颞骨切除后的重建

颞骨切除后软组织缺损的重建可从简单的外耳道缝合到复杂皮瓣整复大面积组织缺损。该文报道１９８７～１９９６年中３４例因肿瘤侵犯颞骨而行侧颅底切除及其重建术的经验。手术操作分为：袖套式切除术、颞骨侧切除术、颞骨次全切除术,未行全颞骨切除术。结果：７例病人行袖套式切除术／或乳突根治术,袖套式切除术后可采用鼓室成形术、外耳道重建术或外耳道封闭术进行修复;２４例病人行颞骨侧切除术,４例行颞骨次全切除术,由颞骨侧切除或颞骨次全切除术所产生的大面积缺损需要通过颞肌瓣和局部旋转皮瓣联合修复（１３例）,低位岛状斜方…     

岩骨次全切除术的临床应用

目的探讨岩骨次全切除术的外科技术要点及其在治疗颞骨病变中的应用和疗效。方法回顾性分析2013年4月-2018年7月于北京协和医院耳鼻喉科行岩骨次全切除术的22例(23耳)患者的临床资料。这些患者中胆脂瘤9例,其中3例为术后复发,慢性化脓性中耳炎4例,脑脊液耳漏1例,其他良性肿瘤6例,外耳道鳞癌术后、放疗后复发1例,颅底黄曲霉感染1例。术后行颞骨增强MRI规律随访。结果保留耳囊19耳,切除耳囊4耳;封闭外耳道9耳,不封闭外耳道14耳。以切除病变为目的19耳,其中1例同期植入振动声桥,2例同期切除病变后植入耳蜗,其中1例为听神经瘤,1例为开放性乳突根治术术后人工耳蜗植入后电极外露取出耳蜗并再次植入;所有患者术后规律随访0.5-5年,1例患者术后5年发现胆脂瘤复发,其余患者均未见复发。5耳为清创引流同期切除病变,术后半年内均干耳,其中1例为双侧放射性中耳炎右耳清创术后4月右耳植入人工耳蜗,左耳行岩骨次全切。1例为行脑脊液漏修补,术后随访9月未见复发。结论岩骨次全切除术可用于彻底切除的颞骨内胆脂瘤、颅中窝底良性、低度恶性肿瘤的颅外部分的切除,颞骨岩部感染的清创干耳。可根据病变灵活决定是否切除耳囊及封闭术腔,对于保留耳囊的患者可同期植入人工听觉装置改善听力。     

外耳道完整切除术治疗早期外耳道癌的临床研究

目的：提高早期外耳道癌诊断和手术治疗效果，介绍外耳道完整切除的手术方法。方法：回顾性分析12例早期外耳道癌的临床表现，所有患者均采用外耳道完整切除、颞骨侧切除和腮腺浅叶切除，随访1～3年。结果：男7例，女5例；年龄28～75岁，其中T1 4例，T2 8例。8例患者术前耳部疼痛或胀痛。6例患者术前有耳流水，其中3例患者有血性分泌物。查体外耳道可见大小不等的新生物，6例患者术前活检而被诊断，另6例以外耳道新生物为主诉，行外耳道肿块切除后病理确诊。术后病理诊断：腺样囊性癌6例，鳞状细胞癌5例，耵聍腺癌1例。腮腺组织和腮腺表面淋巴中未见有肿瘤累及，外切缘足够，向内未突破鼓膜。5例鳞状细胞癌，1例耵聍腺癌和3例腺样囊性癌患者术后接受放射治疗。所有患者在随访期间无瘤存活。有6例患者术后出现术侧不完全性面瘫，House—Brackmann评分为3～4级，均在术后1～3个月内完全恢复。12例患者术前平均听阈（500，1000，2000 Hz）为38dB，术后平均听阈（500，1000，2000 Hz）为65dB，均为传导性听力下降。1例患者术后出现腮腺涎漏，经加压包扎后痊愈。结论：及时的病理活检是诊断早期外耳道癌的关键。具有安全边缘的外耳道的完整切除是提高手术效果的有效途径。     

颞骨骨化纤维瘤1例

颢骨骨化纤维瘤最早于1872年由Mezel描述。属良性骨源性新生物,多见于少儿时期,成人少见。好发于颅面骨,尤以上颌骨多见,额骨、筛骨、蝶骨均可发病,偶见于颞骨。国内耳鼻咽喉科杂志先后报道了发生在鼻窦的病例,而发生颞骨的颞骨骨化纤维瘤十分罕见,我科接诊1例,并对其成功进行手术切除,现结合文献复习报道如下。     

