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。     

扩张皮瓣联合自体肋软骨移植法与改良Brent法全耳再造术对矫正先天性小耳畸形效果比较

目的　对比分析扩张技术联合自体肋软骨移植法与改良Brent法全耳再造术治疗先天性小耳畸形的临床效果。方法　我院2013年1月～2018年1月收治先天性小耳畸形患者94例，手术方式分为扩张法组61例（64耳）和改良Brent法组33例（37耳），对比分析两组患者术后并发症、术后12个月时临床疗效和满意度情况。结果　术后扩张法组 血肿发生率显著高于改良Brent法组（χ2=4.050，P＜0.05）。两组临床疗效比较，扩张法组临床疗效显著低于改良Brent法组，两组比较差异有统计学意义（χ2=5.290，P＜0.05）。两组患者满意度调查比较，扩张法组满意度显著低于改良Brent法组，两组比较差异有统计学意义（χ2=8.060，P＜0.05）。结论　改良Brent法全耳再造术矫正先天性小耳畸形临床效果显著，并发症发生率低，手术易于操作，是治疗先天性小耳畸形较为理想的手术方式。     

耳科学

228 硅胶耳廓在全耳再造中的应用林如衡郭秀英中华耳鼻咽喉科杂志18(3):185,1983 应用硅胶耳廓作为支架代替软骨对先天性小耳畸形和后天性耳廓缺损的患者行全耳再造术,观察达一年以上者7例。其中成功5例。     

局部软骨皮瓣转移修复先天耳廓畸形1例

患儿男,１０岁。右耳先天性耳廓呈杯状小耳畸形,于１９９９年９月求治入我院。患儿全身情况良好。专科检查：右耳廓短小严重畸形,耳轮紧缩,耳轮脚下移,耳轮软骨向下卷曲呈杯状,对耳论的上下脚缺如;耳廓上方有一条状软骨突起紧贴颞侧;耳屏处有副耳赘生。双外耳道及鼓膜未见异常,纯音测听双耳听力正常;乳突Ｘ线片双乳突气化型。诊断;单纯右耳廓先天畸形。右耳廓成形术方法：手术在基础麻醉加局部麻醉下进行,依右耳先天畸形条件,决定先以卷曲的耳轮脚为轴作“Ｚ”字改形转移,将耳轮脚分离提高,用升高之皮瓣连接并包裹高出的异位…     

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。     

136例先天性耳前瘘管手术疗效比较

先天性耳前瘘管是一种常见的先天性畸形,是第一、二鳃弓的耳廓原基在发育过程中融合不全,为常染色体显性遗传。瘘口常位于耳轮脚前,少数开口于耳屏问切迹至口角的连线上,或耳廓、耳垂的其他部位。     

第8肋软骨发育不良的儿童小耳畸形肋软骨支架雕刻临床研究

目的探索第8肋软骨发育不良的儿童小耳畸形肋软骨支架雕刻。方法小耳畸形患者常规进行术前胸部CT扫描和三维重建,选择第8肋软骨发育不良的患者,针对传统的肋软骨支架雕刻方法进行改进,应用全扩张皮瓣法行耳廓再造术。结果2016年1月~2017年12月,收治11例小耳畸形患者为第8肋软骨短小,采用第7肋软骨进行耳轮构建,完成耳廓再造术。其中男性患者7例,女性患者4例;左侧8例,右侧3例。再造耳廓耳轮形态逼真、立体感强,经1年观察支架稳定,无变形和吸收,远期随访仍在观察。结论应用第7肋软骨进行耳轮构建行全扩张法耳廓再造术,操作简单、并发症较少,形态IU Liu,LI Huizheng,CHENG Xingjian,YANG Lei(Department of Plastic Surgery,Third Hospital of Hebei Medical University,Shi Jiazhuang,Hebei逼真。     

“全扩张法”耳廓再造术的临床应用及适应症的探讨

目的分析与总结"全扩张法"耳廓再造术治疗先天性小耳畸形的临床经验,并探讨该方法的适应症。方法自2014年7月至2016年6月,根据患者年龄、耳后乳突区皮肤厚度及松紧度差异,选择年龄大于8岁、耳后皮肤松弛的患者共220例采用"全扩张法"耳郭再造术。手术分三期完成,一期耳后扩张器置入术,二期全耳再造术,三期再造耳修整术。结果 220例患者术后平均随访9个月,196例(89.0%)患者及家属对再造耳廓形态满意,21例(9.5%)认为再造耳廓可以接受,3例(1.4%)对再造耳形态不满意。216例(98.2%)患者胸部瘢痕均未超过4cm,最短只有1.5cm,未出现明显的胸廓畸形;扩张期相关并发症发生率3.2%,再造耳并发症发生率5.0%。结论"全扩张法"耳廓再造术是治疗先天性小耳畸形的理想术式之一。患者年龄大于8岁、耳后乳突区皮肤松弛,是"全扩张法"耳廓再造术治疗先天性小耳畸形的适应症。     

