诊时伴有眩晕史。8例（66.66%）患者CT扫描显示有鼓室盖骨质侵蚀。3例（25%）患者病变侵犯乙状窦，1例（8.33%）患者颈静脉球受累。3例（25%）广泛性胆脂瘤患者进行了盲袋封闭术。2例发生小脑脓肿的患者进行了引流手术。2例（16.66%）患者发生乙状窦血栓形成，1例（8.33%）患者发生岩部炎。
