Medical-Assistant Otolaryngology Department, PhD, University of São Paulo School of Medicine, Av Dr. Eneas de Carvalho Aguir 255 6º. Andar sala 6167, São Paulo, 05403-000, Brazil.
Otorhinolaryngology Department, PhD, National Institute of Rehabilitation, Mexico City, Mexico.
Eur Arch Otorhinolaryngol. 2022 May;279(5):2259-2268. doi: 10.1007/s00405-021-06907-1. Epub 2021 Jun 10.
To evaluate the esthetic and functional results of an osteoplastic flap for mastoid cavity closure in cochlear implant surgery.
Double-blind, prospective, randomized clinical trial.
tertiary referral center.
INTERVENTION(S): On hundred and twenty-six patients were randomized in 2 groups for cochlear implant surgery. Cases (n: 63) underwent simple mastoidectomy using an anteriorly pedicled osteoplastic flap for mastoid closure. In controls (n: 63), a traditional periosteal flap was used. Evaluation with the POSAS questionnaire was performed 1 year after surgery to assess surgical wound esthetics. Sixteen patients from each group had postoperative CT-scans and wideband tympanometry to assess mastoid aeration and middle ear absorbance. Gender and time after surgery were correlated.
MAIN OUTCOME MEASURE(S): Evaluation of the quality of the surgical wound with the application of a questionnaire validated in the medical literature and translated into Portuguese language called POSAS, considering the perception of the blinded patient and doctor regarding the surgical technique proceeded. A lower POSAS score suggests better esthetics of the surgical wound. Secondary outcomes are volumetric measurement of aeration inside mastoid cavity using 3D computer tomography exam, which aims to analyze the influence of fibrocicatricial retraction in the surgical wound into the mastoid and the interference of its aeration volume in the absorption of sound in the middle ear, using the wideband tympanometry exam.
The POSAS questionnaire in the Case group showed a lower level of local pain and itchiness, a skin color and thickness more similar to the surrounding skin and less irregularity and stiffness, with no influence from time after surgery and gender compared to the Control group. The median tomographic volume was 6.37 cc in the cases and 4.60 cc in controls. Wideband tympanometry showed general smaller sound absorbance in the Case group results, specially, at 1000 Hz frequency. No intraoperative or postoperative complications were observed with the osteoplastic flap.
This technique is an effective and safe alternative to alleviate common problems of mastoid surgery for cochlear implantation. In addition to esthetic benefits, it has less interference in middle ear physiology of sound absorbance and less fibrous tissue into the mastoid cavity during the follow-up of more than 1 year.
评估耳后骨成形皮瓣在人工耳蜗植入术中封闭乳突腔的美学和功能效果。
双盲、前瞻性、随机临床试验。
三级转诊中心。
126 例患者随机分为 2 组行人工耳蜗植入术。病例组（n=63）采用经前蒂骨成形皮瓣行单纯乳突切除术封闭乳突腔。对照组（n=63）采用传统骨膜瓣。术后 1 年采用 POSAS 问卷评估手术切口的美学效果。每组各有 16 例患者行术后 CT 扫描和宽带测听，以评估乳突充气和中耳吸收率。分析性别和术后时间的相关性。
采用经医学文献验证并翻译成葡萄牙语的 POSAS 问卷评估手术切口质量，评估盲法患者和医生对手术技术的感知。POSAS 评分越低，手术切口的美观效果越好。次要结果是使用 3D 计算机断层扫描测量乳突腔内充气的体积，分析纤维瘢痕收缩对乳突手术切口的影响，以及其对中耳声吸收的干扰，使用宽带测听检查。
病例组的 POSAS 问卷显示局部疼痛和瘙痒程度较低，皮肤颜色和厚度与周围皮肤更相似，不规则和僵硬程度较低，与对照组相比，不受术后时间和性别影响。病例组的中位 CT 容积为 6.37cc，对照组为 4.60cc。宽带测听显示病例组的一般声吸收率较小，特别是在 1000Hz 频率。采用骨成形皮瓣未观察到术中或术后并发症。
与传统方法相比，该技术是一种缓解人工耳蜗植入乳突手术常见问题的有效且安全的方法。除了具有美学优势外，该技术在术后 1 年以上的随访中对中耳声吸收的生理干扰更小，纤维组织进入乳突腔的程度更小。
