Vestibulotomy above a severely displaced facial nerve.

CONCLUSIONS: Vestibulotomy above a severely displaced facial nerve represents a new surgical approach to achieve serviceable hearing. The lack of facial nerve injury and the potential for hearing restoration make this procedure feasible in patients who would otherwise be marginal or poor surgical candidates. OBJECTIVE: To investigate the feasibility of vestibulotomy above a severely displaced facial nerve. MATERIAL AND METHODS: Eight patients with severe congenital conductive hearing loss underwent vestibulotomy above a severely displaced facial nerve and hearing reconstruction between January 2000 and January 2002. All patients had congenital middle ear deformities. The facial nerves overhung and concealed the oval window niche or lay inferior to the oval window. The facial nerves were transposed in order to reach the oval window niche in four of eight cases. RESULTS: Hearing gain was 15 dB in 2 ears, 16-25 dB in 3 and > 26 dB in 3. There were no cases of postoperative facial paresis.

[Long-term surgical results for congenital aural atresia and hearing reconstruction].

OBJECTIVE: To evaluate the stability of hearing results and complications in long-term following-up who underwent reconstruction surgery. METHODS: Six hundreds and seventy five cases (700 ears) of congenital aural atresia were reviewed from January 1984 to January 2001 at the Department of Otorhinolaryngology Head and Neck Surgery, Tongren hospital. Except 40 ears undone hearing reconstruction, 635 cases (660 ears) underwent long-term following-up for 3 to 19 years, with an average of 7.9 years. RESULTS: Stenosis and recurrent infection of the external auditory canal (EAC) were the most frequent complications. Stenosis was seen in 120 ears, and 2 ears re-atresia, with an incidence of 18.48% (122/660). Recurrent infection of the cavity and canal skin happened in 6 ears. Closure of the air-bone gap (ABG) post-operation were gained in all cases, and ABG gains 20 dB or more occurred in 512 ears (77.57%), but 30 dB or more in 231 ears (35%). Following-up results: Stable hearing results gained in 450 ears over the length of following-up; the hearing worsened than that of 3 weeks postoperatively occurred in 160 ears, including 2 ears with sensorineural hearing loss. Hearing deteriorated more than 20 dB happened in 35 ears, and 10-15 dB in others cases but still be improved compared with that of preoperation. CONCLUSIONS: Atresiaplasty surgery in individuals with congenital aural atresia can yield reliable, lasting hearing results in 68.2% (450/660), with a low incidence of complications; the initial improved hearing deteriorated gradually over the first 6 months post-operation, which are related with the stenosis and infection of canal. Cavity adhesion, bony EAC re-growth, ossicular chain re-fixation or displace may affect the hearing results in some cases. Even unilateral aural atresia may benefit from the reconstruction surgery and achieve serviceable hearing results.

[Clinical application of multiplanar reconstruction of facial canal: preliminary report].

OBJECTIVE: To study clinical criterion of the anterior positior of mastoid segment and low position of tympanic segment in atresia of external auditory canal. METHOD: Facial canal of 80 cases was measured by multiplanar reconstruction. RESULT: A-B less than 0.4 mm was low position of tympanic segment and E-F less than 5 mm was anterior position of mastoid facial canal in atresia of external auditory canal, there was significant difference between the two subgroups (P < 0.01). CONCLUSION: The first time, the multiplanar reconstruction measurement criterion of facial structures in established. Multiplanar reconstruction system is useful for microsurgery doctors to precisely recognize the mark of high dangerous area in and surroundings.

[Investigation of postoperation complications of the congenital aural atresia].

OBJECTIVE: To investigate the treatments and complications of the congenital aural atresia. METHODS: Form 1996 to 2002, 446 ears with congenital aural atresia underwent operations in the Otolaryngology Department of the Tongren Hospital. During the follow up from 6 months to 5 years, 47 ears occurred postoperative complications, which can be divided into five groups: external acoustic pore stenosis, external auditory canal stenosis, hearing loss, facial nerve palsysis. The hearing results of these 43 ears showed 12 ears had a decrease of 10 dB, 19 ears of 20 dB, 12 ears of 30-40 dB. RESULTS: The causes of complications mainly were insufficient opening of bony external canal, secondary infection and lateral healing of the transplanted tympanic membrane, and the surgeon did not master the anatomic characters of the abnormal facial nerve. Forty-three ears received operation again, including 24 ears with external acoustic pore stenosis, 9 ears with external auditory canal stenosis, 8 ears with hearing loss and 1 ear with facial nerve palsysis. Hearing improvement was found in 43 ears (100%) in which 10 ears (23.3%) with improvement of 10-20 dB, 21 ears (48.8%) of 20-30 dB, 12 ears (27.9%) of 30-40 dB. The one ear with facial nerve palsysis recovered 2 months after operation. CONCLUSION: External auditory canal stenosis and lateral healing of the transplanted tympanic membrane are the primary causes of postoperative hearing loss. Do not injure the facial nerve for hearing improvement in cases of facial nerve abnormalities.

[Vestibulotomy about the displaced facial nerve].

OBJECTIVE: To investigate the feasibility of vestibulotomy above the displaced facial nerve. METHODS: From January 2000 to January 2002, eight patients with severe congenital conductive hearing loss underwent the vestibulotomy above displaced facial nerve and reconstruction of the ossicular chain with a total ossicular replacement prosthesis, which all for the congenital middle ear deformity and the facial nerve overhang and concealed the oval window niche or lied inferior to the oval window. In four of eight cases, the facial nerve was transposed in order to access the oval window niche. RESULTS: Hearing of this patients improved 15 dB in 2 ears, 16-25 dB in 3 ears and 26 dB or more in 3 ears. In no case was there a postoperative facial paresis. With 4 months to 28 months follow-up, the postoperative hearing gain was stable. CONCLUSIONS: Vestibulotomy above displacement of the facial nerve allows a final chance of achieving serviceable hearing through surgery. The lack of facial nerve injury and the potential for hearing restoration make this procedure feasible in otherwise marginal or poor surgical candidates.

[Computerized tomographic evaluation of traumatic ossicles disruption].

OBJECTIVE: To investigate the importance of the high resolution computerized tomography of temporal bone in evaluation of traumatic lesions, particularly of the ossicular disruption. METHOD: Ten patients with traumatic ossicles dislocation underwent preoperative CT scanning followed by surgical exploration of the middle ear. RESULT: The radiographic finding was consistent with the operative demonstration for malleoincudal disarticulation (3 ears), incudostapedial dislocation (7 ears), and the fracture of temporal bone (8 ears). CONCLUSION: The incus was the most vulnerable ossicle in the trauma to the middle ear. CT scans can diagnose exactly the damage position in middle ear.