| Popis: |
This study is based on the author's personal experience in a middle ear reconstructions. Errors can occur at each surgical stage--tympanic membrane and chain reconstructions, mobilisation of the footplate. At any moment the surgeon can gain or loose the dB. The operating technique is the main factor. A proper operative technic includes a good operating approach and excellent hemostasis. The tympanic membrane, should be as thin as possible, exactly and carefully dissected. Care should be taken to avoid any damage to the fascia graft fibers. Bad or unsure material should be discarded. The graft should not be too large because if it overlaps the EAC wall, it narrows the canal. If the graft is too small, secondary edge performation can occur. The shallow placement of the graft risk a bad contact. Opposite--too deep--poor ventilation of the middle ear and may lead to adhesions. The annulus should be well prepared, free of epithelial remnants. If not cholesteatoma could develop and discontinuity between the neotympanium and the ossicular chain abolish the transmission effect. The mechanical and lever principles during reconstruction of the sound transmission should be kept in mind at all times. The reconstructed system must be delicate and light. The round window reflex is the most important indice of good performed reconstruction, and should be used similar to the modern monitoring system. Try to prevent the natural structures. They are the most valuable material for the future reconstruction. |
