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Facial nerve dehiscence and middle ear cholesteatoma: endoscopic vs microscopic approach

Presenting Author: Giuseppe Magliulo

Published online by Cambridge University Press:  03 June 2016

Giuseppe Magliulo ,
Giannicola Iannella ,
Benedetta Pasquariello ,
Alessandra Manno  and
Diletta Angeletti
Giuseppe Magliulo
Affiliation:
‘Organi di senso' Department, ‘Sapienza’ University of Rome
Giannicola Iannella
Affiliation:
‘Organi di senso' Department, ‘Sapienza’ University of Rome
Benedetta Pasquariello
Affiliation:
‘Organi di senso' Department, ‘Sapienza’ University of Rome
Alessandra Manno
Affiliation:
‘Organi di senso' Department, ‘Sapienza’ University of Rome
Diletta Angeletti
Affiliation:
‘Organi di senso' Department, ‘Sapienza’ University of Rome
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Abstract

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Learning Objectives: - Endoscopic approach in cholesteatoma surgery - Endoscopy vs microscopic approach in cholestetoma surgery - Facial nerve dehiscence evaluation using oto-endoscopy

Introduction: Facial paralysis is one of the most devastating postoperative complications of cholesteatoma surgery, and dehiscence of the Fallopian canal may contribute to this serious complication. In recent years endoscopic approaches to the middle ear have increasingly been used.The aim of this study was to assess the incidence of facial nerve dehiscence in a group of patients with middle ear cholesteatomas who underwent primary exclusive endoscopic surgery (PEES).

Methods: Forty attic cholesteatomas were enrolled in the study. 20 patients underwent PEES were compared with a group of 20 patients that undergone microscopic surgery. Preoperative and postoperative clinical symptoms and disease duration before surgery were evaluated, together with the presence and site of facial nerve dehiscence, the presence and site of labyrinthine fistula, the type of surgery performed and the duration of the operation.

Results: The incidence of intraoperative facial nerve dehiscence in the EES group was 27.1%. Dehiscence was present in 42.3% of the patients who underwent revision surgery. The most common site of dehiscence (92.3%) was the tympanic segment. Similar data were reported in patients treated with microscopic approach without statistical difference between the two groups. No difference regarding post-operative complications was present in the two groups. PEES exhibited shorter surgical time.

Conclusions:

  • • Primary endoscopic surgery is a minimally invasive approach that circumvented bony work in sclerotic mastoid with antral or periantral cholesteatoma involvement with shorter times compared with mastoidectomy.

  • • Endoscopy is a 1-hand surgical manipulation and in some situations the need of 2-hand manipulation can oblige the use of microscopic dissection. However its complementary option in dehiscent facial nerve appears essential for evaluating hidden areas as in the area posterior to the geniculate ganglion focusing the importance of the floor of the anterior epitympanum.