传导性耳聋合并鼓室段面神经畸形患者的听力重建技术  

The technique of hearing reconstruction in the cases of conductive hearing loss with malformed tympanic segment of facial nerve

作　　者：杨凤[1] 宋任东[1] 刘阳[1] 

机构地区：[1]保定市第二中心医院耳鼻喉科,河北省涿州市072750

出　　处：《中华医学杂志》2016年第5期384-388,共5页National Medical Journal of China

摘　　要：目的总结探讨传导性耳聋合并鼓室段面神经畸形患者的听力重建技术。方法总结海军总医院耳鼻喉科2010年7月至2015年3月期间临床资料完整的鼓室段面神经走形异常伴传导性耳聋患者10例，回顾性分析鼓室段面神经走行位置状态、砧镫骨及前庭窗畸形状态、听骨链重建方式，从胚胎解剖学和外科技术角度进行讨论分析。结果全部10例患者，男7例，女3例，年龄7～30岁，鼓室段面神经均裸露低垂，挤压镫骨或覆盖镫骨前庭窗区域，其中：3例镫骨完整，被面神经挤压，以部分听骨赝复物（PORP）重建听力；2例镫骨上结构消失，底板活动差，以全听骨赝复物（TORP）重建听力；3例前庭窗骨性闭锁，闭锁骨板钻孔后植入Piston听骨；2例前庭窗骨性闭锁，于耳蜗底转鼓阶起始段开窗植入TORP。全部患者无面神经损伤，无神经性听力损伤，无耳鸣，9例气导听力提高，1例鼓阶开窗者气导听力无提高。结论鼓室段面神经畸形挤压覆盖镫骨（底板）前庭窗区域，选择适当的手术方式，可以重建听力；耳蜗底转鼓阶开窗技术为面神经完全覆盖前庭窗的患者提供了又一外科选择。Objective To explore the technique of hearing reconstruction in the cases of conductive hearing loss with malformed tympanic segment of facial nerve. Methods Data of 10 cases from July 2010 to March 2015 were collected. The status of tympanic segment of facial nerve, malformed ossicles and the reconstructed methods of ossicular chain were analyzed and discussed based on the embryo anatomy and surgical technique. Results All facial nerves in 10 cases were exposed and drooping to stapes or cover the oval window. Three patients who had normal stapes, pushed by the exposed facial nerve, were reconstructed with partial ossicular replacement prostheses （PORP）. Two patients who had footplate, with partial fixation, were reconstructed with total ossicular replacement prostheses （TORP）. Three patients who had atresia of the oval window were implanted with Piston after being made hole in the atresia plate. Another two cases who had atresia of the oval window were implanted with TORP after promontory being drilled out. All cases had no injury of facial nerve and nervous hearing, and no tinnitus. Nine cases had conductive heating improvement, except one with promontory drilled out. Conclusions Patients who had conductive heating loss with malformed tympanic segment of facial nerve can be treated by the technique of hearing reconstruction. The fenestration technique in the bottom of the scala tympani of the basal turn provides us a new method for treating patients whose oval window was fully covered by malformed facial nerve.

关 键 词：耳畸形 先天性 面神经 卵圆窗 耳 镫骨 耳外科手术 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]