颞骨次全切除术治疗鼻咽癌放疗后 放射性颞骨坏死临床分析

摘要：目的分析颞骨次全切除术治疗放射性颞骨坏死的疗效。方法回顾性分析诊治的71例Ⅲ、Ⅳ型鼻咽癌放疗后放射性颞骨坏死患者,按随机抽样法分为两组,观察组（35例）行颞骨次全切除术治疗,对照组（36例）行保守治疗。比较两组治疗效果和患者术后行为状态、生活质量。结果观察组显效29例、有效2例、无效4例,总有效率89.16%;治疗效果明显好于对照组（P<0.05）。KPS评分、躯体功能、心理功能、社会功能、认知功能和总体生活质量评分明显高于对照组（P<0.05）。结论颞骨次全切除术对于放射性颞骨坏死具有积极的治疗意义,应在临床中推广。     

颞骨巨细胞瘤(附5例报告)

目的观察颞骨巨细胞病的临床病程,诊断和治疗.方法从我们科收集了5例颞骨巨细胞瘤且进行病理学分析.结果5例颞骨巨细胞瘤,其中女性1例,男性4例,年龄在28到73岁.1例患者病理分型为Ⅰ-Ⅱ级,4例为Ⅱ级.所有5例患者均进行了根治性切除和术后放疗,随访3到12年无复发.结论颞骨巨细胞瘤的诊断基于典型的病理特征,影像和临床表现.根治性切除是最适当的治疗方法,再加术后放射治疗多能获得长期治愈.     

鼻咽癌放疗后颞骨放射性骨坏死的诊治

目的：探讨鼻咽癌放疗后颞骨放射性骨坏死的诊断和治疗。方法：21例（22耳）鼻咽癌放疗后颞骨放射性骨坏死患者，经耳镜及影像学检查16例17耳局限型，5例5耳弥漫型。17耳局限型及1耳弥漫型予耳内镜下死骨刮除术，4耳弥漫型行乳突根治加耳周带蒂筋膜转移填塞术。结果：局限型17耳中，12耳（70．6％）创面完全上皮化，无游离死骨形成而治愈；4耳（23．5％）好转，创面未完全上皮化，但随访无死骨形成；1耳（5．9％）未愈，呈进行性死骨发展。弥漫型5耳中，1耳行有限度的死骨刮除术，创面完全上皮化而治愈；乳突根治4耳中，治愈3耳，1耳死骨形成再次手术，仍有耳漏。结论：耳内镜及颞骨CT为该病提供不同特点的诊断价值，对局限型行局部死骨刮除术能获得较好的疗效，提高患者的生活质量；弥漫型手术选择应慎重，本病有进行性缓慢发展的可能，需定期随访。     

Surgical treatment and outcomes of temporal bone chondroblastoma

Chondroblastoma is an uncommon primary benign bone tumor that usually arises in the epiphyses of the long bones. Temporal bone chondroblastoma is a rare primary bone tumor that affects the floor of the middle cranial fossa and temporomandibular joint (TMJ). The biological nature of temporal bone chondroblastoma is occasionally aggressive because of local invasion and is known to have a high recurrence after curettage. Therefore, complete resection is recommended. However, the literature provides little information regarding long-term surgical outcomes and complications after surgical resection. The authors have retrospectively analyzed four cases of temporal bone chondroblastoma that had been completely excised by a single surgeon with an eventual long-term follow-up. A single surgeon operated on four patients, two males and two females, with a mean age of 34 years, at the Department of Otorhinolaryngology, Severance Hospital. In all cases, the tumor involved the middle cranial fossa dura and the mandibular fossa with variable degree of infiltration. All patients have had no tumor recurrence to date (mean follow-up period of 5 years). Complete surgical resection of the temporal bone chondroblastoma is the gold standard for treatment. Precise preoperative image evaluation of tumor extension and proper management of the dura mater and temporomandibular joint (TMJ) are the major important features in complete surgical removal that minimize complications in temporal bone chondroblastoma treatment.     

