الفهرس 
INTRODUCTION
Imaging of cholesteatomaOnly 14 pages are availabe for public view
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Abstract
The primary goal of management of middle ear cholesteatoma is to eradicate the disease and make the ear safe and dry. Sheehy has articulated the notion that “the key to success in otologic surgery is not whose technique or what technique one uses but how well one uses it”. The second objective in the surgery of cholesteatoma is to restore hearing to serviceable levels by means of tympanoplasty. Besides that, the surgery aims single or minimum number of operations, minimal recurrence rate, an easily cleaned cavity and in general a good quality of life.
Until now there is neither standardized classification for middle ear cholesteatoma nor standardized nomenclature for its surgical management. There is still debate regarding the choice of the appropriate surgical technique whether ICW or CWD techniques, and regarding the trials of modification of both techniques to get maximal surgical and functional success in addition to minimal rate of cholesteatoma recidivism.
Cholesteatoma is diagnosed mainly otoscopically. However, radiological investigations for middle ear cholesteatoma have gained an increasing role in preoperative diagnosis and can effectively help in choosing the type of surgery, in addition to a great value to rule out 2nd look operations. This study showed excellent correlation between HRCT and intraoperative findings.
Atticotympanic cholesteatoma extending to mastoid antrum is the most common clinical presentation of middle ear cholesteatoma. It can be managed effectively with endoscopic assisted Tos modified ICW tympanomastoidectomy with attic reconstruction. Attic reconstruction is essential step to prevent recurrence of cholesteatoma. It can be done using Conchal cartilage, CB or recently bone cement.
Otoendoscopic assisted surgery is of great value in cholesteatoma surgery. It helps improved visualization of middle ear hidden areas as sinus tympani and ensures removal of residual cholesteatoma. And cholesteatoma surgery should further depend on it.
Ossiculoplasty can be done successfully during the same cholesteatoma surgery. Autograft incus or cortical bone can be effectively used. MRL technique has a great value not only in ossiculoplasty but also in prevention of residual and recurrent cholesteatoma.
The concept of FMMS comprises standardization of the nomenclature regarding middle ear cholesteatoma and its management. It is based on single stage management of middle ear cholesteatoma by graded surgical procedures that target the cholesteatoma in the middle ear according to preoperative TMC staging using HRCT, assisted with otoendoscopy and ossiculoplasty done in the same surgery.
FMMS is effective full management strategy for middle ear cholesteatoma with good functional results (healing and hearing) and low rate of cholesteatoma recidivism.