Application of a novel transcanal keyhole technique in endoscopic cholesteatoma surgery

Abstract

Background

It is difficult to deal with epitympanic cholesteatoma in otologic surgery. The keyhole technique can realize minimally invasive surgery and reconstruct the middle ear canal.

Objective

To explore the clinical application of keyhole technique in primary and second-look surgery in middle ear cholesteatoma.

Materials and Methods

34 cases were analyzed retrospectively in terms of residual and recurrence rate, safety (adverse events) and hearing performance at long-term follow-up. The application of the technique in primary or second stage operation was evaluated and the operation was performed by transanal endoscopy or combined approach.

Results

The cholesteatoma revealed by CT before operation was limited to the attic in 23 patients, of which 16 had the same imaging range as that of the keyhole technique. The preoperative imaging findings of 11 showed that the attic cholesteatoma may have extended into the mastoid, of which only 6 cases were confirmed by keyhole technique. An endoscopic second-look surgery using the keyhole technique was performed for these patients, 2 were confirmed to have residual lesions in the attic.

Conclusions

The keyhole technique under otoendoscopy can be used flexibly and conveniently in the second-look surgery to make up for the shortage of diffusion-weighted magnetic resonance imaging.

Chinese abstract

背景：上淋巴胆脂瘤是耳外科治疗的难点。锁孔技术可实现微创手术, 重建中耳道。

目的：探讨锁孔技术在中耳胆脂瘤的外科治疗初诊和复诊中的临床应用。

材料与方法：回顾性分析34例经长期随访的术后残留和复发情况的比率、安全性（不良事件）和听力表现。对一期或二期手术的技术应用进行评估, 并由医生实施经耳道内窥镜或联合入路手术。

结果：23例患者术前CT显示胆脂瘤局限于上鼓室, 其中16例与锁孔技术的成像范围相同。术前影像学检查11例患者的结果显示, 上鼓室胆脂瘤可能已延伸至乳突, 其中6例被锁孔技术证实。采用锁孔技术对这些患者进行了内窥镜下二次手术, 其中2例被证实有上鼓室残余病灶。

结论：耳内镜下锁孔技术可以灵活方便地应用于二次手术中, 以弥补扩散加权磁共振成像的不足。

Keywords:

• Endoscopic ear surgery
• middle ear cholesteatoma
• keyhole technique
• second-look surgery

Disclosure statement

No potential conflict of interest was reported by the author(s).