PubMed · 9522317
The source did not provide an abstract. Follow the original record for more information.
Explore connections, maps & timelines
G Geyer, J Helms. 1998. [Reconstructive interventions].. https://pubmed.ncbi.nlm.nih.gov/9522317/
Cite the original work for its findings. Save a collection to share your selection of sources.
KEEP EXPLORING
The role of closed tympanomastoidectomy in the treatment of chronic ear disease continues to be a subject of debate. This article reviews the position of closed tympanomastoidectomy in the armamentarium of the otolaryngologist. In this article the technique is described and indications are reviewed. A brief history of closed tympanomastoidectomy and the issue of outcome from surgery are also addressed.
BACKGROUND: Many theories have been suggested regarding the origin, pathogenesis, diagnosis, and incidence of congenital cholesteatoma. REVIEW OF LITERATURE: An overview on the current literature on congenital cholesteatoma of the middle ear is presented. It comprises the possible etiology and pathogenesis of congenital cholesteatoma. Among other theories, germ scattering, metaplasia, ingrowth of meatal epidermis, and reflux of amniotic fluid have been proposed. Special emphasis is put on the epidermoid formation theory, which has been described by Michaels and others. CONCLUSIONS: It is widely accepted that congenital cholesteatomas may originate from the postpartum persistence of epidermoid formations. Nevertheless, a clear transition from epidermoid formation to congenital cholesteatoma has yet to be confirmed.
For the past several years there has been much debate regarding the advisability of reusing the incus for ossicular reconstruction in cases involving cholesteatoma. There appears to be some evidence that microscopic foci of cholesteatoma in the incus could lead to reimplantation of the cholesteatoma should the incus be used in the reconstruction phase. In an effort to elucidate the incidence of microscopic residual cholesteatoma, the incudes of patients with cholesteatoma were examined both grossly in the operating room and microscopically in the laboratory for erosion and residual cholesteatoma. Our examination showed that a number of specimens apparently free of cholesteatoma after macroscopic examination had microscopic evidence of cholesteatoma. Likewise, microscopic examination of an incus that appeared to be free of residual cholesteatoma revealed epithelial cells deeply invading the bone. Macroscopic examination consistently underestimated the amount of erosion that was clearly evident upon histologic examination. In light of these findings, gross examination of the incus after removal of cholesteatoma is not reliably predictive of invasive microscopic disease. Reusing the ossicles in this situation creates the potential of reimplanting the disease.