論説
真珠腫に対する外耳道保存型鼓室形成術の有用性とそのコツ
2018 年 111 巻 2 号 p. 79-89
詳細
2018 年 111 巻 2 号 p. 79-89
This report provides detailed guidelines for the surgical removal of a cholesteatoma using the canal wall-up (CWU) method. Five techniques for the CWU method are available to reduce the risk of complications and development of recurrent or residual cholesteatoma.
(1) The operation method must be decided prior to the operation by reference to computed-tomographic images.
(2) The cholesteatoma membrane must be pushed out from the back and removed en bloc.
(3) Two communication routes between the tympanic cavity and mastoid antrum (an anterior and a posterior route) must be created to provide a wide surgical field.
(4) A transcanal endoscope must be used to approach the cholesteatoma around the field of the tympanic sinus.
(5) A 1/2 to 1/3 filleted cartilage must be used for scutumplasty or tympanoplasty.
During cholesteatoma surgery, the canal wall-down (CWD) method or the canal wall reconstruction (CWR) method are sometimes used to reconstruct the external auditory meatus using soft tissue or temporal muscle tissue. These methods are appropriate if growth of the mastoid cavity is apparent or if indicated by the physical condition of the patient. However, the choice between the CWU and CWR method in terms of safety is a matter left to the judgment of the physician. If the external auditory meatus is destroyed, the CWD method must be chosen for re-operation after cholesteatoma recurrence. This greatly improves the postoperative quality-of-life (QOL) of the patients. Preservation of the external auditory meatus is extremely important, and it is imperative that every physician seeks to preserve it.
