摘要
外耳、中耳和面部的多数结构由第一、第二鳃弓衍化而来,因此,由于胚胎发育上的同源性,小耳畸形常与颌面部畸形同时存在。尽管人们对这种关系的认识由来已久,但至今大多数临床学家仍把小耳畸形看作为一个单一的畸形来处理。
在我国,近年来各地相继开展了耳廓再造手术,晚近又有同期进行中耳成形术的报道,在手术设计方面进展较大,但对小耳畸形和颌面部畸形的关系至今尚未见到有关的研究报道,对第一、二鳃弓综合症缺乏足够的认识,反映在对小耳畸形的治疗上也缺乏全面考虑。
本文的研究分两部分进行:一、小耳畸形病人颅颌面部发育情况的研究;二;小耳畸形病人的治疗。
In recent years, reconstruction of the auricle for the patient with microtia has been developmenting rapidly in China, but the relationship between ear and jaw defects in syndromic patterns of malformation cannot be found in Chinese literature.
This study consisted of two sections, the one is about the relationshipe between ear and jaw, the other is about the comprehensive treatment for microtia.
SECTION ONE The relationship between ear and jaw
Despite the major contributions of Grabb and Comverse et al, most clinicians and much recent writing continue to treat unilateral ear deformity as a distinct entity. The purpose of this section is to emphasize again that unilateral microtia is not a srparate syndrome but part of hemifacial microsomia. It is a research which never carried out in China befor.
Materials and method.
In 1986 and 1987, 138 patients with microtia who were scheduled hospital admission for ear reconstruction were studied.
1, Occurrence of congenital anomalies in the family was recorded.
2, The grade of microtia was graded using the system of
引文
1、刘兴国:新生儿先天性畸形发生率。中华医学杂志,58:24.1978。
2、黄婉芬等:4200例婴儿外科体检结果分析。中华小儿外科杂志,8:236,1987
3、宋儒耀等:一次手术完成的全耳廓再造。整形外科医院学报1:9,1981。
4、郝铸仁:全耳廓再造术13例报告。中华外科杂志,18:352,1980。
5、宋业光、宋业亮。改进的一次完成全耳再造术。整形外科医院学报1(2).P11,1981。
6、陈宗基.王显伦:一期全耳廓再造50例报告。中华外科杂志.22:21,1984。
7、陈宗基等:全耳廓一期再造及同期行外耳道一鼓室成形。中华医学杂志,64:466,1984。
8、郝铬仁、陈伟中:先天性小(无)耳廓再造术的经验与教训。中华整形烧伤外科杂志.3:175,1987。
9、宋业光.等:同时恢复听力的全耳再造。中华整形烧伤外科杂志,1:50,1985。
10、冷同嘉等:先天性外中耳畸形鼓室成形与全耳再造术。中华耳鼻喉咽科杂志,21:196,1986。11.陈壁等:戊二醛处理异种(猪耳)软骨的软化塑形和临床应用.中华整形烧伤外科杂志,3:171,1987.
12.闵维宪.王翰章:即刻任意皮瓣存活长度与蒂宽的关系的实验研究.华西口腔医学杂志.5:82,1987。
13.何永照、姜洒长主编,耳科学,上册,上海科技出版社,1983。
14.西村秀雄:小耳症发生。形成外科,17:453,1974
15.福田修:Second branchial syndrome形成外科14:217.1971。
16.古川晴海:小耳症 第1、第2鳃弓症侯群。形成外科.30:543,1987。
17.新武等。当科 第1、第2鳃弓症候群众检讨。形成外科,30:2,1987
18. Adason, J.E.,et al:The growth pattern of the exter nal ear.Ptast.Reconstr. Surg. 36,466, 1965.
19. Anson. B.j,: Surgical Anatomy. 5th ed.W.B. Saunders Co PhiLadeLphia, 1971.
20. Aibers, G.D,, Branchial Anomalies. J.A.M.A. 183,399, 1963.
21. Altmann, F,:CongenitaL atresia of the ear in man and animals.Ann. Otol.Rhinol laryngot, 64,824, 1955.
22. Avetar. J.M,:Microtia, total reconstruction of the auricle in one single operation.Brit. J.Plast. 34:224,1981.23,Avelar.J.M,:Reconstrocao total do pavilhao auricular nu(?) unicotempo eirurgico.Revista Brasileira de Cirugia 67:139,1977.