鼻腔鼻窦骨化纤维瘤9例

目的：探讨提高鼻腔鼻窦骨化纤维瘤诊治水平的途径。方法：回顾性分析9例鼻腔鼻窦骨化纤维瘤患者的临床资料。根据病变范围不同，其中3例选择上颌窦进路，将鼻腔上颌窦肿块完整切除；6例在全身麻醉下行颈侧切开术。结果：2例因手术切除不彻底，分别于术后8个月和9个月复发而再次手术，其余7例随访2～10年无复发，无并发症发生。结论：鼻腔鼻窦骨化纤维瘤是一种以青少年发病为主，具有局部侵袭性的良性肿瘤，临床症状、特别是CT扫描是临床诊断的基础，彻底切除肿瘤是惟一有效的治疗方法。     

外耳道腺样囊性癌8例临床分析

目的 探讨外耳道腺样囊性癌的临床病理特点，总结疗效。方法 回顾性分析1985-2001年收治的8例外耳道腺样囊性癌患者的临床资料。结果 8例患者中行局部肿瘤切除2例；行外耳道袖状切除加腮腺浅叶切除2例；行肿瘤切除加扩大乳突根治3例（1例手术5次，最后1次行颞骨次全切除术）；行耳廓全切除加颞骨次全切除术1例。后4例术后辅以放疗。随访5～15年，2例健在，2例6年后肺转移带瘤生存，2例8年后死于肺转移，2例失访。结论 外耳道腺样囊性癌早期确诊和彻底手术是延长患者生命的关键。肿瘤易发生肺转移，远期预后不佳，提倡综合治疗。     

颞骨鳞癌33例远期疗效分析

目的 评价乳突根治术加手术前或手术后放射治疗颞骨鳞癌的疗效。方法 回顾性分析３３例颞骨鳞吕治疗的远期疗效。根据病变范围分为３个亚组：鳞癌局限于外耳道３例（Ⅰ组））；病变侵及中耳乳突腔１７例（Ⅱ组）；更晚期病变１３例（Ⅲ组）。治疗方式分为：手术２例，放射治疗１１例，综合治疗（手术加术前或术后放射治疗）２０例。手术采用乳突根治术１９例，外耳道局部切除２例，颞骨次全切除１例；放射治疗剂量３５００￣１００     

致外耳道狭窄的单骨型颞骨骨纤维异常增殖症手术疗效分析

目的回顾性分析单骨型颞骨骨纤维异常增殖症导致外耳道狭窄病例手术治疗的效果。方法对我科确诊为单骨型颞骨骨纤维异常增殖症引起外耳道狭窄的7例单耳患者行外耳道成形术,术后随访时间2～6年,对术后听力恢复情况及成形外耳道效果等进行回顾性分析。结果术中发现合并外耳道胆脂瘤4耳,术后6个月平均纯音听阈及气骨导差分别由术前的64.5 dB nHL和46.4 dB nHL下降至术后6个月的35.1 dB nHL和14.9 dB nHL。术后3个月植皮成形之外耳道完全上皮化、通畅,1例患者术后4年出现外耳道再狭窄,予再次行外耳道成形术,术后随访2年未出现再狭窄。结论单骨型颞骨骨纤维异常增殖症致外耳道狭窄必须尽早治疗,防止并发外耳道胆脂瘤,外耳道成形术效果好,术中可仅行外耳道重建恢复听觉功能,不必强求彻底切除所有病变范围,随访过程中发现外耳道再狭窄可再次手术,预后良好。     

外耳道腺样囊性癌6例

目的：探讨外耳道腺样囊性癌的临床及病理特点,以提高诊断和治疗水平。方法：回顾性分析6例外耳道腺样囊性癌患者的临床表现、治疗及随访结果,其中5例行颞骨次全切除术（含外耳道全切除）,1例行外耳道后下壁广泛切除及鼓室成形术。结果：全部患者术后随访8～21个月无复发。结论：外耳道腺样囊性癌生长缓慢,可长期带瘤生存,但远期预后不佳,首次治疗应该采用扩大根治性手术以提高治愈率。     

外耳道癌

作者对1976～1989年中18例外耳道癌治疗随访资料进行评价。本组肿瘤类型:鳞癌11例,基底细胞癌4例,囊性腺癌1例,腺癌1例,恶性黑色瘤1例。分期:T_1局限于外耳道6例;T_2侵入颞骨2例;T_3侵犯颞骨下方组织,如腮腺、颈部、颅底和硬脑膜等10例。疗效:T_1无骨损害,6例均作外耳道大块切除,有2例伴腮腺切除,但标本阴性。术后未放疗,随访1～11年均无瘤生存。T_2基底细胞癌仅侵犯乳突1例,鳞癌1例整块切除,在深部切缘阳性,面神经周和中耳肿瘤残存行放     

