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Science articles
Science articlesThe method of surgical sanation of infralabyrinthine-apical cholesteatoma of the petrous part of the temporal bone
N. N. Khamgushkeeva (1), I. A. Anikin (1), T. A. Bokuchava (2), S. N. Il’in (1)
(1) Federal State Budgetary Institution “Saint Petersburg Research Institute of Ear, Throat, Nose and Speech”, Ministry of Health of the Russian Federation, Saint Petersburg, Russia
(2) State-Financed Health Institution Murmansk Regional Clinical Hospital named after P. A. Bayandin, Murmansk, Russia
UDK: 616.284.253-089
DOI: https://doi.org/10.18692/1810-4800-2017-2-98-103
ABSTRACT
The relevance of the study is determined by the location of cholesteatoma in the petrous part of the temporal bone and its close contact with the vital structures of the temporal bone, which makes impossible the complete excision of cholesteatoma matrix without its damaging. The work presents a method of surgical sanitation of infralabyrinthine-apical cholesteatoma of the petrous part of the temporal bone in the patients with stage 4 of chronic sensorineural hearing loss and subject to the spread of cholesteatoma to the cochlea. The method includes postauricular approach, the extended radical operation with the removal of cells of the cellular path of the temporal bone down the formation, skeletonization of the facial nerve canal, removing the cochlea, hypotympanum sinuses and infralabyrinthine cellular path to the top of the petrous part of the temporal bone, sanitation of the trepanation cavity and closing of the tympanic part of auditory tube by the auto-cartilage and fascial flap. Intraoperative monitoring of the facial nerve is performed simultaneously with the facial nerve canal skeletonization, using needle electromyography with the drill until the occurrence of the threshold events at the current of 0.8 mA to 0.5 mA, and after the sanitation of the generated trepanation cavity plastic extension of the external ear canal is performed, while in the postoperative period trepanation cavity is managed open. The method reduces the risk of relapse. The results of the treatment were evaluated by means of otomicroscope examination, temporal bone MLSCT, the middle ear MRI. The article provides assessment of the results of treatment of 3 patients at the period of 6 months through 2 years.
Publication date:
06.05.2017
Keywords:
cholesteatoma, petrous part of the temporal bone, chronic suppurative otitis media, intraoperative facial nerve monitoring, infralabyrinthine-apical cholesteatoma. For citation:
Khamgushkeeva N. N., Anikin I. A., Bokuchava T. A., Il’in S. N. The method of surgical sanation of infralabyrinthine-apical cholesteatoma of the petrous part of the temporal bone. Rossiiskaya otorinolaringologiya. 2017;2:98–103. https://doi.org/10.18692/1810-4800-2017-2-98-103