带蒂耳后肌骨膜隧道膜瓣在鼓室成形术中的应用

目的探讨带蒂耳后肌骨膜隧道皮瓣作为修补组织及支撑组织应用于鼓室成形术的临床效果。方法选择96耳单纯型和部分骨疡型慢性化脓性中耳炎病例,其中46耳以带蒂耳后肌骨膜隧道膜瓣为修补材料行鼓室成形术I型,另外50耳以游离颞肌筋膜修补鼓膜,作对比;选择71例(73耳)骨疡型或胆脂瘤型中耳炎病例,其中23耳去除外耳道后壁再以带蒂颞肌筋膜隧道膜瓣作为外耳道后壁软支架,另外50耳行乳突根治术,作出对比。结果鼓膜修补术后经过1年成功随访37耳,带蒂转移的肌骨膜隧道皮瓣愈合良好,1年随访成活率为94.6%,游离颞肌筋膜组成功随访3 2耳,成活率为为8 7.5%,术后听力提高相仿。以带蒂耳后肌骨膜瓣作为外耳道后壁软支架的病例组术后1年随访,成功随访16耳,干耳率87.5%,乳突根治术成功随访27耳,干耳率92.6%,术后听1年力提高前者大于后者,行t检验提示有差别。结论带蒂颞肌筋膜隧道膜瓣可作为良好的修补组织及支撑组织应用于慢性化脓性中耳炎的手术中。     

带蒂颞肌筋膜夹层法鼓膜成形术的体会

1992年以来 ,我们对病史长、残留边缘极少的鼓膜大穿孔 40例 50耳采用带蒂颞肌筋膜夹层法鼓膜成形术 ,获得满意疗效 ,报告如下。1　资料与方法1 .1 　 临床资料本组 40例 50耳 ,男 2 0例 2 6耳 ,女 2 0例 2 4耳 ;年龄 1 4～ 55岁 ,平均 30岁。中耳炎陈旧性鼓膜穿孔 36例 46耳 ,外伤性鼓膜穿孔 4例 4耳。鼓膜大穿孔 34耳 ,中等穿孔 1 6耳。1 .2 　 手术方法1 .2 .1 　 鼓膜成形术的适应证 :耳蜗及咽鼓管功能正常 ,鼓膜紧张部穿孔 ,鼓室内无鳞状上皮侵入及隐匿胆脂瘤 ,上鼓室、鼓窦及乳突气房系统的粘膜炎症处于静息状态。1 .2 .2 　 手术方法…     

耳后肌骨膜瓣在鼓室成形术中的应用

对病变较广泛的胆脂瘤型中耳炎行乳突根治术时,我们用耳后肌骨膜瓣缩小乳突术腔,提高了手术一次性干耳率,为同期行鼓室成形术创造了有利条件.     

带蒂颞肌筋膜重建外耳道后壁及鼓室成形术

目的探讨采用带蒂颞肌筋膜重建外耳道后壁及鼓室成形术治疗胆脂瘤中耳炎的初步临床疗效。方法选择74例胆脂瘤中耳炎,在改良乳突根治的基础上,39耳以带蒂颞肌筋膜蒂部重建外耳道后壁、筋膜部修补鼓膜,为重建组;35耳以游离颞肌筋膜修补鼓膜,为开放组。比较两组术后疗效。结果术后随访2～4年,重建组随访37例,外耳道接近正常,筋膜成活率97.29%,复发率5.6%。开放组随访33例,外耳道宽大畸形,筋膜成活率93.93%,复发率6.3%。两组手术前、后语频区(0.5、1、2、4 kHz)骨气导差缩小值,重建组分别为(15.3±0.33)、(15.1±0.30)、(15.6±0.25)、(20.5±1.34)dB;开放组分别为(13.8±0.36)、(13.5±0.43)、(13.4±0.42)、(14.6±0.76)dB,差异有统计学意义。结论耳后带蒂颞肌筋膜重建外耳道后壁及鼓室成形术治疗胆脂瘤中耳炎,术后干耳时间短,外耳道接近正常,修补物成活率高,术后骨气导差缩小显著,复发率低。     

