真珠腫の再発と予防対策

抄録

Recently, there seems an increasing criticism against the use of intact canal wall technique for cholesteatoma cases due to a high incidence of recurrent diseases. In order to study possible causes and effective preventive measures of recurrent cholesteatomas the author has reviewed 426 revision cases operated on during the past 9 years, 121 of which were with cholesteatoma, and 37'staged tympanoplasty. cases, 17 of which were with recurrent cholesteatoma.
The conclusions drawn were
1. Combined approach tympanoplasty should be performed by a well trained and skilled otologic surgeon.
2. Although one stage combined approach tympanoplasty may be possible for cases where non-infected cholesteatoma is restricted in the attic, staged tympanoplasty should be used for extensive, infected, or child cholesteatomas.
3. Combined approach tympanoplasty should be avoided in cases where cholesteatoma has extended into the tympanic sinus.
4. In combined approach tympanoplasty the posterior bony wall should not be too thinned because it may be absorbed later.
5. The defected lateral wall of the attic should be reconstructed with cartilage and a silastic sheet should be used to prevent adhesions of the tympanic membrane. Gelfoam should not be used in the middle ear in large amount.
6. Combined approach tympanoplasty should not be used for cases with eustachian tube dysfunction.