A case of isolated ossifying fibroma of the mastoid cavity of the temporal bones

OBJECTIVES: To describe an isolated ossifying fibroma of the mastoid cavity that did not invade the inner ear and middle ear cavity. STUDY DESIGN: Case report. SETTING: Department of Otolaryngology, College of Medicine, Pusan National University, a tertiary care center in Busan, South Korea. PATIENTS AND INTERVENTION: A 34-year-old woman had an episode of acute right ear otalgia. A computed tomography scan and magnetic resonance imaging scan showed a well-circumscribed, lobulated, 3 x 3 x 3-cm sized tumor mass that was localized to the temporal bone with bony erosion including tegmen mastoid and partial bony destruction and no invasion of the middle and inner ear. A large tumor mass was removed through a simple mastoidectomy. The permanent pathological report confirmed the diagnosis of ossifying fibroma. The patient returned with complaints of recurring right otalgia, 3 years postsurgery. The previous mastoidectomy cavity was filled with a red sandpaperlike lesion; a 3 x 2-cm sized bony defect was also found,and the dura was exposed after removing the eroded tegmen mastoid. Permanent pathological diagnosis was again an ossifying fibroma,and there were no postoperative complications. CONCLUSION: To prevent clinically evident recurrences and potentially life-threatening complications, early complete resection is advised in aggressive and recurring ossifying fibroma involving the temporal bone. Close long-term postoperative follow-up with physical examinations and temporal bone computed tomography will offer the greatest chance of early detection of recurrence.     

乳突部骨化纤维瘤诊治体会

目的通过对罕见案例分析和文献复习,探讨乳突部骨化纤维瘤的临床表现、诊断及治疗,提高对该病的认识,减少临床漏诊误诊。方法分析2020年8月24日就诊的1例乳突部骨化纤维瘤的女性患者,完善术前临床及影像学检查后,在全麻下行乳突部肿瘤切除术,术后随访12个月。结果术后病理诊断为骨化性纤维瘤。患者术后恢复可,无呕吐、眩晕及面瘫。术后随访12个月,患者未再诉头痛及耳鸣等不适,无复发。结论发生在乳突部的骨化纤维瘤临床上十分罕见,早期无明显临床表现,易被漏诊。目前认为影像学与组织病理学分析是确诊及分类的主要依据,手术切除是患者出现临床症状后的首选的治疗方法,而具体的治疗方式应根据肿块的大小、侵袭程度、周围结构受累情况、临床表现以及患者的预后、耐受程度来灵活选择。     

Cemento-ossifing fibroma: two cases

INTRODUCTION: Cemento-ossifying fibroma is a rare benign tumor which can affect both jaw bones, particularly the mandible. CASE REPORTS: We report two cases of cemento-ossifying fibroma which illustrate the radiological and anatomic features of these tumors. Differential diagnosis between cementifying fibroma and ossifying fibroma was particularly difficult. The cementifying fibroma was treated by surgical resection followed by immediate reconstruction with an iliac bone graft. The ossifying fibroma was treated by enucleation-resection. DISCUSSION: The clinical, radiological and histological features of cementifying and ossifying fibroma allow distinction. Surgical treatment is achieved by enucleation resection for small-sized ossifying fibromas and mono-bloc resection with bone reconstruction for large-sized cementifying and ossifying fibromas.     

Fibröse Dysplasie des Felsenbeins

Fibrous dysplasia named after Jaffè and Lichtenstein is a benign, self-limiting disorder of the bone structure. The normal bone is replaced by cellular fibrous connective tissue. Fibrous dysplasia can be differentiated into monostotic and polyostotic forms and the McCune-Albright syndrome (combination of polyostotic areas in the bone with hyperpigmentation of the skin and endocrinological disturbances). The rare disease is predominantly found in the 1st to 3rd decade of life in the femur or humerus. In about 15% of all cases it affects the facial bones, and one-third of these is located in the jaw bone. Extremely rare is the invasion of the petrous bone. A 45-year-old female patient was examined because of tinnitus persisting for 1 year. In addition, she was suffering from increased hearing reduction and recurrent vertigo. The CT and MRT showed a milky glass-like tumor, which was limited by an osteolytic process situated in the left petrous bone. The process was removed via the mastoid. Histological examination revealed fibrous dysplasia. A highly differentiated osteosarcoma and an ossifying fibroma as important differential diagnoses have to be excluded because of the different therapeutic consequences.     

