Analysis of Mastoid Findings at Surgery to Treat Middle Ear Cholesteatoma | Facial Nerve | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
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Original Article
December 2006

Analysis of Mastoid Findings at Surgery to Treat Middle Ear Cholesteatoma

Author Affiliations

Author Affiliations: Departments of Otolaryngology (Drs H.-M. Wang, Lin, Lee, Tai, L.-F. Wang, Chang, Hsu, and Ho) and Pathology (Dr Chai), Chung-Ho Memorial Hospital, Kaohsiung, and the Departments of Otolaryngology (Drs Lee, Tai, and Ho) and Pathology (Dr Chai), Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan.

Arch Otolaryngol Head Neck Surg. 2006;132(12):1307-1310. doi:10.1001/archotol.132.12.1307

Objectives  To analyze mastoid findings, such as facial nerve dehiscence (FND), labyrinthine fistula, and dural exposure; to review its incidence at cholesteatoma surgery; to analyze its association with semicircular canal fistula; and to elucidate its relationship with dural exposure.

Design  One hundred fifty-two patients (65 males and 87 females; 155 ears) were enrolled in a retrospective study of tympanoplasty with or without mastoidectomy.

Setting  Medical university center hospital.

Results  The incidence of FND after exenteration of disease was 29.7% (46/155 ears) for total surgical procedures, 29.7% (43/145 ears) for initial procedures, and 30% (3/10 ears) for revision procedures. The prevalence of FND in the tympanic segment only was 87%, with 8.7% in the vertical segment only and 4.3% in both segments. Three patients (2.0%) developed facial palsy postoperatively, with 8 lateral semicircular canal fistulas (5.2% of total ears operated on), half of these with concomitant FND. The incidence of dural exposure of the mastoid tegmen in the entire surgical group was 16.8% (26 ears), 38.5% with concomitant FND.

Conclusions  The overall incidence of FND in our sample was high at 29.7%, with rates of lateral semicircular canal fistula and dural exposure of 5.2% and 16.8%, respectively. The relationship between FND incidence and presence of lateral semicircular canal fistula was positive in our study. The surgeon should bear in mind that the location of FND with cholesteatoma coincides with the most common area of iatrogenic facial nerve injury during otologic surgery.