先天性小耳畸形多孔高密度聚乙烯支架I期耳廓再造术

目的　研究通过多孔高密度聚乙烯（MEDPOR）支架植入,覆盖颞顶筋膜瓣及表面植皮,I期完成全耳廓再造术,术后观察耳廓外形变化,耳廓的精细结构及双耳对称度,了解I期耳廓再造手术的临床疗效。方法　对前来就诊的先天性小耳畸形患者,术前进行外形、影像学及听力学评估,行MEDPOR支架植入,覆盖颞顶筋膜瓣及表面植皮,I期耳廓再造术,部分患者还同时或分期行听力重建术。术后2周起,定期观察患者耳廓外形恢复情况,了解手术的治疗效果。结果　临床病例102例108耳,术后随访3个月到10年,平均16个月。再造耳廓恢复良好,外形逼真,精细结构显示良好,双耳对称度佳,行听力重建手术对再造耳廓外形没有影响。结论　用该方法进行I期耳廓再造术,具有疗程短、并发症少、临床效果佳等优点。该方法切实可行,可用于临床推广应用。     

3D个性化定制人工材料耳支架在一期全耳再造术中的应用

目的 评价3D个性化定制人工材料耳支架在先天性小耳畸形一期全耳再造术中的临床效果与优势。方法 选择2021年6月—2022年3月接收并行手术治疗的先天性单侧小耳畸形患者，将其随机分为实验组(n=12)和对照组(n=12),实验组采用3D个性化定制的人工材料支架，对照组采用常规需术中拼接的成品耳支架，均行支架植入-颞浅筋膜瓣转移的一期全耳廓再造术，伴或不伴同期听力重建。记录手术耗时，术后随访观察临床效果和并发症发生率，并行耳廓对称度、精细结构评分以及家属满意度调查。结果 所有患者手术均成功，无不良事件和并发症发生。同期行听力重建者听力得到改善，术后言语识别阈平均改善38.6 dBHL,术后最大言语识别率均达到100%。经统计学分析，实验组耳廓对称度和精细结构评分实验组优于对照组(P<0.05);手术耗时实验组较对照组短(P<0.01);家属满意度调查结果中最终每项平均得分实验组高于对照组。结论 3D个性化定制耳支架植入耳再造术安全有效，可同期行听力重建，临床效果优越，可成为先天性小耳畸形耳廓再造术的更优选择。     

改良Brent法全耳再造术治疗先天性小耳畸形的临床分析

目的 探讨改良Brent法全耳再造术治疗先天性小耳畸形的临床效果及经验。方法 选取2018年11月—2021年4月湖南省儿童医院耳鼻咽喉头颈外科收治的用改良Brent法全耳再造术治疗先天性小耳畸形的患儿20例，患儿均为单侧耳畸形，年龄6.5~15岁，平均年龄8.7岁。一期手术首先处理残耳，分离耳后乳突区形成囊腔，同时行耳垂转位。取患耳对侧的肋软骨雕刻成耳廓支架，在传统雕刻的基础上，同时雕刻出耳屏，将耳屏处的基底垫高，尽可能的加深耳舟、三角窝，耳屏、耳屏间切迹的深度，在修剪耳轮时，将耳轮脚的前端尽可能垫高，尖端留置的更长，以凸显耳轮脚的深度。将耳廓支架埋置于耳后囊腔内;二期手术行"立耳"，颅耳角成形;三期手术行耳甲腔成形。结果 20例再造耳一期手术出现血肿1例，二期手术出现感染1例，支架外露1例，通过局部处理均恢复，并继续进行下一期手术。所有患儿三期手术术后随访3~9个月，再造耳双耳对称性佳，耳轮脚、耳屏处形态佳，颅耳沟加深，耳垂与耳廓下部接合处的线条流畅，再造耳总体外观满意。结论 改良Brent法全耳再造术，可更凸显耳屏、耳轮脚、三角窝及耳垂等部位的细微结构，更能呈现出再造耳的立体感，该方法可为先天性小耳畸形手术方式的选择提供参考。     

