Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA.
Otol Neurotol. 2012 Aug;33(6):998-1001. doi: 10.1097/MAO.0b013e31825f2346.
To evaluate patterns of failure for canal wall down mastoid cavities requiring surgical revision.
Retrospective review.
Academic tertiary referral center
Adults and children that underwent revision of an unstable open mastoid cavity from 1995 to 2010.
INTERVENTION(S): Review of demographic data, tympanomastoid pathology, and plausible risk factors for an unstable cavity. Available computed tomography (CT) scans were reviewed for indicators of suboptimal cavity shape. Spearman's correlation analysis was undertaken. Findings were classified as Type 1 (primary tympanomastoid pathology), Type 2 (cavity shape/size), or Type 3 (negative host environment).
MAIN OUTCOME MEASURE(S): Frequency of risk factors and correlation.
Approximately 130 cases were reviewed. Stapes erosion (49.2%), absent malleus (26.2%), cholesteatoma (44.6%), tympanic membrane perforation (34.6%), and fibrotic middle ear mucosa (20.8%) were common. CT scans often demonstrated an intact open mastoid tip (87.5%) and a high facial ridge (54.2%). Notable correlations were discovered between the facial ridge height proximally and the height distally (r = 0.46437, p = 0.0256) and tympanic membrane perforation and absent malleus (r = -0.17944, p = 0.0419). Approximately 68% of the subjects had at least 1 Class 1 risk factor present among cholesteatoma, tympanic membrane perforation/atelectasis, and extruded prosthesis. All CT scans reviewed demonstrated at least 1 class 2 factor.
Although primary tympanomastoid pathology is quite common, some aspect of suboptimal mastoid cavity size and shape is pervasive. Correlation analysis suggests that surgeons tend to either lower the facial ridge completely or not at all and that an absent malleus seems to be associated with a tympanic membrane perforation.
评估需要手术修正的开放式乳突腔失败模式。
回顾性研究。
学术三级转诊中心
1995 年至 2010 年间接受不稳定开放式乳突腔修正术的成人和儿童。
回顾人口统计学数据、鼓窦乳突病理以及不稳定腔的可能危险因素。对现有的 CT 扫描进行了评估，以寻找腔形状不理想的指标。进行了 Spearman 相关性分析。结果分为 1 型（原发性鼓窦乳突病变）、2 型（腔形状/大小）或 3 型（阴性宿主环境）。
危险因素的频率和相关性。
大约有 130 例病例被回顾。镫骨侵蚀（49.2%）、锤骨缺失（26.2%）、胆脂瘤（44.6%）、鼓膜穿孔（34.6%）和纤维化中耳黏膜（20.8%）较为常见。CT 扫描常显示完整的开放式乳突尖端（87.5%）和高面神经嵴（54.2%）。发现面神经嵴近端高度与远端高度之间存在显著相关性（r=0.46437，p=0.0256），以及鼓膜穿孔与锤骨缺失之间存在相关性（r=-0.17944，p=0.0419）。约 68%的受试者在胆脂瘤、鼓膜穿孔/萎缩和挤出的假体中至少存在 1 种 1 类危险因素。所有 CT 扫描均显示至少存在 1 种 2 类因素。
尽管原发性鼓窦乳突病变较为常见，但乳突腔大小和形状不理想的某些方面普遍存在。相关性分析表明，外科医生倾向于要么完全降低面神经嵴，要么根本不降低，而锤骨缺失似乎与鼓膜穿孔有关。
