Professional Documents
Culture Documents
Jun Ho Lee; Sang Ho Jung; Chan Hum Park; Seok Min Hong
Ear, Nose & Throat Journal; Sep 2010; 89, 9; ProQuest Medical Library
pg. 438
ORIGINAL
ARTICLE
Abstract
The external auditory canal (EAC) is nn unusual location
fora cholesteatoma. We present the casesof2 patients with
EAC cholesteatoma who experienced extensive damage that
extended from the inferior EAC wall to the infratemporal
area; there was no mastoid involvement. In both cases, the
cholesteatomas were removed under local anesthesia and
the inferior canal wall was reconstructed with a technique
that involved the placement oja pedicled musculoperiosteal
flap, a cartilage graft, and a full-thickness skin graft.
This simple procedure preserves n normal fAC contour,
middle ear space, and mastoid cavity.
Introduction
External auditory canal (EAC) cholesteatoma
is an
uncommon form of the disease, When it does occur, it
usually affects older patients, who typically present with
chronic otorrhea and dull otalgia. Various treatmen ts for
EAC cholesteatoma have been previously reported.':' If
the bony defect in the EAC is small, the erosive bone can
be saucerized with a diamond bur, and the area of the
defect can be filled with a soft-tissue graft, cartilage, and
temporalis fascia. J If the adjacent anatomic structures
(i.e., the mastoid, skull base, temporomandibular
joint,
and/or facial nerve) are damaged, a canal-wall-down
mastoidectomy and obliteration are preferred.'
We report the cases of 2 patients with EAC cholesteatoma who were treated with an inferior canal waJJ
reconstruction technique that involved the placement
of a pedicled musculoperiosteal
flap, a cartilage graft,
and a full-thickness skin graft.
Case reports
Patient 1. A 67-year-old woman visited our hospital
for evaluation of intermittent
right-sided otorrhea
that had developed over the preceding month. She
also complained of mild hearing impairment on the
affected side, She was receiving medical treatment for
hypertension.
On physical examination, a large defect in the inferior
wall of the EAC was observed; the tympanic membrane was normal (figure l, A). Methicillin-resistant
Staphylococcus at/reus was cultured from the draining
otorrhea. Computed tomography (CT) of the temporal
bone showed destruction of the inferior wall of the
right EAC by a lesion with a soft-tissue density, but
the aeration of the mastoid air cell and the middle ear
space was normal.
The patient was taken for surgery under local anesthesia. Following exposure of the EAC via a retroauricular
approach, the inferior wall of the EAC was found to be
destroyed by the cholesteatoma. After removal of the
cholesteatoma sac, a huge dead space was seen on the
inferior EAC (figure l, B). The muscular fascias of the
infratemporal area were palpated th rough this dead space.
A mastoidectomy was not necessary because the mastoid
cavity was apparently normal and because the removal
of the EACcholesteatoma was relatively easy and did not
require canal widening to reach the mastoid area.
Using an inferior pedicled rnusculoperiosreal
nap
(figure I, C), we covered the dead space (figure l, D).
ENT-Ear, Nose & Throat Journal
September 2010
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Figure 1. Patient /. A: The extensive destruction of the illferior EAC is seen (/1 presentation.
The tympanic membrane is relatively /"/0/"11"11T1h1e. exposed il/ferior /JOIIYall/llIlus
shadow ((/rrol\l) is seen. B: Irl/(jge snows she denr/ space (nrrowhear/) resulting from the
remove! of the cholesteatoma soc. C: All inferior pedicled niuscntoperioueai j7np is
lmrvested. D: Tile IWl"vestedj7np;s rotnted;1I nil antennnediai il/ferior direction 1.0 cover the
dead spnce. E: The rotated flap is covered by the tragal and concha! cortiiage, and a [utlshickness skill graft [mm t"he postauricuior aren is covered by cnrtilage. F: Five weeks
foflolVillg the revision gmtt/ the BAC is neavly 110I"IIlCdand the ly/ll/)(1l1ic druin ((//"1"01\1)
remains nommi.
ENT-Ear, Nose
&
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Nairn R,
auditory
Linthicum
F Jr . Shen T, ct al. Classification
of the external
canal cholesteatoma.
Laryngoscope
2005; 115(3):455-60.
2. 'los M.
3.
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5.
6.
A histo-
September 2010
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