MDT discussion results
All patients participated in a perioperative MDT discussion for the
evaluation of the safety and feasibility of surgery, preliminarily
prediction of the postoperative effects, and prevention of the
occurrence of postoperative complications. The following results were
obtained: 1) All primary lesions were completely controlled after
comprehensive treatment without signs of residues, recurrence, or
metastasis; 2) All patients were classified into three different
classes. Five patients of grade (a), whose ORNTB were localized by an
intact TM and continuous cortical bone of the posterior and superior
walls of the EAC, were accepted for routine CI (Fig. 2a). Two patients
of grade (b) with diffuse ORNTB and an intact TM and a continuous
cortical bone of the posterior and superior walls of the EAC were
subjected to simultaneous extended radical mastoidectomy and CI (Fig.
2b). The other four patients of grade (c) simultaneously underwent
subtotal petrosectomy (STP), external auditory canal elimination,
mastoid cavity obliteration by fat graft or musculoperiosteal flaps and
CI because of their diffuse ORNTB with perforate TM and defects in the
posterior and upper walls of the EAC (Fig. 2c); 3) Radiologists
diagnosed five patients who had different levels of REP depending on
standard MRI and CT. Neurologists and psychiatrists found that four of
them had no abnormal neurological symptoms or clinical signs due to REP.
It is worth noting that a patient had been diagnosed with REP on the
bilateral temporal lobe after epileptic seizures in 2012 and underwent
partial radiation lesion resection of the right temporal lobe. Because
the epilepsy was well controlled and the patient did not occur any
seizure over a year, MDT team did not regard REP as a surgical
contraindication. But REP was predicted to probably affect postoperative
hearing recovery; 4) According to modified Mallampati scores,
anesthesiologists classified four patients into grade IV, characterized
by difficult airway passage, thus nasotracheal intubation under
fiberoptic bronchoscopy was considered, combined with preparation of
emergency measures such as tracheotomy before anesthesia.