先天性耳畸形患者面神经畸形的术前评估及术中防护北大核心CSCD

目的结合术前影像学及术中所见评价先天性外中耳畸形伴外耳道骨性闭锁(congenital aural atresia,CAA)患者的面神经畸形程度,并探讨面神经畸形程度对听力重建手术的影响。方法完善术前影像学及听力学检查,对符合适应证的CAA患者实施手术治疗,留取术中面神经走行相关资料,将面神经术中所见与颞骨影像学特征作对比,同时探讨面神经不同部位畸形对听力重建手术的影响。结果共入组65例(69耳)患者,术前颞骨高分辨率CT(HRCT)显示,面神经位置正常8耳(12.12%),鼓室段低位61耳(88.40%),其中部分遮窗46耳(66.67%),完全遮窗15耳(21.74%),双分支畸形2耳(2.9%),面神经骨管完整6耳(8.7%),骨管缺如63耳(91.3%)。术中见面神经位置正常6耳(8.70%),鼓室段低位63耳(91.3%),部分遮窗45耳(65.22%),完全遮窗18耳(26.09%),双分支畸形3耳(4.35%),面神经骨管完整17耳(24.64%),骨管缺如52耳(76.36%)。面神经第二膝角度变小(急转弯)及乳突段前移至前庭窗18耳,均完全遮盖前庭窗。结论颞骨HRCT对诊断面神经畸形至关重要。CAA患者Jahrsdoerfer评分越低,面神经畸形的发生率及遮窗程度也越重,对听力重建手术的影响也越大。     

颞骨高分辨率CT在55例中耳疾病中的临床应用

目的探讨颞骨高分辨率CT在慢性化脓性中耳炎、中耳畸形及颞骨骨折中的应用价值。方法采集层厚0.5 mm,螺距15,轴状位薄层扫描,骨算法,FOV 9.6 cm、间隔1 mm重建。对44例(耳)慢性化脓性中耳炎,9例(耳)中耳畸形病人进行骨最大密度投影(MIP)及听小骨三维重建(SSD)成像,对2例颞骨骨折致面瘫病人行颞骨矢状斜位成像显示面神经。分别将55例病人的CT图像术中所见对比,分析颞骨、外耳道、中耳(鼓室、鼓窦、乳突、听小骨、面神经、天盖、盾板等)、内耳(骨半规管、耳蜗及前庭)的特征及存在的解剖变异。结果高分辨率CT清晰地显示了耳部微小病灶,明确了病变范围与周围结构的关系,听小骨的SSD对锤骨、砧骨、镫骨、锤砧关节、砧镫关节的显示有着极高的逼真性,颞骨矢状斜位极好地显示了面神经的破坏部位,为临床制定手术方案提供了有力的影像学依据。结论颞骨高分辨率CT对中耳炎症、畸形、颞骨骨折致面瘫的诊断和手术方案的制定有重要的临床价值。颞骨高分辨率CT可列为中耳疾病的常规检查项目。     

颅中窝-乳突联合进路面神经减压术

目的探讨颅中窝-乳突联合进路面神经减压手术适应症、手术方法效果。方法对2000年1月—2007年4月收治的5例外伤性面瘫（House-Brackmann分级Ⅳ-Ⅴ级）患者行颅中窝-乳突联合进路面神经减压术。结果5例行颞骨高分辨CT扫描均显示颞骨骨折,3例显示颅中窝底突起的骨碎片,流泪试验均为阳性。术后随访1-2年,2例面瘫Ⅳ级、2例面瘫Ⅴ级患者完全恢复,1例面瘫Ⅴ级患者恢复至Ⅲ级。结论根据颞骨高分辨CT扫描和流泪试验判断面神经损伤的部位以选择手术进路,颅中窝-乳突联合进路适于面神经全程减压术。     

颞骨高分辨率CT在周围性面瘫诊治中的应用

颞骨高分辨率CT及计算机后处理技术的应用在显示面神经骨管及其周边解剖结构具有明显优势,多层面重建技术可对颞骨内结构进行任意角度观察,曲面重建技术能对面神经骨管进行全程显示。目前,颞骨高分辨率CT在周围性面瘫的病情评估、鉴别诊断中具有越来越重要的参考价值,结合面肌电图和MRI检查,对面神经减压术术前评估及手术并发症的预防具有重要意义。     

高分辨CT扫描在颞骨骨折致面神经损伤中的应用

目的：探讨高分辨ＣＴ扫描在颞骨骨折致面神经损伤中的应用价值。方法：对２８例有面神经损伤的颅脑外伤患者行颞骨薄层ＣＴ扫描,根据颞骨ＣＴ扫描及临床征象行手术。结果：基本恢复６例,部分恢复１８例,无变化４例。结论：高分辨率ＣＴ可明确显示颞骨骨折的位置及走行,有助于手术前判断面神经损伤的部位及相关损伤,以选择适当的手术径路。     