7例颞骨骨巨细胞瘤的临床分析

目的：探讨颞骨骨巨细胞瘤(giant cell tumor of temporal bone，GCTTB)的病因、诊断、鉴别诊断及合理的治疗方法。方法：治疗方法以手术为主，7例中肿瘤根治性切除5例，临界切除2例(术后1年复发，病理Ⅱ级)。结合经病理学证实的GCTTB的临床资料，复习有关文献并对7例GCTB的临床、组织学和影像学等资料进行分析。结果：7例GcTTB中，右侧颞骨5例，左侧2例。病理Ⅰ级1例。Ⅰ～Ⅱ级2例，Ⅱ级4例。临床表现依肿瘤所在具体部位而有所不同：耳呜6例，耳鸣伴听力损失5例，其中有2例患侧耳全聋。眩晕2例．面瘫伴听力受损1例。3例术后行放射治疗，其中2例疗效良好．1例复发(为临界切除患者)。结论：明确诊断GCTTB必须综合临床、影像和病理三方面资料，手术彻底切除是最有效的治疗方法，术后辅以放疗可能有一定的作用。     

颞骨岩部胆脂瘤的手术治疗

目的探讨颞骨岩部胆脂瘤的临床特征、手术治疗及疗效。方法对1993～2002年收治的14例颞骨岩部胆脂瘤均经过手术证实和病理确诊。其中先天性3例，后天性11例。均有重度感音神经性聋或全聋和不同程度的周围性面瘫。手术取颅中窝入路9例，经迷路入路3例，迷路一颅中窝联合入路2例。术中见14例有耳蜗、骨迷路骨质破坏。颈内动脉暴露4例，颈内静脉暴露3例。面神经连续性存在，行全程而神经减压5例；而神经迷路段中断6例，行面神经改道吻合4例，2例因难以辨别中枢段断端，未行手术修复；内听道段损伤1例，因标志不清，无法修复；另外2例术前面肌萎缩，术中面神经未予手术修复。结果术后随访8个月至6年，除l例因复发行4次手术外，其余病人均未见胆脂瘤复发。按House-Brackmann面神经功能评级标准，全程减压5例中3例由Ⅲ级恢复到Ⅱ级，2例无恢复。面神经吻合4例中3例由Ⅳ级恢复到Ⅲ级，1例无变化。结论颞骨CT扫描在临床诊断上具有重要意义。手术是唯一的治疗方法，比较理想的手术入路为颅中窝或颅中窝-迷路联合入路。术中以完全清理病灶为主，尽量一期修复面神经功能。     

颞骨朗格汉斯组织细胞增生症22例临床分析

目的 分析颞骨朗格汉斯组织细胞增生症(Langerhans cell histiocytosis,LCH)的临床表现、诊断、治疗及预后.方法 回顾性分析我院15年来收治的22例颞骨LCH,研究其临床表现、诊断、治疗及预后,并随访1～15年,进行生存分析和无病生存率的Log-rank检验.结果 22例中1例为多系统高危组,3例为多系统低危组,18例为单系统组.临床表现以耳部为主,颞骨CT见大范围的溶骨性骨质破坏.22例患者的误诊率为72.7%(15/22).所有患者采用不同组合的综合治疗,随访1～15年,存活21例(95.5%),死亡1例(4.5%),后遗尿崩症、侏儒症、癫癎各1例,单耳听力严重下降2例,后遗症发生率22.7%(5/22),多系统组与单系统组无病生存曲线差异有统计学意义(x~2=5.87,P<0.05).结论 颞骨LCH多数累及单系统,以耳部临床表现为主,易误诊,治疗方案宜根据受累系统来选择,单系统组预后明显好于多系统组.     

Surgical timing for facial paralysis after temporal bone trauma

Objectives

To explore surgical timing of facial paralysis after temporal bone trauma.

