Temporal breach management in chronic otitis media
Temporal breach management in chronic otitis media
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慢性中耳炎的颞间隙处理
DOI：
10.1007/s00405-008-0633-9
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发表时间：
2008
影响因子：
2.6
通讯作者：
F. Tankéré
中科院分区：
文献类型：
--
作者：
C. Bodénez;I. Bernat;E. Vitte;G. Lamas;F. Tankéré
在1991年至2007年3月在巴黎Pitié-Salpêtrière医院耳鼻喉头颈外科进行的一项回顾性研究中，我们确定了治疗慢性中耳炎耳膜破裂的手术方法。42例病例中，76%为慢性中耳炎合并胆脂瘤，24%为慢性中耳炎无胆脂瘤。28例采用联合入路，8例采用单一的表上入路，6例采用经乳突入路。共有33%的病例显示脑膜膨出或脑膜脑膨出通过联合或经颅上入路治疗。36例经联合入路或经上入路长期随访，平均43个月后无复发或神经/脑膜感染。本研究中有两例患者随访失败。其中3例已采用下入路手术治疗体表上裂。采用下入路手术的6例患者中有2例术后出现脑脊液耳漏。联合入路或表膜上入路似乎最适合于治疗表膜上或复发性被膜断裂，以及对脑膜病变的精确检查和修复。耳膜破裂的治疗可以在一次干预中实现，即使中耳有持续的感染。乳突入路只有在没有神经/脑膜病变的情况下才可用于下突缺损。
In a retrospective study performed at the Otolaryngology, Head and Neck Surgery Department, Pitié-Salpêtrière Hospital, Paris from 1991 to March 2007, we determined surgical procedures for the treatment of tegmen breaches in chronic otitis media. Forty-two cases were examined: 76% corresponded to chronic otitis media with cholesteatoma, and 24% to chronic otitis media without cholesteatoma. Twenty-eight cases were operated using a combined approach, eight cases using a single suprapetrous approach, and six cases using a transmastoid approach. A total of 33% of the cases showed a meningocele or a meningoencephalocele treated through either a combined or a suprapetrous approach. No recurrence or neural/meningeal infectious involvement was found after a mean time of 43 months in the 36 long-term follow-up cases operated through the combined or suprapetrous approaches. Two cases included in the study were a loss to follow-up. Three of the former cases had already been operated for supracentimetric fissure using lower approach. Two out of the six patients operated using lower approach presented post surgery cerebrospinal fluid otorrhea. Combined or suprapetrous approaches seem to be best adapted to the treatment of supracentimetric or recurrent tegmen breaches, as well as to the precise examination and repair of meningeal lesions. Treatment for tegmen breach can be achieved in a single intervention, even when there is an ongoing infection of the middle ear. The mastoid approach should be used only for infracentimetric defects when there is no neural/meningeal lesion.