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American Journal of Otolaryngology and Head and Neck Surgery
2020 | Volume 3 | Issue 2 | Article 1086 1
Cholesteatoma and Facial Canal Dehiscence: A
Comparative Prospective Study
OPEN ACCESS
*Correspondence:
Shahid Rasool, Department of ENT
and HNS, Hamdard Institute of Medical
Sciences and Associated HAHC
Hospital, 110062, New Delhi, India, Tel:
+91-9650177009;
E-mail: srb948@gmail.com
Received Date: 02 Mar 2020
Accepted Date: 26 Mar 2020
Published Date: 30 Mar 2020
Citation:
Rasool S, Garg R, Tandon A, Khatri S,
Priya R, Malik J, et al. Cholesteatoma
and Facial Canal Dehiscence: A
Comparative Prospective Study. Am
J Otolaryngol Head Neck Surg. 2020;
3(2): 1086.
Copyright © 2020 Shahid Rasool. This
is an open access article distributed
under the Creative Commons Attribution
License, which permits unrestricted
use, distribution, and reproduction in
any medium, provided the original work
is properly cited.
Research Article
Published: 30 Mar, 2020
Abstr act
Dehiscence of the facial canal is a matter of great concern for an otologist as one of the most dread
complications of mastoid surgery is injury to the facial nerve. Dehiscence can be congenital or
acquired. Congenital fallopian canal dehiscence is a developmental defect of the bony covering of
facial nerve which usually involves the tympanic segment of the canal in almost 60% of the cases.
While as Acquired cases are most commonly associated with squamousal chronic otitis media or
cholesteatoma. Te incidence of facial injury in cholesteatoma surgery is approximately as 1% to 2%.
Objectives: To fnd the true intraoperative incidence of Facial Canal Dehiscence (FCD) in
squamousal chronic otitis media and compare the results with homogenous control group. Te
second aim of the study is to determine the labyrinthine fstula in presence of FCD.
Methods: Total of 175 patients of chronic otitis media was enrolled in the study. Te study group
consisted of 100 cases of COM with cholesteatoma and control group consisted of 75 cases of
Mucosal COM.
Results: Of total of 100 cases of cholesteatoma group 9% had FCD. While as in control group
only 1.3% had FCD. Which was statistically signifcant (p=0.03). It was found that ears with both
cholesteatoma & FCD had higher intraoperative incidence of labyrinthine fstulas (44%) compared
to those where only cholesteatoma was seen. Which was highly statistical signifcant (p-value of
0.000001)?
Conclusion: Tere is a potential causal relationship between cholesteatoma & facial canal dehiscence.
Te presence of facial canal dehiscence markedly increases the chances of labyrinthine fstulas.
Keywords: Facial canal dehiscence; Cholesteatoma; Labyrinthine fstula; LSCC fstula
Shahid Rasool*, Richa Garg, Ayushi Tandon, Shreya Khatri, Ratna Priya, Junaid Malik, Seema
Monga and Khaja Naseeruddin
Department of ENT and HNS, Hamdard Institute of Medical Sciences and Associated HAHC Hospital, India
Introduction
Any discontinuity in the bony limits of the facial canal resulting in a communication between
the facial nerve and middle ear space or mastoid air cell system is called Facial Canal Dehiscence
(FCD). Dehiscence of the facial canal is a matter of great concern for an otologist. It may result as an
injury to the facial nerve. Te facial nerve injury is one of the most dreaded complications of mastoid
surgery with devastating consequences [1]. Although it can be observed in normal population [2].
Its origin has been found to be either congenital or acquired. Congenital facial canal dehiscence is
a developmental defect of the bony covering of facial nerve which usually involves the tympanic
segment of the canal in almost 60% of the cases [3]. Te acquired type is most commonly associated
with squamousal Chronic Otitis Media (COM) or cholesteatoma [4].
Cholesteatoma is well known for its complications because of pressure necrosis and its
osteoclastic activity [2]. Te incidence of facial injury in cholesteatoma surgery is approximately 1%
to 2% [5]. Te risk of injury increases further with the presence of facial canal dehiscence. Reported
risk of facial nerve palsy is between 0.6% to 3.6% and 4% to 10% in primary and revision surgeries,
respectively [6,7]. Although the possibility of FCD in association with cholesteatoma cannot be ruled
out in every situation, knowledge of its magnitude is the real concern for an operating otologist.
Te present study attempts to measure the true intraoperative incidence of facial canal dehiscence
in squamousal Chronic Otitis Media (COM with cholesteatoma) and compare the results with
a homogenous control group (Figure 1). Te second objective of the study is to analyze the risk
of labyrinthine fstula in the presence of FCD. To the best of our knowledge, there has not been
any published study in the literature concerning the estimation of risk of FCD in mucosal COM