耳郭假性囊肿的手术治疗

目的 评估耳郭假性囊肿手术治疗的临床价值。方法 选择合适的患者30例进行治疗。沿对耳轮作皮肤切口,充分暴露囊肿腹侧的软骨膜及其附着的薄层软骨,然后予以切除,并清除囊肿背侧软骨表面可能存在的纤维束或肉芽组织。以常规方式缝合切口后,再作贯穿耳郭的双侧钮扣缝合固定。结果 所有病例均一期愈合,无并发症发生,随访未见复发。 结论 对耳郭假性囊肿,建议采取手术治疗,但须严格按照无菌操作要求,并防止术后继发感染。     

囊肿前壁软骨切除加缝线包扎治疗耳郭假性囊肿57例

目的 探讨囊肿前壁软骨切除加缝线包扎治疗耳郭假性囊肿的临床疗效。方法 耳郭假性囊肿57例(60耳)采用囊肿前壁软骨切除加缝线包扎治疗,术中彻底切除囊肿前壁的软骨和软骨膜、缝线包扎48～72 h,切口不缝合,观察临床疗效。结果 痊愈85%(51/60),显效11.67%(7/60),无效3.33%(2/60),总有效率96.67%(58/60)。除无效2例外,其余病例随访0.5～2年无复发。结论 囊肿前壁软骨切除加缝线包扎治疗耳郭假性囊肿,手术和加压包扎方法得到改良,病程缩短,耳郭假性囊肿的治愈率提高,临床疗效可靠,适用于各种类型的耳郭假性囊肿。     

改良前囊壁切除联合对穿缝合法治疗耳郭假性囊肿32例

目的 探讨前囊壁软骨切除术联合对穿缝合治疗耳郭假性囊肿的疗效及体会。 方法 回顾性分析62例耳郭假性囊肿患者,随机分为治疗组(32例)和对照组(30例),治疗组接受耳郭假性囊肿前囊壁切除联合对穿缝合法,对照组接受耳郭假性囊肿穿刺抽液并加压包扎法,比较两组患者的临床疗效。 结果 治疗组患者总有效率为93.8%,对照组总有效率为76.7%,治疗组疗效优于对照组,组间差异有统计学意义(P<0.05)。治疗组患者治疗后总并发症发生率为15.6%,对照组治疗后总并发症发生率为50.0%,组间差异有统计学意义(P<0.05)。治疗组患者术后整体满意率为87.5%,对照组患者术后整体满意率为66.6%,组间差异有统计学意义(P<0.05)。 结论 改良前囊壁软骨切除联合对穿缝合法治疗耳郭假性囊肿效果确切,疗效优于传统切开引流、穿刺抽液、 加压包扎、冷冻、 注射硬化剂等,临床值得推广。     

囊壁部分切除法治疗复发性耳郭假囊肿16例

耳郭假囊肿是耳郭软骨内积液表现为耳郭囊性肿胀隆起的非化脓性炎性疾病,其确切病因不清.单纯抽吸积液容易复发,临床治疗方法虽多,但繁简不一,疗效差异较大,并无公认的治疗方法.2008年3月～2010年12月,我科采用局麻下囊壁部分切除法治疗复发性耳郭假囊肿16例,疗效满意,报道如下.     

先天性外中耳畸形(13)——人工材料全耳郭再造研究进展

先天性外中耳畸形是头面部最常见的出生缺陷,包括耳郭形态畸形和结构畸形。结构畸形主要表现为耳郭畸形、外耳道闭锁或狭窄、中耳畸形等,是引起听力缺陷和容貌损害的五官严重畸形,治疗需要耳郭结构再造的同时融合听觉功能重建。目前耳部再造方法主要有自体肋软骨支架技术、人工材料支架技术及组织工程软骨支架技术等。耳郭支架材料首选自体肋软骨,但是当患者肋软骨量不足、肋软骨骨化明显、耳周皮肤条件差、自体肋软骨耳郭再造失败时,人工材料仍是重要的补充选择[1]。经过数十年的发展,人工材料全耳郭再造技术已趋于成熟,本文简述人工材料全耳郭再造的历史及研究进展。     

旋转皮瓣在耳郭断离伤中的应用

目的 探讨耳郭中上部不全或完全断离伤的修复方法。方法 11例中不全断离伤10例,将断耳与残耳相连侧的皮肤尽量保留并对位缝合,去掉断耳对侧皮肤,取邻近皮瓣修复断耳皮肤缺损。1例咬伤致耳郭上部“U”形缺损,断耳丢失,去掉缺损前方耳郭前、后面皮肤,取耳轮脚至耳屏软骨前方皮瓣连同耳屏软骨修复前方缺损,耳后乳突区旋转皮瓣修复缺损后方耳郭皮肤缺损。结果 随访6个月～8年,11例患者断耳全部成活,外形满意,耳郭无明显畸形。结论 对耳郭中上部较小的断离伤,如为不全断离伤,可将断耳与残耳相连侧的皮肤尽量保留并对位缝合,去掉断耳对侧皮肤,取邻近皮瓣修复断耳皮肤缺损。略小于耳屏的耳郭中上部全层缺损,可取带有耳屏软骨的耳前复合组织瓣和耳后旋转皮瓣修复。     

