Horn K L, Brackmann D E, Luxford W M, Shea J J
Ann Otol Rhinol Laryngol. 1986 Jan-Feb;95(1 Pt 1):12-5. doi: 10.1177/000348948609500103.
Acquired attic retraction cholesteatoma involving the anterior epitympanum is infrequently encountered and even less frequently discussed in the literature. The lack of cholesteatoma in this region is mostly due to a ridge of bone extending inferiorly from the tegmen tympani, just anterior to the cochleariform process. The term "cog" was coined and popularized to refer to this bony ridge. Erosion of the cog by cholesteatoma matrix allows extension of cholesteatoma into the supratubal recess. A number of vital structures including the facial nerve, cochlea, middle fossa dura, and internal carotid artery are intimately related to the supratubal recess. A clear three-dimensional understanding of these structures is necessary to remove disease safely from this area regardless of whether the posterior canal wall is left up or taken down. We present a series of dissection illustrations of the supratubal recess and discuss the possible routes of cholesteatoma extension. A series of patients with varying degrees of involvement of the supratubal recess and related structures is presented, and the pitfalls and management of cholesteatoma in this area are discussed.
获得性上鼓室退缩性胆脂瘤累及上鼓室前部较为罕见，在文献中讨论的更少。该区域缺乏胆脂瘤主要是由于从鼓室盖向下延伸的骨嵴，恰好在匙突前方。“cog”这个术语被创造并广泛用于指代这个骨嵴。胆脂瘤基质侵蚀cog可使胆脂瘤延伸至上鼓室隐窝。包括面神经、耳蜗、中颅窝硬脑膜和颈内动脉在内的一些重要结构与上鼓室隐窝密切相关。无论后鼓室壁是保留还是去除，要安全地清除该区域的病变，都必须对这些结构有清晰的三维认识。我们展示了一系列上鼓室隐窝的解剖图，并讨论了胆脂瘤可能的延伸途径。还展示了一系列上鼓室隐窝及相关结构受累程度不同的患者，并讨论了该区域胆脂瘤的陷阱和处理方法。
