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摘要: 目的 探讨在复杂先天性耳畸形患者中，经面神经后径路完成振动声桥(VSB)圆窗植入手术的可能性。方法 本研究回顾了4例先天性耳畸形患者资料，因面神经乳突段重度前移遮盖圆窗，致使无法经常规面隐窝径路植入VSB，后采用经面神经后径路暴露圆窗龛，顺利完成VSB圆窗植入术。结果 4例患者均经面神经后径路顺利植入VSB，术后VSB助听状态下的自由声场阈值及言语识别率均较术前明显改善，均未出现术中或术后并发症。结论 在圆窗振动成型术中，当面神经畸形遮盖圆窗，导致常规经面隐窝径路无法暴露圆窗龛时，可尝试经面神经后径路完成手术。Abstract: Objective To investigate the specific retrofacial approach for application of vibrant soundbridge (VSB) to the round window (RW) in patients with complex congenital ear malformation.Methods The clinical information of four patients with congenital ear malformation were retrospectively analyzed. VSB were implanted unilaterally in these four patients via a retrofacial approach. During the operation, it is difficult to reach the RW via a classic posterior tympanotomy pathway, due to the mastoid portion of FN positioned anteriorly severely. So the round window niche was identified through a retrofacial pathway and the round window vibroplasty was completed.Results All four patients received the round window vibroplasty successfully via retrofacial approach. Satisfied auditory benefit were confirmed after surgery. Compared with the preoperative data, clear improvements in both hearing threshold and the speech discrimination score were confirmed after VSB activation. Neither intraoperative nor postoperative surgical complications was observed in all patients.Conclusion During the round window vibroplasty, when it was unable to access the RW through the classic facial recess pathway due to the aberrant facial nerve, the retrofacial approach could be a valid and feasible alternative approach.
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Key words:
- ear malformation /
- retrofacial /
- approach /
- VSB /
- implantation
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表 1 患者的基本资料
例序 性别 年龄/岁 诊断 术耳 Jahrsdoerfer评分 术前PTA阈值 BC/dB HL AC/dB HL 1 男 4.5 CAA 左 3 5.00 55.00 2 男 7 CAA 右 6 3.75 56.25 3 男 20 CAA 右 6 2.50 53.75 4 男 15 先天性中耳畸形(前庭窗闭锁) 右 无 5.00 55.00 
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表 2 患者HRCT资料
例序 锤骨 砧骨 镫骨 面神经 前庭窗 颞颌关节 乙状窦 鼓室段 乳突段 1 缺如 长脚粗大 缺如 低位、遮窗 重度前移，遮盖圆窗 正常 后位 前移 2 发育不全 形态异常 细小 低位、遮窗；骨管缺如 重度前移，遮盖圆窗 正常 轻度后位 轻度前移 3 缺如 形态异常 显示不良 低位、遮窗 重度前移，遮盖圆窗 正常 正常 前移 4 正常 正常 细小，显示不清 低位、遮窗；骨管缺如；与镫骨弓紧贴 重度前移，遮盖圆窗 闭锁 正常 前移
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表 3 ≤ 12岁患者的术前及术后VSB助听状态下平均SDS(%) MLNT测试结果
例序 术前平均PTA阈值/dB HL VSB助听平均阈值/dB HL 术前SDS(易/难) 术后VSB助听SDS(易/难) BC AC 单音节 双音节 单音节 双音节 1 5 55 31.25 35/35 50/35 85/60 85/75 2 3.75 56.25 35 60/20 65/62.5 80/65 100/85
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表 4 >12岁患者的术前及术后VSB助听状态下平均SDS(%) MSTM测试结果
例序 术前PTA平均阈值/dB HL 术后VSB助听平均阈值/dB HL 65-dB SPL声场(术前/VSB助听) 80-dB SPL声场(术前/VSB助听) BC AC 单音节词 双音节词 单音节词 双音节词 3 2.5 53.75 33.75 26/76 81/96 74/92 95/100 4 5.0 55.00 32.5 10/58 10/71 14/68 40/80
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