24,Bauer B.S,:Reconstruction of the microtic ear. Journal of Pediatric Surgery. 19:440,1984.
25,Bellucci,R.J,:Congenital aural malformations:Diag nosis and treatment.Otolaryngologic clinics of North America. 14,95,1981.
26, Bennun.R. D.et al,:Microtia:A microform of hemifacial microsomia.Plast. Reconstr. Surg. 76,859,1985.
27,Brent.B.:Ear reconstruction with an expansile framework of autogenous rib cartilage.Plast. Rconstr. surg.53:619,1974.
28,Brent.B.:The correction of microtia with autogenous cartilage grafts. I.The classic deformity.Plast. Reconstr. Surg. 66:1,1980.
29,Brent.B.:The correction of microtia with autogenous cartilage grafts. II.Atypical and complex deformities.Plast. Reconstr. Surg. 66:13, 1980.
30,Brent.B., A personal approach to total auricular construction. Clin. in Plast Surg. 8:211,1981.
31, Brown. J.B. et al,:Problems in recontruction of the auricle.Plast. Reconstr.Surg 43:597,1969.32, Campbell, G, ,Otoplasty, Some thing old, Somethine new,reconstruction of the external ear using fresh cadaver homorgaft ear cartilage and a strnonastoid nyocutaneous flap.Br J.Plast Surg. 36:262,1983.
33, Converse. JM,:Reconstruction of the auricle:Part Ⅰ&Ⅱ.Plast.Reconstr.Surg. 22:150, 230,1958.
34,Converse.J.M.:Correction of the auricle in congenital microtia.Plast.Recostr.Surg.32:425,1963.
35, Converse.J.M.et al, :On hemifacial microsomia. Plast.Reconstr.Surg.51:268,1973.
36, Converse, J.M. et al, ,The corrective treatment of the skeletal asymmetry in hemifacial microsomia.Plast.Rec onstr Surg.55:22,1973.
37, Converse. J.M.:Reconstructive Plastic Surgery.vol 4. P2359- 2400. W. B. Saunders Co, Phi ladelphia, 1977.
38, Conway, H. and Wagner.K.J.:Congenital anomalies of the head and neck as reported on birth certificate in New York city, 1952 to 1962 f inclusive) Plast.Reconstr.Surg.36,71,1965
39, Cronin, T.D. ,Use of a silastic frame for total and subtotal reconstruction of the external ear:Preliminary report.Plast.Reconstr.Surg. 37,399,1966.
40,Cronin.T.D., et al,:Follow- up study of silastic??frame for reconstruction of external ear. Plast.Reconstr.Surg,42,522,1968.
41, Curtin.J.M.Bader.K.F. :improved techniques for the sucessful silicone reconstruction of the external ear.Plast.Reconstr.Surg.44:372,1969.
42,Daniel.R.K.,and Williams.H.B.: The free transfer of skin flaps by microvascular anastomosis.Plast.Reconstr.Surg.52,16,1973.
43,David.D.J., et al,:Hemifacial microsomia:A multisystem classification.Plast.Reconstr.Surg. 80:525,1987.
44, Davis.J.:Aesthetic and Reconstructive Otoplasty.Springer- verlag New York Inc. 1987.
45, Davis. J.:Auricle reconstruction. in Saad.M.N., and Lichtveld,P. ( eds) :Reviews in Plastic Surgery:General Plastic and Reconstructive Surgery.Amsterdam,Excerpta Medica,1974.p109.