高分辨率CT在慢性化脓性中耳炎手术中的应用

目的：探讨高分辨率计算机断层扫描(HRCT)在显示中耳结构时的优越性及临床价值。方法：分别将51例患者的HRCT图像与术者术中所见进行对比，分析中耳结构(听小骨、面神经管、半规管和天盖等)的特征及存在的解剖变异。结果：锤骨、天盖、砧骨、迷路的HRCT表现与术中所见一致性好，镫骨及面神经管破坏显示差，k(Kappa statistics)值分别为0．840，0．788，0．700，0．560，0．366，0．310。HRCT可发现潜在的手术危险及变异结构，如硬脑膜低位，颈静脉球高位，乙状窦前置，面神经暴露及周围骨质破坏。结论：除面神经管破坏及镫骨结构外，其他中耳重要结构HRCT均能显示清楚，并对制定手术方案，提高手术效果具有重要意义。HRCT应作为中耳乳突手术前常规检查项目。     

乳突-颞下迷路外径入路面神经减压术治疗颞骨骨折面瘫

目的:探讨乳突-颞下迷路外径入路面神经减压术治疗颞骨骨折面瘫的临床疗效。方法:对2006-01-2008-04收治的26例外伤性面瘫患者行乳突-颞下迷路外径入路面神经减压术。面神经功能House-Braek-mann分级:Ⅴ级12例,Ⅵ级10例,Ⅲ级4例。术前纯音测听检查示:16例纵行骨折语频气导平均听阈为52dB,10例混合性骨折均为重度感音神经性聋。颞骨轴位CT示:13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。结果:全部患者术后一期愈合,无手术并发症发生。术后随访0.5～3.0年,平均1.2年。面神功能恢复达House-BrackmannⅠ级15例,Ⅱ级6例,Ⅲ级5例;语频气导听力平均提高33dB。结论:乳突-颞下迷路外径入路面神经减压术治疗颞骨骨折面瘫高位面神经减压保全和重建听骨链效果满意。     

面神经与岩骨胆脂瘤

岩骨胆脂瘤的诊断和处理是耳外科的一个疑难问题。现报道７例侵犯迷路、面神经管的破坏广泛的岩骨胆脂瘤，按临床表现、术中所见、Ｘ线表现及手术径路做回顾性分析。术前６例出现面瘫合并重度耳聋或全聋，皆有慢性中耳炎史，全部经颞骨外侧径路手术。对有慢性中耳炎的患者出现急性面瘫或渐进性面瘫，即使体检未发现胆脂瘤，应做Ｘ线检查以明确有无岩骨胆脂瘤。     

颞骨骨折导致双侧面瘫的临床观察

目的探讨外伤性颞骨骨折导致双侧面瘫的临床特点、手术适应证及疗效。方法回顾北京电力医院收治的4例外伤致双侧颞骨骨折伴双侧面瘫患者的临床资料, 分析外伤导致颞骨骨折伴面瘫患者的临床特点,对比术前与术后面神经功能及听力的恢复情况,分析手术适应证及手术时机,并进行疗效评估。4例患者中车祸伤3例、头部挤压伤1例,均为双侧颞骨骨折同时伴有颅内外损伤,伤后全部有意识丧失史,所有患者清醒后即发现面瘫。术前面神经功能Sunnybrook评分为（9.0±2.00）分。颞骨高分辨率CT显示8侧颞骨骨折均为纵行骨折,膝状神经节局部结构紊乱6侧,砧骨长脚骨折2侧。结果8侧面瘫中1侧在保守治疗后好转,其余7侧在保守治疗5～12周无明显恢复, 行面神经减压术,其中3侧同时行人工听骨听力重建术。术后随访1年, 面神经功能评分为（78.1±3.55）分,与术前评分比较差异具有统计学意义（P<0.01）;平均听力较术前提高11.87 dBHL,与术前听力比较差异具有统计学意义（P<0.01）。结论车祸伤是造成双侧颞骨骨折伴双侧面瘫的主要原因。颞骨骨折导致双侧面瘫具有合并颅内外损伤较多、面神经骨管损伤较重等特点。面神经减压术对于保守治疗无效的患者具有积极治疗意义,手术越早疗效越好。颞骨骨折导致的传导性聋可同时行听骨链重建治疗。     

颞骨骨折性面瘫的临床和实验观察

为探讨影响颞骨骨折性面瘫预后的主要因素和面神经减压术的意义，总结分析了６４例面瘫预后的主要相关因素。制作面瘫实验西式，测定面神经骨管开放组和非开放线面神经膨胀率，并行电镜观察。结果表明，影响预后的主要因素是否行面神经减主及手术时机。骨管开放组面神经膨胀率显著大于非开放组，非开放组纤维损伤谋生时机提示早期行面神经减压术有 利于面神经功能恢复。     

surgical management of traumatic facial paralysis: a case review study

Objective To evaluate efficacy of surgical treatment in traumatic facial paralysis.Methods:Thirty-three cases were reviewed,including temporal bone fracture and iatrogenic facial nerve injury.All the p...     

