先天性外中耳畸形一次性整复术

Primary restoration for congenital malformation of external and middle ear

目的 :探讨提高先天性外中耳畸形患者的听力、改善仪表、缩短治疗时间的新术式。方法 :采用一次性整复术 ,即全麻或局麻下作“Z”形切口 ,将残耳作为 A瓣 ,耳后皮作为 B瓣 ,乳突骨膜作成蒂在前方的 C瓣 ,完成外耳道及鼓室成形术后将 C瓣翻入腔的前壁 ,A瓣改作新耳的下半部 ,B瓣包裹硅胶支架作成新耳的上半部 ,乳突腔裸面用半厚游离皮衬贴 ,凡士林纱条填塞固定 2周。结果 :用此法治疗 2例 ,分别随访 3年及 1年 ,均获良好的形态及听力效果。结论 :一次性整复术整复先天性外中耳畸形 ,省时、省钱、痛苦小、效果佳 ,值得推广。

Objective:To promote the hearing, improve the appearance, shorten the therapeutic course in congenital malformation of external and middle ear,the program of primary restoration has been designed. Method:Under general or local anaesthesia a Z shaped incision is made in skin. After turn up the flap A(defective ear)and flap B(retroauricular skin), a periosteal flap C with pedicle in front is made and elevated from mastoid.Then made frameworklize on mastoid and perform tympanoplasty. Once the myringograft is put properly the flap C is turn into the mastoidal cavity to serve as the lining of anterior wall. Flap A is sutured with the edge of retroauricular incision to serve as the lower part of new auricle. Then use the flap B to wrap a siliceous frame to make the upper part of new auricle.Finally,the naked walls of mastoidal cavity are lined with free skin graft and the cavity is packed with vaseline gauze for two weeks. Result:Two cases of congenital malformation of external and middle ear were treated with the procedure mentioned above and were followed up for one and 3 years respectively. Both effects of shape and hearing were good.Conclusion:The primary restoration for congenital malformation of external and middle ear designed by the authors is an excellent method worthy to be recommended.