颞骨骨折与胆脂瘤

根据骨折的轴向,颞骨骨折可以分为纵行、横形及混合性三种。多数颞骨骨折是纵行的(80%)并在迷路外,这类骨折可能会涉及鼓室和乳突的骨性组织和软组织,也可能损伤面神经。横形骨折常涉及迷路,往往造成耳蜗和前庭的损伤。混合性颞骨骨折则可兼有以上两种损伤。由于骨迷路内软骨层的修复较差,粘膜的上皮生长会形成瘘管,出现脑脊液长期渗漏,因此横形或混合性颞骨骨折的晚期并发症有发生细菌性脑膜炎的危险。作者主张对这类骨折患者进行长期随     

颞骨骨折致传导性聋的诊断与治疗进展

近年来,由于交通事故的频发,颞骨骨折的发生率也随之增加。颞骨骨折属于头颅外伤的一部分,可伴有不同程度的复合伤,可导致多种并发症,如听力下降、面瘫、脑脊液耳漏等,其中听力下降是比较常见的并发症。颞骨骨折常常引起昕骨链脱位,导致传导性聋,从而影响患者的生活质量。本文重点就颞骨骨折造成的听骨链中断引起传导性聋的流行病学、病因及发病机制、诊断和治疗进展进行综述。     

山东省立医院集团眼耳鼻喉医院颞骨解剖培训课程通知

由山东省立医院集团眼耳鼻喉医院颞骨解剖培训课程将于2014年9月27日～30日在山东省立医院集团眼耳鼻喉医院举办。拟招收学员16名,每名学员提供-侧颞骨,培训课程通过授课、手术录像讲解及颞骨解剖等形式,向学员详细介绍耳科常规手术的基本操作、注意事项、并发症预防处理等。培训费4000元,食宿费自理。学习期满,可获国家级继续医学教育I类学分10分。     

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     

外伤性胆脂瘤

胆脂瘤可能为颞骨骨折的迟发性并发症。文献论述颞骨外伤大多涉及其早期的临床表现,如颞骨骨折的类型,感音神经性或传导性耳聋,脑脊液漏及面瘫等。而很少注意少见的通常是颞骨外伤的远期结果,如中耳及乳突胆脂瘤的发生。作者报道颞骨骨折约在三、六和七年后发生胆脂瘤3例。虽然外伤性胆脂瘤组织学检查完全与非外伤性胆脂瘤相同,但其成因不同。可能发生于外伤后数年。其形成可能为颞骨骨折时皮肤直接入中耳和乳突或由于皮肤经骨折缝向内生长所致。因外伤性胆脂瘤多     

耳道外伤性通脑性囊肿:诊断和治疗

本病为一罕见的严重疾病,为颞骨骨折的晚期并发症,早期诊断及治疗可避免严重的脑膜炎。本文报道三例患者:一例为13岁男孩,因车祸左颞骨骨折,左耳出血,脑脊液耳漏。治愈2年后因脑膜炎及脑脊液耳漏住院。颞骨X-线断层发现鼓室盖有缺损,CT检查左颞叶囊性缺损并与侧脑室相通。行乳突根治术、切除囊肿,缺损的颞骨和硬脑膜用骨质及颞筋膜修补;术后追踪四年无复发。另一例为30岁男性患者因车祸右颞骨骨折,右耳道出血伴脑脊液耳漏及脑瘘。治愈后17个月因右耳聋,发现右耳道内有一灰色囊肿。颞骨X-线断层及CT检查确诊行囊肿切除及缺损修补。术后追踪2年无复发。第三例为11岁男孩,因车祸右颞骨骨折,右耳流血及脑脊液耳漏。治愈后17个月听力下降,检查发现鼓膜呈     

颞骨骨折致听力损害的预后及影响其预后的相关因素分析

目的　　探讨影响颞骨骨折所导致的外伤性听力损害预后的相关因素，从而指导治疗，提高对其预后的预见性。方法　　采用前瞻性研究，对临床所有105例患者资料进行单因素及多因素分析，并根据统计学进行数学处理，认定对其预后产生直接影响的相关因素。结果　根据统计学结果发现听力损害的程度、发生时间、颞骨骨折类型、是否伴有面瘫、脑脊液耳漏，对其预后的影响差异性显著（P＜0．05）。结论　　认定颞骨骨折所致听力损害的预后与其损害程度、性质、发生时间、骨折类型、是否伴有面瘫、脑脊液漏及治疗是否得当密切相关。     

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。     

颞骨岩部胆脂瘤诊疗策略

颞骨岩部位于颅底，位置深在，周围重要的神经、血管多。该区域常见的病变有胆脂瘤、胆固醇肉芽肿和囊肿等。岩部胆脂瘤多为原发性，亦可继发于中耳乳突胆脂瘤，原发者早期症状不典型，不易被早期发现，多数患者直至病变扩展出现颅内或颞骨内神经损伤症状才得以发现。手术治疗有一定的难度和风险，处理不慎可引起严重的并发症。     

