Wadhwa Vikram, Anand T S, Kumar Sandeep, Kathuria Geeta, Rana Indu
Department of Otorhinolaryngology and Head and Neck Surgery, Lady Hardinge Medical College, B-7, Pandara Road, 110003 Delhi, India.
Indian J Otolaryngol Head Neck Surg. 2003 Jul;55(3):170-4. doi: 10.1007/BF02991945.
Healing of the mastoid cavtiycompletely is the desired result after a mastoid surgery. Even after the Sade's principles' of the complete disease clearance, adequate lowering of the facial ridge, good meatoplasty and closure of the perforation of the tympanic membrane are fallowed, the complete healing of tike mastoid cavity is sometimes net the end result. According to various surgeons, the incidence of discharging mastoid cavity after a open cavity mastoid surgery is between /0-60%-H The usual techniques of obliteration of the mastoid cavity to decrease the size of the mastoid cavity, unusually has good healing results due to good vascularity. The failure ta the early detectmn 0/disease recurrence and risk of sudden appearance of intra-cranial complications are the most important disadvantages of the technique. We undertook a study in SO randomly chosen patients of Unsafe CSOM. Twenty five underwent obliteration of the mastoid cavity with Periosteo-Temporofascial flap, which is based on branches of posterior auricular artery and rest twenty five underwent non-obliteration of the mastoid cavity. Tfie results between the two groups were compared in terms of healing of the mastoid cavity and hearing gain after operation. Very good results in terms of healing of the cavity were seen after obliteration surgery. The rate of healing of the cavity was much faster after obliteration. The additional advantage with the flap is the see-through character of the cavity lining, which would lead to early detection of the disease recurrence. No significant increase in the hearing was seen in the obliterated patients as compared to non-obliterated cases.
乳突腔完全愈合是乳突手术后期望达到的结果。即使遵循了萨德原则,即彻底清除病灶、充分降低面神经嵴、做好外耳道成形术以及封闭鼓膜穿孔,乳突腔有时仍不能完全愈合。据不同外科医生称,开放式乳突手术后乳突腔流脓的发生率在10% - 60%之间。通常用于缩小乳突腔大小的乳突腔闭塞技术,由于血运良好,通常具有较好的愈合效果。该技术最重要的缺点是早期难以检测到疾病复发以及存在颅内并发症突然出现的风险。我们对50例随机选取的不安全慢性化脓性中耳炎患者进行了一项研究。25例患者采用基于耳后动脉分支的骨膜 - 颞筋膜瓣进行乳突腔闭塞术,其余25例患者未进行乳突腔闭塞术。比较了两组患者术后乳突腔愈合情况及听力改善情况。闭塞术后乳突腔愈合方面取得了非常好的效果。闭塞术后乳突腔愈合速度快得多。该皮瓣的另一个优点是腔壁具有透明性,这有助于早期发现疾病复发。与未闭塞的患者相比,闭塞患者的听力没有显著提高。