Accuracy of high-resolution computed tomography in locating facial nerve injury sites in temporal bone trauma

In this study, high-resolution, multislice computed tomography findings are compared with surgical findings in terms of the fracture location in patients with traumatic facial paralysis. Patients with traumatic facial paralysis with grade VI House-Brackmann scale who met the criteria for surgical decompression between 2008 and 2012 were included in this study. All the patients underwent a multislice high-resolution, multislice computed tomography (HRCT) using 1-mm-thick slices with a bone window algorithm. The anatomical areas of the temporal bone (including the Fallopian canal) were assessed by CT and during the surgery (separately by the radiologist and the surgeon), and fracture line involvement was recorded. Forty-one patients entered this study. The perigeniculate area was the most commonly involved region (46.34 %) of the facial nerve. The sensitivity and specificity of HRCT to detect a fracture line seems to be different in various sites, but the overall sensitivity and specificity were 77.5 and 77.7 %, respectively. Although HRCT is the modality of choice in traumatic facial paralysis, the diagnostic value may differ according to the fracture location. The results of HRCT should be considered with caution in certain areas.     

Current Considerations in Neck Dissection

Conclusions. High resolution CT imaging can provide useful information about the pathological exposure of the mastoid portion of the facial nerve before mastoid surgery and can assess the injury site of the facial nerve after operation. Objectives. To evaluate the diagnostic value of high resolution CT scanning of pathological exposure of the mastoid portion of facial nerve and provide valuable information for otologic surgery, and to analyse the cause of facial nerve paralysis after operation. Materials and methods. Routine CT scanning was used to examine patients with chronic suppurative otitis media and external auditory canal cholesteatoma preoperatively by axial-transverse and coronal views. If there was any pathological exposure of the mastoid portion of the facial nerve on CT imaging, then this was compared with intraoperative findings. In addition, one patient who had suffered postoperative facial nerve paralysis was also examined by CT scanning to determine whether any pre-existing pathological exposure of facial nerve could be found. Results. Through routine CT scanning six patients with chronic suppurative otitis media and three patients with external auditory canal cholesteatoma were found to have pathological exposure of the mastoid portion of the facial nerve. Coronal views could more clearly show the size and the position of the exposure; the corresponding surgical findings (pathological exposure) for the facial nerve could be confirmed in all nine patients. CT imaging could also show that the patient who had suffered postoperative facial nerve paralysis did indeed have pre-existing pathological exposure of the mastoid portion of the facial nerve.     

CT VIRTUAL ENDOSCOPY IN ASSESSING OSSICULAR CHAIN DISRUPTION CSUSED BY TEMPORAL BONE FRACTURE AND EAR TRAUMA

Objective To explore the value of computed tomography virtual endoscopy (VE) in assessing ossicular chain disruption in temporal bone fracture and ear trauma with intact tympanum. Methods High resolution spiral computerized tomography (CT) was completed in 35 cases of temporal bone fracture and 5 cases of tympanum trauma, all with intact or healed tympanum. Three-dimensional reconstruction was completed us-ing a virtual endoscopy software. Audiological tests were conducted in all patients and evaluation of facial nerve injury in patients with facial paralysis. Patients with mild conductive deafness, ossicular chain sublux-ation on VE, and no facial paralysis were treated conservatively for 4-12 weeks with repeated hearing evalu-ation; those with facial paralysis underwent surgery if no recovery after 4-8 weeks of conservative treat-ment. Patients with moderate to severe conductive hearing loss or mixed hearing loss, incus long process fracture or dislocation on VE and facial paralysis, underwent ossicular chain reconstruction and facial nerve decompression after conservative treatment for 4-8 weeks, or exploratory tympanotomy only if no facial pa-ralysis. VE, audiological tests and facial nerve function tests were repeated in 3-6 months after surgery. Re-sults Of the 6 cases with mild conductive hearing loss, ossicular chain subluxation and no facial paralysis, 3 recovered to normal hearing spontaneously and 3 showed no significant improvement, after 4-12 weeks of conservative treatment. After conservative treatment for 4-8 weeks, 3 of the 12 cases with mild conductive deafness, ossicular chain dislocation on VE and facial paralysis recovered to normal hearing and House-Brackmann (HB) grade I facial function from HB grade II ,4 showed facial function recovery to HB grade I (n=2) or II (n=2) from HB grade III but no hearing recovery, and 5 gained no recovery and went on to receive exploratory tympanotomy and facial nerve decompression. The 11 cases with moderate to severe conductive deafness, incus long process fracture or dislocation on VE and facial paralysis all received ossic-ular chain reconstruction and facial nerve decompression after 4-8 weeks of conservative treatment. The 7 cases with moderate to severe conductive deafness, dislocated or fallen incus on VE but no facial paralysis received ossicular chain reconstruction after conservative treatment. The 4 cases with mixed hearing loss, dislocated or fallen incus on VE and no facial paralysis received ossicular chain repair via the intact canal wall epitympanum approach after conservative treatment. Pharmacological therapies continued postopera-tively in these patients to treat sensorineural deafness. Although temporal bone CT scans displayed the frac-ture line and malleus/incus abnormalities, VE provided additional detailed information on dislocation of in-cudomalleal and incudostapedial joints, incus dislocation or fracture, separation between crus longum incu-dis and stapes, and incus shifting. These were all confirmed during surgery. VE results and surgery findings were 100%consistent in patients with ossicular chain disruption. Conclusion VE can provide reliable visual evidence for accurate assessment of traumatic ossicular chain disruption, timing of surgery and individualiz-ing surgical strategies and postoperative follow-up.     

