開放乳突腔障害に対する皮膚・軟骨・有茎骨膜弁一体型の外耳道後壁再建型鼓室形成術(ブーツ様再建) Boot-shaped canal reconstruction with tympanoplasty using canal skin, sliced cartilage, and Palva flap in open cavity

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開放乳突腔障害12例に乳突皮膚、側頭筋膜、薄切耳介軟骨、有茎骨膜弁を用いた外耳道後壁再建型鼓室形成術を行った。鼓膜が正常か浅在化例では一期的再建を (10/12例)、鼓膜全面癒着例の一部で二期的再建を行った (2/12例)。乳突蜂巣未発達の8例では乳突腔を皮質骨片で充填し、蜂巣発達した4例では含気させて治す方針を取った。2年以上の観察で、全例の乾燥治癒、外耳道、鼓膜の再陥凹を各1例に認めた。聴力改善率は術後12カ月で67%(8/12例)だった。今回の方法は、骨性外耳道の再建ではなく皮膚軟骨一体型の後壁を作ることを意図したもので、長期的にも比較的安定した形態を示した。二期手術の際には、拳上した鼓膜・外耳道が適度な硬さと柔軟さを持ち、元の形、位置に戻すことが容易であった (形状記憶特性)。柔軟性のある筒状の構造物が、ちょうど履物のブーツを連想させるので、簡単に「ブーツ様再建」と呼ぶことを提唱した。

The reconstruction of an open cavity using sliced cartilage, fascia and meatally based musculoperiosteal flap (Palva flap) was performed in 12 cases. All patients were followed for more than two years. The mastoid skin was elevated and trimmed, then sliced cartilage was transplanted to the mastoid side of the skin and covered using Palva flap. In the case of normal or shallow eardrum, ossicular reconstruction was performed in a single stage (10/12 cases, 83%). Two-staged surgery was planned for some of patients with adhesive eardrum (2/12 cases, 17%). The mastoid cavity was obliterated with bone chips in the poorly developed air cell groups (8 cases). However, we attempted to reconstruct a ventilated mastoid in the well-developed air cell groups (4 cases). Re-pneumatization of the mastoid was observed in 3 of these 4 cases. Overall success in hearing improvement was 67% (8/12 cases) 12 months postoperatively. In all cases, epithelialization was complete. None of the patients developed recurrent discharge, cholesteatoma or granulation. The reconstructed tympanum and posterior canal wall became a thick structure made of skin and sliced cartilage. This boot-shaped canal reconstruction was suited to staged ossiculoplasty because of the shape-memory effect that provides an adequate combination of stiffness and flexibility in the second stage. The structure was relatively stable over the long term. This method offers an advantage for adhesive cases that require secondary ossiculoplasty.

収録刊行物

  • Otology Japan

    Otology Japan 22(1), 23-30, 2012-02-29

    日本耳科学会

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各種コード

  • NII論文ID(NAID)
    10030285427
  • NII書誌ID(NCID)
    AN10358085
  • 本文言語コード
    JPN
  • 資料種別
    ART
  • ISSN
    09172025
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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