Pathogenesis of Cholesteatoma Based on Clinical Results of Anterior Tympanotomy

Morimitsu, Tamotsu; Nagai, Tomoyuki; Nagai, Masashi; Ide, Minoru; Makino, K; Tono, Tetsuya; Adachi, Yuuichiro; Kasano, Fujihiko; Fukiyama, Mikiko; Hayashi, Akitoshi

doi:10.1016/s0385-8146(89)80024-0

Cited by 21 publications

(12 citation statements)

References 9 publications

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“…Establishing this auxiliary ventilation route may require opening two bony isthmuses: at the floor of the anterior epitympanic space and at the cog. Thus we confirm the suggested auxil iary ventilation route of Hoshino [14], Interestingly, Morimitsu et al [22], who advocate this auxiliary ventilation route, do not consider compromised openness of the floor of the 'supratubal recess' to be a problem; rather, they consider the anterior attic bony plate (the cog, or trans verse mallear plate) to be the obstruction that must be cleared.…”

Section: For the Surgeonsupporting

confidence: 82%

Bony Anatomy of the Anterior Epitympanic Space

Nh²,

Jh³

1994

ORL

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The anatomy of the anterior epitympanic space is complex and relatively unfamiliar to the surgeon. The size of the space is unpredictable. From the surgeon’s perspective, we studied the bony anatomy of the anterior epitympanic space in 35 cadavers. There was an impressive variability of bony openness into the anterior mesotympanum; the openness was bilaterally symmetrical. As a potential auxiliary ventilation route for the epitympanum of the chronic otitis patient, each specimen was found to have sufficient room to surgically establish a route at least 2 mm in diameter to connect with the anterior mesotympanum. None of the specimens had dehiscent facial nerve in the anterior epitympanic space, but 60% of specimens had dehiscent facial nerve adjacent to the stapes. The anatomic variations of the anterior epitympanic space were not related to prior otitis media. Three fourths of the medial walls of the anterior epitympanic spaces lacked the bony trabeculae that are otherwise typical of the epitympanum. Because the medial wall contours were bilaterally symmetrical, because the contours were unassociated with indicators of prior otitis media, and because of apparent contour differences in Orientals and Caucasians, a congenital factor is suggested to determine the contour of the medial wall of the anterior epitympanic space.

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Section: For the Surgeonsupporting

confidence: 82%

Bony Anatomy of the Anterior Epitympanic Space

Nh²,

Jh³

1994

ORL

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“…Anterior tympanotomy [12] was not found to facilitate recovery in mastoid aeration. This indicates that a new route created by this procedure and posterior tympanotomy does not function in the long term.…”

Section: Discussionmentioning

confidence: 81%

“…Several surgical techniques such as anterior tympanotomy [12] and posterior tympanotomy [9] have been developed in an attempt to widen the route for mastoid ventilation from the ET via the anterior epitympanic recess or the tympanic cavity. However, the relationship between those procedures and mastoid aeration recovery after surgery has not been verified.…”

Section: Introductionmentioning

confidence: 99%

Factors affecting recovery of mastoid aeration after ear surgery

Tanabe

Takahashi

Honjo

et al. 1999

European Archives of Oto-Rhino-Laryngology

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Fifty-six patients after tympanomastoid surgery were examined to determine recovery of mastoid aeration and various pre- and intraoperative factors such as eustachian tube (ET) function, how the mastoid mucosa had been treated during surgery and whether or not a large silastic sheet had been placed in the middle ear or a ventilation tube used. Mastoid aeration recovery was confirmed by computed tomography in 27 of the 57 cases (47%) within 12 months of surgery. Among the factors examined, preservation of the epitympanic mucosa was found to be most important in mastoid aeration recovery. Use of a large silastic sheet to cover the area from the bony ET and tympanic cavity to epitympanum, aditus ad antrum or antrum was found to be of some help in recovery mastoid aeration after complete resection of the mucosa and mastoid air cells. Preoperative ET function, anterior tympanotomy and use of a ventilation tube did not influence recovery.

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“…It may be that when negative pressure occurs in Prusak's space, the epithelium of the external auditory canal will first destroy the structure of Prussak's space and later result in retraction pockets or cholosteatoma. The anatomy and related pathophysiology lead to surgical modifications; for example removing the anterior attic plate (a long, thick bone septum between the epitympanum and the supratubal recess) creates a new ventilating route to the eustachian tube further reducing recurrence rate [6][7][8][9].…”

Section: Canal Wall Up Mastoidectomy (Cwu)mentioning

confidence: 99%