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Science articles
Science articlesThe method of cochlea-sparing surgical sanation of infralabyrinthine-apical cholesteatoma of the petrous part of the temporal bone
N. N. Khamgushkeeva (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
UDK: 616.284-002.258-089.87
DOI: https://doi.org/10.18692/1810-4800-2018-1-106-111
ABSTRACT
Surgical treatment of patients with infralabyrinthine-apical cholesteatoma of the petrous part of the temporal bone involves the radical excision of the formation, often together with the cochlea, which results in the development of the degree 4 of chronic sensorineural hearing loss in the postoperative period.
This article presents a method of cochlea-sparing surgical sanitation of infralabyrinthine-apical cholesteatoma of the petrous part of the temporal bone. This method is applicable to the patients with the preserved function of the auditory analyzer without the extension of cholesteatoma to the labyrinth and high position of the bulb of the jugular vein. The method includes skeletonization of the fallopian canal, expansion of the hypothympanum by removal the bone shelf of the lower wall of the external auditory canal together with the tympanic ring up to the jugular vein bulb, as well as by removal the bone shelf of the anterior wall of the external auditory canal up to temporo-mandibular joint, and thinning of the cochlear capsule up to its membranous region. After that, the sinuses of hypothympanum, infralabyrinthine cellular tract, pericarotid and precaratid cells are removed up to the internal carotid artery, going deeper to the top of the temporal bone pyramid. In this case, before the fallopian canal skeletonization, the access through retroaural approach with extended anthro-mastoidotomy, the excision of malleus, incus, all cells of the cellular tract of the temporal bone. Simultaneously with the phallopian canal skeletonization, intra-operative monitoring of the facial nerve is performed using needle electromyography by means of a drill until the occurrence of threshold events at the current of 0.8 to 0.5 mA; the formed trepanation cavity is sanitized, after that the external auditory canal is plastically expanded, and type 3 or 4 tympanoplasty with ossiculoplasty is performed, depending on the degree of damage of the sound-conducting system of the middle ear; in the post-surgical period the trepanation cavity is managed open. The method provides the reduction of cholesteatoma recurrence development risk and saves the hearing of the patients. The results of the treatment were evaluated using otomicroscopy, temporal bone MSCT, MRI of the middle ear in DWI-mode in the follow-up period of 6 months through 3 years.
Publication date:
27.12.2017
Keywords:
cholesteatoma, petrous part of the temporal bone, chronic suppurative otitis media, intraoperative facial nerve monitoring, infralabyrinthine-apical cholesteatoma. For citation:
Khamgushkeeva N. N. The method of cochlea-sparing surgical sanation of infralabyrinthine-apical cholesteatoma of the petrous part of the temporal bone. Rossiiskaya otorinolaringologiya. 2018;1:106–111. https://doi.org/10.18692/1810-4800-2018-1-106-111