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大韓放射線뽑學會끓‘ 第 26卷 第 6 號 pp. 1104 -1115 , 1990 Journal 01 Korean Radiological Soc ielY, 26(6) 1104 - 1115, 1990
CT of Cholesteatomas - In Respect to Bony Complications-
Hyung Jin Kim, M.D. , Hae Gyeong Chung, M.D. , Jae Chul Gong, M.D. , Si Ok Shin, M.D.*, Sea Young Jeon, M.D.**, Byeong Hoon Lim, M.D.***,
Jae Hyoung Kim, Young Soo Do, M.D. , Sung Hoon Chung, M.D.
〈국문초록〉
Department of Radiology, College of Medicine, Gyeong Sang Nationa1 University
중이 진주종의 전산화단츰촬영 소견
-골미란을 중심으로-
경상대학교 의과대학 방사선과학교실
김 형 진 • 정 혜 경 • 공 재 절 • 신 시 옥 •• 전 시 영 ••
임 병 훈*** • 김 재 형 • 도 영 수 • 정 성 훈
저자들은 최근 147H 월동안 경상대학병원에서 수술로 확진된 28례 의 중이 진주종의 전산화단층촬영
(CT ) 소견을 골미란을 중심으로 분석하였다. 수술로 명확히 범위를 확인할 수 있었던 23례의 진주종 중 1 6례에서 CT 소견은 수술 소견과 일치하였으나 나머지 7례에서는 동반된 육아조직과 진주종의 경계 를 나누기는 불가능하였다. 28례중 16례에서 경판과 상고실 외측벽의 미란이 있었다. CT는 92%에서
이소골의 상태를 정확히 판정했으며 이소골중 침골의 장돌기가 가장 많이 침범되어 있었다. 7례에서 골
성미로의 미란이 관찰되었는데 7례 모두에서 륙반규관의 침범이 있었다. 안면신경관의 미란은 6례에서
관찰되었는데 와우각 부분의 제 1슬부의 원위부와 유양돌기의 수직부에 각각 3례씩의 미란이 있었다. 고
실개와 S자상 정맥통판의 미란은 각각 4례와 6례에서 관찰되었다. 3례에서 두부내 합병중이 있었는바
이 들 모두에서 S자상 정맥통판의 미란이 동반되었으며 , 이중 2례는 측정맥동 혈전증이었고 1례 는 경막
외 농양이었다 3례에서 파괴된 외이도를 통해 진주중이 바깥으로 유출된 자연유돌절제술 ( automasto
idectomy) 의 소견을 보였으며 2례에서는 유양동을 채우고 있는 진주종이 자연유돌절제술에서와 비슷한
골파괴를 통반하고 있어 진주종의 유출이 엄박했음올 짐작케했다. 아울러 저자들은 수술로 확진된 3례
의 재발성 진주종에 대해 간단히 기술했다. 저자들은 고해상력 CT가 진주종의 진단 및 치료방법을 결
정하는데 있어서 가장 유용하리라는 것을 믿어 의심치 않는 바이다.
