先天性单纯中耳畸形术前颞骨HRCT与手术对照研究

Isolated congenital middle ear malformations:comparison of preoperative HRCT and surgical findings

目的:对比先天性单纯中耳畸形术前颞骨HRCT与术中所见,总结可以被CT诊断的中耳畸形表现。方法:采用回顾性研究方法,对临床资料进行回顾,重点关注术前影像及术中所见。所有患者均经手术确诊为先天性单纯中耳畸形。结果:共回顾152例患者,168例耳,其中107例耳(63.7%)可由术前HRCT发现至少一处中耳畸形表现并被诊断为先天性单纯中耳畸形,61例耳(36.3%)术前HRCT报告为完全正常,随后由鼓室探查术得出最终诊断。合并或不合并其他听骨链畸形的镫骨固定占所有患者的51.2%。单纯镫骨畸形和砧镫复合畸形最常见。结论:术前HRCT有助于先天性单纯中耳畸形的术前评估。术前容易诊断的畸形表现为大部分听骨链的缺失畸形或发育不全畸形,如砧骨长脚缺失或发育不全,镫骨上结构缺失,以及前庭窗闭锁。但听骨链的固定畸形难以由术前HRCT做出诊断,确诊仍需依靠鼓室探查。

Objective:To compare preoperative temporal bone HRCT readings to intraoperative findings during exploratory tympanotomy for suspected cases of isolated congenital middle ear malformations(CMEMs)and summarize the malformations that can be diagnosed with HRCT.Method:A retrospective study was conducted.All cases were confirmed as isolated CMEMs during surgery.Detailed clinical records were reviewed,with a focus on imaging and surgical findings.Result:One hundred and fifty-two patients and 168 ears were reviewed.One hundred and seven cases(63.7%)could be identified as isolated CMEMs and at least one as middle ear anomaly using preoperative HRCT.Sixty-one cases(36.3%)were reported to be completely normal and the patients underwent exploratory tympanotomy to determine the final diagnosis.Stapes fixation,either alone or associated with other ossicular chain anomalies,contributed to 51.2%of the cases.The stapes and incudostapedial complex are the most commonly involved structures.Conclusion:HRCT provides helpful preoperative clinical information in CMEM.Most cases of aplasia or dysplasia of the ossicular chain,e.g.,aplasia/dysplasia of the long process of the incus,aplasia of the stapes’superstructure,and atresia of the oval window were easily identified in preoperative HRCT.However,fixation of the ossicular chain can be elusive in HRCT,and exploratory tympanotomy is needed for a definitive diagnosis.