先天性外耳道闭锁听骨链的虚拟耳镜观察

目的：探讨虚拟耳镜对先天性外耳道闭锁听骨链畸形术前评估的作用。方法：23例（28耳）先天性外耳道闭锁、中耳畸形患者,经高分辨率螺旋CT轴位、冠状位颞骨扫描,应用仿真内镜软件行图像三维重建。术前虚拟耳镜结果与手术探查结果进行对比分析。结果：28耳外耳道闭锁、中耳畸形,虚拟耳镜提示25耳听小骨发育不全,3耳狭小鼓室未见听骨。24耳行手术治疗,术中发现锤、砧骨发育不全19耳,镫骨畸形11耳,镫骨缺失3耳,前庭窗闭锁1耳。术前虚拟耳镜观察与术中探查符合率为100％。结论：虚拟耳镜为先天性外耳道闭锁听骨链畸形的术前评估提供了可靠的影像学信息。     

儿童先天性外中耳畸形的高分辨率CT及MPR重建的影像学分析

目的 分析先天性外中耳畸形患儿的颞骨影像学表现.方法 回顾性分析2007年11月-2009年12月在上海交通大学医学院附属新华医院和上海儿童医学中心耳鼻咽喉科因听力障碍(15例)、外耳畸形(55例)而就诊的70例儿童颞骨高分辨率CT和冠状面多平面重建(multiplanar reformation,MPR)结果.结果 CT检查揭示70例患儿共有82畸形耳,分三种情况.(1)64例73耳外耳畸形:其中51例57耳合并中耳畸形,7例10耳存在外、中、内耳畸形,6例6耳仅有外耳畸形.(2)4例6耳中耳畸形同时合并内耳畸形;(3)2例3耳仅存在单纯中耳畸形.所发现的外耳道畸形包括狭窄、膜性闭锁、骨性闭锁;中耳畸形包括乳突气化异常,中耳腔、听小骨及其关节、卵圆窗畸形,另外还发现面神经畸形、脑脊液耳漏及先天性脑膜脑膨出.本组外耳道膜性闭锁的患儿合并中、内耳畸形较多,差异有统计学意义.结论 本组外耳道膜性闭锁的患儿合并中、内耳畸形较多.高分辨率CT检查及MPR重建对外、中耳畸形诊断和分类,对于制定临床干预策略、选择治疗方式提供了重要依据.     

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。     

颞骨高分辨率CT在55例中耳疾病中的临床应用

目的探讨颞骨高分辨率CT在慢性化脓性中耳炎、中耳畸形及颞骨骨折中的应用价值。方法采集层厚0.5 mm,螺距15,轴状位薄层扫描,骨算法,FOV 9.6 cm、间隔1 mm重建。对44例(耳)慢性化脓性中耳炎,9例(耳)中耳畸形病人进行骨最大密度投影(MIP)及听小骨三维重建(SSD)成像,对2例颞骨骨折致面瘫病人行颞骨矢状斜位成像显示面神经。分别将55例病人的CT图像术中所见对比,分析颞骨、外耳道、中耳(鼓室、鼓窦、乳突、听小骨、面神经、天盖、盾板等)、内耳(骨半规管、耳蜗及前庭)的特征及存在的解剖变异。结果高分辨率CT清晰地显示了耳部微小病灶,明确了病变范围与周围结构的关系,听小骨的SSD对锤骨、砧骨、镫骨、锤砧关节、砧镫关节的显示有着极高的逼真性,颞骨矢状斜位极好地显示了面神经的破坏部位,为临床制定手术方案提供了有力的影像学依据。结论颞骨高分辨率CT对中耳炎症、畸形、颞骨骨折致面瘫的诊断和手术方案的制定有重要的临床价值。颞骨高分辨率CT可列为中耳疾病的常规检查项目。     

先天性前庭窗及相关结构畸形的影像诊断及个性化手术

目的分析讨论先天性前庭窗缺如或闭锁的影像学诊断技术及个性化手术方法。方法采用高分辨率CT(High resolution CT,HRCT)、后期多平面重组(Multi-plane reformation,MPR)技术对2010.7-2014.8临床上表现为自幼传导性耳聋、外耳道鼓膜正常、鼓室压图为"A"型曲线、盖莱试验阴性的患者进行筛选诊断,并进行外科听力重建手术。结果术前HRCT及MPR影像诊断为先天性前庭窗畸形6例(耳)、先天性镫骨底板固定2例(耳),经术中探查证实为前庭窗、镫骨及面神经畸形,其中6例以TORP或Piston进行个性化听力重建。结论 HRCT冠状位及MPR可较好的显示前庭窗、镫骨及面神经的畸形,尤其是对固定的镫骨底板及前庭窗闭锁骨板的区分;对于前庭窗闭锁且被面神经完全覆盖的病例,鼓岬开窗不失为一种有效的方法,目前国内外文献尚未见此技术的报告。     

