Agressive cholesteatoma

1
Agressive cholesteatoma
with labyrinthine fistula and exposed facial
nerve
J.Paris, A.Esteve, R.Meller, M.Bruzzo, A.Chays,
J.Magnan
CHU Nord - Marseille
2
Exposed facial nerve labyrinthine fistula

• Classic associated complications
• Pre and intra-operative predictors of fistulas
• Controversial surgical management

3
Exposed facial nerve

• Period Jan 1994 to March 2000
• 568 patients with cholesteatoma
• 64 exposed facial nerve (11)
• (3 pre-operative facial palsy)

4
Exposed facial nerve

• I Labyrinthine segment, II Tympanic segment,
  III Mastoid segment

5
Labyrinthine fistula incidence and exposed facial
nerve

• Global outcome
• 30 patients / 64 (47)

• If 2 segments exposed
• 11 patients / 12 (92)

6
Exposed facial nerve
7
Labyrinthine fistula

• Pre-operative predictors and hearing outcome
• 32 patients (20 male, 12 female) 7
• Mean age 50 years old
• Calculation of PTA for bone conduction

8
Labyrinthine fistula
Surgical technique

• Total removal of cholesteatoma matrix
• Closed technique 30 patients
• Covered with temporalis fascia/perichondrium

9
Labyrinthine fistula
Clinical signs

• Vestibular symptomatology 16 patients / 32
• Fistula test positive in 10 patients (31)

10
Intraoperative findings

• Cholesteatoma 100
• Fistula location

• Lateral SCC 29 patients (91)
• Superior SCC 2 patients (6)
• LSCC SSCC 1 patient (3)

11
Pre-operative audiometric results - PTA
12
Hearing outcomes
13
Hearing outcomes

• Improvement or stabilization of hearing threshold
• 28 patients / 32 (88)
• No anacusis

14
Conclusion

• Fistula predictors facial nerve
• Closed technique
• Complete removal of matrix (1 stage)
• No anacusis, but vestibular symptoms in some
  cases