外耳道胆脂瘤并发化脓性腮腺炎1例并文献复习

Cholesteatoma of the external auditory canal complicated with suppurative parotitis:a case report and literature review

目的探讨外耳道胆脂瘤并发化脓性腮腺炎病因及诊治经验,并进行外耳道胆脂瘤诊疗相关文献复习。方法回顾性分析1例外耳道胆脂瘤并发化脓性腮腺炎病例资料,主要症状为左耳听力下降伴流脓,左侧面部红肿疼痛。颞骨CT及耳部核磁示:左侧外耳道内胆脂瘤形成,累及乳突、鼓室、鼓窦、腮腺及咽旁间隙。临床诊断:外耳道胆脂瘤(左,Holt Ⅲ期)、化脓性腮腺炎(左)。手术方式为左耳外耳道胆脂瘤切除术、开放式乳突根治术、鼓室成形术、人工听骨植入术、耳甲腔成形术、腮腺脓肿清除术及腮腺瘘修补术。结果术中彻底清除外耳道及中耳内胆脂瘤及腮腺脓肿,并修复腮腺瘘。术后随访患者恢复良好,无胆脂瘤复发残留及腮腺炎复发相关症状出现。结论外耳道胆脂瘤具有骨质破坏的潜能。而Holt Ⅲ期外耳道胆脂瘤并发化脓性腮腺炎病例罕见,明确病因并依据病变侵袭范围选择个体化的治疗方案尤为关键。

Objective To investigate the etiology,diagnosis,and treatment of external auditory canal cholesteatoma complicated with suppurative parotitis and to review the relevant literature on external auditory canal cholesteatoma.Methods We retrospectively analyzed a case of patient with external auditory canal cholesteatoma complicated with suppurative parotitis who was admitted to our hospital.The patient presented with hearing loss in the left ear accompanied by otorrhea,as well as swelling and pain on the left side of the face.Temporal bone CT and ear canal MRI showed cholesteatoma formation in the left external auditory canal involving the mastoid process,tympanic cavity,tympanic sinus,parotid gland,and parapharyngeal space.The clinical diagnosis was external auditory canal cholesteatoma(left,HoltⅢ)and suppurative parotitis(left).The surgical methods used were cholesteatoma resection from the left external auditory canal,open radical mastoidectomy,tympanoplasty,artificial ossicular implantation,plasty of the cavity of auricular concha,removal of the parotid abscess,and repair of the parotid fistula.Results The cholesteatoma of the external auditory canal and middle ear and parotid abscess were completely removed,and the parotid fistula was repaired.Postoperative follow-up examinations showed that the patient recovered well without recurrence of the cholesteatoma or parotitis.Conclusion External auditory canal cholesteatoma has the potential to cause bone destruction.Cases of Holt phaseⅢcholesteatoma of the external auditory canal complicated by suppurative parotitis are rare and it is pivotal that the pathogenesis is understood and that individualized treatment plans are chosen according to the full lesion range.