Transcranial fossa approach Eustachian tube plasty

Treatment of diseases: adhesive otitis media Indication Transcranial fossa eustachian tube angioplasty is applicable to: 1. Chronic non-suppurative or adhesive otitis media, preoperative X-ray angiography or sacral CT showed that the isthmus of the eustachian tube was completely obstructed and required tympanoplasty. 2. Tumors that originate in or around the eustachian tube, such as meningioma, hemangioma, and the like. 3. Preoperative preoperative acoustic impedance test, Valsalva drinking water or catheter ventilation can determine the eustachian tube dysfunction. Contraindications 1. The tympanic lesion has an acute infection; the systemic chronic disease, the resistance is weakened. 2. Hearing examination is a sensorineural hearing loss. 3. The acute inflammation of the nose, sinuses and nasopharynx is unhealed. If there is inflammation in the skin of the operation area, surgery should be suspended. Preoperative preparation 1. Cranial fossa surgical instruments, tympanoplasty instruments, eustachian tube whale bone probes. 2. Completely shave your hair before surgery. 3. Preoperative benzobarbital 0.09g, enema. 4. Atropine sulfate 0.5mg into the operating room before subcutaneous injection (adult amount). 5. Fast food and water in the morning. Surgical procedure 1. The incision was anesthetized with 1% lidocaine containing 1:1000 adrenaline infiltration. For injections and incisions, please refer to "Cranial fossa into the nerve decompression of the road". 2. Separate the dura mater. Separate the dura mater from the bottom of the cranial fossa with a stripper and keep it intact. If there is tear, it can cause long-term cerebrospinal fluid leakage. After the dura mater is separated, the hook is used to lift the cranial fossa to expose the bottom of the cranial fossa. The following signs are recognized: 1 The facial nerve cleft through the superficial nerve of the rock. In most cases, the knee ganglion is covered with bone, about 5% to 15% of the knee nerve. The section is exposed without bone coverage; 2 the spine hole of the middle meningeal artery is the mark of the mouth of the eustachian tube; 3 the arched bulge is located behind the spine hole and is the upper semicircular canal mark. 3. Before the exposure, the top of the tympanic cavity and the eustachian tube are drilled with the diamond drill along the rocky superficial nerve to expose the bone, expose the knee ganglia and facial nerve, tympanic crypt and middle ear, remove the bone of the tympanic anterior tympanic cavity, and then enter the eustachian drum. Tube to the isthmus, and then remove the fibrous tissue or hyperplastic bone in the tube. 4. Insert a 2mm diameter silicone or plastic tube into the cartilage of the eustachian tube and expose it to the nasopharynx opening. The outer end is placed at the mouth of the eustachian tube, so that the normal mucosa of the eustachian can grow along the silicone or plastic tube. The ends of the lumen are thick silk lines, which are respectively taken out by the perforation of the tympanic membrane, fixed in the external auditory canal, and are taken out from the pharyngeal opening and fixed in the nasal anterior hole through the nasal cavity. 5. Place a bone piece or a small silica gel plate and a diaphragm of the diaphragm to cover the top of the tympanic cavity to prevent dural drooping and adhesion to the bone. 6. Remove the hook to reset the cerebral temporal lobe of the bulging part, reset and drill the remaining humeral bone piece, suture it with silver wire, suture the wound with the gut and silk thread, and cover with sterile gauze. After eustachian tube formation, the hearing has different degrees of improvement, but if the tympanic sound structure is more serious, it is necessary to use different surgical methods for hearing reconstruction after several months. complication 1. Damage to the dura mater caused by cerebrospinal fluid leakage or cerebral palsy. 2. Bleeding. 3. Damage to the ossicular chain and hearing loss. 4. Damage to the facial nerve.