Black B
Royal Children's Hospital, Department of Otolaryngology, University of Queensland, Brisbane, Australia.
Am J Otol. 1998 Sep;19(5):551-7.
This study aimed to evaluate a chronology of techniques used to manage troublesome open mastoid cavities, with emphasis on the selection of the mastoidectomy elimination technique most appropriate to the case at hand.
The study design was a retrospective review of techniques used in 465 consecutive elimination cases.
The study was conducted at a single surgeon's private otologic practice.
Patients with mastoidectomy elimination who were treated from 1974-1996, including 55 patients with obliterations (cavity fill-in), 372 patients with reconstructions (canal wall repair), and 38 patients with ablations (external canal closure), requiring 823 procedures, were examined.
Clinical success and complication rates of the techniques studied were measured.
Optimal outcomes (89% successful) were recorded from hydroxylapatite reconstruction cases managed with canal revascularization (middle temporal flap) and cholesteatoma prevention (staging and composite grafts).
Obliteration is recommended only over noncholesteatomatous sites because of the risk of residual disease and the difficulty re-exploring these cases. Ablation is effective in selected, severely damaged cases. All ablation cases remained disease-free after surgery. Reconstruction is the preferred method when hearing restoration is required. Canal wall reconstruction required modifications to avoid complications from poor tissue vitality and cholesteatoma. These are outlined and discussed below.
本研究旨在评估用于处理棘手的开放乳突腔的技术年表，重点是选择最适合手头病例的乳突根治术消除技术。
研究设计为对465例连续消除病例中使用的技术进行回顾性分析。
研究在一位外科医生的私人耳科诊所进行。
对1974年至1996年接受乳突根治术消除治疗的患者进行了检查，包括55例闭塞术（腔填充）患者、372例重建术（耳道壁修复）患者和38例切除术（外耳道封闭）患者，共进行了823次手术。
对所研究技术的临床成功率和并发症发生率进行测量。
采用颞中皮瓣进行耳道血运重建及预防胆脂瘤（分期和复合移植）处理的羟基磷灰石重建病例取得了最佳效果（成功率89%）。
由于存在残留疾病风险以及再次探查这些病例的困难，仅建议在非胆脂瘤部位进行闭塞术。切除术在选定的严重受损病例中有效。所有切除病例术后均无疾病复发。当需要恢复听力时，重建术是首选方法。耳道壁重建需要进行改良以避免因组织活力差和胆脂瘤导致的并发症。以下将对此进行概述和讨论。
