Department of Otorhinolaryngology, Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
Eur Arch Otorhinolaryngol. 2022 Dec;279(12):5945-5949. doi: 10.1007/s00405-022-07547-9. Epub 2022 Jul 15.
In most stapes surgeries, the posterior ear canal is enlarged and a piston is inserted posterior to the chorda tympani nerve (post-chorda tympani approach; Post C). Although reports vary, some indicate that more than 60% of the patients experience lingual symptoms following surgery. Endoscopic surgery may permit an anterior approach to the nerve (pre-chorda tympani approach; Pre C). Herein, we propose a suitable approach for endoscopic stapes surgery based on the classification of the chorda tympani nerve.
We retrospectively reviewed the medical records of 23 patients who underwent endoscopic stapes surgery at our institution between 2019 and 2021. The nerve classification previously reported, the modified nerve classification (attached long type is divided into Category 1: lenticular process is visible with 0° endoscope and Category 2: not visible), selected approach (Pre C or Post C), use of a 30° endoscope, and manipulation of the nerve (number of contacts and traction, with or without suction, with or without malposition or extension and amputation, and damage score) were evaluated.
The damage score was significantly lower in the Pre C group (p < 0.05); however, using this approach for all cases is not desirable owing to the high risk of damage to the nerve during posterior malpositioning.
The Post C should be used for the detached and attached long 1 types, while the Pre C with a 30° endoscope should be used for the attached long 2, attached short, ultrashort, and external auditory canal types.
在大多数镫骨手术中，会扩大后耳道，并将活塞插入鼓索神经后方（后鼓索入路；Post C）。尽管报道结果不一，但有些研究表明，超过 60%的患者在手术后会出现舌部症状。内镜手术可能允许从前入路接近神经（前鼓索入路；Pre C）。在此，我们根据鼓索神经的分类，提出一种适合内镜镫骨手术的入路方法。
我们回顾性分析了 2019 年至 2021 年在我院行内镜镫骨手术的 23 例患者的病历。采用先前报道的神经分类和改良神经分类（长附着型分为 1 类：0°内镜下可见晶状体突起和 2 类：不可见）、选择的入路（Pre C 或 Post C）、使用 30°内镜以及神经操作（接触和牵引次数、有无抽吸、有无错位或延长和截断、损伤评分）进行评估。
Pre C 组的损伤评分显著较低（p<0.05）；然而，由于在后位时存在损伤神经的高风险，因此不希望所有病例都采用这种方法。
对于游离长附着 1 型和长附着 1 型，应采用 Post C；对于长附着 2 型、短附着、极短附着和外耳道型，应采用 30°内镜的 Pre C。
