外耳道真珠腫手術における耳後部皮下茎皮弁の応用

Surgical Treatment of External Auditory Canal Cholesteatoma using a Postaural Subcutaneous Pedicle Flap

I．緒言

　外耳道真珠腫の報告は1850年のToynbee^1）が嚆失とされる。本邦では骨部外耳道に拡大があり耳垢の付着や栓塞を伴うものを外耳道真珠腫としている^2）が，欧米ではこれをkeratosis obturans （以後KOと略す）とexternal auditory canal choles—teatoma （以後EACCと略す）に区別^3,4）している。KOは保存的治療が勧められている^3）が，EACCでは手術的治療を勧めるものが多く，とくに経外耳道的に病変が十分明視できず慢性の疼痛が持続するような骨破壊を伴う進展例が適応^5）とされる。手術の要点は真珠腫の除去，炎症性骨の郭清，欠損部の再建^6）であり，とくに欠損部が大きい場合その再建に工夫が必要である。今回われわれは耳後部皮膚を皮下茎皮弁として外耳道再建に用い，若干の知見を得たので報告する。

A postaural subcutaneous pedicle flap was used for repair of the canal skin defect in cases of ex-ternal auditory canal cholesteatoma.

After removal of all dead bone or sequestrum, followed by smoothing of the eroded lesion, the flap was placed over the exposed bone, and the subcutaneous tissue of the flap was tucked under the edges of the normal skin. When the lesion involved the bony anulus, it was recommended that the subcutaneous tissue was underlayed the tympanic membrane after reconstruction of the bony anulus.

In our experiences, there was no problems about undermining the subdermal tissue of the flap and no necrosis was found.

Since the reports on the surgical treatment of external auditory canal cholesteatoma were rare, a bibliographic review was shortly discussed.