• 충북대학교 의과대학 이비인후과학교실 ‘ Department of OtolaIγngology. COllege of Medicine. Chungbuk NationaJ University • 경상대학교 의과대학 이비인후과학교실
•• Department of Otolaryngology. College of Medicine. Gyeongsang NationaJ University • 경상대학교 의과대학 신경과학교실
••• Department of Neurology. College of Medicine. Gyeongsang NationaJ University 이 논문은 1 989년 경상대학교병원 임상연구비의 일부지원으로 이루어졌음
이 논문은 1990년 7월 20일 접수하여 1990년 10월 23일에 채택되었음 Received July 20 , accepted October 23 , 1990
- 1104 -
- Hyung Jin Kim , et al.. CT of Cholesteatoma
- Abstract-
We retrospectively analized tweniy-eight cases of surgically confirmed cholesteatoma with
CT putting emphasis on the following items: (1) location and extent of cholesteatoma ; (2)
erosion of scutum and lateral attic wall; (3) erosion of the ossicles; (4) erosion of the bony
labyrinth ; (5) erosion of the facial nerve canal; (6) erosion of the tegmen ; (7) erosion of the
sigmoid sinus plate; (8) erosion of the bony external auditory canal; and (9) intracranial
complications. CT correctly predicted extent of 16 cases among surgically well documented 23
cholesteatomas. It was difficult to differentiate cholesteatoma from granulation tissue. Erosion
of the scutum and / or lateral attic wall was seen in 16 cases (57 %). The diagnostic accuracy of
CT in the evaluation of the status of the ossicles was 92% (22/24). The most commonly
involved portion of the ossicles was the long process of incus. There were seven cases having
erosion of the bony labyrinth. Lateral semicircular canal was exclusively eroded. Coronal CT
depicted erosion of lateral semicircular canal more accurately. Facial nerve canal erosion was
found in six cases (21 %). Eroded portion was dist외 Iimb of the first genu and mastoid
segment each in three cases. Erosion of tegmen and sigmoid sinus plate was identified in
four (14 %) and six cases (21 %J. respectively. There were three cases of intracranial complica
tion , manifest as lateral sinus thrombosis in two cases and epidural abscess in one case. AlI
these three cases had erosion of the sigmoid sinus plate. We experienced three cases of “ aut
omastoidectomy" and two cases of “ impending automastoidectomy". In both of these tw:o cond
itions , the patterns of erosion of EAC were very similar. The only difference was that whether
the spontaneous drainage of cholesteatomatous mass had occurred or not yet. At the end of
this issue , we brie f1y comment the CT findings of recurrent cholesteatoma we experienced in
three cases. We believe high-resolution CT is a very reliable method and should be the first
step in the evaluation of cholesteatoma.
Index Words: Ear, CT, 2 1. 12ll
Temporal bone , CT. 2 1. 1211
Cholesteatoma. 2 1.264
A cholesteatoma. or more adequately kera
toma. is a sac of keratinizing stratified squam
ous epithelium within the middle ear space or
other pneumatized areas of the petrous bone.
Since the advent and the technical development
of Computerized Tomography(CT). it has proved
to be the most effective for detecting the bony
erosion associated with cholesteatomatous mas
ses . We have correlated CT with surgical findings
of 28 cases of acquried cholesteatomas with sp
ecial attention to their aggressiveness to erode
the a며acent bony structures. In addition. we
briefly discussed CT findings of postoperative re
current cholesteatoma which we experienced in
three cases.
Materials and Methods
During the recent 14 months. we retrospectiv
ely analized CT findings of 22 patients with
cholesteatoma and correlated them with surgical
findings. Six patients had a bilateral disease. so
we obtained overall 28 cases. The youngest was
five years old and the eldest was 55. The m에。r
clincial symptoms and signs were otorrhea in 19
patients. otalgia in 10. headache in 7. and verti
go or dizziness in 6. and there were two patients
with a clinical evidence of facial nerve palsy and
- 1105 -
- 大韓放射線醫學會誌 : 第 26 卷 第 6 號 1990 -
one patient with seizure. All patients had some tomatous mass or if there was direct attachment
degree of conductive or mixed hearing loss. of mastoid portion of facial nerve to cholestea-
All patients had preoperative evaluation by a toma along is course on both axial and coronal
9800 scanner (GE Medical System, Milwaukee) images. We excluded evaluation of horizontal
using 1.5mm collimation with extended window portion of facial nerve canal, because a lot of
width of 4000 HU and with high-resolution bone cases had too extensive cholesteatoma to diffe-
algorithm. All underwent CT in the direct axial rentiate it from the mass.
