By Tamotsu Morimitsu
Acquired aural cholesteatoma poses a distinct procedural predicament in regards to pathogenetic examine and thought construction. simply because cholesteatoma spontane ously happens basically within the poorly pneumatized human ear, its pathogenesis is restricted to people. still, as a result of moral questions surrounding human experimentation, pathogenetic examine has nearly solely concerned nonhuman matters. 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, 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 likely reason for cholesteatoma. This distinction will be discovered 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 be certain this medical distinction due to the fact that there isn't any excellent animal version for the poorly pneumatized human ear. current surgical concepts for cholesteatoma differ enormously in accordance 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. more often than not, the most suitable choice will be to not get rid of the canal wall if cholesteatoma recurrence may be avoided. easily positioned, recurrence of cholesteatoma comes approximately while its reason has now not been got rid of in the course of basic surgery.
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Extra info for Cholesteatoma and Anterior Tympanotomy
Furthermore, there are young vessels with narrow lumens in the granulation tissue (Fig. 2-28d). This finding seems to indicate the active correspondence of granulation tissue to vigorous metabolism. 2-27a-e. Fine structure of normal mucosal folds . a Tensor tympani mucosal fold (light microscopy, X290). b Anterior attic mucosal fold (light microscopy, x300). c Superior mallear fold (electron microscopy, x 4S00) . F,fibrocytes. d Amyelinated nerve fiber in maJlear fold (electron microscopy, X13 000).
3-10). In 1985, we reported a surgical technique to open a closed tubal isthmus by removing the tensor tympani muscle; we called this procedure the musculotubal canal approach for tubal stenosis (Morimitsu et al. 1985). In cases with extremely large cholesteatomas (Fig. 3-11), the facial nerve can be kept as a bony bridge without causing paresis. After pathological tissues have FIG. 3-11. Surgical view of extremely large cholesteatoma. 2 Surgical Technique in Anterior Tympanotomy Using the Canal-Up Method 51 FIG.
1 Mastoid Pneumatization and Age The degree of mastoid pneumatization (PN) was classified into three categories: PN -, 42 bones with minimal formation of bony trabeculae along the mastoid antrum; PN:±:, 19 bones with rich bony trabeculae along the mastoid antrum; and PN +,31 bones with mastoid air cells. Mastoid pneumatization clearly progresses with increased age (Fig. 2-18). 2 Shape of the Supratubal Recess The shape of the supratubal recess (STR) was classified into three categories: underdeveloped STR (27 bones in which upward extension of the STR did not Ears 25 20 15 10 5 o pretenn full tenn lW - lav1 1-2Y 3-10Y Age groups FIG.