外耳道胆脂瘤并发化脓性腮腺炎1例并文献复习

doi:10.6040/j.issn.1673-3770.0.2020.355

摘要/Abstract

摘要： 目的探讨外耳道胆脂瘤并发化脓性腮腺炎病因及诊治经验,并进行外耳道胆脂瘤诊疗相关文献复习。方法回顾性分析1例外耳道胆脂瘤并发化脓性腮腺炎病例资料,主要症状为左耳听力下降伴流脓,左侧面部红肿疼痛。颞骨CT及耳部核磁示:左侧外耳道内胆脂瘤形成,累及乳突、鼓室、鼓窦、腮腺及咽旁间隙。临床诊断:外耳道胆脂瘤(左,Holt Ⅲ期)、化脓性腮腺炎(左)。手术方式为左耳外耳道胆脂瘤切除术、开放式乳突根治术、鼓室成形术、人工听骨植入术、耳甲腔成形术、腮腺脓肿清除术及腮腺瘘修补术。结果术中彻底清除外耳道及中耳内胆脂瘤及腮腺脓肿,并修复腮腺瘘。术后随访患者恢复良好,无胆脂瘤复发残留及腮腺炎复发相关症状出现。结论外耳道胆脂瘤具有骨质破坏的潜能。而HoltⅢ期外耳道胆脂瘤并发化脓性腮腺炎病例罕见,明确病因并依据病变侵袭范围选择个体化的治疗方案尤为关键。

关键词: 外耳道, 胆脂瘤, 化脓性腮腺炎, 分期, 耳外科手术

Abstract: Objective To investigate the etiology, diagnosis, and treatment of external auditory canal cholesteatoma complicated with suppurative parotitis and to review the relevant literature on external auditory canal cholesteatoma. Methods We retrospectively analyzed a case of patient with external auditory canal cholesteatoma complicated with suppurative parotitis who was admitted to our hospital. The patient presented with hearing loss in the left ear accompanied by otorrhea, as well as swelling and pain on the left side of the face. Temporal bone CT and ear canal MRI showed cholesteatoma formation in the left external auditory canal involving the mastoid process, tympanic cavity, tympanic sinus, parotid gland, and parapharyngeal space. The clinical diagnosis was external auditory canal cholesteatoma(left, Holt Ⅲ)and suppurative parotitis(left). The surgical methods used were cholesteatoma resection from the left external auditory canal, open radical mastoidectomy, tympanoplasty, artificial ossicular implantation, plasty of the cavity of auricular concha, removal of the parotid abscess, and repair of the parotid fistula. Results The cholesteatoma of the external auditory canal and middle ear and parotid abscess were completely removed, and the parotid fistula was repaired. Postoperative follow-up examinations showed that the patient recovered well without recurrence of the cholesteatoma or parotitis. Conclusion External auditory canal cholesteatoma has the potential to cause bone destruction. Cases of Holt phase Ⅲ cholesteatoma of the external auditory canal complicated by suppurative parotitis are rare and it is pivotal that the pathogenesis is understood and that individualized treatment plans are chosen according to the full lesion range.

Key words: External auditory canal, Cholesteatoma, Suppurative parotitis, Staging, Otologic Surgical Procedures

中图分类号:

R764

郭芳,张德军,傅则名,郭颖媛,万怡宁,管国芳. 外耳道胆脂瘤并发化脓性腮腺炎1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2020, 34(6): 12-15.

GUO Fang, ZHANG Dejun, FU Zeming, GUO Yingyuan, WAN Yining, GUAN Guofang. Cholesteatoma of the external auditory canal complicated with suppurative parotitis: a case report and literature review[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(6): 12-15.

