Wielgosz Romuald, Mroczkowski Edward
Klinika Otolaryngologiczna Akademickiego Szpitala A Kruppa w Essen (Niemcy).
Otolaryngol Pol. 2006;60(2):175-9.
The palisade tympanoplasties-technique with using of tragal and conchal autografts for reconstruction of the tympanic membrane and the auditory canal wall was described.
The operation started with the endaural incision. Tragal and conchal autograft palisade fragments with perichondrium for reconstruction of the tympanic membrane and the auditory canal wall have been used up to 1996 in 15,300 cases. We placed palisaded cartilage fragments parallel to the manubrium of the malleus in type I tympanoplasties and in type II or III procedures parallel to the long process of the incus. The "tunnel plasty" in the eustachian tubal entrance is performed with "simmering", "architrave" and "anti-architrave" to keep the tubal entrance open. This "tunnel plasty" results in a nice reconstruction of the tympano-meatal niche. The "annulus-stapes plate" in type III tympanoplasties replaces the function of the incus, crossing the promontory and reducing adhesions. This annulus-stapes bridge is fixed with a further palisade cartilage, "step plasty", which connects the "tunnel-plasty" with "annulus-stapes plate". The palisade-epitympanum-antrum plasty allows ventilation of the antrum via a tunnel constructed of well-fitting parallel pieces of cartilage fixed by self-tension (no glue) and replacing the bony canal wall. The "columella-tunnel plasty" has an L-shaped notch in the "annulus-stapes plate" fixing a columella of cartilage, placed in the oval window. Only in a case with a narrow oval window niche, a type IV palisade plasty can be performed or a prosthesis placed.
The "annulus-stapes cartilage plate" is more stable reconstruction in type III tympanoplasties than are incus of foreign body interpositions. Adhesions on the promontory are found more often with fascia than with cartilage fragments. Histologic study of autograft cartilage showed good preservation of cartilage cells even 26 years after transplantation.
The use of palisade cartilage technique brings very good functional and better long-term results.
描述了采用耳屏和耳甲自体移植物重建鼓膜和耳道壁的栅栏式鼓室成形术技术。
手术从耳内切口开始。截至1996年，已在15300例手术中使用带有软骨膜的耳屏和耳甲自体移植物栅栏状碎片来重建鼓膜和耳道壁。在I型鼓室成形术中，我们将栅栏状软骨碎片平行于锤骨柄放置；在II型或III型手术中，则平行于砧骨长突放置。在咽鼓管入口处进行“隧道成形术”，采用“煨制”“楣梁”和“反楣梁”操作以保持咽鼓管入口开放。这种“隧道成形术”能很好地重建鼓室-耳道隐窝。III型鼓室成形术中的“环状-镫骨板”替代砧骨的功能，跨越岬部并减少粘连。这个环状-镫骨桥用另一块栅栏状软骨“阶梯成形术”固定，它将“隧道成形术”与“环状-镫骨板”连接起来。栅栏状上鼓室-鼓窦成形术通过由自我张力固定（不使用胶水）且贴合良好的平行软骨片构建的隧道实现鼓窦通气，这些软骨片替代了骨质耳道壁。“小柱-隧道成形术”在“环状-镫骨板”上有一个L形切口，用于固定置于椭圆窗的软骨小柱。仅在椭圆窗隐窝狭窄的情况下，才可以进行IV型栅栏状成形术或植入假体。
在III型鼓室成形术中，“环状-镫骨软骨板”的重建比异物植入砧骨更稳定。在岬部发现的粘连，使用筋膜比使用软骨碎片更常见。对自体移植软骨的组织学研究表明，即使在移植26年后软骨细胞仍保存良好。
使用栅栏状软骨技术能带来非常好的功能效果和更好的长期结果。
