Palva T, Ramsay H
Department of Otolaryngology, University of Helsinki, Finland.
Am J Otol. 1999 Mar;20(2):145-51.
The attic compartments, except for Prussak's space, are aerated through the tympanic isthmus. The aim of this study was to develop aeration pathways that would bypass the isthmus in surgery for chronic inflammatory ear disease and cholesteatoma.
Microdissection of the epitympanum has shown that the anterior attic and the supratubal recess are separated by the tensor fold, the excision of which creates a large new aeration pathway.
Earlier surgical experience was reexamined as to the access to the tensor fold. Twenty temporal bones were dissected to create clinically useful new surgical routes for tensor fold removal in the presence of an intact ossicular chain.
An endaural atticotomy, extended to the supratubal recess, allows excision of the tensor fold; however, the excision must be performed blindly. Cutting the neck of the malleus to allow lateral lifting of the manubrium exposes the tensor tendon and allows rapid excision of the fold. The elasticity of the tendon assists in approximation of the cut edges. In canal wall up surgery, removal of the lateral attic bone until the root of the zygoma exposes the anterior surface of the head of the malleus and the lateral portion of the transverse crest. Drill-out of the crest leads directly to the posterior side of the tensor fold, allowing its excision under direct vision. Thinning of the attic bone lateral to the body and short process of the incus allows simultaneous removal of the lateral incudomalleal fold.
When the ossicular chain is discontinuous, tensor fold resection can be made under direct vision. With an intact chain, cutting of the neck of the malleus used in tympanic glomus tumors causes no hearing changes, allows complete fold excision, and is adaptable to chronic ear surgery. The frontolateral attic route for removal of tensor fold, together with the lateral incudomalleal fold, can be used in the canal wall up surgery to improve attic aeration.
除了普鲁萨克间隙外，上鼓室各腔通过鼓室峡部通气。本研究的目的是在慢性炎性耳病和胆脂瘤手术中开发绕过峡部的通气途径。
上鼓室的显微解剖显示，前上鼓室和咽鼓管上隐窝被张肌襞分隔，切除该襞可形成一条新的大通气途径。
重新审视早期手术经验中进入张肌襞的方法。解剖20个颞骨，以在听骨链完整的情况下创建临床上有用的切除张肌襞的新手术路径。
经耳道上鼓室切开术，延伸至咽鼓管上隐窝，可切除张肌襞；然而，切除必须盲目进行。切断锤骨颈部以使锤骨柄向外侧抬起可暴露张肌腱，并允许快速切除该襞。肌腱的弹性有助于切缘对合。在开放式鼓室成形术中，切除上鼓室外侧骨质直至颧根，可暴露锤骨头的前表面和横嵴的外侧部分。磨除横嵴可直接通向张肌襞的后侧，使其在直视下得以切除。磨薄砧骨体和短突外侧的上鼓室骨质可同时切除砧镫外侧襞。
当听骨链不连续时，可在直视下切除张肌襞。在听骨链完整时，用于鼓室球瘤手术的切断锤骨颈部操作不会引起听力改变，可实现襞的完全切除，且适用于慢性耳病手术。切除张肌襞及砧镫外侧襞的前外侧上鼓室入路可用于开放式鼓室成形术以改善上鼓室通气。
