Prsentation PowerPoint

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1970 / 1980 TYMPANIC POCKET RETRACTIONS
SADE (4, atelectasia, metula) ARS (3, stable,
instable) CHARACHON (3, mobile, fixed) TOS (4,
papillar) GERSDORFF (6, controlable,
endos) MARTIN (location, type, ossicle) DORNHOFFER
(4, chole.) LIVI (2, safe, unsafe) BLACK (4,
ossicle, chole)
1976
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• Pre-cholesteatoma (Magnan 1972)
• Unsafe retraction pocket
• Marginal
• Keratine debris
• Bony contact or adhesiveness

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1980 CHOLESTEATOMA SKIN IN A WRONG PLACE
Self cleaning
Hyperproliferation of keratine cells Abnormal
migration cholesteatoma
Keratine debris
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1980 /2000 CHOLESTEATOMA A WRONG SKIN in a wrong
place
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IMMUNE RESPONSE
Lymphocyte T
Langerhanscell
 immunological sentinels 
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CHOLESTEATOMA Similar to LICHEN PLANUS
Immunological reaction against is own tissue
antigens
loss of epidermal growth control
Keratinocyte proliferation, fibrinoctine
secretion Growth factors, IL1, TGFx, Cytokeratines
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2000 Cholesteatoma a defective wound healing
Magnan 1993, Albino 1998

• EGF-EGFR
• Autocrine hyperactivity
• keratinization
• proliferation
• chemiotaxis
• wound healing

Respect or restoration of the anatomy physiology
of the ear
AB1
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CHOLESTEATOMA Inflammatory process of both middle
and external ear Wrong skin in a
wrong place
Remove it
Prevent from coming back
defective wound healing
Safety of the normal anatomy
CLOSED TECHNIQUE CONCEPT IS CONFIRMED AS BASIS OF
CHOLESTEATOMA SURGERY
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CLOSED TECHNIQUE
Troublesome OPEN TECHNIQUE
Canal wall Reconstruction
Down Up
Defective wound healing conditions
Good wound healing conditions
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THE FUTURE
1. Fondamental unsolved question WHY ?
Molecular biology Gene
HER family system HER4 receptor overexpressed in
cholesteatoma
2. Immediat technical question What about
mastoid process
to prevent from recurrence ?
Buffer gas pressure Obliteration