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Cholesteatoma of the left ear


1.Otoscopic control before starting the procedure. View of the stapes footplate through a peripheral perforation. Above of the footplate runs the facial nerve (right side of the picture). 2.Otoscopic control before starting the procedure. View of the cholesteatoma above the facial nerve.
3.Retroauricular incision, elevation of the skin of the posterior wall of the external auditory canal, and placement of a retractor. 4.Enlarging the posterior wall of the external auditory canal.
5.Enlargement of the superior wall (epitympanic area). 6.Identification of the sac of the cholesteatoma.
7.Revealing, gradually, the cholesteatoma following the sac towards the anterior epitympanum and the antrum. 8.Trying to identify the borders of the cholesteatoma in the anterior epitympanic recess.
9.Trying to identify the borders of the cholesteatoma in the area of the antrum. 10.Expanding the antrotomy and identification of the posterior limit of the cholesteatoma.
11.Completion of the epitympanotomy and identification of the anterior and the superior limit of the cholesteatoma. 12.Elevation of the cholesteatoma with a round knife from the area of the antrum.
13.Elevating the cholesteatoma from the anterior epitympanum. The malleus head is observed. 14.Removing the cholesteatoma from the tympanic cavity.
15.The cholesteatoma after its complete removal. 16.Cutting the tendon of the tensor tympani muscle with tympanoplasty scissors.
17.Cutting the malleus neck and removal of its head. 18.Removing adhesions from the stapes footplate and checking its mobility.
19.Elevation of the remnant of the tympanic membrane. 20.Receiving a chondral-perichondrium graft from the concha of the auricle.
21.Receiving temporalis fascia as additional graft. 22.Insertion of an acoustic prosthesis (TORP).
23.Placement of the chondral-perichondrium graft over the acoustic prosthesis. 24.Covering the operative cavity with the temporalis fascia graft.
25.Packing the cavity with absorbable material. 26.Canaplasty and wound closure.