Extensive intratemporal cholesteatoma: surgical strategy.
OBJECTIVE
To evaluate the decisional elements in the surgical strategy for extensive intratemporal cholesteatomas.


METHODS
A retrospective review of cases followed up between 1985 and 1996.


METHODS
Tertiary referral center.


METHODS
Nineteen patients with temporal bone cholesteatoma extending beyond the middle ear limits and surgically treated were included. Preoperative imaging distinguished apical (8), infralabyrinthine (3), supralabyrinthine (3), retrolabyrinthine (1), and translabyrinthine (4) cholesteatomas.


METHODS
Apical and supralabyrinthine lesions were treated through a middle fossa approach. Infralabyrinthine and translabyrinthine locations were exposed through a subtotal petrosectomy or a transotic route, depending on the preoperative audiovestibular status and labyrinthine destruction on computed tomography. The retrolabyrinthine lesion was approached through a retrolabyrinthine route.


METHODS
Patients were assessed for postoperative audiologic and facial functions and for recurrence of tumor.


RESULTS
The facial nerve was neither rerouted nor interrupted during surgery. Among the 12 patients with preoperative facial palsy (FP), 5 cases of improvement (42%), 6 cases of stable function (50%), and 1 case of mild deterioration (8%) were observed postoperatively. In patients without preoperative FP, facial function remained unchanged postoperatively. The labyrinth could be preserved in three patients (16%), with postoperative stable hearing function in two (11%), and a 40-dB mean auditory deterioration in one (5%). Complete macroscopic resection was obtained in all patients. Two cases (11%) of postoperative recurrence were observed.


CONCLUSIONS
The surgical strategy, principally based on cholesteatoma location and preoperative auditory function, yielded a high rate of local disease control and facial function preservation.
Grayeli
A B
AB
Department of Otolaryngology-Head Neck Surgery, Hôpital Beaujon, Université Paris 7, Clichy, France.
Mosnier
I
I
El Garem
H
H
Bouccara
D
D
Sterkers
O
O
D000293:Adolescent; D000328:Adult; D001301:Audiometry, Pure-Tone; D018424:Cholesteatoma, Middle Ear / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D007758:Ear, Inner / Q000000981:diagnostic imaging / Q000473:pathology; D004576:Electromyography; D005154:Facial Nerve / Q000503:physiopathology; D005158:Facial Paralysis / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006311:Hearing Disorders / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013506:Otologic Surgical Procedures / Q000379:methods*; D011184:Postoperative Period; D011300:Preoperative Care; D012008:Recurrence; D012189:Retrospective Studies; D013701:Temporal Bone / Q000000981:diagnostic imaging* / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014724:Vestibular Function Tests