pediatric panel: complex cholesteatoma · endoscopic approach to complex cholesteatoma. case 1....
TRANSCRIPT
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Pediatric Panel:Complex Cholesteatoma
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Seiji Kakehata, MD
University of Yamagata
Yagamata, Japan
Stephen Hoff, MD
Northwestern University
Lurie Chidren’s Hospital
Chicago, USA
Panel Chairs
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Sharon Cushing, MD
University of Toronto
SickKids
Toronto, Canada
Alejandro Rivas, MD
Vanderbilt University
Nashville, USA
Michael Tong, MD
Chinese University of Hong Kong
Hong Kong
Panelists
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Samantha Anne, MD
Cleveland Clinic
Cleveland, USA
José Rivas
Clinica Rivas
Bogota, Columbia
Yong Cui, MD
Guangdong Provincial People’s
Hospital
Guangzhou, China
Panelists
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Disclosures
Dr Hoff - None
Dr. Kakahata - None
Dr. Cushing - Speaker’s Bureau – InteracousticsSpeaker’s Bureau – Cochlear CorporationRoyalties Plural Publishing Editor: Balance Disorders in the Pediatric PopulationPatent Holder: Patents #: 7041-0: Systems And Methods For Balance StabilizationSponsored Research Agreement - Cochlear Americas
Dr. Rivas - Consultant: Cook, Stryker, Grace, MED-EL, Advanced Bionics, Cochlear Americas
Dr. Tong - None
Dr. Cui - None
Dr. Anne - None
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Endoscopic approach to complex cholesteatoma
• Access the disease where it starts and spreads
• Able to look around corners where
cholesteatoma hides
• Open ventilation pathways in the middle ear
• Minimally-Invasive
• High patient/parent satisfaction
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Potential disadvantages:
• One-handed surgery
• Bleeding can be frustrating
• Potential damage to ossicles
• Learning curve
• Longer operative times
Endoscopic approach to complex cholesteatoma
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Case 1
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Acquired Cholesteatoma
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Acquired Cholesteatoma
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Suction flap knife
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• Epinephrine-soaked pledgets – use often, and under flap
• Patient positioning – reverse trendelenburg
• Injection of the canal – posterio-superior
• Mean Arterial Pressure (MAP) as low as tolerated
• Irrigation and patience
• Electrocautery and laser in the ear canal and middle ear
Anschuetz et al., 2017
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Acquired Cholesteatoma
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Case 2
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Acquired Cholesteatoma
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Acquired Cholesteatoma
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Acquired Cholesteatoma
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(Panetti Set)
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(Panetti Set)
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Extracting cholesteatoma from the antrum
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CASE 3
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Middle Ear Ventilation
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Middle Ear Ventilation
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Middle Ear Ventilation
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The Tensor Fold
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Images from the Stanford Otology Atlas (with permission):
https://med.stanford.edu/ohns/education/atlases.html
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Pressuti et al, 2018
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CASE 4
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Congenital cholesteatoma – stage IV
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Congenital cholesteatoma – stage IV
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Extent of disease?
Diagnosis? 3 year-old boy
Operative procedure?
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CongenitalCholesteatoma
TP Ivi3 year-old boy
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1 year postopPrePreservation of mastoid
bone and mucosa
Minimum bone removal
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Presurgical image diagnosis Existence and extent of cholesteatoma
Pearls and Pitfalls
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CASE 5
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Congenital cholesteatoma – stage III
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CASE 6
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Second stage – first done elsewhere
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Endoscopic clinic surveillance
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Second Stage - Pearls
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Bonus Cases
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