中耳胆脂瘤行乳突根治术中保留外耳道后壁完整性的意义

目的 探讨中耳胆脂瘤行乳突根治术中保留外耳道后壁完整性的临床意义及技巧.方法 2016年1月～2019年1月对140例(140耳)中耳胆脂瘤患者行乳突根治术,术中切除上鼓室盾板及开放上鼓室,清除病灶后行全人工听小骨或部分听小骨听骨链重建,耳屏软骨-软骨膜修补鼓膜,以耳屏软骨及骨片重建上鼓室外侧壁及外耳道后壁,保持外耳道...     

CT定位行外耳道闭锁手术21例

目的：探讨使用CT定位打开骨性外耳道闭锁板行外耳道成形术治疗先天性小耳并外耳道闭锁的有效性和安全性。方法：对21例(22耳)先天性小耳并外耳道闭锁进行术前高分辨率CT检查,术前在CT定位和指导下打开骨性外耳道,一期进行耳廓、外耳道、中耳成形。结果：术后随访8个月～4年,听力平均提高28dB,耳廓外观满意,无外耳道再狭窄或闭锁。结论：高分辨CT定位、指导下打开骨性外耳道安全、快捷,一期进行耳廓、外耳道、中耳成形能达到满意的手术效果。     

先天性外耳道狭窄伴外耳道或中耳乳突胆脂瘤的手术治疗

目的：探讨先天性外耳道狭窄及伴外耳畸形外耳道、中耳乳突胆脂瘤病人的手术治疗方法。方法：31例病人中为单纯先天性外耳道狭窄伴发外耳道脂瘤，进行外耳道胆脂瘤根治术，并行外耳道成形术，其中7例进行外耳道成形＋鼓室成形术；22例为先天性外耳道狭窄伴发中耳畸形和中耳乳突胆脂瘤，在根治胆脂瘤的同时，行外耳道成形术，其中13例进行鼓室成形术，随访3个月到1年。结果：7例外耳道成形＋鼓室成形术者，成功率为85．7％（6／7）；13例进行乳突根治术＋鼓室成形术者，成功率为76．9％（10／13）。凡鼓室成形术成功者听力均提高15dBHL（语言频率500－2000Hz）。结论：先天性外耳道狭窄伴发外耳道胆脂瘤或中耳胆脂瘤病人，在彻底清作胆脂瘤的基础上进行鼓室成形术，可以提高病人的听力；术中发现中耳畸形常有面神经遮盖卵中无卵圆窗者，对该类病人应在控制感染后再行前庭或半规管开窗术。     

面神经畸形的影像表现

目的 介绍面神经畸形的影像学表现.方法 (1)采用螺旋CT进行颞骨多平面重组扫描,在轴位、冠状位、面神经层面进行观察,对面神经在中耳乳突的走行进行分析.(2)术中采用面神经监护仪确认畸形的面神经.结果 术前CT扫描可以事先观测到面神经的畸形,主要表现为无面神经骨管、面神经悬挂在中耳腔、面神经覆盖卵圆窗等.结论 术前...     

HRCT常规重建与后处理对CSOM及中耳胆脂瘤诊断价值

目的探讨高分辨率CT扫描常规轴位、冠状位重建图像及图像后处理技术对慢性化脓性中耳炎及中耳胆脂瘤的诊断价值。方法对经手术病理证实并行64排螺旋CT容积扫描慢性化脓性中耳炎及中耳胆脂瘤共105例(107耳)进行回顾性分析。在常规轴位及冠状位重建图像基础上,综合运用图像后处理技术,根据主要CT表现:1、鼓室、鼓窦腔软组织密度影;2、听骨链骨质破坏情况;3、鼓室、鼓窦壁骨质破坏情况;进行术前分型,并将手术阳性结果与CT表现进行比较分析。结果慢性化脓性中耳炎59耳,其中单纯型8耳,肉芽型36耳,硬化灶肉芽型15耳;中耳胆脂瘤48耳,术前CT分型准确率为89%。对主要CT征象,常规轴位+冠状位显示率为88%,结合图像后处理技术,显示率为95%。对于所有可CT显示的术中阳性发现,均可以用多平面重组进行显示;容积再现及多平面容积再现对锤骨、砧骨破坏能较好显示,对镫骨破坏显示受到一定限制;曲面重组对面神经骨管破坏显示较满意,对听骨链骨质破坏也有一定的价值。结论 HRCT能对CSOM及中耳胆脂瘤进行较准确的术前分类、分型,常规轴位、冠状位重建图像能较全面、准确地对解剖和病变进行显示,各种图像后处理技术特别是MPR能提高CSOM及中耳胆脂瘤细微病变显示率和诊断准确率,具有很高的临床应用价值。     

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   

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.     

