Tympanoplasty

The tympanic membrane is a very special membrane that concentrates three embryonic developmental structures in the body, in the middle and outside, in a thickness of less than 1 mm. It forms the outer wall of the middle ear, and the air inside the wall is air to generate vibration and hearing. When the tympanic membrane is perforated due to external force, thorns, inflammation, etc., just like a broken drum does not sound drums, people can't hear the sound. After perforation of the tympanic membrane, inflammatory pathological changes occur in the middle ear tissue, and it is also susceptible to infection by external bacteria. Therefore, the best practice is to replenish the tympanic membrane, that is, tympanic membrane repair. Treatment of diseases: tympanic membrane perforation tympanic membrane trauma Indication 1. Chronic suppurative otitis media caused by perforation of the tympanic membrane, dry ears for more than 2 months, including the tympanic mucosal surface. 2. Traumatic tympanic membrane perforation, after 3 months of observation, can not self-heal. 3. There are no squamous epithelium and occult cholesteatoma in the tympanic cavity. 4. Hearing test shows that the ossicular chain and the two windows function properly. 5. Eustachian tube function is good. Contraindications 1. Confirmation of eustachian tube atresia, but does not include obstruction near the tympanic opening. 2. People with acute upper respiratory tract infection or chronic inflammation of the nose and sinus. 3. Suffering from more serious systemic diseases such as coagulopathy, severe hypertension and diabetes. Preoperative preparation 1, mastoid film; 2. Electrical audiometry and inspection; 3, sound guide anti-cloudy listening; 4, the rest with simple mastoid surgery. Surgical procedure (A) cauterization method folding 1, the cotton sheet soaked with 2% tetracaine solution is attached to the surface of the remaining tympanic membrane for 15-20min. 2. Disinfect the external auditory canal and the remaining tympanic membrane with a small cotton swab with 0.1% thimerosal or 70% ethanol. Do not allow the disinfectant to overflow into the drum. 3, using a thin probe to make a small cotton swab, sputum with 50% trichloroacetic acid solution, carefully applied to the edge of the perforation, so that the perforation edge appears 0.5-1.0mm white burning ring, in order to remove the epithelium and scar at the edge of the perforation, Promote tympanic membrane regeneration. After cauterization, a thin cotton sheet containing 5% urea solution was pressed to promote the tympanic membrane growth at the perforation. After the operation, 5% urea solution was instilled three times a day. After one week, the cotton piece was taken out. If the perforation failed to close, it could be cauterized again until it was closed. The cauterization method often needs to be repeated several times and should be patiently adhered to. (B) scraping method folding 1, 2% tetracaine wet cotton sheet attached to the surface of the residual tympanic membrane 15-20min. 2. Disinfect the external auditory canal and tympanic membrane surface with a cotton swab dipped in 0.1% thimerosal or 70% ethanol. 3. Squeeze the epithelium of the perforated edge and the epithelium at the edge of the perforation at 1-2 mm, deep into the fibrous layer of the tympanic membrane, but not penetrated. After surgery, the thin cotton sheet soaked with 5% urea solution can be attached. Thereafter, 5% urea solution was instilled three times a day to promote the growth of the tympanic membrane. After one week, the cotton piece was taken out, and if the perforation failed to close, the above operation was repeated until the tympanic membrane healed. (3) Fully lining method to fold the incision. 2 Peel the skin of the external auditory canal. 3 scrape the perforated edge epithelium. 4 Loose fiber drum ring. 5 put the transplant organization. 6 stuffing and stitching. (4) The sandwiching method is used to fold the incision with the full lining method. 2 peel off the skin of the external auditory canal with the full lining method. 3 Separating the epithelial layer and the fibrous layer of the residual tympanic membrane. 4 The transplanted tissue is placed, and the transplanted tissue is sandwiched between the epithelium of the tympanic membrane and the fibrous layer. 5 tamponade and suture incision with full lining. The tympanic membrane repair can be folded into the skin, vein, fascia, periosteum, perichondrium, etc. From the aspects of convenient material selection and survival effect, the diaphragmatic fascia is preferred, and the otoscope is also used. The steps of taking the temporalis fascia are folded with 1% procaine solution or lidocaine solution (with an appropriate amount of 1:1000 adrenaline solution) for local infiltration at the hairline above the auricle, and for a long time above the hairline. 