By Tamotsu Morimitsu
Acquired aural cholesteatoma poses a distinct procedural drawback in regards to pathogenetic study and conception development. simply because cholesteatoma spontane ously happens in basic terms within the poorly pneumatized human ear, its pathogenesis is restricted to people. still, as a result of the moral questions surrounding human experimentation, pathogenetic learn has virtually completely 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 turns out to be useful, accordingly, just for the research of pathology and never for human pathogenesis. I carry that the pathogenesis of cholesteatoma might be understood by way of learning the cholesteatomatous ear, that's, the malpneumatized ear of the human. The anatomical distinction among the conventional and malpneumatized ear is a possible reason behind cholesteatoma. This distinction will be came across clinically in facial nerve decompression and cholesteatoma surgical procedure, as, for instance, facial nerve palsy happens frequently within the basic, well-pneumatized ear. in fact, traditional animal experimentation won't ascertain this scientific distinction considering there's no excellent animal version for the poorly pneumatized human ear. current surgical options for cholesteatoma range tremendously in keeping 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. typically, the most suitable choice will be to not get rid of the canal wall if cholesteatoma recurrence may be avoided. easily placed, recurrence of cholesteatoma comes approximately while its reason has now not been got rid of in the course of fundamental surgery.
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Additional resources for Cholesteatoma and Anterior Tympanotomy
B Dome-shaped STR (star). Arrows, air cells. 3 Temporal Bone in Neonates and Children 27 Ears 25 20 15 10 5 o preterm fullterm 1W - 12M 1- 2Y 3-10Y Age groups FIG. 2-20. 2-21. Incidence of STRs [underdeveloped (black bars), dome shaped (white bars), or air cell shaped (stippled bars)] by degree of pneumatization [( -), (±), or (+)] 28 2. 3 Size of the Supratubal Recess Using 57 sections from dome-shaped STRs cut at the level of the geniculate fossa, the maximum longitudinal width (1) and the maximum transverse width (2) of the STR as well as the transverse width of the anterior petrosal tegmen (3) were measured, as shown in Fig.
F,fibrocytes. d Amyelinated nerve fiber in maJlear fold (electron microscopy, X13 000). S, Schwann's cell. e Blood vessel in maJlear fold (electron microscopy, X32000). P, pericyte; E, endothelium; M , mucosal folds FIG. 33 34 2. 2-28a-d. Fine structure of pathological mucosal folds. a Perimatrix of cholesteatoma (light microscopy, x 500). M, columnar epithelium. b Foreign-body macrophage at cholesterin crystal (light microscopy, x920). FG, foreign-body macrophage. c Columnar cell with secretory granules (electron microscopy, X 90 000).
Adv AudioI2:1-8 Bhide AR (1982) Combined approach tympanoplasty with lateral tympanotomy-a review of 42 cases. Auris Nasus Larynx (Tokyo) 9:1-7 Farrier JB (1982) The anterior attico-tympanotomy. Laryngoscope 76:768-779 Jansen C (1967) Posteriore Tympanotomie: Zugang zum Mittelohr mit Erhaltung des ausseren Gehoergangs. Arch Otolaryngol 188:2-6 Jansen C (1984) Cited in Deguine C (1984) Cholesteatoma surgery: what about the third intervention? In: Tos M, Thomsen J, Peiterson E (eds) Cholesteatoma and mastoid surgery.