Zhaoyan Wang 1,2,3, Yongchuan Chai 1,2,3, Weidong Zhu 1,2,3, Zhihua Zhang 1,2,3, Huan Jia 1,2,3, Lingxiang Hu1,2,3, Hao Wu 1,2,3
1 Department of Otolaryngology Head & Neck surgery, Shanghai Ninth people’s Hospital Affiliated Shanghai Jiaotong University School of Medicine, Shanghai, China;
2 Ear institute, Shanghai Jiaotong University School of Medicine，Shanghai, China;
3 Shanghai Key Laboratary of Translational Medicine on Ear and Nose disease, Shanghai, China.
This study is aimed to analyze the results of transcanal endoscopic re-surgery in patients with previously surgical history of microscopic canal-wall-down mastoidectomy.
This is a retrospective study including 11 patients undergone microscopic surgical treatment including canal-wall-down mastoidectomy in the first stage, postoperatively developed recurrent ear suppuration or no obvious improvement in hearing during the follow-up period. At the second surgical treatment, totally transcanal endoscopic approach was performed.
All patients were successfully performed surgical treatment by transcanal endoscopic approach without any seriously postoperative complication. For the eight cases with previous cholesteatoma, recurrence of cholesteatoma occurred in 7 cases, and for the remaining one case, a large amount of granulation was found in the middle ear cavity, especially at the orifice of the eustachian tube. For the 3 cases with no postoperative hearing improvement, exploratory operation of middle ear and reconstruction of ossicular chain were performed, and the air-bone gap in all three cases was obviously improved after one months. In 63.6% (7/11) of cases, the tympanic segment of facial nerve was exposed directly and adhered to the surrounding tissues (pathological tissue and/or skin tympanic flap of external auditory canal), and the facial nerve monitor is very important for distinguishing the normal facial nerve under these circumstances.
Transcanal endoscopic re-surgery has the advantages of broad space and clear visualization for the treatment of middle ear lesions, and is an effective and minimally invasive approach. Meanwhile, it is especially noting that facial nerve protection is particularly important because of the direct exposure and adhesion of the facial nerve.