保留鼓索神经的开放式乳突根治鼓室成形术

Canal-wall-down mastoidectomy and tympanoplasty surgery preserving chorda tympani nerve integrality

目的:报告开放式乳突根治鼓室成形术中寻找鼓索神经的方法和保留鼓索神经的意义。方法:66例慢性化脓性中耳炎或中耳胆脂瘤患者,术中以砧骨短突为标志,磨低外耳道后壁,沿面神经垂直段找到鼓索嵴(鼓索神经出骨管处),沿鼓索嵴找到游离于鼓室内的鼓索神经,仔细清理鼓索神经表面的病变组织,保持其完整性。结果:24例中耳胆脂瘤患者和42例慢性化脓性中耳炎患者鼓索神经表面胆脂瘤上皮及肉芽彻底清理,无一例鼓索神经断裂,患者术后味觉无明显变化。结论:开放式乳突根治鼓室成形术中彻底清理病变的同时保持鼓索神经的完整性,保留了鼓索神经的结构和功能,可以减低移植于镫骨头上的听小骨膺复物脱落的危险,且可对移植筋膜起支架作用。

Objective：To report the way for searching the chorda tympani nerve and the significance for preserving the chorda tympani nerve during canal-wall-down mastoidectomy and tympanoplasty surgery.Method：Sixty-six cases with chronic suppurative otitis media underwent canal-wall-down mastoidectomy and tympanoplasty surgery.According to the marker of the short crus of incus,the posterior wall of auditory canal was lowered and crista of the chorda tympani nerve was found through tracing the facial nerve contour.The chorda tympani nerve was preserved after clearing the surrounding tissue.Result：Among the 66 cases,24 cases had middle ear cholesteatoma,42 cases had granulation in middle ear.The cholesteatoma and granulation on the surface of the chorda tympani nerve were cleared thoroughly.No neurotmesis or obvious change of taste occurred after operation.Conclusion：Canal-wall-down mastoidectomy and tympanoplasty surgery preserving chorda tympani nerve integrality may preserve the structure and function of the chorda tympani nerve,reduce the risk of ossicle extrusion above the head of stapes and serve as a frame for transplanting fascia.