외이도 재건을 위해 잔존 외이도 후벽을 보존한 채 시행한 개방형 유양동 삭개술 4예
Canal Wall Down Mastoidectomy with Preservation of Remnant Posterior Canal Wall for Mastoid Obliteration and Canal Wall Reconstruction: 4 Cases
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The aim of cholesteatoma surgery is to completely eradicate cholesteatoma and to reconstruct the normal anatomy of the middle ear. Canal wall down mastoidectomy (CWD) is often applied for the complete eradication of cholesteatoma and prevention of recurrence in patients with cholesteatoma. However, CWD involves a significant destruction of the middle ear and the mastoid anatomy, that leads to potential complications including chronically draining cavity, retention of debris that requires frequent cleaning, and difficulty in fitting a hearing aid. To resolve these problems, surgeons have attempted to reconstruct posterior external auditory canal wall with a variety of techniques and materials. We recently experienced four cases of patients who had tympanomastoid surgery because of cholesteatoma. In the operation, superior segment of posterior canal wall was removed but remnant inferior segment of posterior canal wall was preserved. CWD with preservation of the remnant canal wall was performed unlike the conventional CWD operation. Surgical view was sufficient to eradicate the entire cholesteatoma. Canal wall reconstruction was done with remnant canal wall and conchal cartilage, and then mastoid obliteration was done with Tissue glue mixed demineralized bone matrix. This procedure was enough to eradicate cholesteatoma without lowering facial ridge. Saucerization, mastoid tip amputation and meatoplasty were not even needed. We report these four cases with a review of literature.
Abstract
The aim of cholesteatoma surgery is to completely eradicate cholesteatoma and to reconstruct the normal anatomy of the middle ear. Canal wall down mastoidectomy (CWD) is often applied for the complete eradication of cholesteatoma and prevention of recurrence in patients with cholesteatoma. However, CWD involves a significant destruction of the middle ear and the mastoid anatomy, that leads to potential complications including chronically draining cavity, retention of debris that requires frequent cleaning, and difficulty in fitting a hearing aid. To resolve these problems, surgeons have attempted to reconstruct posterior external auditory canal wall with a variety of techniques and materials. We recently experienced four cases of patients who had tympanomastoid surgery because of cholesteatoma. In the operation, superior segment of posterior canal wall was removed but remnant inferior segment of posterior canal wall was preserved. CWD with preservation of the remnant canal wall was performed unlike the conventional CWD operation. Surgical view was sufficient to eradicate the entire cholesteatoma. Canal wall reconstruction was done with remnant canal wall and conchal cartilage, and then mastoid obliteration was done with Tissue glue mixed demineralized bone matrix. This procedure was enough to eradicate cholesteatoma without lowering facial ridge. Saucerization, mastoid tip amputation and meatoplasty were not even needed. We report these four cases with a review of literature.
참고문헌 (17)
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