Wang D N, Wang B Q, Ren R, Chen P W, Liu Y J, Zhang Q G, Zhao S Q
Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing Institute of Otolaryngology, Key Laboratory of Otorhinolaryngology Head and Neck Surgery(Capital Medical University), Ministry of Education, Beijing 100730, China.
Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2023 Oct 7;58(10):980-985. doi: 10.3760/cma.j.cn115330-20230308-00102.
To explore the safety and reliability of retrosigmoid approach BONEBRIDGE implantation in patients with auricle reconstruction using skin expansion flap. A retrospective analysis was conducted on 43 congenital aural atresia cases (43 ears) who underwent BONEBRIDGE implantation from September 2019 to January 2023 in Beijing Tongren Hospital. 30 males and 13 females were included in this work. The implantation age was 9-36 years old (median age=10 y/o). All cases underwent auricle reconstruction surgery using the posterior ear flap expansion method, with 36 cases using the single expanded postauricular flap method and 7 cases using two-flap method. BONEBRIDGE implant surgery was performed during the third stage of auricle reconstruction or after all stages. The hearing improvements were evaluated by comparing the changes in pure tone hearing threshold and speech recognition rate of patients before and after BONEBRIDGE implantation. Routine follow-up was conducted to observe the hearing results and complications. SPSS 14.0 software was applied for data statistical analysis. All 43 patients healed well and had no surgical complications when discharge. The average bone conduction hearing threshold after surgery was (8.2±6.6) dBHL, and there was no statistically significant difference compared to the preoperative [(8.1±5.7) dBHL] (=0.95). After surgery, the threshold of hearing assistance with power on was significantly lower than that without hearing assistance [(32.8±4.6) dBHL vs (60.5±5.5) dBHL], and the difference was statistically significant (<0.001). The speech recognition rate of monosyllable words, disyllabic words and short sentences in quiet environment increased to 72%, 84%, and 98% respectively. The differences were statistically significant (<0.001). The speech recognition rate of monosyllabic words, disyllabic words, and short sentences in noise environment was significantly increased by 70%, 80%, and 92% respectively (<0.001). After a follow-up of 4 to 47 months (median=24 months), the hearing results were stable and the aesthetic outcomes were satisfying. One patient had delayed hematoma around coil of the implant. After aspiration and compressed dressing for one week, hematoma was not recurrent. For patients after auricle reconstruction using expanded postauricular flap, the preference of retrosigmoid approach is a good choice in terms of safety and reliability of operation, as well as aesthetic appearance.
探讨乙状窦后入路BONEBRIDGE植入术在采用皮肤扩张皮瓣进行耳廓再造患者中的安全性和可靠性。对2019年9月至2023年1月在北京同仁医院接受BONEBRIDGE植入术的43例先天性外耳道闭锁患者（43耳）进行回顾性分析。纳入30例男性和13例女性。植入年龄为9至36岁（中位年龄=10岁）。所有病例均采用耳后皮瓣扩张法进行耳廓再造手术，其中36例采用单耳后扩张皮瓣法，7例采用双耳后皮瓣法。BONEBRIDGE植入手术在耳廓再造第三阶段或所有阶段完成后进行。通过比较患者在BONEBRIDGE植入前后的纯音听力阈值和言语识别率变化来评估听力改善情况。进行常规随访以观察听力结果和并发症。应用SPSS 14.0软件进行数据统计分析。43例患者出院时均愈合良好，无手术并发症。术后平均骨导听力阈值为（8.2±6.6）dBHL，与术前[（8.1±5.7）dBHL]相比差异无统计学意义（=0.95）。术后开机助听阈值明显低于未助听时[（32.8±4.6）dBHL对（60.5±5.5）dBHL]，差异有统计学意义（<0.001）。安静环境下单音节词、双音节词和短句的言语识别率分别提高到72%、84%和98%。差异有统计学意义（<0.001）。噪声环境下单音节词、双音节词和短句的言语识别率分别显著提高70%、80%和92%（<0.001）。随访4至47个月（中位时间=24个月）后，听力结果稳定，美学效果满意。1例患者植入体线圈周围出现迟发性血肿。经抽吸及加压包扎1周后，血肿未复发。对于采用耳后扩张皮瓣进行耳廓再造的患者，乙状窦后入路在手术安全性和可靠性以及美学外观方面是一种不错的选择。