骨桥在先天性小耳畸形伴外耳道闭锁中的应用

目的探讨骨桥在先天性小耳畸形伴外耳道闭锁患儿临床应用的效果。方法对5例先天性小耳畸形伴外耳道闭锁的患儿,行高密度聚乙烯(MEDPOR)支架植入耳廓再造术的同时于乳突腔骨质表面植入骨桥的骨传导装置(BCI),术后3～4周佩戴骨桥听觉处理器,评价患儿听力及言语功能的改变。结果随访3～14个月,术后纯音测听平均听力改善29.62 dB HL,平均气骨导差为20.58 d B HL,平均言语识别阈值提高43.46 dB HL,无眩晕、耳鸣、脑脊液漏及皮瓣感染等并发症发生。结论骨桥植入对于先天性小耳畸形伴外耳道闭锁患儿听力及言语功能改善明显,该方法操作简单,手术可与耳廓再造同期进行,减少了手术周期和费用,并发症少,值得临床推广应用。     

成人小耳畸形的“三瓣法”扩张器耳廓再造术

目的探讨成人小耳畸形的扩张器法耳廓再造术的序贯治疗。方法第一期手术行皮肤定量扩张器埋置;第二期扩张皮肤形成耳前扩张皮瓣(A瓣)、耳下扩张皮瓣(B瓣),同时残耳形成残耳皮瓣(C瓣),应用第七、第八或仅第七肋软骨雕刻立体支架进行耳廓再造术,A,B和C"三瓣"从前方、下后方和下方包裹支架,使用耳后筋膜瓣从后方包裹支架,筋膜瓣后方行皮片移植治疗。结果 2010年1月至2012年6月,共应用成人"三瓣"技术实施扩张器法耳廓再造73例(78耳)。再造耳廓立体感强、表面结构清晰可见,耳后瘢痕隐藏于颅耳沟中部。结论成人"三瓣法"小耳畸形的扩张器耳廓再造术并发症较少,再造耳廓不仅形态逼真而且耳后瘢痕隐蔽,值得推广应用。     

先天性外中耳畸形的听力重建与同步耳廓再造

目的 总结同步进行外耳道、鼓室成形术与应用多孔高密度聚乙烯（MEDPOR）再造耳廓技术治疗先天性外、中耳畸形的手术经验.方法 25例（25耳）外、中耳畸形患者,采用Ⅰ期外耳道、鼓室成形术联合耳后皮下皮肤扩张器埋置术,Ⅱ期应用MEDPOR作支架进行耳廓再造.术后随访1～5年,观察疗效并总结临床经验.结果 术后1个月语频气导听力提高15dB HL以上者21耳（84%）,其中听力提高30dB HL以上、气骨导间距少于15dBHL者10耳（40%）,仍能保持听力稳定者17耳（68%） MEDPOR耳廓再造18耳一期愈合,外形良好,7耳支架外露,需要再次手术修复.结论 听力重建与MEDPOR耳廓再造同步进行可获得较满意的听力提高水平和耳廓外形.     

先天性耳畸形的手术治疗(附24例报告)

目的探讨治疗先天性耳畸形的不同手术方式及疗效，评估同期行耳廓成形及听力重建术的可行性。方法回顾性分析1985～2003年本科收治的24例(24耳)先天性耳畸形的患者，分别为单纯外耳道成形术6耳，外耳道-鼓室成形术10耳，同期行耳廓耳道成形及鼓室成形术8耳。结果行听力重建术的18耳，术后1个月纯音测听言语频率平均气骨导差缩小10～30dB；外耳道成形24耳中，5耳耳道狭窄；耳廓再造8耳均成活，近期耳轮、对耳轮出现，但远期效果较差，耳廓有不同程度的缩小变形。结论外耳道成形及听力重建术是治疗先天性耳畸形有效的手段，而同期行耳廓成形是可行的；以扩张后的薄皮瓣行耳廓成形效果较好，耳后带蒂皮瓣修复外耳道能有效防止外耳道再闭锁。     