75px transverse incision, subcutaneously separated, fixed with mastoid hook, and then continue to separate superficial fascia tissue with mosquito vascular clamp until the fascia close to the diaphragm is exposed, the fascia surface is smooth and thick Evenly, according to the size of the perforation of the tympanic membrane, remove the required fascia, Ningda is not small. The removed fascia must go to the muscle fiber attached to the fascia, then sandwich the fascia between the two dry crepe bags, squeeze the water hard, and place it on the glass plate for later use. The dry fascia is easy to place during transplantation, but staying too long may affect the survival of the fascia. If the anterior lower edge of the perforation of the tympanic membrane can be clearly seen through the ear canal, and the tympanic mucosa is normal, the incision can be used; otherwise, the anterior lower edge of the perforation of the tympanic membrane is blocked by the anterior wall of the external auditory canal, or the chronic inflammation of the middle ear mucosa is obvious. If you need to perform a bulging and mastoid exploration, it is better to use the incision behind the ear. (1) Incision in the ear The lateral head is supine, the needle is inserted into the posterior sulcus, and 1-1.5 ml of anesthetic is injected into the upper, lower, and lower ear canal. A small amount of anesthetic is injected into the tragus and the ear of the ear, and the amount is injected to organize the micro-long, but does not affect The view in the ear canal is good. Use a small round knife to cut the skin and subcutaneous tissue from the external ear canal at 12 o'clock through the tragus and the ear of the ear. After the hemostasis, use two double-toothed hooks to cross the incision and expose the incision. In the ear canal, a fine needle was used for subcutaneous infiltration anesthesia of the bone ear canal, and the surface of the residual tympanic membrane and the tympanic cavity were affixed with cotton sheets impregnated with 1% tetracaine solution. As a second incision, the first incision is made from below the tympanic membrane to 12 o'clock. Insert the incision with a small stripper to peel the flap, straight to the drum ring, and then down the tympanic membrane along the sulcus, pull the drum ring and the residual tympanic membrane, expose the tympanic cavity, and stop the blood. (2) behind the ear incision The lateral head is supine, and the incision is made into an arc-shaped incision at 1.5-50px from the auricle fold line. The pull is pulled by the hook, and the skin and subcutaneous tissue are quickly peeled off by a surgical knife. After the bone external ear canal is touched with a finger, At the 12.5px of the sacral line and the mastoid tip, the incision was deep into the periosteum to form a trapezoidal musculoskeletal flap. The periosteum was pushed to the posterior wall of the ear canal. The skin of the external auditory canal was cut with a small knife, and the two mastoids were held in a self-sustaining position. Retracting the soft tissue provides a glimpse of the tympanic cavity of the perforation of the tympanic membrane. (1) implant If the area of the perforation of the tympanic membrane is less than 1/2 of the area of the tympanic membrane, the anterior epithelium of the tympanic membrane or the fibrous tympanic ring may be scraped off with a right angled hook directly after anesthesia, and then the bare hammer shank is carefully removed with a micro hook. The squamous epithelium is filled with a proper amount of gelatin sponge for support. The transplanted fascia is flattened on the inner side of the residual tympanic membrane, and a small amount of fibrin adhesive is added to prevent the fascia from falling off and filling the external auditory canal. Into the gelatin sponge ball can be. If the perforation of the tympanic membrane is large, after the incision is completed, the ear canal flap is cut at the midpoint of the posterior wall of the external auditory canal, and is divided into upper and lower parts, which are called portal-shaped flaps, and the flap is peeled off and turned forward. If the external auditory canal is narrow, the diamond can be used to remove the bone of the posterior wall of the outer ear. The inner layer of the tympanic membrane and the inner layer of the fibrous drum ring are scraped off with a right angled looper, and then the bare hammer is carefully stripped with a micro hook. The squamous epithelium on the stem, if necessary, first separate the anvil joint to dislocate it, to avoid damage to the inner ear when peeling the epithelium, resulting in irreversible sensory ear nerve spasm. After the peeling is completed, the anvil joint can be reset. The implanted fascia should be cut 1/2-1/3 in the middle so that the end of the hammer handle is exposed from the slit at the time of implantation, and the front part of the fascia is placed on the anterior portion of the tympanic membrane and the front side of the fiber drum ring. The posterior part is attached to the bone surface of the posterior wall of the external auditory canal, the flap of the ear canal is reset, and the fibrin glue is added to prevent the fascia from falling off or shifting. The inner ear canal is filled with gelatin sponge ball and the outer ear canal is filled with one. A small piece of Vaseline gauze can be used for fixing, suturing the incision, and dressing. (2) Explantation The upper, lower, and lower skin of the external auditory canal was cut at 2 mm from the drum ring, and the pedicle was connected to the skin of the anterior wall of the ear canal, and connected to the incision in the original ear to form a pedicle free flap. The width of the flap should exceed the bony bulge of the anterior wall of the external auditory canal, and the lower wall of the external auditory canal should be worn down. On the bone surface outside the original drum ring position, the artificial gully should be ground with a fine drill to a width of 1 mm and a length of about 1/2 turn. "Use a right-angled curved needle, a micro curved needle, a thin straw to remove the scaly epithelium on the surface of the residual tympanic membrane, remove the scaly epithelium on the bare hammer handle, and place the front and lower edges of the transplanted fascia in the "artificial drum ring". The surface, restore the flap, drop the appropriate amount of fibrin adhesive, press the gelatin sponge pellet, suture the incision, and dress. complication The tympanic membrane perforation increases.