By Tamotsu Morimitsu

Acquired aural cholesteatoma poses a distinct procedural difficulty in regards to pathogenetic learn and thought development. simply because cholesteatoma spontane­ ously happens purely within the poorly pneumatized human ear, its pathogenesis is restricted to people. still, as a result moral questions surrounding human experimentation, pathogenetic research has nearly solely 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 unbelievable in comparison with human cholesteatoma. Cholesteatoma within the gerbil comes in handy, consequently, just for the research 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 reason behind cholesteatoma. This distinction will be came across clinically in facial nerve decompression and cholesteatoma surgical procedure, as, for instance, facial nerve palsy happens frequently within the basic, well-pneumatized ear. after all, traditional animal experimentation won't verify this medical distinction seeing that there isn't any perfect animal version for the poorly pneumatized human ear. current surgical thoughts for cholesteatoma fluctuate enormously in accordance with indi­ vidual otosurgeon's opinion. the main severe distinction of opinion is targeted on no matter if to take away the exterior ear canal wall. in most cases, the best choice will be to not get rid of the canal wall if cholesteatoma recurrence will be avoided. easily placed, recurrence of cholesteatoma comes approximately whilst its reason has no longer been got rid of in the course of fundamental surgery.

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Extra info for Cholesteatoma and Anterior Tympanotomy

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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. This bony conglutination was released using chisels and curets to mobilize the ossicular chain. The left ear was operated on using anterior tympanotomy combined with an intact canal wall mastoidectomy.

The malleus develops from Meckel's cartilage in mesenchymal tissue, in which the anterior attic bony plate also develops. In other words, the malleus and the bony plate arise from the same maternal tissue. It may be possible to say that they have a stage positioning very close together during development. Furthermore, we have described that the mucosal fold between the malleal head and the anterior attic bony plate is made by the bony plate changing into a mucosal fold during childhood; we called this the anterior attic mucosal fold.

We never insert a sheet of silicone. Defects in the eardrum are also closed with a free fascial graft. The retroauricular incision in the skin is sutured, usually without placement of any drain, but with use of a drain in cases with severe infection. 48 3. 3-7. Anterior tympanotomy of anterior type. a Removal of cholesteatomatous matrix in front of the malleus. b Removal of the tensor tympani bony plate. 7 Surgical Complications and Related Matters of Anterior Tympanotomy A thorough knowledge of surgical anatomy around the supratubal recess is indispensable to avoiding surgical complications of anterior tympanotomy.

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