The postnatal growth of the temporal bone and its implications for cochlear implantation in children.
The postnatal growth of the temporal bone and its implications for cochlear implantation in children.
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DOI：
10.3109/00016489309128539
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发表时间：
1993
期刊：
影响因子：
--
通讯作者：
M. Dahm;R. Shepherd;G. Clark
中科院分区：
文献类型：
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作者：
M. Dahm;R. Shepherd;G. Clark
在60具不同年龄的成人颞骨标本上，对颞骨的生后生长进行了直接的解剖学测量。将骨头解剖，就像使用后鼓室切开术方法进行耳蜗植入手术一样。在每块骨上确定了19个对人工耳蜗植入手术有影响的解剖/手术标志，并测量了这些点之间的距离。颞骨是一个复杂的结构，在发育学、解剖学和功能上都由四个不同的部分组成，它们在出生后都有独立的发育。内耳和中耳在出生时为成人大小。外耳道和颞骨的大部分部位都有明显的侧向生长。乳突的大小在各个方向上都增加了。然而，在面隐窝中，没有观察到出生后的生长。在出生和成年之间，直接在窦硬脑膜角和圆窗之间观察到平均12 mm（SD 5 mm）的生长，圆窗是接近接收器-刺激器植入部位和内耳电极入口点的标志。然而，如果电极导线固定在皮质固定部位，例如Macewen三角的后上点，则导线将生长约20 mm。这些结果表明，儿科人工耳蜗植入体设计包含可扩展的导线，以适应这种增长应允许长达25 mm的导线延长。相对于圆窗，砧窝没有显示出生长，并且被发现是靠近耳蜗的电极阵列的方便固定部位。从解剖学和手术的角度来看，在非常年幼的儿童中进行人工耳蜗植入是可行的，前提是电极阵列是固定的，并且设计适应于受控的导联线延长。
The postnatal growth of the human temporal bone was examined by direct anatomical measurements on 60 cadaver specimens of all ages. The bones were dissected as one would perform cochlear implant surgery using a posterior tympanotomy approach. Nineteen anatomical/surgical landmarks with implications for cochlear implant surgery were identified on each bone and the distance between these points measured. The temporal bone was found to be a complex structure, phylogenetically, anatomically and functionally consisting of four different parts with independent postnatal development. The inner and middle ears were adult size at birth. The external auditory canal and most parts of the temporal bone were subject to significant lateral growth. The size of the pneumatised mastoid increased in all directions. In the facial recess, however, no postnatal growth was observed. Between birth and adulthood an average of 12 mm (SD 5 mm) of growth was seen directly between the sino-dural angle and the round window, the landmarks approximating the implantation site for the receiver-stimulator and the electrode entry point into the inner ear. However, if an electrode leadwire is fixed at a cortical fixation site such as the posterosuperior point of Macewen's triangle, the leadwire would be subject to approximately 20 mm of growth. These results indicate that a paediatric cochlear implant design incorporating an expandable leadwire to accommodate this growth should allow up to 25 mm of leadwire lengthening. The fossa incudis showed no growth relative to the round window and was found to be a convenient fixation site for the electrode array close to the cochlea. From an anatomical and surgical point of view, cochlear implantation in very young children is feasible, provided the electrode array is secured and the design accommodates for controlled leadwire lengthening.