Revision canal-wall down surgery: comparison of surgical outcomes with three different techniques

Fermi, Matteo; Siggemann, Till; Melchiorri, Claudio; Bonali, Marco; Niederhauser, Laura; Caversaccio, Marco; Presutti, Livio; Anschuetz, Lukas

doi:10.1007/s00405-021-06829-y

Cited by 4 publications

(5 citation statements)

References 18 publications

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“…20 In recent years, there have been some reports that the transcanal endoscopic approach is effective in preventing recurrence and underscores the importance of the mucosa and mastoid air cells. 21,22 It may be necessary to fundamentally reconsider the approach and incorporate methods that strive to preserve the mucosa in future studies.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of repeated recidivism in surgical cases of cholesteatoma requiring canal wall reconstruction

Yazama

Kunimoto²,

Hasegawa

et al. 2021

Ear Nose Throat J

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Objective Few reports discuss the characteristics of repeated recidivism of cholesteatoma. We describe the clinical characteristics of patients with cholesteatoma who experienced at least two recidivism episodes after initial surgery for cholesteatoma requiring canal wall reconstruction. Methods We reviewed the medical records of 11 patients who underwent surgery for cholesteatoma with canal wall reconstruction at our department between April 2008 and March 2018 and subsequently experienced two relapses that necessitated revision surgery involving tympanomastoidectomy with canal reconstruction. Patient age at the time of the first surgery ranged from 6 to 56 (mean, 25.7) years. Seven (63.6%) of the 11 patients were male. These 11 patients were classified according to the type of recidivism, and their characteristics (pathology, operation date, operation method, pattern of relapse, and position of recurrence) were investigated. Results Four cases involved secondary residual cholesteatoma, with the mean interval between the first revision surgery and the second revision surgery being 23.8 (range, 11–39) months. Secondary residual sites included the anterior tympanic cavity, tympanic sinus, and anterior end of the reconstructed cartilage of the canal wall. The other seven cases involved secondary recurrence, with the mean interval between the first and the second revision surgery being 26.1 (range, 12–57) months. The sites of recurrence were at the edges of the reconstructed cartilage. One notable case involved the cartilage junction, leading us to hypothesize that retraction of the temporal muscle flap and the patulous Eustachian tube was the underlying cause. Conclusion For residual cholesteatoma, strict measures are necessary to maintain the operation under clear view, and more careful follow-up is necessary in patients who have had previous surgery at another hospital. For recurrent cholesteatoma, it was recognized that Eustachian tube function must be ascertained in advance, and careful observation of the reconstructed cartilage edge is necessary.

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Section: Discussionmentioning

confidence: 99%

Characteristics of repeated recidivism in surgical cases of cholesteatoma requiring canal wall reconstruction

Yazama

Kunimoto²,

Hasegawa

et al. 2021

Ear Nose Throat J

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“…Due to its wide view and the possibility to use angled lenses to access hidden anatomical areas of the middle ear, it is a suitable minimal‐invasive technique for the treatment of cholesteatoma 1–6 . Due to the locally invasive and destructive behaviour of middle ear cholesteatoma, detection and radical removal of even microscopic residuals is required to prevent re‐growth and complications 7 …”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5][6] Due to the locally invasive and destructive behaviour of middle ear cholesteatoma, detection and radical removal of even microscopic residuals is required to prevent re-growth and complications. 7 Despite technical advancements regarding the visual control of the middle ear as offered by the endoscope, the complete eradication of the squamous cell matrix from the middle ear remains a surgical challenge. Especially in diffusely infiltrating cholesteatoma, it may be difficult to remove the cholesteatoma "en-bloc," and the quest for possible remnants may impact on surgical time.…”

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confidence: 99%

Digital image enhancement may improve sensitivity of cholesteatoma detection during endoscopic ear surgery

Ragonesi

Niederhauser

Fernandez

et al. 2023

Clinical Otolaryngology

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“…[1][2][3][4][5] Furthermore, in revision canal-wall-down mastoidectomy, the endoscope is increasingly used as an exclusive or adjunct tool with favorable outcomes regarding complication rate, duration of surgery, and hospitalization days. 6 With the introduction of the endoscope in middle ear surgery, different classifications for middle ear subspaces were developed. One of the key regions in this context is the retrotympanum, as it is one of the most common localizations of residual cholesteatoma.…”

mentioning

confidence: 99%

“…In particular, the utilization of the endoscope in cholesteatoma surgery enabled the exploration of hidden recesses and consecutively reduced the rate of residual cholesteatoma compared to microscopic canal‐wall‐up mastoidectomy 1‐5 . Furthermore, in revision canal‐wall‐down mastoidectomy, the endoscope is increasingly used as an exclusive or adjunct tool with favorable outcomes regarding complication rate, duration of surgery, and hospitalization days 6 …”

mentioning

confidence: 99%

Accuracy of High‐Resolution Computed Tomography Compared to High‐Definition Ear Endoscopy to Assess Cholesteatoma Extension

Beckmann

Hool

Yacoub

et al. 2023

Otolaryngol.--head neck surg.

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ObjectiveTo correlate radiographic evidence of cholesteatoma in the retrotympanum with intraoperative endoscopic findings in cholesteatoma patients and to evaluate the clinical relevance of radiographic evidence of cholesteatoma in the retrotympanum.Study DesignCase series with chart review.SettingTertiary referral center.MethodsSeventy‐six consecutive cases undergoing surgical cholesteatoma removal with preoperative high‐resolution computed tomography (HRCT) were enrolled in this study. A retrospective analysis of the medical records was conducted. The extension of cholesteatoma regarding different middle ear subspaces, into the antrum and mastoid were reviewed radiologically in preoperative HRCT and endoscopically from surgical videos. Additionally, facial nerve canal dehiscence, infiltration of the middle cranial fossa, and inner ear involvement were documented.ResultsComparison of radiological and endoscopic cholesteatoma extension revealed statistically highly significant overestimation of radiological cholesteatoma extension for all retrotympanic regions (sinus tympani 61.8% vs 19.7%, facial recess 69.7% vs 43.4%, subtympanic sinus 59.2% vs 7.9%, and posterior sinus 72.4% vs 4.0%) and statistically significant overestimation for mesotympanum (82.9% vs 56.6%), hypotympanum (39.5% vs 9.2%), and protympanum (23.7% vs 6.6%). No statistically significant differences were found for epitympanum (98.7% vs 90.8%), antrum (64.5% vs 52.6%), and mastoid (26.3% vs 32.9%). Statistically significant radiological overestimation of facial nerve canal dehiscence (54.0% vs 25.0%) and invasion of tegmen tympani (39.5% vs 19.7%) is reported.ConclusionRadiologic cholesteatoma extension in different middle ear subspaces is overestimated compared to the intraoperative extension. The preoperative relevance of radiological retrotympanic extension might be limited in the choice of approach and transcanal endoscopic approach is always recommended first.

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Revision canal-wall down surgery: comparison of surgical outcomes with three different techniques

Cited by 4 publications

References 18 publications

Characteristics of repeated recidivism in surgical cases of cholesteatoma requiring canal wall reconstruction

Characteristics of repeated recidivism in surgical cases of cholesteatoma requiring canal wall reconstruction

Digital image enhancement may improve sensitivity of cholesteatoma detection during endoscopic ear surgery

Accuracy of High‐Resolution Computed Tomography Compared to High‐Definition Ear Endoscopy to Assess Cholesteatoma Extension

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