对孔穿刺引流冲洗加压包扎术治疗耳郭假性囊肿60例

耳郭假性囊肿是指耳郭软骨夹层内的非化脓性浆液性囊肿,是软骨膜的无菌性炎性反应,好发于一侧耳郭的外侧面上半部,内含浆液性渗出液,形成囊样隆起[1].患者中男性多于女性数十倍,好发于20～50岁成年人.传统治疗方法主要有穿刺抽液注药、导管置入引流、磁疗、手术等方法,操作繁琐且复发率高,容易感染[2].我们采用对孔穿刺引流冲洗加压包扎术治疗耳郭假性囊肿60例,治愈率明显提高,复发率减少,报告如下.     

耳郭化脓性软骨膜炎的治疗体会

耳郭化脓性软骨膜炎病情进展较快,耳痛剧烈并可致软骨坏死及耳郭畸形.自1993年始我们收治了耳郭化脓性软骨膜炎30例,疗效满意,报告如下.     

鼻腔鼻窦骨化纤维瘤9例

目的：探讨提高鼻腔鼻窦骨化纤维瘤诊治水平的途径。方法：回顾性分析9例鼻腔鼻窦骨化纤维瘤患者的临床资料。根据病变范围不同，其中3例选择上颌窦进路，将鼻腔上颌窦肿块完整切除；6例在全身麻醉下行颈侧切开术。结果：2例因手术切除不彻底，分别于术后8个月和9个月复发而再次手术，其余7例随访2～10年无复发，无并发症发生。结论：鼻腔鼻窦骨化纤维瘤是一种以青少年发病为主，具有局部侵袭性的良性肿瘤，临床症状、特别是CT扫描是临床诊断的基础，彻底切除肿瘤是惟一有效的治疗方法。     

乳突部骨化纤维瘤诊治体会

目的通过对罕见案例分析和文献复习,探讨乳突部骨化纤维瘤的临床表现、诊断及治疗,提高对该病的认识,减少临床漏诊误诊。方法分析2020年8月24日就诊的1例乳突部骨化纤维瘤的女性患者,完善术前临床及影像学检查后,在全麻下行乳突部肿瘤切除术,术后随访12个月。结果术后病理诊断为骨化性纤维瘤。患者术后恢复可,无呕吐、眩晕及面瘫。术后随访12个月,患者未再诉头痛及耳鸣等不适,无复发。结论发生在乳突部的骨化纤维瘤临床上十分罕见,早期无明显临床表现,易被漏诊。目前认为影像学与组织病理学分析是确诊及分类的主要依据,手术切除是患者出现临床症状后的首选的治疗方法,而具体的治疗方式应根据肿块的大小、侵袭程度、周围结构受累情况、临床表现以及患者的预后、耐受程度来灵活选择。     

The histology of autologous auricular cartilage implanted into the nasal septum

This study attempts to evaluate the use of auricular cartilage for the treatment of nasal septal defects. A defect was made in the nasal septal cartilage in five rabbits and auricular cartilage grafted into the defect. The cartilage was microscopically examined 4 weeks later. The implanted cartilage was completely covered by ciliated columnar epithelium with minimal scar formation. Proliferation of the implanted cartilage and scattered ossification were observed. Seventeen patients with a nasal septal defect were treated by auricular cartilage implantation from April 1987 to through June 1992. Fiften patients (88%) had relief of symptoms and showed complete closure of the defect with a follow-up period of 2 years. The results of this study suggest that auricular cartilage may be of value in the repair of a nasal septal defect.     

An animal study on cartilage healing using auricular cartilage as a model

We investigated the effect of different surgical procedures on cartilage healing, using auricular cartilage as a model, which would be useful to create a rationale for septal cartilage surgery. Different kinds of manipulations were performed on the auricular cartilage of six female New Zealand white rabbits. Histopathological investigations were performed under light microscopy 4 months postoperatively. The autologous cartilage grafts survived well under the forehead skin regardless of the presence of the perichondrium. The response of perichondrium to either incomplete or complete trauma was not only new cartilage formation but also ossification. When incomplete incisions were made on the non-perichondrial side, new cartilage formation was stimulated whereas ossification was induced when there was perichondrium on the cartilage. If the cartilage with perichondrium was sliced into small pieces and planted back in its original place, many ossification areas occurred. The crushed cartilage was usually absorbed but sometimes replaced by bony plates. The traumatized cartilage with perichondrium undergoes ossification. This finding may be important clinically in that surgeons should not traumatize septal cartilage with perichondrium and work under the perichondrium. This ossification of traumatized cartilage may later result in thickening of the septal cartilage which we sometimes face in revision surgery.     

