Wehrs R E
University of Oklahoma College of Medicine.
Otolaryngol Clin North Am. 1989 Oct;22(5):1003-13.
Ossicular reconstruction in ears with cholesteatoma is similar to ears without cholesteatoma involvement. The important difference is that all cholesteatoma must be meticulously and completely removed or the reconstruction will fail. Special prostheses of bone or hydroxyapatite are used to rebuild the conductive mechanism. If only the incus is absent, an incus replacement prosthesis is employed between the malleus and intact stapes. When the stapedial superstructure is also missing, the incus-stapes prosthesis is utilized. These prostheses are interlocking in that a notch created in the top of the body of the implant engages the malleus and a cup in the lower part slips over the stapedial head, or a shaft extends to the stapedial footplate when the stapedial crura are missing. In either case the patient hears by direct columellar pressure from the new tympanic membrane to the fluids of the inner ear. Care is taken to preserve the patient's tissues and anatomy for use in reconstruction. If the patient's malleus or posterior bony wall must be sacrificed to eradicate the disease, these structures are immediately rebuilt with homograft tissue so that an orderly rebuilding of the conductive components may proceed. If the cholesteatoma has been extensive or infected and the middle ear mucosa is of poor character, definitive reconstruction is delayed to a second stage.
胆脂瘤型耳的听骨重建与无胆脂瘤累及的耳相似。重要的区别在于，所有胆脂瘤都必须仔细、彻底清除，否则重建将会失败。使用特殊的骨或羟基磷灰石假体来重建传导机制。如果仅砧骨缺失，则在锤骨和完整的镫骨之间使用砧骨替代假体。当镫骨上部结构也缺失时，则使用砧骨 - 镫骨假体。这些假体相互锁定，即植入体主体顶部的切口与锤骨接合，下部的杯状物套在镫骨头上方，或者当镫骨脚缺失时，轴延伸至镫骨底板。在任何一种情况下，患者通过新鼓膜对内耳液体的直接柱状压力来听声音。要注意保留患者的组织和解剖结构以供重建使用。如果为根除疾病必须牺牲患者的锤骨或后骨壁，则立即用同种异体组织重建这些结构，以便有序地重建传导部件。如果胆脂瘤范围广泛或已感染且中耳黏膜质量差，则将确定性重建推迟到第二阶段。
