经面隐窝入路人工耳蜗植入乳突切开最小面积探索

Minimal mastoidectomy required for cochlear implant through facial recess approach

目的探索顺利经面隐窝入路人工耳蜗植入术所需最小乳突切开面积,为微创人工耳蜗植入提供帮助。方法对2014年7月~2015年11月期间,在不影响人工耳蜗植入操作的情况下,逐渐切开乳突,能完成46例人工耳蜗植入,并按年龄进行分两组（3岁以下组和大于等于3岁组）,测量乳突骨皮质切开范围大小,包括乳突切开的前后径、上下径及其面积,并计算出平均值。结果乳突骨皮质切开形状为类三角形,上缘前后径的距离,左耳为（25.86士13.63）mm,右耳为（23.52士5.72）mm。上下径的距离左耳为（10.61士5.15）mm,右耳为（17.87士4.52）mm。切开的面积左耳（352.4士17.16）mm2,右耳为（414.2士12.01）mm2。两组比较差异无统计学意义（P〉0.05）3岁以下乳突切开面积和年龄较大者接近,两者差异无统计学意义（P〉0.05）。结论经面隐窝入路的人工耳蜗植入手术中,在不影响砧骨短脚暴露、面神经隐窝开放、圆窗膜暴露或鼓岬开窗、电极插入增加手术操作难度的情况下,最小程度的切开乳突,减少创伤和术后耳后塌陷,

Objective To study the minimum extent of mastoidectomy required in cochlear implantation via the facial recess approach, to facilitate minimally invasive cochlear implantation. Methods Forty six cases of cochlear implantation completed between July 2014 and November 2015 were divided into two groups based on age（under 3 years or at or older than 3 years）. Without negatively impacting the implantation procedure, mastoidectomy was gradually expanded and its extent measured, including the anteroposterior and vertical diameters as well as the total area. Results The shape of cortical mastoidectomy was essentially a triangle, with an mean anteroposterior diameter at the upper border of 25.86±13.63 mm on left and 23.52±5.72 mm on right. The mean vertical diameter was 10.61±5.15 mm on left and 17.87±4.52 mm on right.The mean area of mastoidectomy was 352.4±17.16 mm2 on left and 414.2±12.01 mm2（P〉0.05）. The area of mastoidectomy was similar between the two age groups（P〉0.05）. Conclusions For cochlear implantation via the facial recess approach, limiting the extent of mastoidectomy, without compromising exposure of incus short process, facial recess, round window membrane and promontory fenestration or electrode insertion, can reduce surgical trauma and postoperative retroauricular collapse and is an important part of minimally invasive cochlear implantation.