Elbary Mohammad El-Sayed Abd, Nasr Wail Fayez, Sorour Samir Sorour
Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Human Medicine, Zagazig University, Zagazig, El Sharkya, Egypt.
Int Arch Otorhinolaryngol. 2018 Apr;22(2):103-107. doi: 10.1055/s-0037-1602694. Epub 2017 May 17.
Canal wall down (CWD) mastoidectomy has many drawbacks, including chronic otorrhea not responding to medications, granulations, dizziness on exposure to cold or hot water, and tendency of debris accumulation in the mastoid cavity, demanding periodic cleaning. Many of these problems can be solved by reconstruction of the posterior meatal wall (PMW). To assess the results of PMW reconstruction after CWD mastoidectomy for cholesteatoma using titanium mesh and platelet-rich plasma (PRP) mixed with bone pate. This study was conducted with 20 patients that have atticoantral chronic suppurative otitis media. All cases were subjected to CWD mastoid surgery with complete elimination of the disease and reconstruction of the PMW by titanium mesh and the mixture of PRP with bone pate. All patients were exposed to a full preoperative evaluation and full postoperative assessment of the complications, the appearance of the external auditory canal contour, and the hearing gain expressed by the change of the air bone gap postoperatively. The PMW reconstructed by titanium mesh and the mixture of PRP with bone pate showed a smooth contour. During the follow-up of 12 to 36 months, the postoperative appearance of the external auditory canal contour was found to be smooth without hidden pouches, irregularities or stenosis in all cases. No granulation, foreign body reaction, or extrusion and/or displacement of the titanium mesh were registered. No facial palsy or recurrent cholesteatoma was reported. The surgical reconstruction of the PMW using PRP, bone pate and titanium mesh after CWD mastoidectomy appears to be reliable without considerable complications, giving a smooth appearance to the PMW.
开放式乳突根治术（CWD）有许多缺点，包括药物治疗无效的慢性耳漏、肉芽组织、冷热刺激水时的头晕，以及乳突腔内有碎屑堆积的倾向，需要定期清理。这些问题中的许多都可以通过重建外耳道后壁（PMW）来解决。
评估使用钛网和富含血小板血浆（PRP）混合骨粉进行CWD乳突根治术后重建PMW治疗胆脂瘤的效果。
本研究纳入了20例上鼓室鼓窦慢性化脓性中耳炎患者。所有病例均接受CWD乳突手术，彻底清除病灶，并使用钛网以及PRP与骨粉的混合物重建PMW。所有患者均接受了全面的术前评估以及术后并发症、外耳道轮廓外观和术后气骨导差变化所表示的听力增益的全面评估。
用钛网以及PRP与骨粉的混合物重建的PMW轮廓光滑。在12至36个月的随访期间，发现所有病例的外耳道轮廓术后外观均光滑，无隐匿性袋状结构、不规则或狭窄。未发现肉芽组织、异物反应或钛网挤出和/或移位。未报告面神经麻痹或复发性胆脂瘤。
CWD乳突根治术后使用PRP、骨粉和钛网对PMW进行手术重建似乎可靠，无明显并发症，使PMW外观光滑。
