摘要
目的 通过手术方法的改进探讨自然的耳廓亚结构构建在耳廓再造中的应用.方法 对2011年3月至2014年3月253例（257耳）先天性小耳畸形患者施行耳廓再造手术,其中腊肠型182耳,耳垂型15耳,耳甲腔型60耳.手术方法的改进主要为在雕刻对耳轮上脚时通过增加对耳轮上脚的宽度,在上脚软骨两侧雕刻斜坡使其平滑过渡,同时在底板上挖槽,软骨两侧边缘的厚度与底板凹槽的深度一致,以此实现对耳轮复合体与底板的自然过渡与衔接;对耳轮下脚的宽度约为上脚的1/3,下脚尽量狭窄而突出;对耳轮两侧雕刻成斜坡状,使对耳轮稳坐于底板凹槽,并与底板自然衔接.术后随访6 - 30个月,平均11个月.结果 患者对耳轮及上下脚、耳舟、三角窝均获得了相对自然的形态,再造耳廓的整体轮廓更加协调.患者及家属的满意度进一步提高.结论 自然的耳廓亚结构构建是耳廓再造未来的发展方向.对耳轮及上下脚位于耳廓中心位置,其自然的构建可以使耳舟、三角窝、耳甲腔的形态更加自然逼真,使再造耳廓整体形态更加完美.
Objective Previous literatures have reported favorable results in ear reconstruction.Many details in fabricating cartilage framework have been paid much attention.Whereas,many patients still complain about unnatural contours.This article is to provide a new technique to solve some of the problems.Methods A total of 253 patients underwent reconstruction using the modified technique from 2011 to 2014.In fabricating the complex of antihelix,the authors modified the prior method.Instead of sculpting a sharp Y-shaped cartilage graft for projecting the prominent structures,the authors increased the width of the superior crura,sculpted a gentle slope in the both sides of superior crura,simultaneously carved a groove in the base frame to join with the carved attachment smoothly.The width of inferior crura was about one third of the superior crura width,and the iuferior crura was narrow and prominent.A gentle slope was carved on the antihelix and a groove was carved on the base frame for the antihelix to sit on.Results Four cases have been selected to illustrate the favorable results of this technique.Due to the modified details,the superior crura,inferior crura,antihelix and the structures around them,in these cases,show natural contours,and provide a coordinated figure to the integrity of reconstructed ear.Conclusions Antihelix complex is one of the most important structures for creating a natural auricle.The natural superior and inferior crura and antihelix can enhance theimpression of a harmonious shape,and acquire an increased satisfaction for both patients and surgeons.
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2015年第3期187-191,共5页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
基金
国家自然科学基金面上项目（81372081）
上海市重中之重临床医学中心建设项目
关键词
耳廓
先天畸形
修复外科手术
Ear auricle
Congenital abnormalities
Reconstructive surgical procedures