46,Dellon.A.L., et al,:Hemipalatal Palsy and microtia.Ann. Plast. Surg.10:475,1983.
47,Dingman.R.O., and Grabb.W. C.:Reconstruction of both mandibular condyles with metatarsat bone grafts.Plast.Reconstr.Surg. 34:441,1964.
48, Dupertuis.S.M.,Musgrave. R.:Experiences with the reconstruction of the congenitally deformed ear.Plast.Re??constr.Surg. 23:361,1959.
49,Edgerton.M.T, :Ear reconstruction in children with congenital atresia and stenosis. Plast. Reconstr. Surg.43,373,1969.
50,Edgerton.M.T.,et al. ,The feasibility of craniofacial osteotomies in infants and young children.Scand.J.Plast.Surg, 8:164,1974.
51,Edgerton.M.T.,and Marsh. J.L. .Surgical treatment of hemifacial microsomia Plast. Recostr. Surg.59,653,1977.
52,Entin.M.A.:Reconstruction in congenital deformity of the temporomandibular component.Plast.Reconstr.Surg.21,461,1958.
53,Fukuda.O. :The microtic ear:Survery of 180 cases in 10 years.Plast.Reconstr.Surg.53:458,1974.
54,Fukuda.O., and Yamada. A,:Reconstruct ion of the microtic ear with autogenous cartilage. Clinic in plastic Surgery.5:351,1978.
55, Gibson.T.,Pavis. W.B.:The fate of preserved bovine cartilage implants in man.Br J.Plast Surg. 6,4,1953.
56,Glasscock, M.E., et al.:Management of congenital ear malformations Ann otol Rhinol laryngol 92:504,1983.
57, Gorlin, R. J., and Pindborg.J.J.:Syndrome of the Head and Neck.McGraw Hill Book Co.New York.1964.58, Gorney.M.,et al.:Spliced autogenous conchal carti lage in secondary ear reconstruction.Plast.Reconstr. Surg.47,432,1971.
59,Grabb.W.C.:The first and second branchial arch syndrom. Plast.Reconstr.Surg. 36:485,1965.
60,Hirose .T,:Reconstruction of the external ear,Surgery ( Japan) 36,1296,1974.
61, Ide, C.H, .et al,,Famial facial dysplasia. Arch Ophthal 84,427,1970.
62,Jaffe.B. F. .Deformities of the external ear associ ated with middle ear, inner ear, or distant malformations.Clin in Plast Surg. 5:413,1978.
63,Kaban, L.B., et al.:Three dimensional approach to analysis and treatment of hemifacial microsomia. Cleft Palate J.18:90,1981.
64, Kaseff.L.G., Investigation of congenital Malformations of the ears with tomography.Plast. Reconstr.Surg.39,283,1967.
65, Knowles.C.C.Cephalometric treatment planning and analysis of maxillary growth following bone grofting to the ramus in hemifacisl microsomia Dent. Practit. 17:28,1966.
66,LaRossa, D., et al.: The use of microvascular free??flaps for soft tissue augmentation of the face in dhildren with hemifacial microsomia. Cleft.Palate.J. 17:138,1980.
67, Lauritzen. C., et al.,Classification and treatment of hemifacial microsomia. Scandi.J. Plast. Reconstr. Surg.19,33,1985.
68, Longacre,J.J., et al.,The surgical management of first and second branchal arch syndromes.Plast.Reconstr.Surg.31:507,1963.
69, Luce.E.A., et al.,Veopharyngeal insufficiency in hemifacial microsomia.Plast. Reconstr. Surg. 60,602,1977.
70,Munro.I.R.,Treatment of Craniofacial microsomia.clin in plast surg.14:177,1987.
70, Manchester.W.M.,Some technical improvements in the reconstruction of the mandible and temporomandibular Joint.Plast. Reconstr.Surg.50:249,1972.