畸形小耳的残耳组织在耳廓再造成型术中的临床应用

目的探讨畸形小耳的残耳组织在耳廓再造成型术中的作用及效果。方法对29例先天性小耳畸形患者临床资料进行回顾性分析,所有患者均接受外科耳廓再造术治疗,分析内容包括治疗方法、临床疗效等。结果29例先天性小耳畸形患者均顺利完成耳廓再造手术治疗,手术成功率100.00%,其中1例(3.45%)出现组织皮瓣坏死及血运障碍,经对症处理后痊愈出院。结论对先天性小耳畸形患者利用残耳组织实施耳廓再造手术治疗可显著提高其疗效及预后,有利于保障患者生活质量及身心健康。     

先天性小耳畸形的耳廓再造

目的探讨先天性小耳畸形的耳廓再造与重建方法。方法 2003年1月至2012年12月,采用皮肤软组织扩张法,利用健耳相片,通过计算机photoshop软件数字化翻转处理形成即要再造耳廓的相片,然后进行耳廓软骨支架的雕刻,用扩张后的患耳乳突区皮瓣覆盖雕刻的自体肋软骨耳廓支架行耳廓再造。结果 1102例(1165耳)经过6个月¹0年的随访观察。其中56例(56耳)再造耳廓有不同程度的软骨吸收、变形;2例(2耳)肋软骨支架感染、肋软骨液化、坏死;1044例(1107耳)再造耳廓与健耳匹配,凹凸结构显示清晰,形状相似、逼真,颅耳角的角度与健耳对称。结论用皮肤软组织扩张法行耳廓再造,术中应用数字化技术形成患耳相片指导自体肋软骨耳廓软骨支架的雕刻,效果满意、并发症少,是先天性小耳畸形较好的治疗方法。     

耳内镜鼓膜修补术后并发耳廓软骨膜炎2例并文献复习

目的 报道2例耳内镜鼓膜修补术后并发耳廓软骨膜炎患者的病历资料,为临床医师提供参考。方法 对2例耳内镜鼓膜修补术后并发耳廓软骨膜炎患者采用抗炎、对症等治疗,对脓肿形成者广泛切开引流,清理坏死软骨。结合文献复习阐述耳廓软骨膜炎的发病原因、临床特点及治疗方法。结果 患者1随访4个月后复查右耳廓上端稍有塌陷畸形,修补鼓膜愈合良好,患者自觉听力改善,声阻抗示A型,纯音测听示气骨导差基本消失;患者2随访2个月后见伤口局部无渗出,切口逐渐对位愈合。结论 由于耳内镜鼓膜修补技术的广泛开展,对于耳屏软骨的操作增加。临床医生需警惕术后耳廓化脓性软骨膜炎的发生。手术中严格消毒,术后做好切口观察护理。发生后应早诊断,早治疗,尽可能减少耳廓畸形的发生。     

Clinical outcomes following ear reconstruction with adjuvant 3D template model

Conclusions: The use of the 3D template model in microtia surgery leads to satisfactory results, for its contribution to the engraving and localization of the microtia auricle in auricle reconstruction.

Objectives: The aim of the study was to create an anatomical correct 3D rapid prototyping model for patients with microtia, to assist with the accurate fabrication and localization of a coastal cartilage framework for auricular reconstruction, and patients, who had undergone rib-cartilage reconstruction to treat a congenital auricular defect, were evaluated for aesthetic outcomes following ear reconstruction with a different template model.

Methods: Forty patients with unilateral congenital microtia were enrolled in this study during the last 2 years, they were divided into two groups randomly before surgery; 20 patients who had a 3D digital template made for clinical application and the other 20 who underwent ear reconstruction with a 2D template.

