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。

Clinical analysis of modified Brent method for total auricular reconstruction of congenital microtia

Objective To explore the clinical effect of and experience in modified Brent method for total auricular reconstruction of congenital microtia. Methods A total of 20 children with congenital microtia treated by modified Brent method total auricular reconstruction in our hospital from Nov 2018 to April 2021 were selected. All the children had unilateral microtia, and aged from 6.5 to 15 years old with an average of 8.7. The first stage involved the management of the residual ear. The mastoid region was separated to form a cyst, and the earlobe was simultaneously transposed. The costal cartilage on the opposite side of the affected ear was harvested and carved into the auricle framework. On the basis of traditional carving, the tragus was carved at the same time to deepen the depth of the scapha,triangular fossa and intertragic notch as much as possible. In the trimming helix, the leading end of crus was elevated and the tip left longer to accentuate the depth of the helix. And then, the manicured framework was embedded in the postauricular cyst. The second stage was auricular erection, the formation of cranioauricular angle. And the third stage was plasty of cavity of auricular concha. Results Among all the 20 cases, one had hematoma in the first-stage operation, one had infection and another had stent exposure in the second-stage operation. After local treatment, all the 3 cases got recovered and received subsequent operation. All the patients were followed up for 3 to 9 months after the third-stage surgery. The reconstructed ears showed good binaural symmetry, good shape of the helix crus and tragus, deepened cranio-auricular grooves, and smooth transition between the earlobe and the lower part of the auricle, with satisfactory overall appearance. Conclusion With better highlighting the fine structures of the tragus, helix crus, triangular fossa and earlobe as well as better presentation of the stereoperception of reconstructed ear, the modified Brent method of total auricular reconstruction can provide reference for the selection of surgical method for congenital microtia.