简介:Oneday,theteacherinquiredPeter:“Howmuchisfourminusfour?”Peterwastongue-tied.Theteachergotangryandsaid,“Whatafool!Yousee,ifIputfourcoinsinyourpocket,butthereisaholeinyourpocketandallofthemleakout,nowwhatisleftinyourpocket?”“Thehole,”repliedPeter.WhatIsLeftinYourPocket?!湖北@罗成勇
简介:Aims:Thegoalofthepresentstudyistosummarizeourexperienceonsurgicalmanagementofretractionpockets(RP)asapreventivetoolagainstcholesteatomas.Methods:Twenty-fiveearshavebeenfollowedupforameanperiodof6.16±4.35years(from1to17years).Thesamplepresentedameanageof47.56±19.11years(from16to73years).Allpatientsunderwentcartilagegraftsurgery.Furthermore10(40%)underwenttympanoplasty(TPL)typeI,14(56%)TPLtypeIIand1(4%)TPLtypeV.Results:Elevenears(44%)showedcholesteatoma:allthesecaseswerestageIIIaccordingtoCharachonstaging,andstageIVorVaccordingtoGersdorffclassification.Twelvepatients(48%)showederosionoftheossicularchain.Ofthese,fivewereassociatedwithcholesteatomaandsevenonlywithretraction.Therecurrencerateofcholesteatomawas12%.NoneofthepatientswithastageIIorIIIRP(accordingtoGersdorffclassification)developedcholesteatoma.TherecurrenceofRPwas0%.Inregardstoliteraturereview,sevenreferenceswereselected.Thesestudiesshowedasuccessraterangingfrom79.1%to88%,whilerecurrencesofRPvariedfrom6.4%to13%.Onlyonestudyspecifiedarecurrencerateofcholesteatomaof28%.Conclusions:SurgicaltreatmentofstagesIIandIIIRPisaneffectivetooltopreventcholesteatomaformation.ThepresenceofkeratinaccumulationandcholesteatomaattheRP(stagesIVandV,accordingtoGersdorff)aretherealpredictorsofpoorprognosis.