Tanaka Kentaro, Yano Tomoyuki, Homma Tsutomu, Tsunoda Atsunobu, Aoyagi Masaru, Kishimoto Seiji, Okazaki Mutsumi
Department of Plastic and Reconstructive Surgery, Graduate School of Medical Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
Department of Otolaryngology, Graduate School of Medical Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
Laryngoscope. 2018 Nov;128(11):2605-2610. doi: 10.1002/lary.27170. Epub 2018 Mar 25.
In advanced temporal bone carcinoma cases, we attempted to preserve as much of the auricle as possible from a cosmetic and functional perspective. Difficulties are associated with selecting an adequate position for reconstructed auricles intraoperatively. We improved the surgical procedure to achieve a good postoperative auricle position.
Nine patients were included in this study. All patients underwent subtotal removal of the temporal bone and resection of the external auditory canal while preserving most of the external ear, and lateral skull base reconstruction was performed with anterolateral thigh flaps. We invented a new device, the auricle localizer, to select the correct position for the replaced external ear. The head skin incision line and two points of three-point pin fixation were used as criteria, and a Kirschner wire was shaped as a basic line to match these criteria. Another Kirschner wire was shaped by wrapping it around the inferior edge of the external ear as the positioning line, and these two lines were then combined. To evaluate the postoperative auricle position, the auricle inclination angle was measured using head frontal cephalogram imaging.
The external ear on the affected side clearly drooped postoperatively in nonlocalizer cases, whereas this was not obvious in localizer cases. Auricle inclination angles 1 year after surgery significantly differed between these two cases (P = 0.018).
The surgical device, the auricle localizer, is useful for selecting intraoperative accurate auricle positions. The assessment index, the auricle inclination angle, is useful for quantitatively evaluating postoperative results.
4 Laryngoscope, 2605-2610, 2018.
在晚期颞骨癌病例中，我们试图从美容和功能角度尽可能多地保留耳廓。术中为重建耳廓选择合适位置存在困难。我们改进了手术方法以获得良好的术后耳廓位置。
本研究纳入9例患者。所有患者均接受了颞骨次全切除和外耳道切除，同时保留大部分外耳，并采用股前外侧皮瓣进行侧颅底重建。我们发明了一种新装置——耳廓定位器，用于为替换的外耳选择正确位置。以头部皮肤切口线和三点针固定的两点为标准，将一根克氏针塑形为基本线以匹配这些标准。另一根克氏针绕外耳下缘缠绕塑形作为定位线，然后将这两条线合并。为评估术后耳廓位置，使用头部正位头颅X线成像测量耳廓倾斜角度。
在未使用定位器的病例中，患侧外耳术后明显下垂，而在使用定位器的病例中则不明显。这两组病例术后1年的耳廓倾斜角度有显著差异（P = 0.018）。
手术装置耳廓定位器有助于术中选择准确的耳廓位置。评估指标耳廓倾斜角度有助于定量评估术后结果。
4 喉镜，2605 - 2610，2018年。
