Inagaki Akira, Takahashi Mariko, Murakami Shingo
Toyohashi Day-Surgery Clinic Toyohashi Japan.
Department of Otolaryngology, Head and Neck Surgery Nagoya City University Graduate School of Medical Sciences Nagoya Japan.
Laryngoscope Investig Otolaryngol. 2022 Dec 27;8(1):185-191. doi: 10.1002/lio2.1001. eCollection 2023 Feb.
To determine the frequency-specific benefits of ossicular chain preservation compared to performing disarticulations and reconstructions in transmastoid facial nerve decompression surgery in patients with an intact ossicular chain.
A retrospective chart review (January 2007 and June 2018) of patients undergoing transmastoid facial nerve decompression on the intact middle ear for severe facial palsy at a tertiary referral center. Surgery was performed with ossicular chain disarticulation on an as-needed basis using either ossicular chain preservation (without ossicular disarticulation), incudostapedial separation, or incus disarticulation technique. Hearing outcomes were assessed.
The 108 patients were included in this study. Among these, 89 patients underwent ossicular chain preservation, 5 underwent incudostapedial separation and 14 underwent incus repositioning. The proportion of patients with a change in the 4-frequency air conduction pure-tone average of less than 10 dB was 91%, 60%, and 50%, respectively, for the three surgical techniques; these were significantly different (Fisher's exact test, < .001). Frequency-specific analysis showed that air conduction was significantly better following the ossicular chain preservation technique compared with the incus repositioning technique at stimulation frequencies lower than 250 Hz and higher than 2000 Hz, and compared with the incudostapedial separation technique at 4000 Hz. Analysis of biometric measures determined on CT images suggested that the feasibility of the ossicular chain preservation technique correlates with incus body thickness on coronal CT images.
Ossicular chain preservation is an effective approach for hearing preservation in transmastoid facial nerve decompression or similar surgical procedures.
确定在砧骨链完整的患者中，经乳突面神经减压手术中保留砧骨链相较于进行关节离断和重建的特定频率益处。
对一家三级转诊中心2007年1月至2018年6月期间因严重面瘫接受中耳完整的经乳突面神经减压手术的患者进行回顾性病历审查。手术根据需要采用保留砧骨链（不进行砧骨离断）、砧镫关节分离或砧骨离断技术进行砧骨链离断。评估听力结果。
本研究纳入108例患者。其中，89例患者进行了砧骨链保留，5例进行了砧镫关节分离，14例进行了砧骨复位。三种手术技术中，4频率气导纯音平均变化小于10 dB的患者比例分别为91%、60%和50%；这些差异具有统计学意义（Fisher精确检验，P <.001）。特定频率分析表明，在低于250 Hz和高于2000 Hz的刺激频率下，保留砧骨链技术后的气导明显优于砧骨复位技术，在4000 Hz时优于砧镫关节分离技术。对CT图像上生物测量指标的分析表明，保留砧骨链技术的可行性与冠状位CT图像上的砧骨体厚度相关。
保留砧骨链是经乳突面神经减压或类似手术中听力保留的有效方法。