带蒂颞肌瓣填塞在二次乳突根治术中的应用

目的 探讨耳后带蒂筋膜-颞肌瓣在二次开放式乳突根治术中乳突腔填塞的临床应用.方法 对开放式乳突根治术后长期渗液不干耳患者20例(20耳),行二次开放式乳突根治术.行开放式乳突根治术(RM)10例,行开放式乳突根治术伴乳突填塞术(CWDM)10例.CWDM均采用耳后带蒂筋膜-颞肌瓣乳突腔填塞.结果 术后均随访2年,RM干耳时间平均(58.4±4.45)d,复诊次数平均(17.1±2.33)次,持续不干耳1例.CWDM 干耳时间平均(29.6±2.37)d,复诊次数平均(6.1±1.52)次,无不干耳及术后复发.两组比较,CWDM干耳时间短、复诊次数少(P<0.001).结论 CWDM干耳时间、复诊次数、术后复发等指标均优于RM,采用带蒂筋膜-颞肌瓣乳突腔填塞效果良好.     

外耳道成形术在筋膜外植法鼓室成形术中的应用

目的：观察在筋膜外植法鼓室成形术中施行外耳道成形木的作用。方法：在筋膜外植法鼓室成形术同时行外耳道成形术59耳（部分伴完壁式乳突根治术）,通过耳道内和耳后联合切口,分离外耳道后壁皮瓣并向前上翻起固定,游离外耳道前壁皮肤,磨除外耳道前下方悬骨及周边骨质,扩大骨性外耳道,开放鼓沟,充分暴露鼓环,鼓膜彻底去上皮化。清除中耳病变后,外植铺放颞筋膜,回复外耳道前壁皮肤和后壁皮瓣,明胶海绵固定。术后1周开始滴耳,外耳道明胶海绵4～6周自然排空。结果：随访0．5～3．5年,所有患者切口Ⅰ期愈合,外耳道宽敞,鼓膜形态好,无皮瓣坏死、外耳道狭窄和胆脂瘤珠形成等并发症。结论：外耳道成形术是筋膜外植法鼓室成形术的必备步骤,有助于鼓膜彻底去上皮化、筋膜铺放及避免胆脂瘤珠形成,并且便于术后观察。     

用耳后带蒂肌筋膜骨瓣修复听骨链的疗效

目的探讨用耳后带蒂肌筋膜骨瓣修复听骨链在听力重建手术中的应用。方法对47例（47耳）胆脂瘤中耳炎病人。在清除病变的同时一期行鼓室成形术。用耳后带蒂肌筋膜骨瓣修复听骨链进行听力重建。结果随访0．5～3年，全部病例均干耳。无一例胆脂瘤复发。术前临床测试平均气导51．93dB，平均骨导23．17dB；术后平均气导36．59dB。平均骨导24．23dB，术前、术后骨气导差距分别为28．76dB和12．36dB，骨气导差距改善了16．40dB。68％的病人骨气导差距缩小到20dB以内，无听力下降者。结论鼓室成形术中用耳后带蒂肌筋膜骨瓣修复听骨链行听力重建，能有效改善听力，降低胆脂瘤复发率，是一种较为实用的手术方法。     

颞肌筋膜瓣在颅面部肿瘤术后缺损修复中的应用

目的:探讨颞肌筋膜瓣(TMF)在修复颅面部肿瘤术后缺损中的应用。方法:根据缺损大小和部位 设计TMF,对10例颅面部肿瘤术后缺损患者进行修复,其中3例修复颅底缺损,5例修复口咽部缺损,2例修复 眶。结果:随访8～50个月,10例TMF全部成活;修复颅底者,未出现颅内感染及脑脊液漏;修复口咽者,语言、 吞咽功能无明显障碍;修复眶者解剖形态基本恢复,外观满意。结论:TMF是修复颅面部肿瘤术后缺损的理想选 择。     

