| Objective:For open tympanoplasty,auricular cavity with appropriate size and shape and external auditory canal with appropriate volume were explored.Methods:Sixteen cases?single side ear disease?that met the inclusion criteria were selected.After the complete removal of middle ear lesions,all cases were treated with annular conchiplasty and meatoplasty,meanwhile,mastoid cavity was packed.3 months after the operation,the following examinations were performed during the follow-up visit:1.The leica M525 F50 operating microscope and the supporting high definition recording system were used to collect pictures,and the image lasso tool in Photoshop was used to measure the cross-sectional area of the ear canal outside the ear during the operation:S0 before operation,S1after operation,and S2 of cross section area of the outer ear canal of the opposite ear.The volume of external auditory canal was measured:preoperative V0,postoperative V1,and contralateral V2.?1?Compare S0and S1,and evaluate the extent of transection area enlargement of external auditory canal after plasty;?2?Comparison of V1/S0 and V1/S1:if conchiplasty was not performed on the operative ear,the ratio of the volume of the external auditory canal to the area of the opening of the external auditory canal was V1/S0 and V1/S1 after conchiplasty.The ratio of the volume of the external auditory canal to the cross-sectional area of the external auditory canal after plasty was evaluated.?3?Comparison of V1/S1 and V2/S2,V1/S0 and V2/S2:both the contralateral ears were normal ear.It was assumed that the ratio of the volume of the external auditory canal to the cross-sectional area of the external auditory canal mouth V2/S2 was reasonable,so as to evaluate whether the ratio of the volume of the external auditory canal to the area of the external auditory canal after conchiplasty was closer to the normal reference value V2/S2.2.The postoperative dry ear time of each patient was recorded,and the effect of the difference between the operative ear V1/S1 and the contralateral ear V2/S2 on the dry ear time was compared.3.Long-term efficacy observation:whether the ear is dry,the incision healing status of auricular cavity,whether the operative cavity has exudation and pus flow,the epithelial status of the operative cavity,whether there is granulation or recurrence of cholesteatoma;There is no postoperative tinnitus,encounter cold air stimulation dizziness and other symptoms of ear discomfort;There are no facial paralysis,parotid gland leakage,auricular perichondritis and other complications.4.Operational feasibility:whether it is complicated,whether the operation duration is appropriate,how easy it is to grasp,how difficult it is for doctors to observe and clean dressing after operation,whether quantifiable indicators can be provided.5.Observe the shape of the external auditory canal and auricular cavity of this operation,and investigate the comfort and satisfaction of the patients'aural appearance.Finally,statistical analysis was carried out to objectively evaluate the value of the operation.Results:1.?1?The mean S1 cross-sectional area of the external auditory canal after the plasty was 0.6980±0.1466cm2,the mean S0 of the external auditory canal before the operation was 0.4401±0.7417cm2,the mean S1 after the operation was greater than the mean S0 before the operation,and the comparison between the two groups was statistically significant?P<0.05?,so the plasty could effectively expand the cross-sectional area of the external auditory canal.?2?The mean value of V1/S1after plasty was 2.7489±0.7904,and the mean value of V1/S0 without conchiplasty was 4.2883±0.9204.The mean value of V1/S1 was both smaller than V1/S0,and the intergroup comparison of V1/S0 and V1/S1 was statistically significant?P<0.05?.This indicates that annular conchiplasty and meatoplasty effectively reduce the V/S ratio,which conforms to the ratio V/S law of Portmann and Smyth of the volume of the surgical cavity and the cross-sectional area of the external auditory canal.?3?The mean value of V2/S2 in the contralateral ear was 2.3879±0.4598,and there was no statistically significant comparison between the two groups of V1/S1and V2/S2?P>0.05?,while the comparison between the two groups of V1/S0 and V2/S2 was statistically significant?P<0.05?.After the V1/S1 and give ear to the V2/S2 is the absolute value of the average was0.7710±0.6387,such as no ear cavity forming the V1/S0 and give ear to the V2/S2 is the absolute value of the average was 1.9158±0.9256,the average of the|V1/S1-V2/S2|less than the average of the|V1/S0-V2/S2|,contrast between the two groups of data with statistical significance?P<0.05?,a cavity keratoplasty makes V/S ratio is closer to the normal reference value V2/S2,annular conchiplasty and meatoplasty is feasible.2.The mean dry ear time of 16 patients was 8.06±1.73 weeks,and the closer the ratio of the operative ear V/S was to the normal reference value V2/S2,the shorter the dry ear time was.3.All the patients had good wound healing,no exudation or purulent flow in the operative cavity,normal epithelialization of the operative cavity,no granulation or recurrence of cholelioma,4 patients?two of whom had tinnitus before the operation?had tinnitus after the operation,and no patients had dizziness or other symptoms of ear discomfort.No facial paralysis,parotid gland leakage,auricle perichondritis and other complications.4.The operation is simple,easy to operate and easy to master.The operation lasts for about 15 minutes and will not excessively increase the operation load.It can provide a quantifiable index of cross-sectional area in clinic.5.The external auditory canal and auricular cavity of this operation have beautiful shape.The patient was satisfied with the appearance of the operative ear and felt comfortable.Conclusions:1.The operation of annular conchiplasty and meatoplasty is simple and easy,which can provide a quantifiable index of the cross-sectional area of the external ear canal for the clinic,so we can accurately determine the incision range of the auricular cavity.2.It can effectively expand the opening of the external ear canal,so that the open tympanoplasty cavity can exchange freely with the external air and ensure the surgical effect.3.Convenient for postoperative observation and cleaning.4.The appearance of the ear is considered on the basis of the above.It also conforms to human body aesthetics and takes care of patients'postoperative feelings. |
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