Tono T, Segawa Y, Tsuboi Y, Morimitsu T
Department of Otolaryngology, Miyazaki Medical College, Japan.
Nihon Jibiinkoka Gakkai Kaiho. 1996 May;99(5):669-74. doi: 10.3950/jibiinkoka.99.669.
We present a 76-year-old male patient with adhesive-type cholesteatoma and with metal foreign bodies which were shown to be located in the bony eustachian tube by computed tomography. He sustained a burn injury of the left tympanic membrane when he was struck by a bomb 52 years ago, during World War II. The cannonball fragments that entered the tympanic cavity were apparently transported to and stuck in the eustachian tube isthmus by mucociliary action after spontaneous closure of the tympanic membrane perforation. Persistent tubal obstruction due to the impacted foreign bodies and surrounding granulation tissue seems to have caused chronic adhesive otitis, leading to cholesteatoma which developed in the attic and mastoid antrum. No foreign bodies became visible after cholesteatoma removal by an intact canal wall technique in conjunction with anterior tympanotomy for wide exposure of the supratubal recess and the tympanic osteum of the eustachian tube. Therefore, anterior tympanotomy was further extended anteriorly to open the enlarged bony eustachian tube, allowing visualization and safe removal of two cannonball-fragments firmly impacted within it. We call this surgical approach to the bony eustachian tube "extended anterior tympanotomy". The transmastoidal accessibility of the bony eustachian tube produced by this technique should be assessed by preoperative computed tomography.
我们报告一名76岁男性患者，患有粘连型胆脂瘤，并伴有金属异物，计算机断层扫描显示这些异物位于骨性咽鼓管内。他在52年前第二次世界大战期间被炸弹击中时，左侧鼓膜受到烧伤。进入鼓室的炮弹碎片在鼓膜穿孔自发闭合后，显然通过黏液纤毛作用被输送并卡在咽鼓管峡部。由于异物和周围肉芽组织的持续阻塞，似乎导致了慢性粘连性中耳炎，进而发展为位于上鼓室和乳突窦的胆脂瘤。通过完整外耳道壁技术结合前鼓室切开术广泛暴露咽鼓管上隐窝和咽鼓管鼓口切除胆脂瘤后，未见异物。因此，前鼓室切开术进一步向前扩展以打开扩大的骨性咽鼓管，从而能够看到并安全取出两枚紧紧卡在其中的炮弹碎片。我们将这种针对骨性咽鼓管的手术方法称为“扩大前鼓室切开术”。术前计算机断层扫描应评估该技术所产生的经乳突到达骨性咽鼓管的可及性。
