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。     

人造耳支架植入在先天性小耳畸形中的应用——18年临床经验总结

目的 观察并探讨高分子聚乙烯人造耳支架植入行全耳廓再造术的临床效果与经验。方法 收集2003年5月—2021年6月诊治的小耳畸形患者1 057例(1 063耳),分别对其手术方式、手术成功率、耳廓的对称度、耳廓精细结构显示、患者的满意度、并发症发生情况及听力恢复情况进行评估。结果 术后随访6个月至16年。1 063耳手术均成功,耳廓形态随着时间的延长而逐渐显露。对耳廓的7个对称度指标进行评分,均在5分以上;对耳廓的14个精细结构进行评分,945耳(88.90%)≥10分。患者的总满意率为92.00%(978/1 063耳)。同期行听力重建的患者术后得到不同程度的听力改善。结论 先天性小耳畸形高密度聚乙烯人造耳支架植入全耳廓再造术在临床上安全可行,可以作为耳再造的方法之一;并可以同期行听力重建术,在再造耳廓的同时取得较好的听力康复效果,也可以使再造耳廓在形态上更加逼真,提高患者的满意率。     

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。     

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.     

先天性小耳畸形全耳廓成形及听力重建术

目的:探讨先天性小耳畸形的临床特点及全耳廓成形及听力重建术的方法和效果。方法:统计、整理2005-01-2010-10期间在我科住院治疗的58例(62耳)小耳畸形患者的资料,本组患者均为先天性耳廓畸形伴外耳道闭锁、听骨链畸形、重度传导性聋。所有患者术前行颞骨CT检查并三维重建,听力学检查。手术分2期进行,一期行耳廓一次成形,外耳道重建,中耳重建手术;二期行耳后植皮,颅耳角再造,对术前、术后的资料进行回顾性分析。结果:耳廓成形加外耳道、中耳重建术后再造耳廓外形良好,耳廓和外耳道口位置接近正常,大部分患者术后听力获得改善。结论:对先天性耳廓畸形并外耳道闭锁的患者,术前应精心设计,根据多层螺旋CT三维重建结果确定听力重建入路及中耳畸形程度,全耳廓成形及听力重建术后可以同时改善耳廓外形和提高听力。     

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。     

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。     

耳科学

971990全耳廓再造术与听力重建术同步进行/冷同嘉//中华整形烧伤外科杂志一1997,13(1)一5~8 为使先天性小耳畸形外耳道骨性闭锁患者同步取得增进听力并改善耳廓外形一举两得的双重效果.巧8例(16。耳)同步完成听力重建及耳廓再造术。结果:听力增进率(20一45dB)132例(133耳)占83.1%。全耳廓再造成活率155例(157耳)占98.2%,耳廓外形优良(解剖轮廓清楚) 137耳(85.6%)。认为在严格选择病例的情况下可获增进听力及良好外耳形态的效果。图2参9(蓝锋),71,91先天性耳廓畸形耳廓再造术40例小结/周其友…//临床耳鼻咽喉科杂志一1 997.11(4)一176~177,7…     

Medpor与膨体聚四氟乙烯在耳廓和外耳道一期重建术中的应用

目的：探索先天性小耳并外耳道闭锁行耳廓和中耳一期成形术的效果。方法：对6例（耳）采用Medpor聚乙烯材料作为对耳轮支架，膨体聚四氟乙烯（PTFE）作为耳轮支架，一期进行耳廓，外耳道，中耳成形。结果：术后随访8-23个月，听力平均提高28dB，耳廓外观满意，无再狭窄或闭锁。结论：Medpor作为对耳轮支架，PTFE作为耳轮支架，一期进行耳廓，外耳道，中耳成形，可以达到满意的术后效果。     

MEDPOR在肋软骨已钙化患者耳廓再造术中的应用

目的探讨对于肋软骨已发生钙化的先天性小耳或后天性耳缺损患者,以MEDPOR作为再造耳廓支架的可行性。方法手术分为2期,1期是在残耳后埋置皮肤软组织扩张器,扩张皮瓣或瘢痕瓣。2期是以扩张皮瓣、耳后乳突区皮下筋膜瓣、残耳、MEDPOR支架、中厚皮片移植行耳廓再造术。自2009年1月---2014年1月,以此种方法行耳廓再造术34例,男性23例,女性11例,年龄32岁-61岁,均为单侧耳廓再造。结果 34例耳均顺利完成二期耳廓再造手术。术后随访时间,最短2年,最长5年7个月,形态令人满意,支架无外露发生。结论对于肋软骨已发生钙化的先天性小耳或后天性耳缺损患者,MEDPOR支架是较为适合的再造耳廓支架材料。     

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   

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.     

耳软骨在中耳手术中的应用

目的 探讨软骨在中耳手术中的应用,以拓展手术范围,改善手术疗效。方法 (1)用自体软骨进行鼓膜修补;(2)在乳突根治术后应用软骨重建外耳道后壁;(3)治疗粘连性中耳炎。结果 (1)软骨组的鼓膜愈合率为93.4％,颞肌筋膜组为80％。两组的听力结果无显著性差异。(2)应用软骨重建外耳道后壁的43耳中有40耳一期愈合(93％),干耳时间平均为4.19+1.00周。对照组干耳时间平均为5.54+1.83周。二者有显著性差异。(3)41耳粘连性中耳炎术后平均骨气导差为27.9+10.7dB。共有18耳(43.9％)术后骨气导差<20dB。有26耳术后提高>15dB。术后24耳(56％)的鼓室接近正常。结论 (1)软骨是修补鼓膜穿孔的一种好材料。(2)应用软骨同时修补鼓膜并重建外耳道后壁,不仅能够缩短干耳时间,改善听力,而且免除了二次手术,明显改善了病人的生活质量。(3)应用软骨治疗粘连性中耳炎疗效有所提高,但要严格选择手术适应症。     

Navigation-assisted construction of an external ear canal using an autogenous foreskin graft

Classic microtia is combined with external ear canal atresia and middle ear malformation. In order to evaluate whether an operation to improve hearing ability and the use of computer-assisted surgery are indicated, preoperative high-resolution navigation CT is mandatory. We combined atresia surgery and tympanoplasty with auricular reconstruction in the case of an 8-year-old boy with bilateral microtia, aural atresia and malformation of the middle ear. After creating an auricle framework with rib cartilage and transplanting it under the skin of the mastoid plane, we shifted it forward in the second step, and the new auditory canal was drilled under computer-assisted navigation and facial nerve monitoring. In the same operation, tympanoplasty was accomplished, and a silastic cylinder, wrapped into pieces of rib cartilage, was inserted into the constructed canal and removed 2 months later. For lining the new auditory canal, we used the patient's prepuce, harvested by elective circumcision.     

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.     

耳廓软骨在修补鼓膜和重建外耳道后壁中的应用

目的：探讨应用耳廓软骨修补鼓膜并同时进行外耳道后壁重建的疗效。方法：对43耳慢性化脓性中耳炎患者，于彻底清除病灶后用耳廓软骨行鼓膜修补，同时进行外耳道后壁重建。结果 ：43耳中，3耳失败，40耳一期愈合。与同期未进行外耳道后壁重建，只进行鼓室成形的病例相比，外耳道后壁重建者的干耳的时间比未重建者短；复发率差异无显著性意义。两组术后均有较好的听力。结论：应用耳廓软骨同时修补鼓膜并重建外耳道后壁，是一种较好的治疗慢性化脓性中耳炎的方法，不公能缩短时间，改善听力，而且免除了二次手术，明显改善了患者的生活质量。