Otolaryngologic Clinics of North America最新文献

Endoscopic endonasal approaches have revolutionized anterior skull base surgery, with multilayer vascularized reconstruction emerging as the gold standard for preventing postoperative cerebrospinal fluid leaks. Compared with free graft or single-layer techniques, multilayer repairs provide watertight closure, address high-flow leaks, and reduce long-term morbidity. The nasoseptal flap remains the primary vascularized option, though alternative flaps and grafts are vital in revision or salvage cases. Success depends on meticulous defect preparation, graft orientation, and material selection tailored to defect size, location, and patient factors. Adjuncts such as sealants and packing may support repairs, but do not independently lower leak rates.

Cement ossiculoplasty and endoskeletal ossicular chain reconstruction using glass ionomer cement (GIC) are innovative techniques for restoring middle ear function after ossicular discontinuity. GIC is highlighted for its use with these techniques and biocompatibility, stability, and ability to bond with ossicles and titanium prostheses to help accomplish long-term, successful reconstructions and hearing outcomes. Fundamental principles of the methods that are described are: (1) attempt to replicate native anatomy as close as possible during ossicular chain reconstruction, (2) reduce extrusion rates; and (3) optimize long-term hearing outcomes. Detailed descriptions of the authors' surgical techniques when using GIC are included.

The need for ossiculoplasty in the repair of congenital aural atresia (CAA) is rare, occurring approximately 5% to 8% of patients. Predicting the need for ossiculoplasty in CAA repair based on high resolution computed tomography imaging is challenging. The technique is similar to traditional ossiculoplasty methods, with a prosthesis placed onto a mobile stapes bone extending up to a reconstructed tympanic membrane. Hearing results can be variable, but are, in general, inferior to reconstruction with the patient's native ossicular chain. This article describes the indications, technique, and surgical and hearing results of ossiculoplasty in the repair of congenital aural atresia.

Congenital middle ear anomalies are relatively rare but significant causes of pediatric conductive hearing loss. The Teunissen and Cremers classification, determined intraoperatively, guides tailored surgical management: stapes surgery for class I, combined ossiculoplasty and stapes surgery for class II, tympanoplasty for class III, and vestibulotomy for class IV. Transcanal endoscopic ear surgery provides hearing outcomes comparable to microscopic ear surgery, with advantages in visualization and minimal invasiveness. Class IV anomalies carry a high risk of facial nerve and inner ear injury; thus, hearing aids or bone-anchored devices are often recommended for younger patients or when surgical risks are substantial.

Contemporary surgical techniques and alloplastic implants have made ossiculoplasty a safe and well-tolerated procedure in the past several decades. There has been significant evolution in types and materials of prostheses used to reconstruct the ossicular chain. Generally, the presence of an intact stapes may predict better outcomes, but this is not always the case. A wide range of underlying disease burden can lead to variable audiologic outcomes that are difficult to predict preoperatively. Though rare, intraoperative or postoperative complications can be bothersome and may require revision surgery.