Results: The patients who had undergone ear reconstruction with the 3D template model had a better result of the appearance and location of the constructed auricle, and a higher level of satisfaction with their clinical outcomes (p?相似文献   

How we do it: BAHA positioning in patients with microtia requiring auricular reconstruction

• ? Bilateral microtia is a challenging problem as these patients require both reconstruction of the auricle and rehabilitation of hearing.
• ? Our aim was to find the optimal position for bone‐anchored hearing aids (BAHA) in patients requiring reconstruction of the auricle on the same side.
• ? From an analysis of five such operated patients, it was found that siting a BAHA 6.5–7.0 cm from the position of the external auditory meatus is probably the correct distance to facilitate optimal auricular reconstruction.
• ? Using these criteria, a group of another five patients with BAHA awaiting auricular reconstruction were reviewed. Of these only three (60%) have been satisfactorily sited.

     

Sound lateralization test in patients with unilateral microtia and atresia after reconstruction of the auricle and external canal and fitting of canal-type hearing aids

Conclusion: In patients with unilateral microtia and atresia after reconstruction of the auricle and external canal and fitting of a canal-type hearing aid for the operated ear, the ability to discriminate the inter-aural intensity difference (IID) was acquired in all of the patients, whereas that to discriminate inter-aural time difference (ITD) was acquired in one-half of the patients. Objective: To study the post-operative sound lateralization ability in patients with unilateral microtia and atresia after reconstruction surgery of the auricle and external canal and fitting of a canal-type hearing aid of the operated ear. Methods: Eighteen patients with unilateral microtia and atresia ranging from 13–24 years of age were recruited in this study. All of them underwent reconstruction of the auricle and external canal and were fitted a canal-type hearing aid for the operated ear. The sound lateralization test was conducted to determine IID and ITD using a self-recording apparatus. The test stimulus was a continuous narrow-band noise at 500 Hz and 50 dBHL presented to the right and left ears through the air conduction receivers. Results: IID could be measured in all of the patients, whereas ITD could be measured in only nine out of the 18 patients. Post-operative binaural hearing could be acquired in all the patients.     

Integration des aktiven Mittelohrimplantates in die plastische Ohrmuschelrekonstruktion

Background

Patients with high-grade microtia and atresia require a sophisticated annd specific treatment. Apart from the plastic reconstruction of the auricle, in some cases hearing rehabilitation is medically indicated or is desired by the patients. The long-term results of simultaneous middle ear reconstruction with tympanoplasty are often inadequate owing to a persisting air–bone gap, and new techniques in hearing rehabilitation are needed for these patients.

Methods

We present three cases of unilateral atresia to illustrate a combined approach integrating hearing rehabilitation using the active middle ear implant Vibrant Soundbridge® (VSB) into plastic auricular reconstruction. The VSB was attached to the stapes suprastructure via the titanium clip in two of these cases and in the third case a subfacial approach was used to attach it directly to the membrane of the round window.

Results

The air–bone gap was reduced to 17 dB, 14 dB and 0.25 dB HL. In free-field speech recognition tests at 65 dB SPL the patients achieved 100%, 90% and 100% recognition with the activated implant. No postoperative complications such as facial nerve paresis, vertigo or inner ear damage were found.

Conclusions

The integration of active middle ear implants in auricular reconstruction iopens up a new approach in complete hearing rehabilitation. The additional implantation of the VSB does not have any negative effect on the healing process or the cosmetic outcome of the auricular reconstruction.     

Vibrant SoundBridge combined with auricle reconstruction for bilateral congenital aural atresia

ObjectivesTo report an integrating surgical method of Vibrant SoundBridge (VSB) implant and auricle reconstruction.Methods4 cases of congenital bilateral external/middle ear malformation were enrolled. All of them were diagnosed as bilateral bony atresia and grade III microtia. Stapes vibroplasty was performed for all subjects in one operation with auricle reconstruction stage 3. The clinical information and hearing outcomes were analyzed.ResultsSatisfied aesthetic outcomes were confirmed by sculptured outline and symmetric shape on both sides. Mean improvement in hearing threshold with VSB activation was 25.9 dB HL, while mean scores of speech recognition test were 21.8–46.3%.ConclusionCombined surgical method of VSB implant and aesthetic reconstruction is safe and efficient for congenital external/middle ear malformation case.     

