TEES Technique for Pars Flaccida Cholesteatoma

By June 7, 2019

Takahashi, Masahiro1; Motegi, Masaomi1, Yamamoto, Kazuhisa1; Yamamoto, Yutaka1; Kojima, Hiromi1
1 Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan.

The disadvantages of transcanal endoscopic ear surgery (TEES) include the fact that the procedure can often only be carried out one-handed, especially when transcanal atticotomy is performed using a bone-drilling device, and it is difficult to collect many materials for reconstruction. Surgery for pars flaccida cholesteatoma often requires a more extensive atticotomy than surgery for other middle ear diseases. Therefore we will present our surgical technique for pars flaccida cholesteatoma, which overcomes the disadvantages of TEES, via a video presentation.

Epithelial defects are minimized by peeling back the ear canal skin to isolate the retracted part.  Atticotomy is performed with multiple hands using the VISAO®; i.e., the assistant holds the endoscope and injects water, and so surgery is performed with a total of four hands. ƒ The extent of lateral wall drilling is minimized using a 70-degree angled endoscope and curved forceps.

These techniques can overcome the disadvantages of TEES. It is a bit difficult to perform the operation with a 70-degree angled endoscope, but it becomes easier as the surgeon becomes familiar with ESS using a 70-degree angled endoscope. However, we have to be careful to not insert the endoscope too far to prevent it coming into contact with the ossicles. These techniques can also be applied to other diseases.

This TEES technique represents a great step forward in the development of a surgical approach for pars flaccida cholesteatoma. We will accumulate cases and examine their postoperative outcomes, in order to establish a suitable surgical procedure.