Peng J C, Hoppe F
Department of Otolaryngology, National Taiwan University Hospital.
Laryngorhinootologie. 1994 Jul;73(7):375-80. doi: 10.1055/s-2007-997156.
From the 1950s onwards ossicular bone autografts have been used to restore the middle ear sound conduction mechanism. Controversy still exists regarding the appropriateness of autologous ossicular bone grafts in chronic middle ear diseases. This communication is based on a study of 149 ossicles surgically removed from 120 patients with different ear diseases, at the Department of Otolaryngology, Head and Neck Surgery of the University of Wuerzburg. It is the object of this study to systematically investigate the histological findings in the ossicles in cholesteatoma and chronic suppurative otitis media, and also to try to assess their significance. For comparison the ossicles of traumatic subluxation and otosclerosis are also included in our material. In about one-fourth of the incidences of cholesteatoma, squamous epithelium is found adherent to the ossicles with subepithelial connective tissue of varying thickness separating the matrix from the involved ossicle so that the matrix is never in direct contact with the underlying bone. Osteomyelitis is shown in both groups. Bone resorption predominates in the complicated metaplastic process due to the action of osteoclasts irrespective of the cholesteatoma group or the chronic otitis media group. Bone erosion is evident not only on the surface of the ossicles but also in the bone. On the other hand, ossicles in the groups of traumatic subluxation and otosclerosis remain histologically normal without evidence of pathologic changes. On the basis of these histological observations and on account of the high probability of adherent squamous epithelium in our opinion autologous ossicles from cholesteatoma and chronic suppurative otitis media should not be used in reconstructive middle ear surgery.
从20世纪50年代起，听小骨自体骨移植就被用于恢复中耳的声音传导机制。关于自体听小骨移植在慢性中耳疾病中的适用性，目前仍存在争议。本报告基于一项对149块听小骨的研究，这些听小骨是从维尔茨堡大学耳鼻咽喉头颈外科的120例患有不同耳部疾病的患者身上手术摘除的。本研究的目的是系统地调查胆脂瘤和慢性化脓性中耳炎患者听小骨的组织学发现，并试图评估其意义。为作比较，我们的材料中还包括了外伤性半脱位和耳硬化症患者的听小骨。在大约四分之一的胆脂瘤病例中，发现鳞状上皮附着于听小骨，其下上皮结缔组织厚度不一，将基质与受累听小骨分隔开来，因此基质从未与下方的骨质直接接触。两组均显示有骨髓炎。由于破骨细胞的作用，在复杂的化生过程中，骨质吸收占主导地位，无论胆脂瘤组还是慢性中耳炎组均如此。骨质侵蚀不仅在听小骨表面明显，在骨质内部也很明显。另一方面，外伤性半脱位和耳硬化症组的听小骨在组织学上保持正常，无病理改变迹象。基于这些组织学观察结果，并且鉴于鳞状上皮附着的可能性很大，我们认为来自胆脂瘤和慢性化脓性中耳炎的自体听小骨不应在中耳重建手术中使用。
