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The authors present their experience of secondary cholesteatomas of the middle ear explored by computerized tomography (CT). Following a brief anatomicopathological description of secondary petrous bone cholesteatomas, and of the CT technique used for their exploration, they describe and illustrate the classical "bag-shaped" internal or external attical forms usually extended to the antrum and the mastoid process, and the less common locations often due to relapse or postoperative recurrences (anterior hypotympanic or posterior mastoidal). The holotympanic forms, usually due to "lamellar" cholesteatomas, create diagnostic problems with other opacities in the cavity, as also do certain forms that are evacuated spontaneously or by aspiration. One of the qualities of CT lies in the preoperative extension assessment. The lesion may extend towards the internal wall of the cavity (lateral semicircular canal, second portion of the facial nerve), towards the labyrinth to the petrosal apex and/or the geniculate ganglion, and above all towards the inferior labyrinth which might bring the cholesteatoma into contact with large vessels (e.g. jugular vein bulb for postero-inferior extensions, carotid canal for antero-inferior extensions). Extension into anfractuosities of the cavity walls (sinus tympani, subratubal fossette) must be systematically looked for in order to avoid postoperative recurrences.

译文

作者介绍了他们通过计算机断层扫描(CT)探索的中耳继发性胆脂瘤的经验。在对继发性岩性胆脂瘤和用于探查的CT技术进行了简要的解剖病理学描述之后,他们描述并说明了通常延伸至窦腔和乳突的经典“袋状”内部或外部阁楼形式,其次常见部位通常是由于复发或术后复发(前鼓膜下或乳突后)。通常由于“片状”胆脂瘤而引起的全神贯腹形式,以及其他自发性或通过抽吸而排空的形式,也给腔内的其他混浊带来了诊断问题。 CT的特质之一是术前扩展评估。病变可向腔内壁(外侧半规管,面神经的第二部分),迷路延伸至椎尖和/或膝状神经节,最重要的是向下迷路延伸,可能导致胆脂瘤与大血管接触(例如,颈静脉球用于后下延伸,颈动脉用于前下延伸)。为了避免术后复发,必须系统地寻找腔壁(鼓膜窦,管下突窝)的畸形。

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