再發性膽脂瘤之修正手術

Revision Surgery for Recidivistic Cholesteatoma

黃鈞儒(Chun-Ju Huang) ； 賴仁淙(Jen-Tsung Lai)

《中華民國耳鼻喉科醫學雜誌》 36卷1期 (2001/02) Pp. 16-21

https://doi.org/10.6286/2001.36.1.16

摘要

BACKGROUND: Recidivistic cholesteatoma can be categorized into recurrent and residual types. Revision operations for recidivistic cholesteatoma carry a high level of difficulty and risk.
METHODS: A study of medical records at this hospital revealed that 235 operations for cholesteatoma were performed during the period spanning January 1995 and June 2000. Excluding “staged operations”, there were 20 revision procedures, with 11 ears in males and nine ears in females. The left ear was involved in eight patients and the right ear in 12.
RESULTS: Recurrent cholesteatoma was present in 17 ears and residual cholesteatoma in three ears. The areas of failure included a diffuse mesotympanum in three ears, the facial canal or tympanic sinus in eight, the oval window in four, the hypotympanium in one, the attic in 10, the antrum in 12, and the mastoid air cells in 13. The revision procedures included exploratory tympanotomy in four ears, atticoantrotomy in four and mastoidectomy in 12. The possible causes of failure of the previous operation included severe dysfunction of the E-tube in 17 ears, inadequate ear canal size in 11, a high facial ridge in eight, and inadequate mastoidectomy in 11. Of seven ears undergoing hearing reconstruction, a type III tympanoplasty was performed in four and a type IV tympanoplasty was performed in three. With the exception of two ears for which hearing data was incomplete, there were three ears with a hearing improvement (＞10dB) and all three underwent a type III tympanoplasty.
CONCLUSIONS: In the series, recurrent cholesteatomas usually occurred in the superior or posterior direction of the facial canal while residual cases occurred inferiorly or anteriorly. E-tube dysfunction appeared to be the most important factor resulting in failure of the previous operation. Only a small proportion of patients were suitable for hearing reconstruction and only type III tympanoplasties produced a significant improvement in hearing.

關鍵字

再發性 ； 復發性 ； 殘留性 ； 膽脂瘤 ； 修正性手術

並列摘要

BACKGROUND: Recidivistic cholesteatoma can be categorized into recurrent and residual types. Revision operations for recidivistic cholesteatoma carry a high level of difficulty and risk.
METHODS: A study of medical records at this hospital revealed that 235 operations for cholesteatoma were performed during the period spanning January 1995 and June 2000. Excluding “staged operations”, there were 20 revision procedures, with 11 ears in males and nine ears in females. The left ear was involved in eight patients and the right ear in 12.
RESULTS: Recurrent cholesteatoma was present in 17 ears and residual cholesteatoma in three ears. The areas of failure included a diffuse mesotympanum in three ears, the facial canal or tympanic sinus in eight, the oval window in four, the hypotympanium in one, the attic in 10, the antrum in 12, and the mastoid air cells in 13. The revision procedures included exploratory tympanotomy in four ears, atticoantrotomy in four and mastoidectomy in 12. The possible causes of failure of the previous operation included severe dysfunction of the E-tube in 17 ears, inadequate ear canal size in 11, a high facial ridge in eight, and inadequate mastoidectomy in 11. Of seven ears undergoing hearing reconstruction, a type III tympanoplasty was performed in four and a type IV tympanoplasty was performed in three. With the exception of two ears for which hearing data was incomplete, there were three ears with a hearing improvement (＞10dB) and all three underwent a type III tympanoplasty.
CONCLUSIONS: In the series, recurrent cholesteatomas usually occurred in the superior or posterior direction of the facial canal while residual cases occurred inferiorly or anteriorly. E-tube dysfunction appeared to be the most important factor resulting in failure of the previous operation. Only a small proportion of patients were suitable for hearing reconstruction and only type III tympanoplasties produced a significant improvement in hearing.

並列關鍵字

recidivistic ； recurrent ； residual ； cholesteatoma ； revision surgery