中耳胆脂瘤伴高位颈静脉球1例并文献复习

doi:10.6040/j.issn.1673-3770.0.2023.189

摘要/Abstract

摘要： 目的探讨中耳胆脂瘤伴高位颈静脉球的临床表现、诊断依据以及治疗策略。方法回顾分析1例中耳胆脂瘤伴高位颈静脉球患者的临床资料并复习相关文献进行总结。结果术前耳内镜及CT预判高位颈静脉球达中鼓室,手术采用耳内镜水下操作模式,彻底清除胆脂瘤、掀起松弛部和紧张部后上方内陷袋,去除被部分破坏吸收的锤骨和砧骨残体,镫骨上结构消失,底板活动正常。掀起外耳道皮瓣分离鼓环的同时避免损伤颈静脉球,2.5 mm全听骨链赝复物重建听骨链,耳屏软骨筋膜瓣修复。结论中耳手术术前除了评估乳突及鼓窦、听骨链、面神经之外,还应充分评估颈静脉球情况,以免术中大出血等严重并发症。耳内镜水下技术对合并有高位颈静脉球的中耳胆脂瘤有独特优势。

关键词: 高位颈静脉球, 中耳胆脂瘤, 耳内镜水下操作技术

Abstract: Objective This report delves into the clinical manifestation, diagnosis, and treatment of cholesteatoma accompanied by a dehiscent high jugular bulb. We conducted a retrospective study on a patient with this condition and supplemented our findings with a literature review. Methods Our patient exhibited signs of a dehiscent high jugular bulb reaching the mesotympanum, as observed through otoscopy and CT scans. To address the cholesteatoma, we utilized underwater otoscopy, successfully removing the cholesteatoma, rectifying the retraction pocket involving pars flaccida and the posterosuperior aspect of pars tensa, and extracting the partially eroded malleus and incus. The arches of stapes were absent, but the footplate functioned well. During tympanoplasty with ossiculoplasty, we carefully navigated around the protruding jugular bulb while raising the tympanomeatal flap. A 2.5 mm total ossicular replacement prosthesis and preserved tragal cartilage perichondrium were used. Results In addition to pre-operative assessments of the mastoid, antrum, and ossicular chain, evaluating the jugular bulb is crucial to prevent severe complications like profuse hemorrhage. The underwater otoscopy technique demonstrated unique advantages in managing acquired cholesteatoma with a dehiscent high jugular bulb. Conclusion This case highlights the importance of thorough evaluation, including the jugular bulb, in cholesteatoma cases. The underwater otoscopy technique proved effective in our management approach.

Key words: High jugular bulb, Cholesteatoma, Underwater otoscopy technique

中图分类号:

R764.9

高欣妤,周函,刘丁丁,陆玲,陈杰,钱晓云. 中耳胆脂瘤伴高位颈静脉球1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2024, 38(3): 82-87.

GAO Xinyu, ZHOU Han, LIU Dingding, LU Ling, CHEN Jie, QIAN Xiaoyun. Case report and literature review of cholesteatoma accompanied with a dehiscent high jugular bulb[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2024, 38(3): 82-87.

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