Cholesteatoma

Surgery Of Cholesteatoma & Chronic Otitis

April 10 2020
A Lecture by Dr. Robert K. Jackler, MD

With further growth, the cholesteatoma continues to accumulate keratin as it expands toward the aditus-ad-antrum.

Growth Patterns of Cholesteatoma

Canal wall down tympanomastoidectomy cavity with fascia tympanoplasty, cartilage graft, and partial ossicular replacement prosthesis.

Microdissection of Cholesteatoma

Limited epitympanic disease can be handled by an atticotomy.

The Facial Nerve in Cholesteatoma

Cholesteatoma involving the posterior mesotympanic spaces (facial recess and sinus tympani). The long process of the incus and stapes superstructure is frequently eroded. (Used with permission from Jackler RK. The surgical anatomy of cholesteatoma. Otolaryngol Clin NA 1989;22:883–896.)

Sinus Tympani & Facial Recess in Cholesteatoma

Anterior Epitympanic Cholesteatoma

Cholesteatoma matrix on a lateral semicircular canal fistula. Management options include resection of the matrix or exteriorization via canal wall down procedure.

Semicircular Canal Fistula in Cholesteatoma

Microsurgical trimming cholesteatoma matrix followed by laser vaporization of the portion adherent to the stapes superstructure. Use of the laser minimizes vibratory trauma to the inner ear. Due to the proximity of the facial nerve, periodic irrigation is important to reduce thermal impact which could injure the nerve.

Dr. Jackler and Ms. Gralapp retain copyright for all of their original illustrations which appear in this online atlas. We encourage use of our illustrations for educational purposes, but copyright permission should be sought before publication or commercial use. To request permission for publication or commercial use please contact Christine Gralapp (eyeart@chrisgralapp.com, https://www.chrisgralapp.com).