参考文献

[1] Dhingra P, Pusalkar AG. Spontaneous external auditory canal cholesteatoma: case series and review of literature[J]. Indian J Otolaryngol Head Neck Surg, 2020, 72(1): 86-91. doi:10.1007/s12070-019-01755-2.
[2] Hamed MA, Nakata S, Sayed RH, et al. Pathogenesis and bone resorption in acquired cholesteatoma: current knowledge and future prospectives[J]. Clin Exp Otorhinolaryngol, 2016, 9(4): 298-308. doi:10.21053/ceo.2015.01662.
[3] 赵昱, 彭军, 刘汝利. 破骨细胞分化因子及基质金属蛋白酶-2在外耳道胆脂瘤中的表达及意义[J]. 中国眼耳鼻喉科杂志, 2019, 19(2): 95-99. doi:10.14166/j.issn.1671-2420.2019.02.008. ZHAO Yu, PENG Jun, LIU Ruli. Expression and clinical significance of receptor activator of nuclear factor-κB ligand and matrix metalloproteinase-2 in external auditory canal cholesteatoma[J]. Chinese Journal of Ophthalmology and Otorhinolaryngology, 2019, 19(2): 95-99. doi:10.14166/j.issn.1671-2420.2019.02.008.
[4] Wiatr A, Strek P, Wiatr M. Patterns of bone damage in patients with chronic middle ear inflammation[J]. Ear Nose Throat J, 2020: 014556132092414. doi:10.1177/0145561320924144.
[5] JING Zou, ANTTI Isom?ki, TIMO Hirvonen, et al. Label-free visualization of cholesteatoma in the mastoid and tympanic membrane using CARS microscopy[J]. Journal of Otology, 2016, 11(3): 127-133.
[6] Bujía J, Holly A, Antolí-Candela F, et al. Immunobiological peculiarities of cholesteatoma in children: quantification of epithelial proliferation by MIB 1[J]. Laryngoscope, 1996, 106(7): 865-868. doi:10.1097/00005537-199607000-00015.
[7] 杨扬, 肖潇, 陈敏, 等. 儿童中耳胆脂瘤JOS分期及其临床特征[J]. 山东大学耳鼻喉眼学报, 2019, 33(5): 52-55. doi:10.6040/j.issn.1673-3770.0.2019.376. YANG Yang, XIAO Xiao, CHEN Min, et al. JOS staging and clinical features of middle ear cholesteatoma in children[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(5): 52-55. doi:10.6040/j.issn.1673-3770.0.2019.376.
[8] 王登元, 陈智斌, 陈若希, 等. 外耳道胆脂瘤的临床特征及疗效评估[J]. 山东大学耳鼻喉眼学报, 2017, 31(5): 62-66. doi:10.6040/j.issn.1673-3770.0.2017.237. WANG Dengyuan, CHEN Zhibin, CHEN Ruoxi, et al. Clinical characteristics and treatment of external auditory canal cholesteatoma[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2017, 31(5): 62-66. doi:10.6040/j.issn.1673-3770.0.2017.237.
[9] 丛林海, 汤勇, 张帆, 等. 易延误诊治的耳外伤后外耳道胆脂瘤[J]. 中国耳鼻咽喉颅底外科杂志, 2019, 25(3): 271-273, 280. doi:10.11798/j.issn.1007-1520.201903010. CONG Linhai, TANG Yong, ZHANG Fan, et al. Misdiagnostic cholesteatoma of external auditory canal after trauma[J]. Chinese Journal of Otorhinolaryngology-Skull Base Surgery, 2019, 25(3): 271-273, 280. doi:10.11798/j.issn.1007-1520.201903010.
[10] 伊海金, 杨仕明. 重视耳部外伤诊疗工作[J]. 山东大学耳鼻喉眼学报, 2020, 34(1): 1-3. doi:10.6040/j.issn.1673-3770.1.2019.045. YI Haijin, YANG Shiming. Value the diagnosis and treatment of ear trauma[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(1): 1-3. doi:10.6040/j.issn.1673-3770.1.2019.045.
[11] 孔维佳, 周梁, 王斌全. 耳鼻咽喉头颈外科学[M]. 3版. 北京: 人民卫生出版社, 2015.
[12] 裴智, 张晓波, 邓湖山, 等. 外耳道胆脂瘤感染致腮腺瘘一例[J]. 中华耳鼻咽喉头颈外科杂志, 2006, 41(1): 42. doi:10.3760/j.issn:1673-0860.2006.01.019. PEI Zhi, ZHANG Xiaobo, DENG Hushan, et al. One case of parotid gland fistula caused by the external auditory canal cholesteatoma[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2006, 41(1): 42. doi:10.3760/j.issn:1673-0860.2006.01.019.
[13] Piersiala K, Klimza H, Jackowska J, et al. Parotid gland cholesteatoma in a 23-year-old male: Case report[J]. SAGE Open Med Case Rep, 2017, 5: 2050313X1774908. doi:10.1177/2050313x17749083.
[14] Tornari C, Pal S, Lingam RK, et al. Facial extention of ear pathology: infected cholesteatoma causing a parotid abscess[J]. Case Rep, 2015, 2015(mar20 1): bcr2014207550. doi:10.1136/bcr-2014-207550.
[15] 张迎晖. 72例化脓性腮腺炎的临床治疗效果分析[J]. 临床医药文献电子杂志, 2018, 5(31): 53. doi:10.3877/j.issn.2095-8242.2018.31.043.
[16] 周霓, 李玲波, 林琳. Ⅱ-Ⅳ型外耳道胆脂瘤临床特征及手术治疗[J]. 临床耳鼻咽喉头颈外科杂志, 2016, 30(16): 1287-1289, 1296. doi:10.13201/j.issn.1001-1781.2016.16.007. ZHOU Ni, LI Lingbo, LIN Lin. Clinical characteristics and surgical treatment of types Ⅱ to Ⅳ external auditory canal cholesteatoma[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2016, 30(16): 1287-1289, 1296. doi:10.13201/j.issn.1001-1781.2016.16.007.
[17] Holt JJ. Ear canal cholesteatoma[J]. Laryngoscope, 1992, 102(6): 608-613. doi:10.1288/00005537-199206000-00004.
[18] 何观文. 外耳道胆脂瘤诊疗进展[J]. 中华耳科学杂志, 2017, 15(5): 591-594. doi:10.3969/j.issn.1672-2922.2017.018. HE Guanwen. Advances in diagnosis and treatment of external auditory canal cholesteatoma[J]. Chinese Journal of Otology, 2017, 15(5): 591-594. doi:10.3969/j.issn.1672-2922.2017.018.
[20] 顾凤明. 侵及中耳的Ⅲ期外耳道胆脂瘤的手术方法探讨[J]. 中国耳鼻咽喉颅底外科杂志, 2017, 23(3): 275-276, 279. doi:10.11798/j.issn.1007-1520.201703019. GU Fengming. Surgical treatment of Holt Ⅲ external auditory canal cholesteatoma invading the middle ear[J]. Chinese Journal of Otorhinolaryngology-Skull Base Surgery, 2017, 23(3): 275-276, 279. doi:10.11798/j.issn.1007-1520.201703019.
[20] Castle JT. Cholesteatoma pearls: practical points and update[J]. Head Neck Pathol, 2018, 12(3): 419-429. doi:10.1007/s12105-018-0915-5.

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