(0 degree) and coronal (105 degree) planes. The
intravenous contrast medium was not given ex- Results
cept one in which case a noncholesteatomatous
tumor was clinically suspected. We obtained add- 1. Location and Extent of Cholesteatomas
itional enhanced brain scans, if there was a clin
ical suspicion of an intracranial complication.
We had particularly paid attention to the foll
owing features: 1) location and extent of choles
teatoma; 2) erosion of scutum and/ or lateral at
tic wall; 3) erosion of the ossicles ; 4) erosion of
the bony labyrinth ; 5) erosion of the facial nerve
canal; 6) erosion of the tegmen; 7) erosion of
the sigmoid sinus plate; 8) erosion of the bony
external auditory canal ; 9) presence of an intra
cranical complication. We presumably thought it
a cholesteatoma as a whole , if there was a non
dependent soft tissue within other spaces, con
tiguous to an attic mass. We did not make efforts
to divide cholesteatoma into a pars flaccida or a
pars tensa type , because it would not change the
surgical methods in the presence of the overt CT
findings , and because there were many cases of
extensive cholesteatomas of which origin could
not be actually discerned. We exclued stapedi외
evaluation from this study, because there is a
limitation of CT to find it out consistently2 .3.4l
and because many surgical reports lacked the
statement about it. The erosion of the bony
labyrinth was considered to be definite , if both
axial and coronal scans showed the bony dehisc
ence , and equivocal, if only either of the two
scans had a positive findings. Facial nerve canal
erosion was thought to be present, if there was
no identifiable thin bony plate to separate first
genu of facial nerve from an abutting cholestea
On CT , the soft tissue mass was present with
in both attic and mastoid antrum in 25 cases
(89 %). In the other three cases , a small choles
teatoma was confined to the epitympanum and
in one of the two , it was present purely within
the Prussak’s space (Fig. 1). Qf 25 atticoantral
cholesteatomas , there were seven cases of the
combined involvement in the mesotympanum ,
and fifteen cases of the hologympanic involvem
ent. No cases showed a cholesteatoma confined
within the middle ear cavity other than the epit
ympanum. External auditory canal was involved
by cholesteatoma in six cases(21 %). At surgerv ,
these findings were closely correlated in 16
cases . In seven cases in which a contiguous soft
tissue was present in the tympanic cavity other
than the ep파mpanum, it actually proved to be a
granulation tissue. In five cases , surgical notes
were incomplete or lacking about the extent of
cholesteatoma (Table 1).
In one case in which a noncholesteatomatous
tumor was clinically suspected, it was conside-
Table 1. Location and Extent of Cholesteatoma
atticoantral confined to attic
confined EMT* HT** CT 3
3 7 15
Op*** 10 10 3
* mesotympanum * * holotympanum * * * Excluding five cases of poor surgical record
1106
- Hyung Jin Kim , et al. : CT of Cholesteatoma
Fig. 1. Small cholesteatoma , coronal scan. A small soft tissue lesion is present only within Prussak‘s space (arrow) without ossicular erosion or displacement. Fig. 2. Infected cholesteatoma, axial scan. A large well-enhancing soft tissue mass (arrows) is found at the attic and mastoid , eroding the ossicles and additus ad antrum. The mass occupies the entire middle ear space on lower scans (not shown here ), and it proves to be an infected cholesteatoma.
rably enhanced on CT, and it proved an infected
cholesteatoma on the operation field (Fig. 2).
2. Erosion of scutum an션 ,. or lateral attic wall
Sixteen cases (57 %) had the erosion of scu
tum and/ or lateral attic wall bya nearby choles
teatoma.
3. Erosion of the ossicles
On CT , total or partial ossicular destruction
was noted in 22 cases. The involved ossicles were
malleus only in zero , incus only in seven , com
bined malleus and incus in 15 cases. The most
commonly involved individual portion was the
long process of incus in 20 cases , followed by
body and short process of incus in 17 cases ,
head of maleus in 13 cases , and handle and neck
of malleus in seven cases. At surgery, these find-
could not correlated with surgical findings due
to the lack of surgical records about it. So , the
frequency of ossicular erosion according to sur
gery was 67 % (16 / 24). There was no false nega
tive case. Therefore , among surgically confirmed
24 cases , diagnostic accuracy of CT to detect
ossicular erosion was 92 % (22 / 24) (Table 2).