侧颅底疾病的外科治疗及颅底重建（附20例报告）

目的探讨侧颅底疾变的外科治疗和体会。方法回顾性分析20例侧颅底疾病患者的临床资料,其中颞骨占位性病变破坏内听道、颈静脉孔区等占位病变与颅内沟通者1 1例,采取经迷路、乳突腔引流以及经乳突切除肿瘤手术;中耳炎性疾病破坏鼓室、鼓窦天盖与颅内沟通者2例,采取扩大乳突根治手术;外伤与畸形造成侧颅底骨质破坏,脑脊液耳漏、鼻漏7例,采取经迷路、乳突修补手术。结果其中颞骨占位性听神经瘤3例、面神经肿瘤3例、静脉孔区胆固醇肉芽肿1例、原发于颞骨的胆脂瘤4例,肿瘤均完全切除;中耳胆脂瘤2例,乳突根治术后无复发;Mondini畸形合并内听道底骨质缺损导致耳漏2例、颞骨骨折致耳漏5例,术后脑脊液漏消失。重要的神经、血管、位听器官以及颅底和颅脑组织得到保护或重建。结论外科手术是治疗侧颅底疾病的主要方法,术中应注意保护重要的血管、神经、位听器官以及颅底、颅脑组织。     

Primary temporal bone chondrosarcoma: experience with 10 cases

Abstract

Background: Temporal bone chondrosarcoma (TBC) are uncommon primary temporal bone malignancies, and clinicians lack experience in its diagnosis and treatment. The optimal management of patients with tumor of TBC also remains a topic of debate and controversy.

Objectives: This article summarizes the experience of diagnosis and treatment of TBC, in order to improve the quality of life of cancer patients in the future.

Material and methods: We conducted a retrospective analysis of 10 patients who were referred to our hospital from June 2009 to June 2018 for the treatment of TBC.

Results: There were 3 males and 7 females. The most common presenting symptoms were facial paresis (50%) and hearing loss (40%), whereas otalgia (10%), vertigo (10%) and headache (10%) were less common. All tumors originated from the temporal bone, and 80% involved the jugular foramen area. All patients survived without evidence of disease at a median time of follow up of 28.8 months.

Conclusions and significance: TBC mostly originated in the middle ear mastoid area, and easily extended to the jugular foramen area. An individualized surgical procedure that removes tumors integrally with minimal nerve and blood vessel damage provides long-term cancer control and minimal morbidity in most cases.     

Surgical management of parapharyngeal tumors - our experience

Fifteen cases of parapharyngeal tumors treated surgically in ENT department of Calcutta National Medical College in last 2 years were included, 80% cases were of benign tumors, most common being schwannomas. Most important investigation was found to be CT scan. The study gives an overview regarding the surgical approach, based upon the extent and histology of the tumor and transcervical approach was found to be most efficient for all practical purpose.     

Liposarcoma of temporal bone: a case report

This is the third case report of liposarcoma of the temporal bone. A 69-year-old man complained of left otalgia, left otorrhea, and dizziness for several months, with a past history of tympanoplasty for cholesteatoma 28 years previously. Otoscopy revealed debris in the attic. We performed tympanoplasty for recurrent cholesteatoma. The postoperative pathological diagnosis was well-differentiated liposarcoma. Palliative resection of liposarcoma was performed 3 months after the first surgery. Neither local recurrence nor distant metastasis has been detected for 24 months after the first surgery. The favorable outcome in this patient was probably due to the histological type of his liposarcoma.     

Pseudotumour of the temporal bone: a usual cause of otorrhoea and facial palsy

An inflammatory pseudotumour of the temporal bone is a rare, idiopathic, fibro-inflammatory lesion which mimics malignancy. Although such a lesion is known to occur elsewhere in the body such as the liver, abdominal viscera, pelvis, thorax and the upper respiratory tract, the involvement of the temporal bone is extremely unusual. We present such a case in a 60-year-old man, which provided a great diagnostic challenge. We review the key radiological and histological results that confirmed the diagnosis and demonstrated for the first time that oral steroids alone may completely resolve the condition. An erratum to this article can be found at     