脱细胞真皮基质与颞肌筋膜在Ⅰ型鼓室成形术中的临床疗效分析

目的 探讨脱细胞真皮基质(acellular dermal matrix,ADM)与颞肌筋膜在Ⅰ型鼓室成形术中的临床疗效.方法 回顾分析2014年1月～2015年1月广州军区广州总医院收治的慢性化脓性中耳炎静止期患者60例(60耳),局麻下显微镜下耳内切口,内植法完成Ⅰ型鼓室成形术,其中32例(32耳)采用ADM,28例(28耳)采用颞肌筋膜.比较分析两组患者手术时间,术后疼痛程度,鼓膜愈合情况及术后听力恢复效果.结果 两组患者手术时间和术后疼痛比较,差异有显著性统计学意义(t=-21.78和-8.920,P均<0.05),鼓膜愈合成功率和术后听力提高均无显著统计学意义(P>0.05).结论 使用ADM修复鼓膜与颞肌筋膜修复疗效相当,但是使用ADM患者手术时间短,术后疼痛轻,避免开创2次手术区域,值得临床推广应用.     

断桥式乳突根治术中用带蒂颞肌骨片重建外耳道后壁

目的 探讨在开放式鼓室成形术中，既能彻底清除病灶，又能恢复正常的中耳及外耳道解剖结构的方法，达到提高听力的目的。方法 用带蒂颞肌骨片对47例（耳）胆脂瘤型中耳炎病人于开放式鼓室成形术中，行外耳道壁修复重建术。结果 47例（耳）病人术后经0．5～3年随访，12耳听力提高15 dB （25．53％），15耳提高20dB（31．91％），7耳提高30dB（14．89％），3耳提高40dB（6．38％），2耳提高50dB（4．26％）；8耳提高小于15dB（17．02％）。所有重建的外耳道壁及中耳乳突腔均接近正常状态，无外耳道闭锁或塌陷。结论 利用带蒂颞肌骨片在开放式鼓室成形术中行外耳道壁重建，既能彻底清除中耳乳突腔内的胆脂瘤及肉芽组织，又能保证良好的外耳道和中耳的形态和功能。术后听力提高明显．是较为理想的手术方式。     

Myringoplasty using rotation flap of canal skin for total tympanic membrane perforation

Objective

To evaluate the efficacy of a novel technique of using rotation flap of canal skin in patients with total or subtotal tympanic membrane (TM) perforation with no anterior residual tympanic membrane.

Methods

A retrospective study of 50 patients with total or subtotal perforation repaired with rotation flap of canal skin. Clinical and audiometric data were recorded.

Results

The overall perforation closure rate was 96%. A statistically significant shortened healing time was observed.

Conclusion

The rotation flap of canal skin could be an effective and safe technique for perforations with no anterior residual TM.     

Comparison of temporalis fascia and tragal cartilage grafts in type 1 tympanoplasty in elderly patients

Objective

To investigate the success rates and hearing outcomes of temporalis fascia and tragal cartilage grafts used for type-1 tympanoplasty in the elderly (³65 years)

Clinical advantages of cartilage palisades over temporalis fascia in type I tympanoplasty

Objective

To compare the post-operative outcomes in using temporalis fascia and full thickness broad cartilage palisades as graft in type I tympanoplasty.

Methods

This study, conducted at a tertiary referral institute, included 90 consecutive patients with mucosal type chronic otitis media requiring type I tympanoplasty with a 60/30 distribution of cases with fascia and cartilage palisades, respectively. The fascia group consisted of primary cases in adults and excluded revision cases, near-total or total perforations and pediatric cases. The cartilage group included pediatric, revision cases and near-total or total perforations. The fascia group utilized the underlay technique for grafting, whereas the cartilage group used tragal full thickness broad cartilage palisades with perichondrium attached on one side placed in an underlay or over-underlay manner. Post-operative graft take-up and hearing outcomes were evaluated after 6 months and 1 year with subjective assessment and pure tone audiometry.

Results

The graft take-up rate was 83.3% in the fascia group and 90% in the cartilage palisade group. The mean pure tone air–bone gaps pre- and post-operatively in the fascia group were 30.43 ± 5.75 dB and 17.5 ± 6.94 dB, respectively, whereas for the cartilage group, these values were 29 ± 6.21 dB and 7.33 ± 3.88 dB, respectively.

Conclusion

Cartilage grafting with full thickness palisades is more effective than fascia as graft material, particularly in “difficult” tympanoplasties fraught with higher failure rates otherwise.     

