Lower Intact-Bridge Tympanomastoidectomy with Preservation of Ossicular Chain / 听力学及言语疾病杂志

Objective To reduce the recurrence rate and improving the hearing recovery effect in chronic otitis media patients with obstructive lesions in the attic, through the low bone intact-bridge tympanomastoidectomy.Methods A total of 23 patients with little severe or severe localized attic lesions granulation wrapped in ossicular chain blocking the entrance of tympanic antrum or affecting the attic drainage were included in this study.We have modified the intact-bridge tympanomastoidectomy to low bone intact-bridge tympanomastoidectomy (At the tympanic antrum entrance and lateral attic wall, we retained a more narrow low bone bridgestructure), completely cleared the localized lesions, released the activities limited ossicular chain and unobstructed the attic and middle tympanum drainage channel.And patients were followed up for 0.5~3 years.Results Before operations, the average pure tone auditory hearing threshold of all 23 patients was 43.91±9.90 dB HL,the preoperative air-bone gap was 24.04±5.10 dB.While the postoperative stable pure tone hearing test results were 33.17±7.63 dB HL and 14.70±4.52 dB, respectively.All patients had postoperative dry ear within 3 months.There was no recurrence of tympanic membrane perforation during follow-up.One patient had tympanic effusion(secretory otitis media) had accepted grommet insertion, 6 months after T-tube insertion, the tube was removed, and was followed up to 1 year.Conclusion The low bone intact-bridge tympanomastoidectomy by preservation of low bone bridge used in patients with chronic otitis media and obstructive lesions in the attic middle tympanum could reduce the recurrence rate and improve the recovery of hearing.

Characteristic of the vertical and pyramidal segment of facial nerve canal / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the vertical and pyramidal segment of facial nerve canal based on three-dimensional reconstruction of temporal bone CT, and provide a quantitative data for the middle ear and mastoid surgery.@*METHOD@#Reconstruction of adult axial CT images shows the vertical and pyramidal segment of facial nerve canal. Using the Able Software 3D-DOCTOR 3.5 to show and measure the angle of the vertical and pyramidal segment of the facial nerve canal and to analyze the features and regularity based on the measured data.@*RESULT@#According to the angle of the vertical and pyramidal segment of facial nerve canal based on the three-dimensional reconstruction model. A certain regularity has been found in the direction and the angle of different segments of the vertical and pyramidal segment of facial nerve canal.@*CONCLUSION@#The temporal bone CT three-dimensional reconstruction can accurately show the characteristic and angle of the vertical and pyramidal segment of facial nerve canal. The characteristics and quantitative angle of the vertical and pyramidal segment of facial nerve canal from the anatomical viewpoint for clinical utility could keep the vertical and pyramidal segment of facial nerve from injury in temporal bone surgery.

Quantitative positioning of facial nerve based on three-dimensional CT image reconstruction of temporal bone / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore a set of quantitative methods to determine the position of the facial nerve based on three-dimensional CT reconstruction of temporal bone structures on personal computer, which can provide a series of important parameters for ear and the lateral skull base surgery.@*METHOD@#The internal structures of temporal bone were reconstructed based on a set of axial CT images of adult patients, the complicated relationship and their morphologic characteristics were clearly presented by using Able Software 3D-DOCTOR. The precise measurement of some parameters between facial nerve and its adjacent structures could easily be processed with the software. Based on all obtained data, the relationship of facial nerve and its adjacent structures were effectively summarized and analyzed.@*RESULT@#Three-dimensional images, including the facial nerve, tympanic anulus, auditory ossicles, chochleariform process, pyramidal eminence, internal auditory, the cochlea, semicircular canal, jugular fossa and carotid artery in the temporal bone, were reconstructed. Some parameters obtained from measuring the distance or angle between the facial nerve and its adjacent structures in the three-dimensional models had some extent regularity, which were benefit to design surgical approach and determine the position of facial nerve during relevant operation.@*CONCLUSION@#CT 3D reconstruction can accurately display the detailed internal structures anatomy of the temporal bone and their quantitative spatial relationships.