耳部外傷性膽脂瘤

膽脂瘤常見於中耳及乳突而罕見於外耳道。因外傷性顳骨骨折引起外耳道膽脂瘤極爲罕見，在美國國內報告只有8例，在國際上發表過的病例不超過12例。由於初期症狀不明顯，且不易觀察耳道內變化，導致外耳道膽脂瘤緩慢形成及擴展可長達數年，當出現臨床表徵時，通常已侵犯相當嚴重，手術治療的困難度大幅增加，並多數伴有嚴重併發症。秀傳紀念醫院於2005年10月經歷一名40歲男性，主訴續斷頭痛及頭暈達5個月之久，曾在本院神經內科及外院耳鼻喉科診治多次，症狀均未獲得改善。理學檢查顯示，右耳耳膜正常且外耳道皮膚完整但有稍微隆起，經仔細以棉棒探查才發現隆起的後方有凹陷區域，故安排顳骨電腦斷層掃描，顯示右顳骨存在未癒合的骨折縫，形成外耳道壁缺陷，軟組織腫塊佔據乳突及中耳腔併聽小骨缺損。聽力檢查呈現氣骨導差33分貝。回朔病史，病人於10年前曾經歷車禍，右側顳骨骨折。經修正性根除式乳突鑿開術證實爲右側外傷後之外耳道膽脂瘤，逐予移除並進行聽小骨重建，術後聽力有改善；目前門診追蹤下，並無復發之跡象。由此病例得知，當有頭部外傷史的病人抱怨新出現的耳科症狀，必須懷疑存在外耳道膽脂瘤，嚴謹地顯微鏡檢及適時棉棒探查是必要的。

關鍵字

耳部外傷性膽脂瘤

並列摘要

Cholesteatoma that has developed in the middle ear and mastoid cavity is common but the disease is rare in the external canal. Furthermore, cholesteatoma as a result of a traumatic fracture of the temporal bone is an extremely rare condition. Only eight cases of traumatic cholesteatoma formation have been reported in the United States, and less than a dozen cases have been reported internationally. The long interval to diagnosis and the absence of clinical symptoms allows extensive growth of the cholesteatoma; this can result in it being difficult to manage surgically on presentation. In October 2005, a 40-year-old male visited our OPD with his chief complaints being fluctuating headaches and dizziness for more than five months. He had been treated by various neurologists and otolaryngologists, but there had been no improvement. The local findings revealed that the right eardrum was intact without retraction and the skin of external canal was intact, but there was a slightly elevated area at the posterosuperior aspect of the osseous external canal. Using careful cotton tip palpation, we found there seemed to be a defect behind the slightly elevated area. Therefore, CT visualization of temporal bone was carried out, and this showed the present of an unhealed temporal bone fracture line; this had resulted in a bony defect of the ear canal. Furthermore, a large soft tissue mass occupied the tympanomastoid cavity and a loss of incus was also noted. An audiogram was conducted and this reported right conduction hearing loss with a 33-dB gap. On tracing his history, it was discovered that he had been involved in a car accident about ten plus years previously and suffered a right temporal bone fracture. There had been no history or symptoms of ear disease before that time. Under the impression of traumatic cholesteatoma of the external canal with tympanomastoid invasion, he underwent canal-wall-down modified radical tympanomastoidectomy with meatoplasty. The impression was confirmed intraoperatively. The patient has received regular follow up in our OPD without evidence of recurrence up to the present. We recommend that medical practitioners should be alert to the possibility of post-traumatic cholesteatoma when patients who have suffered a longitudinal or mixed temporal bone fracture present with any new otological complaint. In these circumstances, it is essential to perform a detailed examination together with extensive and meticulous cotton tip palpation.

並列關鍵字

traumatic aural cholesteatoma

國際替代計量

耳部外傷性膽脂瘤

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