The modified temporalis muscle flap in reconstruction of palate and temporal deformity

Purpose: The purpose of this article was to introduce a modified temporalis muscle flap (TMF) which was used to reconstruct palate and temporal deformity.

Patient and methods: This was a retrospective review of the use of the modified TMF in reconstruction of palate and temporal deformity. We evaluated the result which included operative time, bleeding, necrosis, infection, facial nerve deficit, and cosmetic deformity.

Results: All the 16 patients accepted the modified TMF surgery successfully. There were no complications. All of them were satisfied with the postoperative appearance.

Conclusions: The modified TMF was a reliable and safe flap that can be used to reconstruct the surgical defect of plate and fill the temporal fossa.     

颈部矩形返折肌皮瓣Ⅰ期下咽重建

目的：探讨颈部矩形返折肌皮瓣Ｉ期修复下咽缺损的疗效,方法：总结我院２０例下咽 行喉全切除及下咽部分或全部切除,应用颈部矩形返折肌皮瓣Ｉ期修复下咽的临床资料,结果;２０例颈部矩形返折肌皮瓣全部成活,５例术后有小咽瘘,７～１０ｄ自愈,１例术后２个皮管下端吻合口狭窄,行ＩＩ期手术除狭窄治愈,全部病例随访３～９年,３年、５年生存率分别为５０．０％和３３．３％,结论：颈部矩形返折肌皮瓣是Ｉ期修复下咽缺损的简单易行、成功率高的有效方法。     

Island cartilage vs temporalis fascia in type 1 tympanoplasty: A prospective study

Objective

(1) To compare the results of graft take-up and audiological outcome of temporalis fascia versus island cartilage graft in type 1 tympanoplasty. (2) To compare the rate of postoperative retraction of neotympanum in both.

阔筋膜和转移皮瓣在颅脑组织缺损修复中的应用

目的：探讨阔筋膜修补硬脑膜和局部转移皮瓣在颅脑组织缺损修复重建中的应用效果。方法：8例头皮鳞癌侵犯颅骨、硬膜及脑内的患者,切除侵犯的头皮颅骨及硬膜后,组织缺损较大,采取自体阔筋膜修补硬脑膜,局部转移皮瓣修复皮肤缺损,皮瓣供区游离中厚皮片修复。结果：术后2周8例转移皮瓣100％存活,游离植皮区皮肤85％～100％存活,经换药治疗2周均修复。无伤口及颅内感染、无脑脊液瘘。结论：针对头皮鳞癌手术后造成的皮肤颅骨及硬膜缺损,采用自体阔筋膜修补硬膜,局部转移皮瓣和游离皮片移植技术可取得较好的疗效,提高患者生活质量。     

Long-term results of type I tympanoplasty with perichondrium reinforced cartilage palisade vs temporalis fascia for large perforations: A retrospective study

Objective:To compare the rate of graft uptake and postoperative hearing outcomes of Type I tympanoplasty with perichondrium reinforced cartilage palisade to temporalis fascia for large tympanic membrane(TM)perforations over 5 years follow-up period.Materials and methods:This was a retrospective comparative study involving patients with chronic otitis media with large TM perforations.The patients underwent type I tympanoplasty using either perichondrium reinforced cartilage palisade(CP group)or temporalis fascia(TF group)as the graft via a transmeatal approach and under local anesthesia.Morphological and functional results were recorded at three-and five years follow-up.Demographic profiles including age and sex,surgery side,contralateral disease and graft uptake rate,as well as hearing outcomes,were compared between the two groups.Results:At three years follow-up,graft uptake was 94.87%for perichondrium reinforced cartilage palisade and 80.7%for fascia,respectively,(p?0.67).At five years follow-up,the uptake rate dropped to 87.17%in the CP group,but to 66.6%in the TF group(p?0.019).Hearing improved after surgery in both groups,and showed no significant difference between the two groups.Conclusion:Over long-term,perichondrium reinforced palisade showed a statistically significant better outcome regarding graft uptake than temporalis fascia in type Itympanoplasty for large TM perforations with comparable audiometric results.