Chondromyxoid fibroma of the temporal bone: case report and review of the literature

OBJECTIVES: We describe the clinical presentation, imaging, and pathology results of a patient with chondromyxoid fibroma (CMF) involving the mastoid portion of the temporal bone. The literature covering CMF of the head and neck is reviewed. METHODS: The patient chart, including imaging and pathology results, was analyzed. An English-language literature review of skull base CMF was performed. RESULTS: Eighty-seven cases of CMF involving the head and neck have been reported in the scientific literature. Sixty-two cases involved the skull base, temporal bone, nasal cavity, or paranasal sinuses. Including this patient, only 8 cases of CMF isolated to the temporal bone have been reported. Most patients experience insidious onset of symptoms such as hearing loss or headache. A computed tomographic scan best shows the relationship of the tumor to surrounding bone and may show intratumoral calcification. Surgical removal was the treatment most commonly used. Although irradiation has been used in selected cases, it is usually avoided because of the potential risk for malignant transformation. CONCLUSIONS: Chondromyxoid fibroma, a slow-growing bone tumor, is exceedingly rare within the mastoid. Its differential diagnosis includes chordoma, chondroid chordoma, and low-grade myxoid chondrosarcoma. Surgical excision is the treatment of choice.     

Aggressive psammomatoid ossifying fibroma in a 3-month-old boy—A case report

Aggressive psammomatoid ossifying fibroma (APOFs) is a benign mesenchymal tumor of the bone with a large growth potential, occurring usually in young adolescents and children. In this case report we are presenting a 3-month-old boy who was diagnosed with an aggressive psammomatoid ossifying fibroma of the nose and paranasal sinuses. In this age early diagnosis is difficult and may results in misdiagnosis such as chronic rhinitis. Endoscopic approach was chosen to remove the tumor. This case report demonstrates that complete endoscopic removal of large tumor involving nasal cavity and paranasal sinuses is effective, though technically challenging.     

Sclerosing lesions of the temporal bone

Sclerosis of the mastoid portion of the temporal bone is often seen on radiographs of patients who have or have had chronic otitis media. Occasionally lesions are seen that cause sclerosis of the entire temporal bone. The otolaryngologist must be alert to the fact that these findings may signify important pathology beyond that of chronic otitis media and indeed may be indicative of life threatening problems in adjacent or distant areas. In this paper the differential diagnoses of sclerotic lesions of the temporal bone will be discussed. These include fibrous dysplasia, osteopetrosis, meningioma, ossifying fibroma and metastatic lesions to the temporal bone. Three representative cases with sclerotic temporal bones are presented. The first is a patient with a conductive hearing loss secondary to stenosis of the external auditory canal. He was found to have a fibrous dysplasia of the temporal bone. The second case is an elderly male with a draining ear and a facial nerve paresis. He was found to have adenocarcinoma of the prostate gland metastatic to the temporal bone. The third case is that of a woman with a meningioma who demonstrated a sclerotic temporal bone on routine radiographs of the skull.     

Temporal bone central giant-cell granuloma presenting as a serous otitis media

Central giant cell granuloma is a benign intraosseous lesion that most commonly occurs in the facial bones. Its location in the temporal bone is extremely rare and only 20 cases have been reported in the literature. We report a case of an adult female patient presenting with a right serous otitis media and mastoiditis associated with a mixed hearing loss during 6 months. CT-scan and MRI revealed a temporal bone tumor involving the mastoid, and surrounding the right temporo-mandibular joint. Tumor was totally removed after a canal-wall-down mastoidectomy and middle ear exclusion. Pathology revealed a central giant cell granuloma. Seven months following the surgery there was no evidence of recurrence. Central giant cell granuloma is a rare temporal bone lesion, with non specific clinical and imaging signs but characteristic pathological features. Today, a total surgical removal and regular MRI follow-up is the best management option.     

Pleomorphic adenoma of the external auditory canal complicated by hearing loss secondary to chronic otitis media

Pleomorphic adenoma (PA) rarely occurs in the external auditory canal (EAC). A case of PA complicated with chronic otitis media is reported. The patient was a 36-year-old male who began to experience a hearing loss in the left ear in 1996. He sought medical attention only after ear pain developed in April 2003. At the initial examination, a tumor covered by smooth skin was seen filling the left EAC. Pure-tone audiometry showed residual hearing at low frequencies and scale-out across middle to high frequency range. The CT and MRI findings led to a diagnosis of a tumor of the left EAC complicated with an inflammatory middle-ear lesion. The tumor was excised en bloc with the overlying skin, and tympanoplasty was performed. The pathological diagnosis was PA of the left EAC and inflammatory granuloma of the middle ear.     

Desmoplastic fibroma of the temporal bone

A desmoplastic fibroma is a rare entity in the temporal bone. An 86-year-old woman was seen for evaluation of ear discharge and stenosis of the ear canal with a mass involving the post-auricular region. The tumor was found to be a desmoplastic fibroma. The clinical picture, pathology, diagnosis and prognosis of the tumor are discussed.