FROM TYMPANIC RETRACTION POCKET TO CHOLESTEATOMA

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Transcription de la présentation:

FROM TYMPANIC RETRACTION POCKET TO CHOLESTEATOMA

Classifications of retraction pockets SADE (4, atelectasia, metula°) ARS (3, stable, instable) CHARACHON (3, mobile, fixed) TOS (4, papillar) GERSDORFF (6, controlable, endos) MARTIN (location, type, ossicle) DORNHOFFER (4, chole.) LIVI (2, safe, unsafe) BLACK (4, ossicle, chole)

DRUM COLLAPSE ONTO THE PROMONTORIUM Pars tensa retraction pocket stage IV Middle ear Atelectasis Adhesive Otitis Cholesteatoma by retraction pocket Mesotympanum Cholesteatoma « Epidermose du fond de caisse »

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PRE-CHOLESTEATOMA marginal keratine debris Unsafe retraction pocket marginal keratine debris Bony contact or adhesiveness

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OTOSCOPIC CLASSIFICATION NON Marginal retraction pocket Marginal +/- fixed invagination pocket, control, tube Hyperkeratosis epith. précholesteatoma, surgery Extend +/- osseous lysis cholesteatoma SKIN IN A WRONG PLACE

migration retraction proliferation

ATELECTASIA ADHESIVE OTITIS my Myringomalacia , collapsed eardrum Retraction pocket ATELECTASIA ADHESIVE OTITIS

WRONG SKIN

IMMUNE RESPONSE Lymphocyte T Langerhans’cell « immunological sentinels »

Cholesteatoma a defective wound healing EGF-EGFR Autocrine hyperactivity keratinization proliferation chemiotaxis wound healing

LOSS OF GROWTH CONTROL

The pathogenesis of cholesteatoma does not only depend on the middle ear, but also very probably on the immunological status of the external auditory bottom skin cells, which have an unique laminar migratory potential. The transformation of a retraction pocket into a true precholesteatoma is an active phenomenon with an intrinsic dysfunction of the external auditory canal bottom skin immune system.

Tympan Absence de 3 couches – Perforation Absence de 3 couches et proliferation epiderme – Cholesteatom Absence de 2 couches LP et muq – Poche de retraction Absence de 2 couches LP et muq et proliferation epiderme - Cholesteatome Non marginal Marginal

Les origins 1683 Du Verney steatoma 1829 Cruveilhier tumeur perlée 1830 Muller cholésteatoma cholestrine, graisse, tumeur

Le moyen age – Cholesteatoma - Osteite Cholesteatome / Mastoide (Wiitmack, Diamant) Essais de redefinition Keratom, Margaritom, Cholesteatose (Young), épidermose (Toumarkin), cholesteatose desquamante (Birrel, Ruedi),keratose obstructive (Biber), epidermose desquamante (Mac Guckin)

1990 I’ere actuelle Definition Presence d’un epithelium malphigien kératinisant dans les cavités tympaniques (avec accumulation de squames) Pseudo-tumeur inflammatoire de type épidermique présentant un double potentiel de desquamation et de d’érosion (Susceptible de récidive) Presence de peau dans l’oreille moyenne avec accumulation de kératine formant une véritable tumeur bénigne

1990 I’ere actuelle Definition Poche de rétraction Poche d’invagination Pré-cholesteatome (wrong) skin in the wrong place

De la poche de rétractione au cholesteatome Le tympan est la façade de l’otite chroniqie Cholesteatome résiduel: Améliorer la chirurgie d’exérése La récidive du cholesteatome: Améliorer la chirurgie réparatrice