Retraction pocket excision with cartilage grafting as a preventive surgery for cholesteatoma

作     者：Comacchio Francesco Mion Marta Pedruzzi Barbara 

作者机构：Institute of Otolaryngology Department of Neurosciences Padova University Via Giustiniani 2 35121 Padova Italy Institute of Otolaryngology Ospedali Riuniti Padova Sud Via Albere 30 35043 Monselice Italy 

出 版 物：《Journal of Otology》 (中华耳科学杂志（英文版）)

年 卷 期：2017年第12卷第3期

页      面：112-116页

核心收录：

学科分类：1003[医学-口腔医学] 1002[医学-临床医学] 100213[医学-耳鼻咽喉科学] 10[医学] 

主　　题：Cartilage Cholesteatoma Graft Pockets Retraction 

摘      要：Aims: The goal of the present study is to summarize our experience on surgical management of retraction pockets(RP) as a preventive tool against ***:Twenty-five ears have been followed up for a mean period of 6.16 ± 4.35 years(from 1 to 17 years). The sample presented a mean age of 47.56 + 19.11 years(from 16 to 73 years). All patients underwent cartilage graft surgery. Furthermore 10(40%) underwent tympanoplasty(TPL) type Ⅰ, 14(56%) TPL type Ⅱ and 1(4%) TPL type Ⅴ.Results: Eleven ears(44%) showed cholesteatoma: all these cases were stage Ⅲ according to Charachon staging, and stage Ⅳ or Ⅴ according to Gersdorff classification. Twelve patients(48%) showed erosion of the ossicular chain. Of these, five were associated with cholesteatoma and seven only with retraction. The recurrence rate of cholesteatoma was 12%. None of the patients with a stage Ⅱ or Ⅲ RP(according to Gersdorff classification) developed cholesteatoma. The recurrence of RP was 0%.In regards to literature review, seven references were selected. These studies showed a success rate ranging from 79.1% to 88%, while recurrences of RP varied from 6.4% to 13%. Only one study specified a recurrence rate of cholesteatoma of 28%.Conclusions: Surgical treatment of stages Ⅱ and Ⅲ RP is an effective tool to prevent cholesteatoma formation. The presence of keratin accumulation and cholesteatoma at the RP(stages Ⅳ and Ⅴ, according to Gersdorff) are the real predictors of poor prognosis.