摘要
目的探讨颞下—迷路上隐窝进路膝状神经节减压术治疗颞骨骨折面瘫的临床疗效。方法16例颞骨骨折面瘫患者,按House-Brackmann标准,面神经功能Ⅵ级3例,Ⅴ级9例,Ⅲ级4例。术前纯音测听检查,13例纵行骨折语频气导平均听阈为52dB,3例混合性骨折均为重度感音神经性聋。颞骨轴位CT13例可见骨折线,虚拟耳镜观察9例听骨链中断,面神经曲面重建显示膝状神经节区、鼓室段及乳突段骨管不规整。手术经完壁式上鼓室进路,开放上鼓室,探查听骨链;听骨链完整者,在锤骨头、砧骨体与天盖之间磨开颞下迷路上隐窝;听骨链中断者,取下砧骨,直接开放迷路上隐窝,暴露膝状神经节及面神经迷路段远端;砧骨脱落或脱位者行砧骨复位术,砧骨骨折行锤-镫链接术。结果13例纵行骨折患者,其膝状神经节明显水肿,3例岩浅大神经受损,5例面神经裂孔区出血,9例听骨链中断,锤砧及砧镫分离,3例砧骨脱落直接压迫于面神经鼓室段,1例砧骨长脚骨折;3例颞骨混合型骨折,可见鼓岬、半规管及前庭窗裂折。全部病例术后一期愈合,无手术并发症。术后随访0.5￣3.0年,平均观察1.2年,面神经功能恢复达House-BrackmannⅠ级9例,Ⅱ级5例,Ⅲ级2例;语频气导听力平均提高33dB。结论颞下-迷路上隐窝进路膝状神经节减压术对面神经功能及听力恢复均获满意疗效。
Objective To investigate the clinical outcomes of facial nerve decompression via a subtemporal-supralabyrinthine approach to geniculate ganglion for management of facial paralysis in temporal bone fracture. Methods Sixteen patients with unilateral facial paralysis due to temporal bone fracture were graded as having House-Brackmann Grades Ⅲ in 4, Ⅴ in 9 and Ⅵ in 3. The preoperative mean air conduction threshold was 52 dB in 13 cases with longitudinal temporal bone fracture and serious sensorineral hearing loss in 3 cases with transverse temporal bone fracture. The fracture lines were detected in 13 cases by temporal bone axial CT scans and ossicular disruption could be determined in 9 cases by virtual endoscopy. The geniculate ganglion, the tympanic and mastoid segment of the facial nerve displayed an irregular morphology in curved planar reformation images of the facial nerve canal. After an intact canal wall mastoido- epitympanectomy, the ossicular chain damage was evaluated. If the ossicular chain was intact, the supralabyrinthine recess was opened by drilling through the cells between the tegmen tympani and ossicular chain; if the ossicular chain was interrupted, then the incus was removed and the supralabyrinthine recess was directly opened. The geniculate ganglion and the distal labyrinthine segment of the facial nerve were exposed. After completing facial nerve decompression, a dislocated incus was replaced, or a fractured incus was reshaped to bridge the space between the malleus and the stapes. Results Pronounced ganglion geniculatum swelling was found in 13 cases of longitudinal fractures, the greater petrosus nerves were damaged in 3 cases, bleeding was found in 5 cases, an interrupted ossiclular chain in 9 cases, a dislocated incus resulting in crushing of the horizontal portion of the facial nerve in 3 and fracture of the incus long process in 1. In 3 trasverse fractures, a dehiscence on the promontory, semicircular canal and oval window was founded. All cases had primary healing and no complica
出处
《中华耳科学杂志》
CSCD
2008年第3期260-264,共5页
Chinese Journal of Otology
基金
广东省医学科研基金项目(编号A2007335)
关键词
颞骨骨折
面瘫
面神经减压术
耳外科
Temporal bone fracture
Facial paralysis
Facial nerve decompression
Ear surgery
