One-stage tympanic cavity ventilation tube placement in canal wall down tympanomastoidectomy / 临床耳鼻咽喉头颈外科杂志

Objective:To research the clinical application of tympanic cavity ventilation tube placement in canal wall down tympanomastoidectomy. Method:There were 52 patients with otitis media received canal wall down tympanomastoidectomy. We placed ventilation tube in posterior hypotympanum during the surgery. After surgery, all patients were followed up in 12 days, 1 month, 2 months, 6 months, and 1 year. The ventilation tubes were withdrew 6 months later, and then the hearing level and tympanic cavity status was evaluated after another half year. Result:All cases were followed up at least 1 year after surgery. Forty-four patients' tubes were removed 6 months later, but other 8 tubes had been extruded within 1 to 3 months. After 1 year, all 52 cases of ears were dry; 39 patients' tympanic membranes were stable, the postoperative complications included tympanic membrane retraction in 7 cases, middle ear effusion in 4 cases, and tympanic membrane perforation at anterior-inferior quadrant in 2 cases; CT examination indicated that 39 patients' aeration between tympanic cavity and Eustachian tube bony portion was normal, 9 patients' tympanic cavity aeration was smaller, and 4 patients' cavity was obstructed; 52 patients' average air conduction thresholds were 12.5 dB lower than that of preoperation. Conclusion:One-stage tympanic cavity ventilation tube placement is a simple, safe and effective method in canal wall down tympanomastoidectomy for middle ear diseases with Eustachian tube severe stenosis or obstruction in bony portion.

The lateral attic wall reconstruction with tragal cartilage and temporalis fascia graft / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the reconstruction method of lateral attic wall with tragal cartilage and temporalis fascia graft. And analyze the postoperative result of its clinical application.@*METHOD@#From Jan 2005 to Jul 2014, 45 patients whose middle ear disease were limited to attic received this surgery in our department. Among 31 cases of cholesteatoma otitis media and 14 cases of external auditory canal cholesteatoma were included. In order to expose the attic fully, we operated epitympanotomy through retroauricular incision and then removed the scutum and lateral attic bone wall. After eliminating the lesions, we reconstructed the lateral attic bone wall with tragal cartilage, covered the cartilage with temporalis fascia and then repaired the tympanic membrane and external ear canal skin. After surgery, all patients were followed up at 10 days, 1 month, 2 months, 6 months and 1 year.@*RESULT@#Two months after surgery, 45 patients' achieved one-stage wound healing. Six months later, all of the patients' operation area had epithelized completely. After 1 year, 37 patients had recovered the normal shapes and stable audition; 7 cases patients have different level tympanic membrane retraction; 1 patient suffered from tympanic membrane retraction and recurrent cholesteatoma.@*CONCLUSION@#With regard to the lesion limited to the attic, we can remove it by operating epitympanotomy through retroauricular incision, and then reconstruct the lateral attic wall with tragal cartilage and temporalis fascia. By the support of the cartilage, we can keep the epitympanic aeration, reduce the retraction of pars flaccida membrana tympani, and maintain the fundamental shape of lateral attic wall.

The anatomic study of tragal cartilage and its clinical application in ear surgery / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#Dissecting adult cadaver's tragal cartilage and researching its clinical application in ear surgery.@*METHOD@#Dissect the bilateral tragal cartilage of 22 adult cadavers immersed in formalin (both of male and female are 11). Measure and compute the average value of the length, width, thickness and area. Summarize autologous tragal cartilage's clinical application in ear surgery.@*RESULT@#The statistic values of male tragal cartilage were: length (22.55 ± 0.89) mm, width (19.00 ± 1.09) mm, thickness (1.04 ± 0.09) mm, and area (315.70 ± 32.57) mm2. The statistic values of female respectively were (19.36 ± 0.86) mm, (15.73 ± 0.69) mm, (0.93 ± 0.06) mm, and (229.64 ± 13.97) mm2. Tragal cartilages were utilized in 419 middle ear surgeries in my department, including tympanoplasty(type I 189 cases, type II and III 116 cases), atticotomy (65 cases), and the repair of the lateral skull base (3 cases). The postoperative effect was satisfactory.@*CONCLUSION@#Tragal cartilage is in the operation region, which is convenient to be harvested and shaped. Hence, the donor can satisfy the requirement of general ear surgery and it is suitable for widely application in ear surgery.

Canal wall reconstruction with tragus cartilage and tempralis fascia graft / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#This paper highlights the therapeutic effect of tragus cartilage and temporalis fascia graft on repairing bone and skin defect in external auditory canal.@*METHOD@#Forty-one surgical patients were recuited, including 39 cases of external auditory canal cholesteatoma and 2 cases of osteoma. External auditory canal bone wall and skin defect and mastoid air cells exposure were found during operation. We followed up these cases periodically (in 3 weeks, 3 months, 6 months and 1 year later respectively) after repairing the patients' external auditory canal bone wall and skin with tragus cartilage and temporalis fascia graft.@*RESULT@#Twenty-nine cases healed perfectly while other 12 cases grew small granulation in 3 weeks. After shaving granulations and tamping Tela Iodoformum, wounds healed in the following week. The epithelization of the external auditory canal in our patients was complete after 3 months and no stenosis were found. Natural morphology of external auditory canal was maintained without mastoid air cells exposure after 6 months to 1 year of time.@*CONCLUSION@#It is not only convenient to acquire the tragus cartilage and temporalis fascia, but also easy to repair the defect of external auditory canal bone wall and skin. It can reconstruct the wall of external auditory canal, obliterate mastoid cells and perfectly maintain the normal form of external auditory canal via the cartilage.