Correlation between microtia and temporal bone malformation evaluated using grading systems.
Correlation between microtia and temporal bone malformation evaluated using grading systems.
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DOI：
10.1001/archotol.131.4.326
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发表时间：
2005-04
期刊：
影响因子：
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通讯作者：
S. Ishimoto;Ken Ito;T. Yamasoba;K. Kondo;S. Karino;H. Takegoshi;K. Kaga
中科院分区：
文献类型：
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作者：
S. Ishimoto;Ken Ito;T. Yamasoba;K. Kondo;S. Karino;H. Takegoshi;K. Kaga
目的应用客观分级系统评价日本患者颞骨异常与小畸形严重程度的关系。设计1992年至2003年间进行的回顾性病例系列研究。学术，三级保健，转诊医疗中心。患者109例日本患者142耳，其中男85例，女24例，平均年龄12.8岁[范围2-36岁]。主要观察指标：根据马克思分级法对小脑症的严重程度进行分级。颞骨发育异常通过计算机断层扫描（CT）评分系统进行评估，该评分系统是在Jahrsdoerfer及其同事使用的系统之后改进的，使用颞骨高分辨率CT扫描。使用非参数统计方法评估从这两个分级系统获得的分数之间的相关性。结果在我们的日本患者中观察到男性优势和双侧病例发生率约为30%。单侧和双侧病例小脑的严重程度无显著差异。CT评分系统中+/- SEM平均总分（满分，10分）为：I级微畸形7.9 +/- 0.4分，II级6.6 +/- 0.6分，III级6.4 +/- 0.3分；总分与小脑评分呈负相关。耳廓的发育与中耳空间的通气显著相关，但与听骨发育或椭圆形/圆形窗口的形成无关。根据CT评分系统（> - 5分），可接受手术的比例为：I级小体缺失79%，II级小体缺失52%，III级小体缺失65%。结论日本小耳症患者“耳廓发育越好，中耳发育越好”的原则得到了证实；然而，即使是II/III级小畸形，超过一半的患者被认为适合闭锁手术。
OBJECTIVE To evaluate the relationships between temporal bone abnormalities and the severity of microtia in Japanese patients using objective grading systems. DESIGN Retrospective case series study conducted between 1992 and 2003. SETTING Academic, tertiary care, referral medical center. PATIENTS One hundred forty-two ears of 109 Japanese patients (85 male and 24 female patients; mean age, 12.8 years [range, 2-36 years]) with microtia. MAIN OUTCOME MEASURES The severity of microtia was classified according to Marx classification. Developmental abnormalities of the temporal bone were evaluated by a computed tomographic (CT) scoring system modified after the system used by Jahrsdoerfer and colleagues, using high-resolution CT scans of the temporal bone. Correlations between the scores obtained from these 2 grading systems were evaluated using a nonparametric statistical method. RESULTS Male preponderance and incidence of bilateral cases of approximately 30% were observed in our Japanese patients with microtia. There was no significant difference in the severity of microtia between unilateral and bilateral cases. The mean +/- SEM total points in the CT scoring system (full marks, 10) was 7.9 +/- 0.4 for grade I microtia, 6.6 +/- 0.6 for grade II, and 6.4 +/- 0.3 for grade III; the total points correlated inversely with the microtia grade. Development of the auricle correlated significantly with aeration in the middle ear spaces but not with ossicular development or formation of the oval/round windows. Proportion of acceptable surgical candidates according to the CT scoring system (>5 points) was 79% for grade I microtia, 52% for grade II microtia, and 65% for grade III microtia. CONCLUSION The principle "the better developed the auricle, the better developed middle ear" was confirmed in Japanese patients with microtia; however, even with grade II/III microtia, more than half of the patients were considered suitable for atresia surgery.