Satisfactory surgical option for congenital microtia with defects of external auditory meatus (EAM) and middle ear

CONCLUSIONS: Improved appearance and hearing and increased efficiency are achievable for congenital microbia with defects of external auditory meatus (EAM) and middle ear. First the site of the external auditory meatus (EAM) orifice must be located according to the results of the temporal CT scan, then the auricle can be reconstructed employing the three-stage method. At the third stage, the EAM and middle ear can be reconstructed at the same time. OBJECTIVE: To select the best approach for reconstruction of congenital microtia with defects of the EAM and middle ear. PATIENTS AND METHODS: This study analyzed 498 cases (528 ears) of auricle reconstruction by the three-stage method and 77 cases (91 ears operation/120 ears) of EAM and middle ear reconstruction. RESULTS: For auricular reconstructions, the effects of reconstructed auricles were classified into four grades according to their structure verisimilitude and the bilateral symmetry. The majority of patients/families were satisfied. For 52 ears with normal movement of stapes, reconstructions of EAM and middle ear improved hearing by 15-50 dB, but long-term improvement was not ideal. In bilateral patients, 20 of 24 ears with reconstructed EAMs exhibited relapse of stenosis or atresia. For patients whose EAMs were reconstructed first, scar developed around the orifice and affected the skin flap and later auricle reconstruction, while reconstructing the auricle first sometimes resulted in the location of the EAM orifice deviating from an ideal position.     

Sound lateralization ability of patients with bilateral microtia and atresia after bilateral reconstruction of auricles and external auditory canals and fitting of new canal-type hearing aids to replace a bone conduction hearing aid

Abstract

Conclusion: Each of eight patients with bilateral microtia and atresia underwent bilateral reconstruction of the auricles and external auditory canals and were fitted bilateral canal-type hearing aids in the operated ears to replace a bone conduction hearing aid. The ability to discriminate inter-aural intensity difference (IID) and even inter-aural time difference (ITD) was retained in all these patients.

Objective: This study studied the post-operative sound lateralization ability of patients with bilateral microtia and atresia after total reconstruction of both auricles and external auditory canals, followed by fitting of bilateral canal-type hearing aids.

Methods: Eight patients with bilateral microtia and atresia ranging in age from 13–43 years were recruited in this study. Each of them underwent bilateral reconstruction of the auricles and external auditory canals and were fitted canal-type hearing aids in both the operated ears to replace a bone conduction hearing aid. A sound lateralization test was conducted to determine IID and ITD discrimination ability thresholds.

Results: In all the patients, the IID discrimination ability thresholds of the patients were more than 3-fold those of the controls, the ITD discrimination ability threshold was more than 5-fold those of controls, and binaural hearing was retained.     

Advances in the treatment of microtia

PURPOSE OF REVIEW: Creating the fine details of the ear in a patient with a congenital absent ear is extremely challenging. Each component of the multidisciplinary team that manages the ear reconstruction, hearing restoration, and associated craniofacial anomalies of these patients has seen recent progress. RECENT FINDINGS: Population studies have provided new insights into the etiology of microtia. Novel techniques for costal cartilage harvest, implantation, and positioning add to the techniques of Brent and Nagata, which remain the gold standard for microtia repair. Advances in the use of alloplasts and tissue-engineered cartilage appear promising. SUMMARY: Technical advances in combined aural atresia/microtia reconstruction, bone-anchored prosthetics, bone-anchored hearing aides, and use of alloplastic implants provide numerous options to patients and practitioners. Implantable, tissue-engineered auricular frameworks appear to be a promising option for the future.