Department of Otorhinolaryngology Head and Neck Surgery, University of Health Sciences Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.
Department of Otorhinolaryngology Head and Neck Surgery, Adıyaman Kahta State Hospital, Adıyaman, Turkey,
ORL J Otorhinolaryngol Relat Spec. 2021;83(2):112-118. doi: 10.1159/000514227. Epub 2021 Feb 8.
Tegmen defect (TD) has a potential of intracranial spread of middle ear infection, meningoencephalic herniation (MEH), and cerebrospinal fluid leakage (CSFL). Especially the defects >1 cm with MEH or CSFL are generally repaired via the classical middle fossa or minicraniotomy technique. The aim of this study was to show the efficiency of the intracranial, extradural placement of the septal cartilage graft in the closure of the TD larger than 1 cm via the transmastoid (TM) approach.
The demographic, preoperative, intraoperative, and postoperative data of 11 patients with chronic otitis media (COM) who had TD larger than 1 cm were reviewed retrospectively. Hospitalization time and hearing preservation with respect to MEH or CSFL were analyzed.
The most common etiology of TD was cholesteatoma (82%), and 91% of the patients had multiple COM surgery history. The mean TD size was 15.4 (10-25) mm. Fifty-five percent of the patients presented with either MEH or CSFL. The mean follow-up of the patients was 22.5 (8-42) months. There was no significant difference between preoperative and postoperative mean bone conduction thresholds. Mean hospitalization time was 5.2 (3-10) days. There was no significant difference in the hospitalization time between patients with MEH or CSFL and without MEH or CSFL. Neither recurrence nor graft infection was encountered.
Extradural grafting with the septal cartilage in the large TD up to 25 mm can be repaired efficiently via the TM approach without application of a lumbar drainage.
鼓室天盖缺损（TD）有中耳感染向颅内扩散、脑膜脑疝（MEH）和脑脊液漏（CSFL）的潜在风险。特别是有 MEH 或 CSFL 的>1cm 缺损一般通过经典的中颅窝或小颅窗技术修复。本研究旨在展示通过经乳突（TM）入路将鼻中隔软骨移植物颅内、硬膜外放置于>1cm 的 TD 中的效果，以闭合该缺损。
回顾性分析了 11 例慢性中耳炎（COM）患者的临床资料，这些患者均有>1cm 的 TD，研究其人口统计学、术前、术中及术后资料。分析了与 MEH 或 CSFL 相关的住院时间和听力保留情况。
TD 最常见的病因是胆脂瘤（82%），91%的患者有多次 COM 手术史。TD 的平均大小为 15.4（10-25）mm。55%的患者有 MEH 或 CSFL。患者的平均随访时间为 22.5（8-42）个月。术前和术后平均骨导听阈无显著差异。平均住院时间为 5.2（3-10）天。有 MEH 或 CSFL 与无 MEH 或 CSFL 的患者之间，住院时间无显著差异。未发生复发或移植物感染。
通过 TM 入路，采用鼻中隔软骨进行硬膜外移植，可有效修复最大 25mm 的大型 TD，无需应用腰椎引流。
