By Tamotsu Morimitsu

Acquired aural cholesteatoma poses a different procedural quandary with reference to pathogenetic examine and thought construction. simply because cholesteatoma spontane­ ously happens merely within the poorly pneumatized human ear, its pathogenesis is particular to people. still, a result of moral questions surrounding human experimentation, pathogenetic examine has nearly completely concerned nonhuman topics. certainly, makes an attempt have failed in just about all animal expe­ riments other than with the gerbil, or even right here experimental designs were inconceivable in comparison with human cholesteatoma. Cholesteatoma within the gerbil comes in handy, as a result, just for the examine of pathology and never for human pathogenesis. I carry that the pathogenesis of cholesteatoma may be understood by means of learning the cholesteatomatous ear, that's, the malpneumatized ear of the human. The anatomical distinction among the conventional and malpneumatized ear is a possible explanation for cholesteatoma. This distinction can be came upon clinically in facial nerve decompression and cholesteatoma surgical procedure, as, for instance, facial nerve palsy happens often within the general, well-pneumatized ear. in fact, traditional animal experimentation won't make sure this scientific distinction seeing that there isn't any excellent animal version for the poorly pneumatized human ear. current surgical concepts for cholesteatoma range tremendously in line with indi­ vidual otosurgeon's opinion. the main severe distinction of opinion is targeted on even if to take away the exterior ear canal wall. as a rule, the best choice will be to not eliminate the canal wall if cholesteatoma recurrence will be avoided. easily positioned, recurrence of cholesteatoma comes approximately whilst its reason has no longer been got rid of in the course of basic surgery.

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Sample text

Her pure-tone audiogram revealed bilateral severe conductive deafness with a stiff curve (Fig. 3-12). Tests of her aural reflexes revealed fixation of the ossicular chain with intact eardrums. Computerized tomographic examination (CT scan) of the temporal bone revealed bony conglutination of the malleus to the anterior attic bony plate bilaterally (Fig. 3-13). The right ear was operated on using a transmeatal approach to atticotomy. The malleus was found completely fixed by bony adhesion to the anterior attic bony plate.

22 2. Anatomical Studies d e FIG. 2-16a-e. 2 Embryonal Temporal Bone 23 tympani tendon into the labyrinthine branch and the eardrum branch. Development of the latter branch stops at the lower level, and that of the former branch stops at the upper level, of the anterior process of the malleus. The branches develop later into the inferior and superior supratubal recess, respectively. The saccus medius develops upward between the ossicles and the labyrinth, and then is divided into anterior and posterior branches by the superior mallear ligament.

The most important landmark is the facial nerve, which runs under the malleal head from the internal auditory meatus to the mastoid. If the bony wall of the labyrinth, under the malleal head, is not drilled there is no chance of damaging the facial nerve. In some cases the nerve may already be exposed when the bony wall has been absorbed by cholesteatoma. Exposure of the nerve itself during use of a diamond burr is not harmful. There is also a possibility that the greater petrosal nerve can be exposed at the tegmen tympani; we have, however, never seen such a case.

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