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。     

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   

Congenital periauricular fistulas: Possible variants of the preauricular sinus

ObjectiveAlthough most preauricular sinuses are located near the anterior limb of the ascending helix, some are located in unusual areas around the auricle, as shown previously in limited reports. This study analyzed the clinical manifestations of congenital periauricular fistulas with unusual fistula locations and the possible relationship with the classical preauricular sinus.MethodsWe reviewed the medical records of patients who underwent congenital periauricular sinus excision by three surgeons and followed them for more than 6 months. Clinical manifestations were compared between classical preauricular sinus (classical group) and congenital periauricular fistula (variant group) patients.ResultsThe classical and variant groups included 192 and 20 ears each, respectively. In the variant group, the fistula locations were in the ascending helix crus (15 ears, most common), infra-auricular area (3 ears), supra-auricular area (1 ear), and anterior to tragus (1 ear). In ears with fistulas in the ascending helix crus, the fistulous tract most often showed a medial direction (9 ears). There were 4 ears in the variant group with fistulous tracts running toward the postauricular area.ConclusionsCongenital periauricular fistulas can be located anywhere around the auricle, and also considered the variant of preauricular sinus because the whole tracts were limited to lateral side of temporalis muscle and parotid gland as well as not associated with external auditory canal and facial nerve. Among them, the most common variant was a fistula on the ascending helix crus with short fistulous tract directed medially.     

Aesthetic surgery for microtia

We describe here a technique for reconstruction of the external ear based upon an autogenous costal cartilage graft which is inserted into a cutaneous pocket dissected in the auricular area. Three subsequent procedures are then performed: rotation of the ear-lobe; reconstruction of the tragus; and elevation of the auricle. The ideal age for reconstruction is about 7 years. This technique was originally described by Brent, who has a very extensive experience with this kind of surgery. Skin deficiencies can be overcome by using either a temporo-parietal fascial flap or a skin expander.     

Anthropometric growth study of normal human auricle

OBJECTIVE: The aim of this study was to reveal the anthropometric growth of auricula from birth to the age of 18 years and to bring out the dynamics of ear growth. MATERIAL AND METHODS: A total of 1552 children in 50 groups were evaluated. Six surface measurements were performed directly on the right auricle of the subjects: the length from the superaurale to subaurale, the width from the tragus to helix, the width from the tragus to antihelix, the conchal depth, the height from the helix to mastoid at superauraler level, and the height from the helix to mastoid at tragal level. The frequency of prominent ear deformity and the degree of attachment of the lobule were also noted. RESULTS: Vertical auricular growth was complete in girls at the age of 11 and in boys at the age of 12, whereas the auricular width from the tragus to helix, the height from the helix to mastoid at superauraler level and the height from the helix to mastoid at tragal level were found almost complete at the age of 6. The auricular width from the tragus to antihelix attained its full size at 6 months for girls and 12 months for boys. The conchal depth was found almost complete at the age of 5 in both sexes. The incidence of prominent ear deformity and attached lobule was 9.8 and 26.5%, respectively. CONCLUSIONS: Different ear growth pattern and maturation size from previously published reports are obtained in different populations. There is still need for future studies comparing populations with different social and ethnic background to interpret common knowledge about the size of the ear. This study gives dimensional information and the growth pattern of the auricle, and therefore may reveal important implications for the adequate timing of the surgical treatment of auricular deformity.     

Aesthetic surgery for microtia

Summary We describe here a technique for reconstruction of the external ear based upon an autogenous costal cartilage graft which is inserted into a cutaneous pocket dissected in the auricular area. Three subsequent procedures are then performed: rotation of the ear-lobe; reconstruction of the tragus; and elevation of the auricle. The ideal age for reconstruction is about 7 years. This technique was originally described by Brent, who has a very extensive experience with this kind of surgery. Skin deficiencies can be overcome by using either a temporo-parietal fascial flap or a skin expander.Presented at the First European Congress of Oto-Rhino-Laryngology and Cervico-Facial Surgery, Paris, 26–29 September 1988     

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.     

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.     

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.