Abstract
ObjectiveThis study aimed to investigate the abnormal high-resolution computed tomography (HRCT) findings in cholesteatomatous chronic otitis media (CCOM) patients preoperatively and the coexistence of abnormal HRCT findings with facial canal dehiscence (FCD) observed intraoperatively to identify the predictive factors associated with FCD.MethodsThe medical records of 151 CCOM patients who had undergone tympanomastoidectomy at our center were retrospectively examined in terms of the patients’ age and gender, preoperative HRCT findings [scutum defect, posterior wall of external auditory canal (PWEAC) defect, lateral semicircular canal (LSSC) defect, tegmen defect, and sigmoid plate erosion]. Operation records containing information about FCD were also analyzed.ResultsThe prevalence of FCD was found to be 33.8% (51/151). There was a significant correlation between the presence of scutum, PWEAC, LSSC, and tegmen defects and the presence of FCD. However, no statistically significant correlation was found between the presence of sigmoid plate erosion and the presence of FCD. The results of regression analysis of the coexisting pathologic findings for FCD showed that the risk of FCD was highest in patients with LSSC + scutum defects (34.3-fold increase), followed by LSSC + PWEAC defects (31.6-fold increase).ConclusionOur study revealed that the presence of scutum, PWEAC, LSSC, and tegmen defects on HRCT indicates a higher risk of FCD preoperatively. This risk is even greater when multiple abnormal findings coexist.
Highlights
Facial paralysis is one of the most feared complications encountered during cholesteatoma surgery
This study aimed to investigate the abnormal high-resolution computed tomography (HRCT) findings in cholesteatomatous chronic otitis media (CCOM) patients preoperatively and the coexistence of abnormal HRCT findings with facial canal dehiscence (FCD) observed intraoperatively to identify the predictive factors associated with FCD
There was a significant correlation between the presence of scutum, posterior wall of external auditory canal (PWEAC), LSSC, and tegmen defects and the presence of FCD
Summary
Facial paralysis is one of the most feared complications encountered during cholesteatoma surgery. The reported risk of facial injury is 0.6-3.6% for primary surgery and 4-10% for revision surgery [2]. The risk of injury during surgery is high in cases of dehiscence of the facial nerve (FN) canal [3,4]. Facial canal dehiscence (FCD) may be caused by developmental defects due to failure during the ossification process of the bony canal or bony erosion resulting from cholesteatoma and inflammation. FCD was reported to occur at a higher rate during revision surgery than primary surgery [12]. The status of the facial canal during COM surgery remains a challenging issue even for experienced surgeons. Some pathological conditions such as scutum erosion, defects of the posterior wall of the external auditory canal (PWEAC), labyrinth fistula, complete ossicular chain defect, and the presence of cholesteatoma were found to be important signs for the prediction of FCD [13,14,15]
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