Farrior J B
Laryngoscope. 1983 Jan;93(1):75-86. doi: 10.1288/00005537-198301000-00015.
The endaural, postauricular and transmeatal incisions are the most commonly used surgical approaches for tympanoplasty. Each incision used in tympanoplasty has its own advantages and limitations so that no single approach is the best approach for all tympanic membrane perforations. The incision selected for tympanoplasty should be determined by the location and extent of disease. Forty adult temporal bones were studied to understand the limiting factors for each surgical approach used in tympanoplasty. The external endaural incision has been modified to permit easier visualization of the crescentic endomeatal canal incisions. The anterior external endaural incision allows direct exposure of temporalis fascia, the external meatus, bony canal and perforation involving the posterior tympanic membrane and ossicular chain. The postauricular incision gives direct exposure of the anterior tympanic membrane with preservation of the anterior canal wall skin. The transmeatal approach should be reserved for smaller central perforations with limited risk for squamous ingrowth into the middle ear. In the transmeatal tympanoplasty, the ear canal should permit the use of a speculum large enough to expose the entire perforation.
耳内、耳后和经耳道切口是鼓室成形术最常用的手术入路。鼓室成形术中使用的每种切口都有其自身的优缺点，因此没有一种单一的入路适用于所有鼓膜穿孔。鼓室成形术选择的切口应根据疾病的部位和范围来确定。研究了40块成人颞骨，以了解鼓室成形术中每种手术入路的限制因素。耳内切口已进行改良，以便更易于观察新月形的耳道内切口。耳内前切口可直接暴露颞肌筋膜、外耳道、骨管以及涉及鼓膜后部和听骨链的穿孔。耳后切口可直接暴露鼓膜前部，同时保留外耳道前壁皮肤。经耳道入路应保留用于较小的中央穿孔，鳞状上皮向内生长至中耳的风险有限。在经耳道鼓室成形术中，耳道应允许使用足够大的窥镜以暴露整个穿孔。
