I introduce three cases (two cases written in the abstract and another case) with the amputation of the malleus handle using a laser with and without reconstruction of the malleus handle

We select an approach for the treatment of congenital cholesteatoma depending on the location and extension of the disease.
Today we focus on a cholesteatoma seen through the anterior superior quadrant of the tympanic membrane.

This shows the amputation site of the malleus handle for each patient.

The first case is 3 year old girl with a white mass seen through the anterior half of the tympanic membrane.
Peep show audiometry showed almost normal hearing in the left ear.

A soft tissue shadow in the anterior part of the tympanic cavity.
These are 3 dimensional …show more content…
After the dislocation of the incudomalleal joint following atticotomy, we vaporized the malleus handle using a semiconductor laser, amputated the malleus handle using a malleus nipper, and checked residual behind the neck of the malleus using a mirror.

The tympanic membrane 1 and a half years after surgery．

Post-operative CT images show no residual cholesteatoma and a blue arrow shows the amputated handle.

Post-operative 3 dimensional reconstructive images also show the same findings.
Post-operative peep show audiometry shows a mild hearing loss one year after surgery.

We have reconfirmed two key factors to maintain hearing levels for the treatment of this type of cholesteatoma.
One is the presence of the malleus handle, another is the attachment of the umbo and the tip of the malleus handle to maintain the conical shape of the postoperative tympanic membrane.

The second case is a 2 year old boy with a small white mass seen through the anterior superior quadrant of the tympanic membrane.

DPOAE (distortion product otoacoustic emissions) appeared to be normal hearing in both ears.

Temporal bone CT images showed a round soft tissue shadow anterior to the