残耳组织在小耳畸形外耳再造中的应用

APPLICATION OF RESIDUAL EAR IN AURICULAR RECONSTRUCTION OF MICROTIA

目的总结外耳再造术中对残耳进行的不同处理,探讨合理应用残耳的方法。方法2005年9月-2006年7月,对128例单侧小耳畸形患者采用分期手术进行矫治。男79例,女49例;年龄5～21岁,平均11岁。左耳44例,右耳84例。残耳呈花生状56例,腊肠状35例,舟状27例,贝壳状10例。外耳道正常存在5例,狭窄11例,闭锁112例。患耳按耳廓发育情况分为:Ⅰ度17例,Ⅱ度98例,Ⅲ度13例。一期手术时植入50mL肾形扩张器1枚。对于残耳上端距发际线较近者,同期将残耳中上部纵行切开,去除多余的残耳软骨,切口直接缝合。二期手术时利用残耳中上部覆盖软骨支架下部,根据残耳的具体位置,应用"V-Y"推进、"Z"成形术和残耳向上逆转等方法矫正残耳位置。三期手术时利用保留的残耳再造耳轮脚或覆盖再造耳修整时形成的创面。?结果患者残耳经改形或移位后血运良好,全部成活。切口Ⅰ期愈合。患者均获8～15个月随访。以残耳形成的耳垂外形丰满自然,再造耳与健侧耳基本对称。再造耳耳垂存活良好,无破溃。再造的耳轮脚清晰可见,耳轮、对耳轮及三角窝结构清晰,患者及家属均满意。结论合理应用残耳是成功施行外耳再造术、保证再造耳与健侧耳对称的重要环节。

Objective To summarize different treatments of the residual ear in auricular reconstruction, to investigate the reasonable applications of the residual ear. Methods From September 2005 to July 2006, 128 patients （79 males, 49 females; aging 5-21 years with an average of 11 years） with unilateral microtia underwent the staged repair. In the patients, there were 44 cases of left-unilaterally microtia and 84 cases of right-unilaterally microtia. The residual ears looked like peanut in 56 patients, like sausage in 35 patients, like boat in 27 patients, and like shells in 10 patients. Among all the patients, the external acoustic meatus was normal in 5 patients, stenosis in 11 patients, and atresia in 112 patients. According to auricular developmental condition, the patients were divided into three types： 17 cases of type Ⅰ, 98 cases of type Ⅱ, and 13 cases of type Ⅲ In the first stage operation, a 50 mL kidney-liked expander was implanted into post aurem subcutaneous tissue. The residual ear whose superior extremity was close to the hair line was treated. The middle and superior part of the residual ear was cut. The redundant residual auricular cartilage was removed. In the second stage operation, the inferior part of the cartilage frame was covered by the middle and superior part of the residual ear. According to the location of the residual ear, ＂V-Y＂ plasty, ＂Z＂-plasty and reversal of the residual ear were used to correct the location of the residual ear. In the third stage operation, the remained residual ear was used to reconstruct crus of helix or cover the wound surface which was resulted from repairing the reconstructed ear. Results The residual ears which were reshaped and transferred had good blood circulation. All residual ears were survival. The wounds healed by first intention. The follow-up for 8-15 months showed that the auricular lobule of the reconstructed ear was turgor vitalis and natural. The locations of the reconstructed ear and normal side ear were symmetry. The auricular lobules of the reconstructed ear survived well. The reconstructed crus of helix, helix, antihelix and triangular fossa were clear. The results were satisfactory. Conclusion Using residual ear reasonably is an important procedure of successful auricular reconstruction and the symmetry of the reconstructed ear and uninjured side ear.