Petrous bone cholesteatoma: our experience of 51 patients with emphasis on cochlea preservation and use of endoscope

Gao, Zhen; Gao, Gang; Zhang, Weidong; Jia, Xian‐Hao; Yu, Jing; Dai, Chenyang; Chen, Bing; Chi, Fang‐Lu; Wang, Jing; Yuan, Yasheng

doi:10.1080/00016489.2019.1605455

Cited by 8 publications

(4 citation statements)

References 17 publications

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“…This patient was operated on years later because of a cholesteatoma, leading to a new complete FNP. Perhaps an endoscopic resection of cholesteatoma could have been a better option to preserve the facial nerve, as described by Gao et al 24 Another gracilis transfer, using the masseteric nerve as a recipient nerve, restored the motion but could not achieve the symmetric and coordinated smile that the patient previously had.…”

Section: Discussionmentioning

confidence: 99%

Salvage Procedures for Facial Reanimation With Neurovascular Flaps When Previous Surgeries Failed

Ibarra

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2022

Ann Plast Surg

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Background: Facial paralysis reconstruction can be difficult in extensive defects after complex facial or cranial base tumor resection and radiotherapy or when primary smile reanimation attempt has failed. The surgical challenge is more complicated when defects are associated with recipient vessels or nerves depletion. This scenario has not been well described in the literature, and the present article will address the alternatives that plastic surgeons may use in these circumstances. Methods: Seventy-five patients operated in the Hospital Gregorio Marañon between 2008 and 2020, for dynamic reconstruction of facial paralysis, were retrospectively evaluated, collecting data about previous facial nerve surgeries, radiotherapy, chemotherapy, recipient nerve for motor restoration and vessels used for free flaps, type of neurovascular free flap (NVFF), and functional score before and after the facial reanimation surgery. Patients presenting recipient vessel and/or nerve depletion after several facial surgeries requiring a variation from the common NVFF surgical protocol were included in this study. Results: Six cases (8%) with facial paralysis and absent recipient homolateral vessels or nerves after severe cranial base surgery, parotid malignancies, or schwannoma surgery were included. Two patients had an immediate functional reconstruction during the oncologic resection surgery, and 4 patients had a delayed reconstruction. Three patients had previous reconstruction with free flaps, and the vascular pedicles of previous flaps were used for the new NVFF. In the other 3 cases, interposition vein grafts to the contralateral recipient vessels were required to perform NVFF. Masseteric nerve in 4 cases, hypoglossal nerve and posterior branch of the deep temporal nerve in 1 case each, were used as recipient nerves. House-Brackmann score improved in all patients after surgery. Conclusions: Neurovascular free flap can be successfully performed to restore facial motion after depletion of homolateral recipient vessels or nerves after previous facial or cranial base surgeries. In these cases, interposition vascular grafts or the pedicle of previous flaps are essential to provide vascularization as well as an optimal orientation of flaps, to reach recipient nerves in a 1-step procedure.

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Section: Discussionmentioning

confidence: 99%

Salvage Procedures for Facial Reanimation With Neurovascular Flaps When Previous Surgeries Failed

Ibarra

Lasso

2022

Ann Plast Surg

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“…The disadvantages of this technique are its two-dimensional vision and the need to perform one-handed surgery. 24 Gao et al, 25 using the combined microscopic and endoscopic technique, reported cochlea preservation in 76.9% of patients with supralabyrinthine PBC, followed by 66.7% of infralabyrinthine and 66.7% of infralabyrinthine-apical ones.…”

Section: Discussionmentioning

confidence: 99%

“…Gao et al, 25 using the combined microscopic and endoscopic technique, reported cochlea preservation in 76.9% of patients with supralabyrinthine PBC, followed by 66.7% of infralabyrinthine and 66.7% of infralabyrinthine-apical ones.…”

Section: Discussionmentioning

confidence: 99%

Petrous Bone Cholesteatoma: Facial and Hearing Preservation

et al. 2021

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Objectives: Petrous bone cholesteatoma (PBC) is a rare condition of the petrous portion of the temporal bone. Treatment of choice consists of radical surgical removal, paying attention to protect the facial nerve and inner ear as far as possible. The aim of the present study was to evaluate the efficacy of modified translabyrinthine techniques in preserving hearing function and the use of the adjuvant endoscopic techniques in a group of PBC patients. Methods: This study comprised 16 cases of PBCs surgically treated in our Department. Pre- and post-operative hearing status was assessed with pure tone audiometry and speech discrimination and graded according to the Gardner- Robertson classification system. Facial function was based on the House Brackman (HB) classification. PBCs were grouped using Sanna’s classification. The choice of surgical technique was based on the above findings together with preoperative evidence. Post-operative follow-up ranged from 1 to 10 years and also included Computed Tomography and Magnetic Resonance Imaging assessment. Results: PBCs were classified as follows: 37.5% infralabyrinthine; 43.75% supralabyrinthine; and 18.75% massive. Preservation of the bone conduction threshold was feasible in 62.5% of patients. For supralabyrinthine PBCs a subtotal petrosetomy was performed in all cases and hearing preservation was possible in 57% of them: an adjuvant endoscopic approach was performed in 43%. Infralabyrinthine PBCs were treated using a modified translabyrinthine approach with preservation of bone conduction in 83% of patients; an adjuvant endoscopic approach was performed in 50% cases. One patient with a massive cholesteatoma was treated by modified translabyrinthine approach, preserving a serviceable level of hearing. In all massive cases, an adjuvant endoscopic approach was performed. In 2 patients with preoperative palsy, facial nerve function showed an improvement. The follow-up period revealed evidence of limited recurrence at CT imaging in 2 patients. Conclusions: The introduction of modified surgical approaches, able to preserve the anatomical-functional structures, have shown an improvement of post-operative hearing outcomes.

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“…The surgical choice has evolved from petromastoid exteriorization with drainage of the cavity to complete radical excision following obliterative techniques 7 with efforts to protect the facial nerve and inner ear. 8 Despite great advancements in microscopic skull base surgical techniques, PBC surgery is still a challenge for otologists, and postoperative morbidity remains an issue.…”

Section: Discussionmentioning

confidence: 99%

Subtotal Petrosectomy With Preservation of Chorda Tympani for Petrous Bone Cholesteatoma: Case Report

et al. 2020

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A petrous bone cholesteatoma (PBC) is a rare epidermoid cyst of the petrous portion of the temporal bone. The main treatment is subtotal petrosectomy (SP), which generally involves sacrificing the chorda tympani. We report a case of extensive supralabyrinthine PBC in an elderly patient undergoing hemodialysis that was treated by SP with anatomical preservation of the chorda tympani. To the best of our knowledge, preservation of the chorda tympani during SP has not been previously reported. For maintenance of postoperative taste and appetite, preservation of the chorda tympani is a meaningful maneuver whenever possible.

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Petrous bone cholesteatoma: our experience of 51 patients with emphasis on cochlea preservation and use of endoscope

Cited by 8 publications

References 17 publications

Salvage Procedures for Facial Reanimation With Neurovascular Flaps When Previous Surgeries Failed

Salvage Procedures for Facial Reanimation With Neurovascular Flaps When Previous Surgeries Failed

Petrous Bone Cholesteatoma: Facial and Hearing Preservation

Subtotal Petrosectomy With Preservation of Chorda Tympani for Petrous Bone Cholesteatoma: Case Report

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