4. Erosion of the bony labyrinth
On CT , lateral semicircular canal erosion was
thought to be intact in 20 cases (71 %), equivo
cal in four cases (1 4 %), and definte in four cases
(1 4 %), in one of which there was concomitant
erosion of vestibule and superior semicircular
canal (Fig. 4 a-c) . At surgery, all four cases that
erosion was thought as definite had positive ero
sion. In four cases that we thought equivoc외,
ings were closely matched in 22 cases , including Table 2. CT Accuracy of Ossicular Erosion*
six cases with intact ossicles. There were two
cases of false positive findings , in which cases
the apparently small and irregularly marginated
ossicle on CT was intact , but was wrapped by
op\‘ T Positive Negative Total
Positive
16 2
18
Negative Total
o 16 6 8 6 24
cholesteatoma at surgery (Fig. 3). Four cases * Excluding four cases of poor surgical record
- 1107
- 大韓放射線홉學會誌 · 第 36 卷 第 6 號 1990 -
a Fig. ~. False positive case of ossicular erosion. axial(a) and coronal(b) scans. Cholesteatoma within the epitympanum surrounds the apparently small and irregular head of malleus and body of incus (arrow). The shape and position of the ossicles are well maintained. Note intact long process of incus and crus of stapes(b). At surgery. normal ossicles wrapped by cholesteatoma were seen.
c
b
Fig. 4 a-c. Massive cholesteatoma causing erosion of the bony labyrinth. axial(a) and coronal(b) scans. A huge cholesteatoma in the entire middle ear space and mastoid has caused massive erosion of vestibule and superior semicircular canal as well as lateral semicircular canal erosion (straight arrows in a and b). Posterior semicircular canal is intact(curved arrow in b). In addition. dist외 Iimb of labyrinthine portion of facial nerve canal is also destroyed (arrowhead in a) as well as lateral wall of mastoid. Air in the external ear is replaced by the soft tissue mass . and there is extensive erosion of posterior wall of external auditory canal. Compare these findings with that of normal contralateral ear shown in c.
- 1108 -
Hy ung Jin Kim , et al : CT 01 Cholesteatoma-
surgery confirmed the actual erosion in t l;1(ee cases (14 %) (Fig. 6 c , 8 b)
cases. In all these three cases , coronal scan corr
ec t1y demonstrated the erosion (Fig. 5 a and b)
One of equivocal cases in which axial scan
showed erosion had intact canal at surgery
(Table 3).
5. Erosion of the facial nerve canal
On CT, erosion of the facial nerve canal was
found in six cases (22 %). In three cases (1 1 %),
the eroded portion was distal limb of the first
genu (Fig. 4 a) , and in the other three (11 %), it
was the vertical segment (Fig. 6 a-Ç, 8 a) . At
surgery, these findings proved correct in all
cases. There was no false negative case.
6. Erosion of the tegmen
On coronal scans , tegmen tympani and / or teg
men mastoidea was seen to be eroded in four
Table 3. CT Accuracy of Erosion of LSCC'
o읍\ST Intact Equivocal Eroded TotaI
Intact 20 1 o 21 Eroded o 3 4 7
TotaI 20 4 4 28
‘ Lateral semicircular can외
7. Erosion of the sigmoid sinus plate
On axial scans , there were six cases (21 %) of
the erosion of sigmoid sinus' plate (Fig. 6 a , 9 a).
