Selection and application in the approach of Bonebridge implantation for bilateral congenital malformation of external and middle ear: selection and application
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摘要: 目的 根据双侧外中耳畸形患者在骨桥植入术前是否已行耳廓再造术，采用不同的手术方案完成骨桥植入，探讨个性化外形及听力重建的可行性。 方法 对35例双侧外中耳畸形患者制定个体化骨桥植入及耳廓再造综合手术计划，完成单侧骨桥植入术。6例患者采用一侧骨桥植入，对侧同期行耳后皮肤扩张器植入术；7例患者于自体肋软骨耳廓再造术第二期同期行骨桥植入术；22例患者于耳廓再造术后行骨桥植入术。 结果 35例患者均未发生术中并发症，术后无面瘫、眩晕、耳鸣、脑脊液漏等并发症发生。1例患者术后发生植入体表面皮肤感染，取出骨桥植入体7个月后于同侧再次行骨桥植入术，随访16个月无并发症发生。 结论 根据患者个体情况个性化选择不同的骨桥植入手术方式，有利于获得理想的外形和听力效果。Abstract: Objective According to whether auricle reconstruction has been performed before the implantation of Bonebridge, the different surgical plan of combination of ear reconstruction and hearing rehabilitation with Bonebridge were respectively applied for the individuals with congenital outer and middle ear malformation. The study aim to explore the feasibility of personalized comprehensive treatment of congenital outer and middle ear malformation. Methods We developed individualized surgical plans of Bonebridge implantation and auricular reconstruction for 35 patients with bilateral external and middle ear malformation. Six patients underwent Bonebridge implantation on one side, and the post-auricular skin expander implantation on the other sidesimultaneously; seven patients underwent Bonebridge implantation at the same time as the second stage of auricular reconstruction; twenty-two patients had their Bonebridge implantations performed after the reconstruction of the auricles. Results No intraoperative complications occured in 35 patients. No facial paralysis, vertigo, tinnitus and cerebrospinal fluid leakage was reported. One patient had skin infection after Bonebridge implantation. The Bonebridge was removed and 7 months later and the Bonebridge implantation was re-performed on the same side. No complication occurred after 16 months of follow-up. Conclusion According to the individual condition of the patients, different surgical plans of Bonebridge implantation and auricular reconstruction can be selected personally, which is beneficial to obtain the ideal aesthetic and hearing outcome.
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表 1 35例患者一般情况资料
例序 性别 骨桥植入时
年龄/岁综合征 耳廓畸形Marx分级
(右耳/左耳)平均听阈
/dB HL骨桥植入前手术史 植入
侧别骨桥植入
手术方案1 女 11.5 无 Ⅲ/Ⅰ 61.25 无 右 A 2 男 10.5 无 Ⅲ/Ⅱ 67.50 双侧耳廓再造 左 C2 3 男 13.5 无 Ⅲ/Ⅲ 68.75 左侧耳廓再造术 右 B2 4 男 7.0 Treacher Collins
综合征Ⅲ/Ⅰ 66.25 无 左 A 5 女 7.0 无 Ⅲ/Ⅲ 68.75 左侧耳廓再造术 右 B2 6 男 8.5 无 Ⅲ/Ⅲ 72.50 双侧耳廓再造术 左 C2 7 男 18.5 无 Ⅲ/Ⅱ 67.50 双侧耳廓再造术 右 C2 8 女 8.5 无 Ⅲ/Ⅰ 63.75 双侧耳廓再造术 右 C2 9 男 9.0 无 Ⅲ/Ⅲ 63.75 双侧耳廓再造术 左 C2 10 女 7.5 Goldenhar综合征 Ⅳ/Ⅰ 63.75 无 右 A 11 男 9.5 无 Ⅲ/Ⅲ 67.50 左侧耳廓再造术 右 B2 12 男 10.0 无 Ⅲ/Ⅲ 76.25 双侧耳廓再造术 左 C1 13 女 11.0 无 Ⅲ/Ⅲ 68.75 双侧耳廓再造术+右侧耳道再造 右 C2 14 男 9.5 无 Ⅲ/Ⅲ 71.25 双侧耳廓再造术 右 C2 15 男 8.5 无 Ⅲ/Ⅲ 73.75 双侧耳廓再造术+右侧耳道再造 左 C2 16 男 8.5 无 Ⅲ/Ⅲ 65.00 双侧耳廓再造术+左侧耳道再造 右 C2 17 男 9.5 无 Ⅲ/Ⅲ 65.00 右侧耳廓再造术 左 A 18 女 11.5 无 Ⅲ/Ⅲ 72.50 左侧耳廓再造术 右 B2 19 男 8.0 无 Ⅲ/Ⅱ 68.75 双侧耳廓再造术 右 C1 20 男 7.0 复合畸形 Ⅱ/Ⅲ 68.75 双侧耳廓再造术 左 C1 21 女 8.5 无 Ⅰ/Ⅲ 61.25 无 右 A 22 女 7.5 无 Ⅲ/Ⅲ 71.25 双侧耳廓再造术 右 C2 23 女 9.0 无 Ⅲ/Ⅲ 73.75 双侧耳廓再造术 左 C2 24 女 12.5 无 Ⅲ/Ⅲ 71.25 双侧耳廓再造术 右 C2 25 男 26.5 无 Ⅲ/Ⅲ 72.50 双侧耳廓再造术 右 C1 26 男 27.0 Treacher Collins
综合征Ⅰ/Ⅰ 68.75 无 右 A 27 男 18.0 无 Ⅲ/Ⅲ 71.25 左侧耳廓再造术 右 B2 28 男 16.0 无 Ⅱ/Ⅲ 68.75 双侧耳廓再造术 左 C2 29 男 12.0 无 Ⅲ/Ⅲ 68.75 双侧耳廓再造术 左 C2 30 男 17.5 无 Ⅲ/Ⅲ 72.50 双侧耳廓再造术 右 C2 31 女 14.5 无 Ⅲ/Ⅲ 68.75 左侧耳廓再造术 右 B2 32 女 13.0 无 Ⅲ/Ⅲ 73.75 双侧耳廓再造术 右 C1 33 女 6.0 复合畸形 Ⅲ/Ⅲ 68.75 右侧耳廓再造术 左 B2 34 男 10.0 无 Ⅲ/Ⅲ 71.25 双侧耳廓再造术 右 C1 35 女 11.0 无 Ⅲ/Ⅱ 68.75 双侧耳廓再造术 右 C1 
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