颞骨骨化纤维瘤

目的：探讨颞骨骨化纤维瘤的诊断和治疗，提高对该病的认识。方法：报道1例颞骨骨化纤维瘤男性患儿，取耳后沟外切口，暴露瘤体，彻底切除肿瘤组织，封闭外耳道残端，取自体腹壁脂肪填塞术腔；术后定期随诊。结果：术后病理证实为颞骨骨化纤维瘤，术后随访1年无复发，外耳道内端封闭完好。结论：颞骨骨化纤维瘤临床罕见，虽为良性肿瘤，但可压迫和侵袭邻近重要组织和器官，引起功能障碍和颅内感染,一旦确诊，应尽早完整切除。     

Eosinophilic granuloma of the temporal bone

Summary Involvement of the temporal bone by cosinophilic granuloma is rare. Two cases are presented and their clinical manifestations, histopathological findings and treatment procedures discussed.     

Validation of a 3D-printed human temporal bone model for otology surgical skill training

HypothesisThree-dimensional (3D) printed temporal bones are comparable to cadaveric temporal bones as a training tool for otologic surgery.BackgroundCadaveric temporal bone dissection is an integral part of otology surgical training. Unfortunately, availability of cadaveric temporal bones is becoming much more limited and concern regarding chemical and biological risks persist. In this study, we examine the validity of 3D-printed temporal bone model as an alternative training tool for otologic surgery.MethodsSeventeen otolaryngology trainees participated in the study. They were asked to complete a series of otologic procedures using 3D-printed temporal bones. A semi-structured questionnaire was used to evaluate their dissection experience on the 3D-printed temporal bones.ResultsParticipants found that the 3D-printed temporal bones were anatomically realistic compared to cadaveric temporal bones. They found that the 3D-printed temporal bones were useful as a surgical training tool in general and also for specific otologic procedures. Overall, participants were enthusiastic about incorporation of 3D-printed temporal bones in temporal bone dissection training courses and would recommend them to other trainees.Conclusion3D-printed temporal bone model is a viable alternative to human cadaveric temporal bones as a teaching tool for otologic surgery.     

106例颞骨骨折的诊治

目的总结颞骨骨折的诊治效果。方法回顾性分析1997～2004年诊治106例颞骨骨折的临床资料。其中,行开颅术4例,骨折复位术14例,清创缝合术45例,乳突探查止血术6例,中耳乳突探查加听骨链重建术3例,中耳乳突探查加面神经管减压术1例,外耳道骨折复位术5例。结果106例中转院和自动出院14例。面瘫恢复7例,好转2例。听力下降、眩晕多数恢复,其他不同程度改善。结论以外伤史及6大征象为依据,结合颞骨CT进行诊断。治疗危重者按“抢救诊断治疗”原则进行,急救按保证呼吸道通畅,呼吸道管理,循环系统的稳定、保温、吸氧、对症手术等顺序进行;为更好地确定骨折部位指导治疗,必要时应行高分辨率CT扫描。     

耳颞部朗格汉斯组织细胞增生症(附10例报告)

目的研究耳颞部朗格汉斯组织细胞增生症(LCH)的诊断和治疗。方法回顾分析10例经病理证实的耳颞部LCH病例。10例中男女各5例,年龄1~60岁,平均18.3岁。3例为韩-薛-柯病,7例为嗜酸性肉肿。临床主要表现为耳颞肿胀、颅骨缺损、耳漏、鼓膜穿孔、耳道肉芽、耳鸣、眩晕、耳聋、头痛、尿崩症等。结果8例接受手术加放疗后痊愈,2例接受手术后化疗治愈。遗留尿崩症、侏儒症各1例。结论LCH根据临床表现、影像学及组织病理学特征可做出诊断。手术、放疗和化疗是治疗LCH的有效疗法。尽管LCH病情危重,只要未累及重要生命器官、不误诊、及时合理治疗,一般预后良好,但其后遗尿崩症或侏儒症残疾则顽固难治。