8. Erosion of the bony external auditory canal
(Automastoidectomy)
Three cases demonstrated erosion of the bony
external auditory canal at the pO!SLerosuperior
portion , resulting in spontaneous drainage of
much of cholesteatomatous debris through the
eroded external auditory canal (Fig. 7). This is
called 경utomastoidectomy". In two cases , there
was a lso an interesting findings , which we called
퍼npending automastoidectomy" , in which the
pattern of bony destruction was very similar to
“ automastoidectomy", but the cholesteatoma sti1l
resided in the mastoid antrum and middle ear
cleft , and so the expulsion of the cholesteatoma
would be very likely in the n earby future (Fig. 4 ,
8).
9. Intracranial complications
There were three cases of intracranial compl
ication (11 % ) which was confirmed surgically.
a b Fig.5_ Discrepancy between axiaI(a) and coronaI(b) scans as to erosion oflateral semicircular canal . On coronal scan. there is no intervening septum between atticoantral cnolesteatoma and lateraI semicircular canal, which seems intact on axial scan. At surgery. lateral semicircular canal was dehiscent , as seen in b(arrow).
- 1109 -
- 大韓放射線醫學會誌 : 第 26 卷 第 6 號 1990 -
These were two cases of the lateral sinus throm- toma. that is. congenital and acquired5 .6l . Conge-
bosis (Fig. 9) and one case of the epidural absc- nital cholesteatoma is believed to arise from
ess. All three cases had the simultaneous erosion aberrant embryonic rests and comprises only 2
of the sigmoid sinus plate. % of all cholesteatomas. It is considered when a
cholesteatoma is found behind an intact tym-
Discussion panic membrane in a patient with no history of
otitis media. Acquired cholesteatomas account
There have been a lot of descriptions about the for the other 98 % and arise either from the pars
usefulness of CT in the field of otology. and it’s flaccida or from the pars tensa of the tympanic
of no doubt that CT is the most effective method membrane. The pars flaccida cholesteatomas
in the evaluation of cholesteatoma2-17l. A choles- comprise about four-fifths of all the acquired
teatoma is a sac of stratified squamous epithe- cholesteatomas. anå exclusively begin in the Pru-
lium filled with an accumulation of exfoliated ssak ’s space. There are many fine anatomic bar
kera tin that is trapped and growing within the riers to keep the disease limited in one comp
middle ear space or other pneumatized areas of artment of the middle ear space. particualrly in
petrous bone 1l . There are two types of cholestea - the attic7.8 l. The most common pathway of a
a b
c
Fig. 6. Erosion of facial nerve canal at mastoid segment, axial(a and b) and coronal(c) scans. The vertical segment offacial nerve canal directly attaches to a large botryoid cholesteatoma in the mastoid (arrows) . Cholesteatoma is 외so found in the entire middle ear. Notice the focal erosion of sigmoid sinus plate (arrowhead in a J. lateral semicircular canal (double arrowheads in b J. and tegmen tympan i( triple arrowheads in c)
1110
- Hyung Jin Kim , et al.: CT 01 Cholesteato ma-
a b Fig. 7. Automastoidectomy, axial(a) and coronal(b) scans. Direct communication of air-filled mastoid with external auditory canal is seen through the bony defect of posterosuperior portion of EAC in this patient having no history of previous operation. Note residual cholesteatoma in the mastoid
a b Fig. 8. Impeding automastoidectomy, axia l(a) and coronal(b) scans. This is the same case as in Fig.2. Huge cholesteatoma with entire ossicular erosion is present in the whole middle ear and m astoid. It has eroded entire posterosuperior wall of EAC and much of air in the EAC has been replaced by cholesteatoma. Also note erosion of vertical facial nerve canal (arrow in a) and tegmen tympani (a rrowheads in b).
