LeClair Karissa L, Bessen Sarah Y, Rees Christiaan A, Saunders James E
Dartmouth Geisel School of Medicine Hanover New Hampshire USA.
Dartmouth-Hitchcock Medical Center Lebanon New Hampshire USA.
Laryngoscope Investig Otolaryngol. 2020 Aug 4;5(4):743-749. doi: 10.1002/lio2.419. eCollection 2020 Aug.
To analyze surgical outcomes of a novel alloplastic reconstruction technique for partial external auditory canal (EAC) defects in tympanomastoidectomy.
Retrospective study of 51 patients with cholesteatoma who underwent repair of partial EAC defects during tympanomastoidectomy at a tertiary referral center over 8 years. Nineteen patients were treated with a novel alloplastic graft technique using hydroxyapatite cement and bone pâté for EAC repair. Thirty-two patients treated with traditional cartilage repair of the EAC served as a control group. The primary outcomes measured were postoperative cholesteatoma recurrence rates, infection rates, and mean air-bone gap (ABG).
Twenty of the 51 cases (39.2%) were revision surgeries for cholesteatoma recidivism, with a greater proportion of revision surgeries in the alloplastic group (57.9% vs 28.1%, = .04). There was no significant difference in postoperative cholesteatoma recurrence ( = 1.00) or infection rates ( = .64) between the two techniques, with the alloplastic group experiencing slightly lower rates of recurrence (36.8%) and infection (5.3%) than cartilage repair (37.5% recurrence, 12.5% infection). Mean postoperative ABGs were comparable between the alloplastic (21.5 dB) and cartilage group (26.0 dB, = .10).
Composite alloplastic and bone pâté reconstruction is an effective technique to repair partial EAC defects in tympanomastoidectomy, with comparable postoperative hearing outcomes and no increased risk of cholesteatoma recurrence or infection compared to traditional cartilage repair. Recidivism rates were relatively high in both groups, likely due to the high rate of revision surgeries and aggressive nature of cholesteatoma within the cohort.
Level 3B.
分析一种用于鼓室乳突切除术中外耳道（EAC）部分缺损的新型异体修复技术的手术效果。
对一家三级转诊中心8年间在鼓室乳突切除术中接受EAC部分缺损修复的51例胆脂瘤患者进行回顾性研究。19例患者采用新型异体移植技术，使用羟基磷灰石水泥和骨泥进行EAC修复。32例采用传统EAC软骨修复的患者作为对照组。主要测量指标为术后胆脂瘤复发率、感染率和平均气骨导间距（ABG）。
51例患者中有20例（39.2%）为胆脂瘤复发的翻修手术，异体修复组的翻修手术比例更高（57.9%对28.1%，P = 0.04）。两种技术在术后胆脂瘤复发率（P = 1.00）或感染率（P = 0.64）方面无显著差异，异体修复组的复发率（36.8%）和感染率（5.3%）略低于软骨修复组（复发率37.5%，感染率12.5%）。异体修复组（21.5 dB）和软骨组（26.0 dB，P = 0.10）术后平均ABG相当。
异体材料与骨泥复合重建是修复鼓室乳突切除术中EAC部分缺损的有效技术，与传统软骨修复相比，术后听力结果相当，且胆脂瘤复发或感染风险未增加。两组的复发率相对较高，可能是由于翻修手术率高以及队列中胆脂瘤的侵袭性所致。
3B级。
