Leonetti J P, Buckingham R A, Marzo S J
Department of Otolaryngology/Head and Neck Surgery, Loyola University Medical Center, Maywood, IL 60153, USA.
Am J Otol. 1996 Nov;17(6):823-6.
Posteromedial retraction of the tympanic membrane, between the oval window superiorly and the round window niche inferiorly, results in the formation of an epithelium-lined pocket within the sinus tympanic recess. Failure to recognize posterior invagination of the tympanic membrane intraoperatively leads to inadvertent tearing of the tympanomeatal flap at the level of the annulus with epithelial seeding of the middle ear and probably cholesteatoma recurrence. This article focuses on the clinical manifestations and radiographic findings suggestive of sinus tympanic epithelial retraction of the pars tensa and provides direct correlation between human cross-sectional temporal bone anatomy and otomicroscopy. The surgical management of these challenging lesions includes initial endaural access, external meatal bone removal posteromedial to the tympanic annulus and anterior to the vertical portion of the facial nerve, and middle ear ventilation after marsupialization of the epithelial retraction. Although early tympanic membrane retraction can be treated with a ventilation tube, deep epithelial pockets may require additional surgical treatment. A method for the management of sinus tympanic cholesteatomas is demonstrated.
鼓膜向后内侧退缩，位于上方的卵圆窗和下方的圆窗龛之间，导致鼓室隐窝内形成一个内衬上皮的囊袋。术中未识别出鼓膜的后内陷会导致在鼓环水平意外撕裂鼓室瓣，使中耳上皮植入，可能导致胆脂瘤复发。本文重点关注紧张部鼓室上皮退缩的临床表现和影像学表现，并将人体颞骨横断面解剖与耳显微镜检查直接关联。这些具有挑战性病变的手术治疗包括最初的耳内入路、在鼓环后内侧和面神经垂直段前方去除外耳道骨质，以及上皮退缩袋形缝合术后的中耳通气。虽然早期鼓膜退缩可用通气管治疗，但深部上皮囊袋可能需要额外的手术治疗。文中展示了一种处理鼓室胆脂瘤的方法。
