Jung Timothy T K, Park Seong Kook
Division of Otolaryngology, Head & Neck Surgery, Loma Linda University School of Medicine and Jerry L. Pettis Memorial Veterans Medical Center, Loma Linda, CA, USA.
Acta Otolaryngol. 2004 May;124(4):440-2. doi: 10.1080/00016480410016450.
Intact-canal-wall mastoidectomy procedures leave an unsightly depression in the postauricular area. Until now, there have been few reports of successful reconstruction of mastoidectomy defects, and none using titanium mesh. When secondary mastoidectomy is not anticipated, as in endolymphatic sac shunt procedures, the postauricular defect resulting from mastoidectomy can be eliminated by reconstruction using titanium mesh. This is a retrospective study of 14 patients who underwent reconstruction of a mastoidectomy defect with titanium mesh.
All 14 patients underwent mastoidectomy as part of endolymphatic sac shunt procedures for Ménière's disease. All of the patients had mastoid bones free of chronic infection or cholesteatoma. At the time of mastoidectomy, a large piece of cortical bone was removed and saved instead of being drilled away. After the main procedure was completed, and before closing the postauricular skin, a piece of 1.3-mm titanium mesh was cut to cover the mastoidectomy defect. The mesh was then attached to the mastoid bone at the four corners using 4- or 6-mm screws. The piece of cortical bone removed at the beginning of the mastoidectomy was attached under the mesh and across the mastoid defect. Patients were followed for a period of 6 months to 3 years. The outcome was considered successful when there was no depression at the mastoidectomy site and no evidence of any infection.
All patients who underwent reconstruction of a mastoidectomy defect with titanium mesh maintained a normal contour of the mastoid bone without depression or infection. There were no failures.
Mastoidectomy defect reconstruction with titanium mesh is a reliable method for preventing an unsightly depression at the mastoidectomy site. This method is ideal when repeat mastoidectomy is not expected.
完整外耳道壁乳突切除术会在耳后区域留下难看的凹陷。到目前为止，关于成功重建乳突切除术后缺损的报道很少，且尚无使用钛网进行重建的报道。当不预期进行二次乳突切除术时，如在内淋巴囊分流手术中，乳突切除术后导致的耳后缺损可通过使用钛网进行重建来消除。这是一项对14例使用钛网重建乳突切除术后缺损患者的回顾性研究。
所有14例患者均接受了作为梅尼埃病内淋巴囊分流手术一部分的乳突切除术。所有患者的乳突骨均无慢性感染或胆脂瘤。在进行乳突切除术时，取下一大块皮质骨并保存，而不是将其钻除。在主要手术完成后，在关闭耳后皮肤之前，裁剪一块1.3毫米的钛网以覆盖乳突切除术后的缺损。然后使用4或6毫米的螺钉将钛网在四个角固定于乳突骨上。在乳突切除术开始时取下的那块皮质骨附着于钛网下方并横跨乳突缺损处。对患者进行了6个月至3年的随访。当乳突切除部位没有凹陷且没有任何感染迹象时，结果被认为是成功的。
所有使用钛网重建乳突切除术后缺损的患者乳突骨轮廓均保持正常，无凹陷或感染。无一例失败。
用钛网重建乳突切除术后缺损是防止乳突切除部位出现难看凹陷的可靠方法。当不期望进行再次乳突切除术时，此方法是理想的。
