Beruflich Dokumente
Kultur Dokumente
MAJOR
hematoma formation, skin flap necrosis, infection,
and pneumothorax.
MINOR
malpositioning, scar contracture or hypertrophy,
and poor contour.
MANAGEMENT OF CONGENITAL AURAL ATRESIA
de Alarcon A, Jahrsdoerfer RA, Kesser BW. Congenital absence of the oval window: diagnosis, surgery, and audiometric outcomes. Otol
Neurotol. 2008;29:2328.
SURGICAL APPROACHES OF
ATRESIAPLASTY
Three possible approaches can be followed for
congenital aural atresia repair. They are:
1. Anterior
2. Modified anterior
3. Mastoid
ANTERIOR APPROACH
Is the most common approach used these days.
In this approach a post auricular incision is made and the
subcutaneous tissue and periosteum are raised anteriorly
up to the level of glenoid fossa.
If any remnant of tympanic bone is present drilling is
started at the cribriform area, and if no tympanic bone is
present the drilling begins at the temporal line just
posterior to the glenoid fossa.
Drilling is continued anteriorly and medially till
epitympanum is entered.
The most common anamoly encountered in the middle ear
of these patients is a fused malleal - incudal joint. Stapes is
usually normal in these patients.
The atretic bone is carefully removed uncovering the
ossicles.
The facial nerve usually lie medial to the ossicular mass,
and must be protected at all costs.
Drilling is continued till the canal is about 10mm in size.
Ossicular chain reconstruction is performed and a neo
tympanum is fashioned using temporalis fascia graft.
Split thickness skin graft is used to line the external
auditory canal.
A wide meatoplasty is fashioned and a large wick is
inserted to stent the canal.
MODIFIED ANTERIOR APPROACH
This approach is used in patients with a thick atretic plate
because of poor orientation during dissection.
This poor orientation may risk carotid artery, facial
nerve, and lateral semicirular canal to injury.
Orientation in these patients could be achieved by an
initial posterior dissection up to the level of sinodural
angle. This enables the surgeon to identify the level of
lateral canal and ossicular mass. From here on the
approach is similar to that described under anterior
approach
MASTOID APPROACH
In this approach the external auditory canal is
created at the expense of mastoid cavity.
It involves drilling out the mastoid and
identifying the sino-dural angle.
This is a risky procedure because of distorted
anatomy of the facial nerve in these patients.
COMPLICATIONS OF ATRESIAPLASTY
Facial Nerve Inury Transient or Permanent
SNHL
External auditory canal wall stenosis
Lateralized tympanic membrane causing CHL
Recurrent acute otitis, otitis media with effusion,
retraction pockets, cholesteatoma, mastoiditis,
chronic suppurative otitis media, tympanic
membrane perforation, or any other disease of
the ear