薄切しない軟骨膜/軟骨島状弁を用いた鼓室形成術

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  • 中江 進
    社会医療法人生長会ベルランド総合病院耳鼻咽喉科・頭頸部外科

書誌事項

タイトル別名
  • Cartilage Tympanoplasty Using a Perichondrium/Full-Thickness Cartilage Island Flap
  • 臨床 薄切しない軟骨膜/軟骨島状弁を用いた鼓室形成術
  • リンショウ ウスギリ シナイ ナンコツマク/ナンコツ シマジョウベン オ モチイタ コシツケイセイジュツ

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<p>Grafting of cartilage has been recognized as useful for tympanoplasty of retracted ear drums or ear drums with high-risk perforation.</p><p>During cartilage tympanoplasty, the cartilage for the graft is generally sliced very thin so as to have it much the ear drums in morphology and functionality.</p><p>However, thinly sliced cartilage often curls unacceptably towards the side with perichondrium, making placement difficult and less precise.</p><p>A perichondrium/cartilage island flap made from full-thickness tragal cartilage is an excellent graft, as it allows a better fit in the middle ear and never curls.</p><p>We used a tragal perichondrium/full-thickness cartilage island flap for cartilage tympanoplasty in 26 cases of high-risk perforations of the tympanic membrane. The perichondrium, backed with full-thickness cartilage, led to rapid epithelialization of the ear drum.</p><p>After removing a small V-shaped cartilage at the top of the flap to accommodate the short process and handle of the malleus, we placed the island flap in an overlay fashion.</p><p>The closure rate of the tympanic membrane in the patients who underwent tympanoplasty using a tragal perichondrium/cartilage island flap was 100%. According to the guideline for reporting hearing results for middle ear and mastoid surgery (2010) proposed by the Japan Otological Society, the hearing results of tympanoplasty using a full-thickness tragal island flap were better than those of surgery using a thinly sliced cartilage.</p><p>Because use of a full-thickness cartilage allows more precise reconstruction and better hearing results than that of thinly sliced cartilage, we recommend the use of full-thickness grafts for cartilage tympanoplasty.</p>

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