71,Marden.PM., et al: congenital anomalies in the new born infant, including minor variations. J.Pediatr.64,357,1964.
72,Matsumoto,K, ,A new method of reconstruction in microtia with emphasis on conchal creation.Ann.Plast.Surg.5,51,1980.
73,McKenzie.J., and Craig. J.:Mandibulofacial dysostos is.Arch.Dis.Child.30:391,1955.74,Meurmann.Y.:Congenital microtia and meatal atresia.Arch. Otolaryngol. 66,443,1957.
75,Milton.S.H. .Pedicled skin flap, the fallacy of the length.width ratid.Br.J.Surg.57,502,1970.
76,Mulliken. J.B.,et al., Analysis and treatment of Hemifacial microsomia in childhood.Clin in Plast Surgery.14:20,1987.
77,Munro. I.R.:One- Stage reconstruction of the tempo romandibular joint in hemifacial microsomia.Plast.reconstr.Surg.66:699,1980.
78,Munro. I.R. and Lauritzen. C.G.K.:Classification and treatment of hemifacial microsomia. Craniofacial Surgery.edited by E.P. Caronni.p391.Little.Brown, and Co.Boston,1985.
79,Munro. I.R.:Treatment of craniofacial microsomia.Clin in Plastic Surg. 14:177,1987.
80,Murphy,M. L., et al.:Comparison of teratogenic chem icals in the rat and chick embryos.Pediatries.19:701, 1957.
81,Murray.J.E., et al. :Correction of midfacial deformities. Surg. Clin North Am.51:341, 1971.
82,Murray.J.E., et al.:Analysis and treatment of hemi facial microsomia.Plast. Reconstr Surg. 74,186,1984.
83, Murray, J.E. et al.:Analysis and treatment of hemif??acial microsomia.Craniofacial Surgery.edited by E.P. Caro nni.p377.Little.Brown and Co Boston, 1985.
84,Nakai.H. .Reconstruction of microtia with a contour- accentuated framework and supplemental coverage.Plast.Reconstr.Surg. 78:602,1987.
85,Obwegeser, H.L.;Correction of the skeletal anomalies of otomandibular dysostosis.J.Maxillofac. Surg. 2,73,1974.
86,Ohmori.S., et al.,Follow- up study on reconstruction of microtia with a silicone framework.Plast.Reconstr Surg.55:555,1974.
87,Ohmori.S..Reconstruction of microtia using the silastic frame. Clin Plast Surg. 5:379,1978.
88, Ohmori.S., et al.:A refined approach to ear recons truction with silastic frames in major degrees of microtia.Br.J Plast. Surg.32:267,1979.
89, Ohmori.S.,Silicon implants. in Aesthetic and recon structive Otoplasty. edited by Davis.J.Springer- Verlag. New York Inc 1987.
90, Oneal.R.M., et al, Skin expansion as an adjunct to reconstruction of the external ear.Br.J.Plast.Surg.37:517,1984.
91,Ortiz,Monasterio.F.,Fuente del campo. A.:Early ske??letal correction of hemifacial microsomia. Craniofacial Surgery. edited by E.D. Caronni.p401 Little Brown and Co.,Boston, 1985.
92,Poswillo.D. :The pathogenesis of the first and sec ond branchial arch syndrome.Oral Surg .35:302,1973.
93,Poswillo. D.,Causal mechanisms of craniofacial def ormity.Br.Med.Bull.31,101, 1975.
94,Rogers.B.O., Berry- Treacher- Collins syndrome A review of 200 cases.Br. J.Plast. Surg.17,109,1964.
95, Rogers.B.O., Microtic, Lop, cup and Protruding ears,four directly inheritable doformities? Plast. Reconstr.Surg. 41,208,1968.
96,Ruechert.F.and Brown. F.E.:Microtia, in Plast Surg ery of the Head and Neck .Vol I. edited by R.B. stark. Chur chill Livingstone. 1987.P488.
