Meuser W
Clin Otolaryngol Allied Sci. 1978 Nov;3(4):377-84. doi: 10.1111/j.1365-2273.1978.tb00717.x.
After closed operation techniques recurrences of cholesteatoma are often caused by retraction of squamous epithelium under the bony annulus, under which it spreads into the attic or the mastoid cavity. Consequently, retractions under the bony annulus can be avoided, if the annulus is removed. An endaural operation technique is described in which the superior and posterior bony ear canal wall is completely removed and the posterior wall is reconstructed by means of a meatal skin flap. As the oval window is often partly hidden by the frame of the tympanic membrane it is more favourable for the restoration of the sound conducting mechanism if the frame and surface of the tympanic membrane are extended backwards. This can be done by repositioning the posterior cutaneous ear canal wall and grafting the tympanic membrane with fascia. By doing this, the attic is incorporated into the ear canal. Should the factors which originally induced the development of the cholesteatoma remain effective and cause a new retraction, the full breadth of the posterior ear canal skin will retract into the exenterated mastoid cavity. An easily accesible open cavity and not a recurrence will be the result. In a follow-up study of 112 patients it was found that 67 of them had developed such an open cavity, which caused no serious problems.
在采用闭合式手术技术后，胆脂瘤复发通常是由鳞状上皮在骨环下退缩引起的，鳞状上皮会在骨环下蔓延至鼓室上隐窝或乳突腔。因此，如果去除骨环，就可以避免骨环下的退缩。本文描述了一种耳内手术技术，即完全切除外耳道的上壁和后壁骨质，并用耳道皮瓣重建后壁。由于卵圆窗常常部分被鼓膜环所遮挡，如果将鼓膜环和鼓膜表面向后延伸，对于恢复声音传导机制更为有利。这可以通过重新定位外耳道后壁皮肤并使用筋膜移植鼓膜来实现。通过这样做，鼓室上隐窝就被纳入了耳道。如果最初诱发胆脂瘤形成的因素仍然起作用并导致新的退缩，外耳道后壁皮肤的全层将退缩到已切除的乳突腔内。结果将是形成一个易于清理的开放腔隙，而不是复发。在对112例患者的随访研究中发现，其中67例形成了这样的开放腔隙，并未引起严重问题。
