先天性小耳畸形治疗技术体系的构建  

Establishment of a technical system for the treatment of congenital microtia

作　　者：章庆国 ZHANG Qingguo(nd Ear Reconstruction Department of Plastic Surgery,Peking Union Medical College,Plastic Surgery Hospital,Chinese Academy of Medical Sciences,Beijing 100144,China)

机构地区：[1]中国医学科学院整形外科医院外耳整形再造二科,北京100144

出　　处：《中国美容整形外科杂志》2023年第8期449-451,463,共4页Chinese Journal of Aesthetic and Plastic Surgery

摘　　要：先天性小耳畸形因畸形复杂,其治疗也相对复杂。笔者总结了中国医学科学院整形外科医院章庆国耳再造团队、张智勇颅颌面团队以及北京同仁医院赵守琴听觉治疗团队联合治疗该疾病的经验,并初步建立了联合治疗技术体系。该体系通过对小耳畸形患者术前多学科联合评估畸形的特点并建立个体化的联合治疗方案。治疗原则是以耳郭再造优先并以耳后乳突区皮肤、肋软骨长度和宽度等条件确定耳郭再造具体的手术方案,如两次法耳郭再造、部分扩张皮瓣法耳郭再造、完全扩张皮瓣法耳郭再造等。根据颅面畸形的程度确定耳郭再造与颌骨延长在儿童期可同期完成,可增加颌骨骨量,改善咬平面的对称性。根据中耳畸形的程度选择听觉治疗的方案,如外耳道重建和听小骨成形、骨桥或声桥植入等,通常可在耳郭再造的最后一期与听觉治疗同期完成。Microtia is characterized by complicated deformities,making its treatment a huge challenge for plastic surgeons.This study summarized the multi-team experience in the joint treatment of microtia,on which the joint treatment system was initially established.It is a collaborative effort between three teams to provide the joint treatment,including the auricular reconstruction team led by Zhang Qingguo and the craniomaxillofacial surgery team led by Zhang Zhiyong from the Plastic Surgery Hospital of Chinese Academy of Medical Sciences,and the auditory rehabilitation team led by Zhao Shouqin from the Department of Otolaryngology Head and Neck Surgery of Beijing Tongren Hospital.In this system,the results of a joint multidisciplinary preoperative assessment and deformity characteristics are used to develop individualized treatment plans for microtia patients.Generally,the first step is to make a surgical plan for ear reconstruction.This is mainly based on the skin condition of the retroauricular mastoid region and the length and width of the costal cartilage.The optional surgical methods include modified two-step method,partial expansion flap method and completely expanded flap method.Secondly,mandibular distraction can be performed concurrently with ear reconstruction if facial asymmetry and stomatognathic system dysfunction necessitate it.Last but not least,the surgical plan for hearing reconstruction,such as external auditory canal plastic surgery,tympanoplasty and implantation of a vibrant soundbridge or a bone-anchored hearing aid,depends on the extent of middle ear deformity and is usually completed concurrently with auditory treatment in the final phase of ear reconstruction.

关 键 词：小耳畸形 耳郭再造术 颌骨延长术 听觉治疗 

分 类 号：R764.7[医药卫生—耳鼻咽喉科]