The pre-chorda and post-chorda tympani approach in endoscopic stapes surgery based on the chorda tympani nerve classification
The pre-chorda and post-chorda tympani approach in endoscopic stapes surgery based on the chorda tympani nerve classification
复制标题
基于鼓索神经分类的内镜镫骨手术中鼓索前和鼓索后入路
DOI：
10.1007/s00405-022-07547-9
复制
发表时间：
2022
影响因子：
2.6
通讯作者：
Kojima Hiromi
中科院分区：
文献类型：
--
作者：
Takahashi Masahiro;Motegi Masaomi;Yamamoto Kazuhisa;Yamamoto Yutaka;Kojima Hiromi
目的在大多数镫骨手术中，外耳道扩大后，将活塞插入鼓索神经后方（后鼓索入路; Post C）。虽然报告各不相同，但有些报告指出，超过60%的患者在手术后会出现舌症状。内窥镜手术可以允许神经的前入路（鼓索前入路; Pre C）。在此，我们提出了一个合适的方法，内镜镫骨手术的基础上分类的鼓索nerve.MethodsWe回顾性分析了2019年和2021年之间在我们的机构进行内镜镫骨手术的23例患者的病历。神经分类以前报告，修改神经分类（附着长型分为1类：0°内窥镜可见透镜状突，2类：不可见），选定方法（C前或C后），使用30°内窥镜和操纵神经（接触和牵引次数，有或没有吸引，有或没有错位或伸展和截肢，结果前C组损伤评分明显低于前C组（P < 0. 05（p< 0.05）;但是，在此情况下，由于后路错位时神经损伤的风险很高，因此并不是所有病例都采用这种入路。应用于分离和附着长1型，而带30°内窥镜的Pre C应用于附着长2型、附着短型、超短型和外耳道型。
PurposeIn most stapes surgeries, the posterior ear canal is enlarged and a piston is inserted posterior to the chorda tympani nerve (post-chorda tympani approach; Post C). Although reports vary, some indicate that more than 60% of the patients experience lingual symptoms following surgery. Endoscopic surgery may permit an anterior approach to the nerve (pre-chorda tympani approach; Pre C). Herein, we propose a suitable approach for endoscopic stapes surgery based on the classification of the chorda tympani nerve.MethodsWe retrospectively reviewed the medical records of 23 patients who underwent endoscopic stapes surgery at our institution between 2019 and 2021. The nerve classification previously reported, the modified nerve classification (attached long type is divided into Category 1: lenticular process is visible with 0° endoscope and Category 2: not visible), selected approach (Pre C or Post C), use of a 30° endoscope, and manipulation of the nerve (number of contacts and traction, with or without suction, with or without malposition or extension and amputation, and damage score) were evaluated.ResultsThe damage score was significantly lower in the Pre C group (p< 0.05); however, using this approach for all cases is not desirable owing to the high risk of damage to the nerve during posterior malpositioning.ConclusionThe Post C should be used for the detached and attached long 1 types, while the Pre C with a 30° endoscope should be used for the attached long 2, attached short, ultrashort, and external auditory canal types.