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Aural Atresia Surgery Techniques and Complications
- 1. aural ATRESIA • Dr surbhi • Patna medical college
- 2. • 1 in 10,000 birth • Unilateral atresia is 7 times of bilateral • 10 percent syndromes associated
- 3. history • Recognised over 70years • Surgical techiques late 50s • NAGER advocated taloring of surgical techniques
- 4. Group 1- normal or stenotic canal hypoplastic tympanic cleft end aural approach Group 2- fistulous track Complete atresia Bony atresia Opening of antrum
- 5. • Group 3- complete atresia Non pneumatised fenestration
- 6. • Based on severity SCHIKNECHT divided aural atresia into 3 groups fenestration canalplasty type 3 tplasty
- 7. belluci • Seperated middle ear malformations • minor-normal canal and tm Stapes fixation,absence of ossicles and oval window Single crus • major-aural atresia,absent canal and tm Some degree of malformation
- 8. • JAHRSDOERFER Ant approach in 1978 This is STANDARD APPROACH
- 9. • Atretic bone drilled away • Ossicles freed • Temporalis fascia used as onlay graft • Split thickness skin graft • meatoplasty
- 10. • With few modification this technique is used • Gives improved result • Without opening mastoid • Fewer complications
- 11. Surgery for u/l vs b/l • Unilateral-sorting of high risk on hrct indicating low likelyhood of success • Defined as post op srt less than equal to 30dBhl • Criteria lenient in b/l cases • Marginal candidate operated atleast one ear
- 12. Avoided in- No aeration Facial nerve at risk Low lying tegmen
- 13. Grading system • 7-8 out of 10
- 16. Other options • For b/l cases baha for over 6yrs • For those undergone surgery-conventional behind the ear or in the ear
- 17. Options for microtia repair • Porous polyethylene • Autologus rib graft • Silicone prosthesis Porus polyethylene implant ie medpor used in grade 3 microtia repair
- 24. • Small suction drains • 3 months later-lobule • 3rd stage-post auricular sulcus • 4th stage-atresia repair and tragus
- 25. • Advantage of rib graft microtia-no concern for regection
- 27. Who should be operated first • Recently undertaken-atresia before medpor • Decreases risk of exposure or extrusion • A recent report-result of aresia surgery before medpor comparable to atresia surgery after rib graft
- 28. timing • b/l atresia BAHA is used soon after birth • No amplification required in u/l • For rib graft delayed upto 6-7yrs • For grade 2 , 3 microtia can be done at 5 • Medpor at 3yrs
- 31. • Bone is removed 360degree around • Ossicular chain mobility • Any malformation • Fascia grafting • Bone in the periphery is drilled • For fascia which is placed in ossicular mass • Skin graft harvested
- 33. • Has thicker and thinner border • Thinner kept at level of ear drum • Thicker sutured at meatus • Skin graft is notched at medial end
- 34. • For successful hearing-thin TM AND SKIN GRAFT Silastic is placed over new tm meatoplasty
- 36. Post op care • Discharged on oral antibiotics • Seen after 1 week where suture and packing removed • Second visit-1 month later • Canal is debrided • Audiogram • no restriction after 1 month
- 37. complications • Meatal canal stenosis • Snhl • Facial nerve injury
- 38. conclusion • While Technically challenging, surgery can be successful • With pre op careful patient selection • Meticulous surgery • Restoring of hearing is one of the most rewarding.
- 39. •Thank you