Diagnosis of the pathological exposure of the mastoid portion of the facial nerve by CT scanning

CONCLUSIONS: High resolution CT imaging can provide useful information about the pathological exposure of the mastoid portion of the facial nerve before mastoid surgery and can assess the injury site of the facial nerve after operation. OBJECTIVES: To evaluate the diagnostic value of high resolution CT scanning of pathological exposure of the mastoid portion of facial nerve and provide valuable information for otologic surgery, and to analyse the cause of facial nerve paralysis after operation. MATERIALS AND METHODS: Routine CT scanning was used to examine patients with chronic suppurative otitis media and external auditory canal cholesteatoma preoperatively by axial-transverse and coronal views. If there was any pathological exposure of the mastoid portion of the facial nerve on CT imaging, then this was compared with intraoperative findings. In addition, one patient who had suffered postoperative facial nerve paralysis was also examined by CT scanning to determine whether any pre-existing pathological exposure of facial nerve could be found. RESULTS: Through routine CT scanning six patients with chronic suppurative otitis media and three patients with external auditory canal cholesteatoma were found to have pathological exposure of the mastoid portion of the facial nerve. Coronal views could more clearly show the size and the position of the exposure; the corresponding surgical findings (pathological exposure) for the facial nerve could be confirmed in all nine patients. CT imaging could also show that the patient who had suffered postoperative facial nerve paralysis did indeed have pre-existing pathological exposure of the mastoid portion of the facial nerve.     

Rehabilitation of the face following traumatic injury to the facial nerve

Etiology, diagnosis, and surgical management of facial paralysis due to traumatic injury of the VIIth cranial nerve are discussed. Sixty patients are reviewed who underwent some type of surgical procedure for the repair of the facial nerve. These cases are categorized according to etiology, which includes temporal bone fractures, iatrogenic injuries, and penetrating wounds of the head and neck. The results of a poll of eight leading otologists on their approaches to several aspects of the surgical management of these injuries are presented in the Discussion section. The diagnostic and prognostic studies associated with facial paralysis, as well as the more common surgical procedures available for repair of the facial nerve, are briefly reviewed.     

颞骨骨折面瘫及听力损失处理的探讨

目的　对１８ 例颞骨骨折面瘫及听力损失的处理进行探讨。方法　应用纯音测听、（ 儿童用ＡＢＲ 及４０ Ｈｚ ＡＥＲＰ检测） 、声导抗测试、泪分泌试验、面肌电图及颞骨ＣＴ对每一例患者进行检测。根据面神经损伤部位，选择不同的手术进路进行处理。结果　颞骨内面神经损伤均进行神经减压术，颞骨外面神经损伤均按腮腺手术进路行端对端吻合术或神经移植术。４ 例传导性聋经听骨链重建术后，其中３ 例纯音听阈达到应用水平（ 语频平均达３０ ｄＢ 以上） ，１ 例气骨导差≤１５ ｄＢ。结论　凡颞骨纵形骨折位于膝状神经节附近有岩浅大神经损伤者，以采取颅中窝进路最佳     

New aspects of facial nerve pathology in temporal bone fractures

Electron microscopic examination of intratemporal facial nerve segments removed from 12 patients with persisting facial paralysis following temporal bone fractures revealed that traumatic injury at the geniculum induces retrograde degeneration through the labyrinthine and distal meatal segments of the facial nerve. Fibrosis may occur in the traumatized labyrinthine segment and block regenerating motor fibers. The surgical treatment of traumatic facial nerve injuries should be aimed to avoid or eliminate fibrosis within the labyrinthine segment of the Fallopian canal.