Centro Hospitalar Universitário do Porto, Porto, Portugal.
Centro Hospitalar Universitário do Porto, Porto, Portugal.
Acta Otorrinolaringol Esp (Engl Ed). 2022 Nov-Dec;73(6):339-345. doi: 10.1016/j.otoeng.2021.05.004.
The goal of this study was to determine the impact of external and middle ear findings in the incidence of facial canal dehiscence (FCD) during mastoidectomy for chronic otitis media.
We examined the operative details of 186 patients who underwent primary tympanomastoidectomy for chronic otitis media between January 2015 and January 2020 retrospectively. In this study we only evaluated the second portion of the facial nerve canal.
The global prevalence of FCD was 22.6% (42/186 patients) with a higher incidence, of 38.7% (36/93), in patients with chronic otitis media with cholesteatoma (C-COM). Associations were found between facial canal dehiscence, labyrinthine fistula (p˂ .001) and facial nerve paralysis (p˂ .001). Ossicular erosions were observed at a significant level in patients with facial canal dehiscence, the incidence of FCD was significantly higher (p=.005, Odds ratio 5.489) when malleus and incus were eroded, incus plus stapes were eroded (p=.014; OR 4.059) and malleus, incus, and stapes together were eroded (p=.002; OR 4.929).
This study revealed an incidence of facial canal dehiscence of 22.6%. It also revealed that the presence of lateral semicircular canal fistula is associated with a higher prevalence of facial canal dehiscence. The same was noted in the case of some ossicular erosions, especially the combinations of eroded malleus and incus, incus and stapes, and all 3 ossicles. These findings raise awareness about the usefulness of middle ear findings in predicting FCD, thus providing valuable information for the otological surgeon to avoid iatrogenic injuries.
本研究旨在确定慢性中耳炎乳突根治术中，外耳和中耳发现对面神经管缺损（FCD）发生率的影响。
我们回顾性分析了 2015 年 1 月至 2020 年 1 月期间因慢性中耳炎行初次鼓室乳突切除术的 186 例患者的手术细节。在本研究中，我们仅评估面神经第二部分管。
FCD 的总患病率为 22.6%（186 例患者中有 42 例），其中慢性中耳炎伴胆脂瘤（C-COM）患者的发病率更高，为 38.7%（36/93）。面神经管缺损与迷路瘘（p<.001）和面神经麻痹（p<.001）之间存在关联。在面神经管缺损患者中观察到听骨侵蚀有显著意义，当锤骨和砧骨侵蚀、砧骨和镫骨侵蚀（p=.014；OR 4.059）以及锤骨、砧骨和镫骨同时侵蚀时，FCD 的发生率显著更高（p=.005，OR 5.489）。
本研究显示面神经管缺损的发生率为 22.6%。此外，还发现外侧半规管瘘的存在与面神经管缺损的发生率较高相关。在一些听骨侵蚀的情况下也发现了同样的情况，尤其是侵蚀的锤骨和砧骨、砧骨和镫骨以及所有 3 个听小骨的组合。这些发现提高了对面神经管缺损的认识，即中耳发现对面神经管缺损的预测有用性，从而为耳科医生提供了有价值的信息，以避免医源性损伤。