97, Snyder. C. C, et al.,Trial of a sternoclavicular wh ole joint graft as a substitute for the temporomandibular joint.Plast.Reconstr.Surg. 48,447, 1971.
98, Song.R., et al,:Reconstruction of the external ear.Clin Plast. Surg. 9:49,1982.
99, Song. Y., and Song.Y.:An improved one- stage total ear reconstruction Procedure.Plast.Reconstr. Surg. 71,615,1983.100,Spina.V.,et al.,Total reconstruction of the ear in congenital microtia Plast.Reconstr.surg. 48,349,1971.
101,Stark.R.B. and Saunders.D.E. .The first branchial arch Syndrome,the oral- mandibular- auricular Syndrome. Plast. Reconstr. Surg, 29,229,1962.
102, Stark.R.B. and Saunders. D.E., Natural appearance restored to the unduly prominent ear.Br.J.Plast.Surg .15,385,1962.
103, Stell.P.M. ,The pig as an experimental model for skin flap behaviour,A reappraisal of previous studies.Br.J.Plast .Surg 30,1,1977.
104, Steffenson W. H., Comments on total reconstruction of the external ear.Ptast.Reconstr.Surg. 10,186,1952.
105, Steffenson.w.h., Comments on reconstruction of the external ear.Plast.Reconstr.Surg.16,194,1955.
106, Sun.Y.L.,et al.,Single stage total ear reconstr uction without using auricular skin.Clin Med.J.( engle) 95,167,1982.
107, Tanaka.F.,et al. (?)An attempt to perform simulatn eously plastic surgery for microtia and creation of the external auditory canal. Trans. Sixth Internal Congr.Plast.Surg.Amsterdam Excerpta.Medica, 1976.
108, Tanzer.R.C.,Total reconstruction of the external??ear.Plast Reconstr. Szur9. 23, 1, 1959.
109. Tanzer.R.C.,An analysis of ear reconstruction.Plast.Reconstr. Surg.31,16, 1963.
110. Tanzer.R.C.,Total reconstruction of the auricle, A 10years report.Plast.Reconstr. Surg.40,547, 1967.
111. Tanzer. R. C. Secondary reconstruction of microtia. Plast. Recons tr. Sruo. 43,345, 1969.
112. Tanzer.R.C.,Total reconstruction of the auricle. The evolution of aplan.Plast.Reconstr. Surg. 47,523, 1971.
113. Tanzer. R.C.,Deformities of the auricle,Congenital deformities, p1671.in Convers J.M.(ed) Reconstructive Plastic Surgery. Vol 3.2nd. ed. W. B. Saunders. Phi ladelphia, 1977.
114. Tanzer.R.C.,Micrtic- a tong- term follow- up of forty- four reconstructed auricle.Plast.Reconstr.Surg. 61,161, 1978.
115. Tanzer.R, C.,Microtia. Clin.Plast. Surg. 51′317, 1978.
116. Tegfmeier.R.E.,and Goodin9 R.A.,The use of a fa cial flap in ear recon- struction.Plast.Rconstr.Surg. 60:406, 1977.
117. Walia. I.,et al.,Does 9rowth occur in youn9 rabbit cartilage 9rafts transplanted in youn9 rabbits?Plast. Reconstr. Surg. 29,259, 1962.118. Wesst. J.H. and Edgerton.M.T.,Correction of severe hemifaciat atrophy with a free dermis- fat flap from the lower abdomen. Plast. Reconstr. Surg. 59,223, 1977.
119. Wildervanck. L. S.,Hereditary malformations of the ear in three generations.Acta. Otolary. 54:553, 1962.
120. Williams.H.B. and Crepear.R.J.,Free dermal fat flap to the face.Ann.Plast.Surg. 3,1,1979.
121. Wukelich. S.,et al.,Use of a silastic testicular implant in reconstruction of the temporomandibutar joint of a 5- year- old child. Oral.Surg.32,4, 1971.