pars flaccida cholesteatoma is via the superior The feature most suggestive of cholesteatoma
inculda l space to the posterior lateral attic and in a patient with middle ear opac ification is bone
subsequently through the aditus into the erosion. In fact . the absence of bone erosion with
antrum and mastoid51 . In this study. we did not middle ear opacification is more consistent with
categorize the individual type of acquired choles- uncomplicated inflammatory disease41 . The fact
teatomas. because it would not have affected sur- that a ll th e pa rs flaccida cholesteatomas arise
g ical procedures in the face of straightforward from Prussak's space from which th ey extend
CT findings and because there were many cases with a preferentia l pathway will h ave us under-
of an extensive cholesteatoma. the origin of stood th e frequ ency of erosion of the scutum and
which was h a rdly ide ntifiable. lateral a ttic wall . as s een in our cases (57 % ). It
- 1111
大옳放射線醫學會誌 : 第 26 卷 第 6 號 1990
has been reported that cholesteatoma is associa
ted with ossicular erosion in 50-90 %4.9) and
that CT can predict this preoperatively with acc
uracy rates ranging from 89 % to 94 %2.10).
Among surgically correlated 24 cases. we noted
ossicular erosion in 18 cases on CT. Surgery
confirmed this in 16 cases. In two false positive
cases. normal ossicle was surrounded by choles
teatomatous mass without erosion (Fig. 3) We
think it is difficu1t to evaluate the status of oss
icle when the cholesteatomatous mass surrounds
the apparen t1y small and irregular ossicle. In
that case. the gross shape and relationship of
the ossicles may be helpful in the evaluation of
its erosion
It is crucial to warn the surgeon about the
more serious complications. such as erosion of
the bony labyrinth. erosion of the facial nerve
cana1. erosion of the tegmen. erosion of the sig
moid sinus plate. and other intracranial com
plications. The propensity for erosion of the bony
labyrinth. especially lateral semicircular cana1. by
the cholesteatoma is well-known. and it occ
urred in 25 % (7/28) in this study. ln one of our
series. an extensive cholesteatoma caused
marked destruction of bony coverings of vestib
ule and superior semicircular canal as well as
lateral semicircular canal (Fig. 4). There have
been different opinions as to the optimal scan
method for evaluation of lateral semicircular can
al2 .4 •5 .6 ). In our series. coronal scans showed the
erosion of lateral semicircular canal more accura-
tely than axial scans did (7/7 vs 4/7) (Fig. 5).
Furthermore. in one case in which only axial
scan demonstrated erosion. surgery confirmed
lateral semircircular canal intac t. It probably re
sulted from the slight obliquity of lateral semicir
cular canal to zero degree plane which we used
on axial scans. We think coronal scan is prefer
able to axial scan in the evaluation of the state of
lateral semicircular canal. if nonoblique true
axial and coronal scans are used. At times. cho-
lesteatoma assaults the facial nerve canal result
ing in facial palsy. It is said to occur in 1. 1 %5).
This is especially like1y to occur in the region of
the first j:(enu at the level of the cochlea or in the
horizontal portion of the undersurface of lateral
semicircular cana1. In our cases. there were six
cases of facial nerve canal erosion (21 %). the
portion of which was the first genu in three
cases (Fig. 4 a) and the mastoid segment in the
other three cases (Fig. 6. 8 a). In the latter cases.
there was a large cholesteatoma extending into
the lowermost part of mastoid. The reason for
much higher frequency of facial nerve canal ero
sion seems to be due to large numbers of more
extensive and far-advanced disease in our series
There was no false positive cases. Needless to
say. it should be derived from the methodology
we adopted. It is well known that the horizontal
portion of facial nerve canal is normally dehis
cent in a considerable proportion of patients.
and that the partial volume averaging effect
mimcks erosion of facial nerve canal when a cho
lesteatomatous mass just abuts thin bony plate
of ηmpanic segment2 .4 .5.6.1이. So. we exlcuded
evaluation of horizontal tympanic segment of fa
cial nerve canal in this study. In the viewpoint of
significance of facial nerve canal erosion. the
most important thing, we think. is to correlate
CT with clinical signs.
