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在乳突凿开术和鼓室成形术中保留外耳道后壁有两个优点:第一,消除潜在的乳突腔。第二,保留支持鼓膜的骨壁,便于施行鼓室成形术。这些优点已被应用联合进路手术所证实。由于外耳道后壁的存在,在采用联合进路手术方法时不能窥清中耳全部及难于窥清鼓窦。所以手术时在外耳道与乳突腔间保留一个分离的骨桥,可以起到术中视野清楚,术后又将两腔隔开的作用。Portmann和Guilford曾倡用术后将应该移去的骨桥复位,像游离的自体移植物那样。本文报告76例将“活动骨桥”向前移位以便进入中耳清除病灶及进行鼓室成形术,以后再将骨桥复位于正常位置。“活动骨桥”应附着于骨移植片前面的外耳道皮肤,以维持骨桥的血液供给。
Maintaining the posterior wall of the external auditory canal in mastoidotomy and tympanoplasty has two advantages: first, eliminating the potential mastoid cavity. Second, to preserve the tympanic membrane wall, easy to perform tympanoplasty. These advantages have been confirmed by the use of combined approach surgery. Due to the existence of the posterior wall of the external auditory meatus, we can not glimpse the middle ear completely and find it difficult to see the drum sinus when using the combined approach. Therefore, surgery in the external auditory canal and mastoid cavity to maintain a separate bone bridge, you can play a clear field of vision, postoperative separation of the role of the two chambers. Portmann and Guilford have advocated the replacement of the bridge of the bone that should be removed postoperatively, as with free autografts. This article reports 76 cases of “active bone bridge” to move forward in order to enter the middle ear to clear the lesion and tympanoplasty, and then the bone bridge in the normal position. “Active bone bridge” should be attached to the outer ear canal skin in front of the bone graft to maintain bone graft blood supply.