Own experience in 3D reconstruction of the middle ear in spiral computer tomography

Based on spiral computer tomography data three dimensional reconstruction of temporal bone have been made. Anatomical details of the middle ear on obtained images as above have been shown. Reviewed own material and literature the technical assumption and potential possibilities of the three dimensional middle ear reconstruction were presented. Emphasised that three dimensional CT is a valuable source of supplementary information on ossicular chain continuity.     

扩张皮瓣加筋膜瓣“两瓣法”在小耳畸形患者耳郭再造中的应用

目的 探讨带蒂扩张皮瓣加带蒂筋膜瓣“两瓣法”在先天性小耳畸形患者耳郭再造中的应用及效果。 方法 总结2012年1月至2018年1月期间712例(756耳)先天性小耳畸形患者,全部采用“两瓣法”行耳郭再造。 结果 术后随访1~6年,712例(756耳),其中15例(15耳)术后出现钢丝外露,经及时处理,拆除钢丝后治愈;10例术后出现再造耳郭皮下血肿,经更换负压引流管,引流通畅后,血肿消失;3例因术后患者保护不当,再造耳郭受压、碰伤导致软骨支架外露,经局部皮肤拉拢缝合,带蒂筋膜瓣覆盖表面植皮,及时处理后治愈。全部病例最终效果均满意,再造耳郭的大小、形态、位置与健耳对称,再造耳郭皮肤颜色正常,耳郭软骨支架无外露及吸收,细微凹凸结构显示清晰。 结论 “两瓣法”耳郭再造效果确切,术后并发症少,是先天性小耳畸形行耳郭再造较好的方法。     

Characteristics of functional rehabilitation of congenital malformations of the ear in children

The author presents diagnostic and clinical characteristics in congenital malformations of the external and middle ear in 100 patients aged 3 to 16 years. Computed tomography (CT) data are of key importance in deciding on surgical correction of hearing in patients with microtia. Incidence of significant CT signs and score assessment of CT findings are described. The results of 37 meatotympanoplasties are described. It is very important to select patients for certain surgery correctly. A universal approach to selection of patients for surgery was tested. The author came to the conclusion that improvement of the hearing function in patients with microtia is feasible in cases with hearing thresholds of 55-70 dB without neurosensory component. CT of the temporal bone should define pneumatic tympanic cavity, good differentiation of the hammer and anvil, unaffected labirynthine windows, facial nerve and inner ear.     

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。     

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.     

不同类型先天性中耳畸形的手术治疗

探讨先天性中耳畸形的临床分型及其手术策略。方法选取2016年6月—2019年12月收治的23例（33耳）先天性中耳畸形患者进行中耳畸形临床分型及不同的手术策略进行回顾分析，观察术后疗效和听力的恢复情况。术前对23例（33耳）中耳畸形患者均行耳内镜检查、听力学检查及颞骨CT并听骨链三维重建检查。结果23例患者中18例为术前明确畸形，5例为术中探查发现畸形。其中15例为锤、砧骨畸形，选择人工听骨赝复物（TORP或PORP）或自体听骨植入修复；6例为镫骨畸形，选择人工镫骨赝复物（Piston）植入；1例为鼓膜穿孔伴有先天性中耳畸形，先行鼓膜成形术，二期行听骨链重建手术；1例畸形程度比较复杂，面神经走形异常，在前庭窗处分叉，遮挡前庭窗，未能行进一步治疗。术后气导阈值提高至正常的有15例（65.2%）；骨气导差（ABG）恢复至30 dB以内的有16例（69.6%），ABG术后仍超过30 dB的有5例（21.7%），1例听力未改善（4.3%），1例无法行听骨重建（4.3%）。结论先天性中耳畸形术前诊断比较困难，CT检查很难精确评估，手术探查为最有说服力的诊断标准，明确中耳畸形临床分型后选择最佳的手术方式，是治愈疾病并提高患者术后听力最佳选择。     

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.