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Surgical strategy for cholesteatoma in children J.Huszka MD

Surgical strategy for cholesteatoma in children J.Huszka MD. ESPO 2008 Budapest Hungary. W e propose a modified canal-wall-up technique in conjunction with a planned, staged operation. The goal is to eradicate cholesteatoma from the middle ear and mastoid.

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Surgical strategy for cholesteatoma in children J.Huszka MD

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  1. Surgical strategy for cholesteatoma in childrenJ.Huszka MD ESPO 2008 Budapest Hungary

  2. We propose a modified canal-wall-up technique in conjunction with a planned,staged operation. • The goal is to eradicate cholesteatoma from the middle ear and mastoid. • It is important to fit the procedure to the pathologic condition found at surgery, • to preserve the ossicular chain. • We do not restore the chain continuity at the first stage. • We usually plan a second stage explorative tympanotomy to check the middle ear cavity, to remove residual or recurrence cholesteatoma, if there is, and restore the continuity of the ossicular chain.

  3. Canal wall down proceduresare usually performed when the cholesteatoma is extensive and the complete, safety removing is uncertain. • Modified radical mastoidectomy (this is the conservative radical operation) • Radical mastoidectomy (radical operation)

  4. The second stage/the second look • 6 months after the initial procedure(because the residual or recurrent cholesteatoma grows more rapidly in children than in adults) • Intraoperative findings: 30 % residual or recurrent cholesteatoma after intact canal wall mastoidectomy-tympanoplasty procedures in children.

  5. Children must be observed by periodic examination for years. • If severe atelectasis or retraction pocket develops, myringotomy and insertion of a tympanostomy tube are indicated.

  6. Controversial aspect • The second-stage procedure may not be necessary if the surgeon is convinced the disease was totally removed at the initial operation, if the tympanic membrane is translucent without evidence of progressive disease medial to the eardrum after the surgery, and if the hearing is stable during the postoperative follow-up period. Has somebody a different opinion?

  7. To use needle endoscope • to remove remnant cholesteatoma, if a small part of it remains somewhere in the middle ear. Has someone any experience in connection with this method?

  8. After radical mastoidectomy poorly functioning Eustachian tube may have to be closed surgically to prevent the reflux of nasopharyngeal secretions resulting inflammation and otorrhea.

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