耳管狭窄の新手術法・筋耳管管法について

A MUSCULOTUBAL CANAL TECHNIQUE, A METHOD OF EUSTACHIAN TUBOPLASTY

　I．緒言

　最近における中耳手術，特に鼓室成形術の進歩が目覚しいだけに耳管に対する外科的アプローチの立ち遅れは甚だしい感がある。

　耳管機能不全症例に対しては鼓室成形術は禁忌であることはいうまでもなく，その聴力改善はもとより，耳漏の停止すらも望めない。

　It is the purpose of this paper to describe a new technique of eustachian tuboplasty. There are two kinds of treatment for tubal dysfunction reported in the literature: one, by making a bypass, either, to the external ear canal by means of drainage tube to the maxillary or the frontal sinus and, the other by reopening the stenotic tube with a burr or by means of middle cranial fossa approach. The new technic is called "musculotubal canal technic" which belongs to the latter group. The surgical technic of this procedure is as follows:

　1. Surgical exposure of the bony anterior wall of the external ear canal.

　2. Removal of bone with diamond burr to expose the processus cochliariformis at the front of themalleus head.

　3. Extraction of the musculus tensor tympani from the semicanalis musculi tensor tympani.

　4. Remove the septum canalis musculotubarii until the cartilage of the eustachian tube can be removed.

　5. Opening the mucous membrane of the tube and covering the rough osseous surface.

　6. Intubation of a teflon tube from the tympanic cavity to the nasal orifice through the pharyngeal ostium until it slips spontaneously.

　The virtues of this technic lies in the minimum risk to which the carotis interna may be exposed and the easier regeneration of the mucous membrane lining of the reopened tube because of the plentiful reservation of the mucous membrane.