The most serious and potentially fatal compli
cation of cholesteatoma is intracranial extension
resulting in meningitis. intracerebral. subdural
or epidural abscesses. and venous sinus thromb
osis 1). It has been markedly decreased in the era
of antibiotics. We experienced three cases of int
racranial complications (11 %). These were two
cases of lateral sinus thrombosis (Fig. 9) and one
case of eqidural abscess. All these three cases
허so had concomitant erosion of the sig찌oid
sinus plate. In my opinion it is thoughtful to
obtain additional enhanced brain scans when
there is evidence of erosion of the sigmoid sinus
- 1112
- Hyung Jin Kim , et al.: CT of Choles teatoma -
a b Fig. 9 a, b. Lateral sinus thrombosis. Large cholesteatoma in the mastoid has caused the erosion of sigmoid sinus plate (arrow in a). On enhanced brain scan , rim-enhancing lesion due to lateral sinus thrombosis is seen at the region of sigmoid sinus (arrowheads in b)
plate on axial CT.
Three cases of our 28 previously nonoperated
cholesteatomas had another uncommon but uni
que characteristic of cholesteatoma , so called,
“ automastoidectomy" (Fig. 7). In this variant
there is a central air collection, replacement of
the bony septa of the mastoid antrum , erosion of
the middle ear cavity, and a mural debris , all of
which are reminiscent of postsurgical ear4). lt is
the result of spontaneous drainage of cholestea
toma through the destroyed external auditory
canal at superoposterior portion. ln two cases
there was also an very interesting findings which
we called 퍼npending automastoidectomy". The
pattern of bony destruction is very similar to
that of automastoidectomy, but the cholestea
toma still resides in the mastoid and middle ear
space , so the expulsion of it is likely to be very
imminent (Fig. 4 , 8).
Las tly, we11 briefly mention the findings of re
current cholesteatoma after mastoidectomy ,
whiCh we have en countered in three cases. The
type and extent of middle ear and mastoid sur
gery depends on the a mount of disease en cou nt-
1113
ered. Mastoidectomy can be divided into cJose
d-cavity types , in which the external auditory
canal (EAC) wall is ma inta ined , and open-cavity
types , in which the EAC walls a re taken down
posteriorly. The cJosed-cavity operations a re fu
rther subdivided into the simple m astoidectomy
and the intact can a l wall mastoidectomy , a nd the
open-cavity procedures into the radical m as to
idectomy and the midified radical m asto idect
omy ' :l) . Two of our three cases had undergone
open-cavity surgery , a nd one undergon e clo
sed- cavity surgery. In short, recurrent cholestea
toma was demonstrated either as a well demar
cated soft tissue mass outlined by air (Fig. 10) or
as an irregula rly marginated mass filling mastoid
or middle ear space with or withou t bone ero
sion3 .14
). No case showed any in tact ossicJe at alJ.
We could n ot dete rmine whether it was caused
by the previous opera tion or by th e recurrent or
res idua l cholestea toma. Nevertheless , we think
CT can afford the s urgeon not only the knowle
dge of th e type of previous operation but the ex
tent a nd associated complications of recurrent
cholesteatoma
- 大韓放射線醫學會픔 . 第 26 卷 第 6 號 1990
a b Fig.l0. Recurrent cholesteatoma. axial(a) and coronal(b) scans. This thirty three-year old woman had a history of mastoidectomy five years ago. On CT. there is absence of the superoposterior wall of EAC as w.ell as surgical window at the mastoid. Well-demarcated soft tissue mass surrounded by air is well demonstrated within the mastoid bowel. The cholesteatoma is a lso seen at the posterior mesotympanum (arrowheads in a). Note the similarities to the findings of “automastoidectomy" shown in Fig. 7.
Regardless of his or her preferred approach.
every surgeon wants to know the extent and
location of cholesteatoma preoperatively. Need
less to say. high resolution CT would suffice it.
In addition. it should be the procedure of choice
in the e、raluation of bone erosion complicated by
cholesteatoma.
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