Chomarat J, Fabre C, Schmerber S, Quatre Raphaële
Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital Grenoble-Alpes, Grenoble Cedex 09, BP 217 38043, France.
Faculty of Medicine, Domaine de la Merci, University of Grenoble-Alpes, BP170, 38043, Grenoble Cedex 9, France.
Eur Arch Otorhinolaryngol. 2025 Jun 6. doi: 10.1007/s00405-025-09508-4.
The main objective of this study was to compare the residual and recurrence rates in canal wall up, canal wall down, and canal wall down with reconstruction tympanoplasty for the treatment of cholesteatoma, considering the different filling materials used: no mastoid obliteration versus obliteration using Bone Pate versus obliteration using G45S5 (Glassbone).
This was a retrospective cohort study conducted at a single tertiary medical center. Patient who underwent canal wall up, canal wall down or canal wall down with reconstruction tympanoplasty for a cholesteatoma (primary, secondary, recurrent or residual), with or without mastoid obliteration, with Bone Pate or G45S5 between January 2007 and March 2023 were included. Patients with congenital cholesteatoma and with a follow-up less than 6 months or with any other type of surgery techniques were excluded.
A hundred and eight (46%) surgeries were performed without any mastoid obliteration, 66 (28%) with Bone Pate obliteration and 62 (26%) with G45S5 obliteration with a total of 236 surgeries. Survival analysis revealed significantly better outcomes for the Bone Pate cohort compared to without obliteration cohort on the recurrence and recidivism rate (HR 0.26; p = 0.03 and HR 0.39; p = 0.01 respectively). However, none of the statistical analyses showed significant differences between the non-obliteration cohort and the G45S5 cohort.
Our study highlights the benefits of Bone Pate obliteration in cholesteatoma surgery. However, it does not provide conclusive evidence on the effectiveness of G45S5 obliteration in preventing residual and recurrent cholesteatoma.
本研究的主要目的是比较上鼓室保留、上鼓室开放和上鼓室开放并重建鼓室成形术治疗胆脂瘤时的残留率和复发率，同时考虑使用不同的填充材料：不进行乳突腔填充、使用骨粉进行填充以及使用G45S5（玻璃骨）进行填充。
这是一项在单一三级医疗中心进行的回顾性队列研究。纳入2007年1月至2023年3月期间因胆脂瘤（原发性、继发性、复发性或残留性）接受上鼓室保留、上鼓室开放或上鼓室开放并重建鼓室成形术的患者，无论是否进行乳突腔填充，填充材料为骨粉或G45S5。排除先天性胆脂瘤患者、随访时间少于6个月的患者以及接受任何其他手术技术的患者。
共进行了236例手术，其中108例（46%）未进行任何乳突腔填充，66例（28%）使用骨粉填充，62例（26%）使用G45S5填充。生存分析显示，与未填充组相比，骨粉填充组在复发率和再发率方面的结局显著更好（风险比分别为0.26；p = 0.03和0.39；p = 0.01）。然而，所有统计分析均未显示未填充组与G45S5填充组之间存在显著差异。
我们的研究突出了骨粉填充在胆脂瘤手术中的益处。然而，它并未提供关于G45S5填充在预防胆脂瘤残留和复发有效性的确凿证据。