A case of relapsing polychondritis with respiratory symptom manifestation alone

Relapsing polychondritis, a comparatively rare condition systemically affecting organs containing collagen, such as cartilage tissue, is diagnosed based on clinical manifestations and pathological findings. Our case report involves a respiratory symptom alone. A 65-year-old man seen for fever and dyspnea was found in computed tomography and endoscopy to have subglottic and tracheal stenosis, necessitating tracheostomy and tracheal cartilage biopsy. Pathologically bony cartilage change was seen but no definite auricular inflammation findings. Additional auricular cartilage biopsy, showed no inflammation. Residual auricular cartilage scarring, however, indicated cartilage destruction by previous inflammation or trauma, yielding a final diagnosis of relapsing polychondritis. Steroid therapy quickly relieved symptoms. Auricular cartilage biopsy thus proved useful in definitively diagnosing this condition.     

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。     

Petrified auricular cartilages pointing the diagnosis of post-partum hypopituitarism in an encephalopathic patient

True ossification of ear auricles is exceptional. We present the first case linking this finding to post-partum hypopituitarism. A 57-year-old female presented with a 2-day history of fever, headache and behavioural disturbances. Brain magnetic resonance imaging was normal. Since cerebral spinal fluid could not be obtained, she was treated empirically for a meningitis. A urinary tract infection was subsequently identified as the cause of fever but when she improved she remained apathetic. At this time petrified auricles were noticed; histological examination revealed true ossification. Endocrinological screening showed partial hypopituitarism and thyroid autoimmune disorder. Initial symptoms could be dated to the birth of her last child 15 years before, with breast feeding difficulties, loss of body hair, and transient amenorrhoea. The absence of overt peripartum bleeding, resumption of menses 1 year later, preservation or recovery of some hypophyseal function, and presence of an associated autoimmune thyroid disorder and of hypophyseal tissue in a normal sella turca, all suggest lymphocytic hypophysitis rather than Sheehan syndrome as the primary disorder. Of the 15 patients reported to date with auricular ossification, two had Addison disease. The present case suggests that low cortisol is the key factor in this clinical finding.     

婴儿鼻腔软骨间叶性错构瘤2例及文献复习

目的 探讨婴儿鼻腔软骨间叶性错构瘤的临床及病理特点、诊断、治疗及预后。 方法 回顾性分析2016年5月至2019年3月上海交通大学医学院附属新华医院收治的2例经病理证实为鼻腔软骨间叶性错构瘤患儿的临床及病理资料,并对该病的诊断、治疗及预后进行探讨。 结果 起源于鼻腔或颅底的鼻腔软骨间叶性错构瘤经鼻内镜术完整切除,长期随访无复发。组织学显示间叶细胞及胶原纤维围绕软骨结构,呈良性增生特性。 结论 婴儿鼻腔软骨间叶性错构瘤临床表现多样且无特异性,早期诊断困难。鼻内镜手术是治疗鼻腔软骨间叶性错构瘤的主要手段,并且具有良好的临床效果。     

Ossification of the external ear: a case report and review of the literature

A rare case of idiopathic bilateral ossification of the auricular cartilage and cartilage of the external ear canal is reported. The hardening and thickening of the external ear canals with subsequent narrowing and impaired exposure resulted in symptomatic hearing loss because of the recurrent impediment of inspissated cerumen, the removal of which finally became impossible. Surgical resection of the cartilage external ear canal and tragus was indicated to provide a more permanent treatment of conductive hearing loss. Histological examination revealed complete replacement of the fibroelastic cartilage by normal bone structures showing Haversian canals and bone marrow. The present case report is unique because of the involvement of both the auricles and external ear canals, the symptomatic hearing loss and the surgical treatment to relieve symptoms.     

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。     

The petrified auricle: comments on ossification, calcification and exostoses of the external ear

The petrified auricle is a clinical entity in which the auricle, in part or total, has become stone-hard and moves as a rigid unit. This uncommon condition is most often due to ectopic calcification of the auricular cartilage. It may occur as a result of local trauma, in association with various systemic diseases such as Addison's disease, hypopituitarism, thyroid or parathyroid disorders, or following radiation therapy. Auricular ossificans (ectopic ossification) is a rare phenomenon in which the rigidity of the petrified ear is due to replacement of the elastic cartilage by bone. In the literature there are presently nine cases documented histologically. Two more cases are reported here. In most cases, the auricular changes are preceded by acute, severe hypothermia (frostbite). Exostoses of the external auditory canal is another disease of the external ear in which the proliferation of bone follows chronic mild hypothermia of the external auditory canal caused by exposure to cold water while surfing. It is postulated that if surfers who have developed exostoses of the external auditory canal from the cold water continue to enjoy such littoral activities, ossification of the auricle may also occur.