外伤性周围性面瘫的诊断及手术治疗

颜面及头部外伤引起的周围性面瘫在耳科的临床实践中并不少见,特别是随着社会经济的发展,交通事故引起的外伤性面瘫近年有所增加,其中头部外伤引起的颞骨骨折是导致周围性面瘫的主要原因。但目前对于颞骨骨折的分型、外伤导致面瘫的治疗方法、是否手术探查等问题上还存在争议,特别是在手术时机的选择的问题上尚无统一标准。本文拟通过复习文献,结合我科在外伤性周围性面瘫外科治疗方面的经验,针对外伤性面瘫的常见原因、颞骨骨折的分型以及面神经减压手术时机的选择等问题进行讨论。     

Hyperpneumatization of the temporal,occipital and parietal bones

Hyperpneumatization of the temporal bone with extension into the occipital bone and even the parietal bones is a rare condition. According to a review of the literature, it mostly appears unilaterally in men and on the right side. Often it is discovered when complications like pneumatocele or pneumocephalus appear. The authors review and analyze all reported cases of hyperpneumatization, its symptoms, complications and treatment. We present a patient with extensive pneumatization found in the mastoid process, temporal bone, occipital bone and both parietal bones, who was discovered accidentally. The cause of the extension of pneumatization into the occipital and parietal bone is probably incomplete closure of the occipitomastoid synchondrosis and lambdoid and sagital sutures, which usually close in early adulthood and later, even in the 30s. Asymptomatic patients should be aware of possible complications, and in case of complications, operative therapy is often indicated.     

Fibrous dysplasia of the temporal bone complicated by cholesteatoma and thrombophlebitis of the transverse and sigmoid sinuses: a case report

Fibrous dysplasia is a benign condition that can affect the skull and facial bones and cause a broad spectrum of otolaryngologic conditions. We present the case of a boy with polyostotic fibrous dysplasia with involvement of the temporal bone that was first diagnosed when he was 9 years old. His condition eventually became complicated by cholesteatoma and thrombophlebitis of the left transverse and sigmoid sinuses, and he died of his disease at the age of 19 years. We discuss these and other complications of fibrous dysplasia of the temporal bone and their management.     

Radiographic classification of temporal bone fractures: clinical predictability using a new system

OBJECTIVE: To compare the traditional system of radiographic classification of temporal bone fractures (transverse vs longitudinal vs oblique) with a newer system (otic capsule violating vs otic capsule sparing) with respect to their ability to predict sequelae of temporal bone trauma. DESIGN: Retrospective chart and radiology review. SETTING: University trauma center and Department of Otolaryngology-Head and Neck Surgery. PATIENTS: Patients with temporal bone fractures. INTERVENTIONS: Clinic records and computed tomographic scans were reviewed to evaluate the clinical predictability of complications of temporal bone fractures. MAIN OUTCOME MEASURES: Complications of temporal bone fractures (ie, sensorineural hearing loss, conductive hearing loss, cerebrospinal fluid leakage, and facial nerve weakness) were recorded. Two classification schemes for temporal bone fractures were statistically analyzed and compared as to their ability to predict each complication. RESULTS: A total of 234 temporal bone fractures were identified; 30 cases met our strict criteria for inclusion. The traditional classification system of temporal bone fractures did not significantly predict temporal bone complications (P = .71). On the other hand, the otic capsule-based system did demonstrate statistically significant predictive ability (P < .001). Patients with otic capsule-violating fractures were 5 times more likely to have facial nerve injury, 25 times more likely to have sensorineural hearing loss, and 8 times more likely to have cerebrospinal fluid otorrhea than those with otic capsule-sparing fractures. CONCLUSIONS: The traditional radiographic classification system failed to demonstrate clinical predictability in our series. Furthermore, the newer system of classification (otic capsule sparing vs otic capsule violating) demonstrated statistically significant predictive ability for serious clinical outcomes associated with temporal bone fractures.     

基于CT片的颞骨计算机三维重建及实体模型复制

目的利用快速成形技术复制基于颞骨CT片重建的颞骨三维模型，探讨其临床应用前景。方法利用GE16排螺旋CT扫描重建的正常人及5例干颞骨水平断层片和Materialise Mimics 6．3体绘制软件重建颞骨三维立体模型。利用Auro SLA光固化快速成形机复制颞骨实体模型并进行手术演练。结果成功重建并复制了颞骨立体模型，模型表面骨性标志明显，不同断面剖切显示内部精细结构清晰。手术演练证明该模型能较好地满足手术模拟的要求。结论快速成形技术能够成功复制颞骨实体模型并用于术前手术演练，在侧颅底外科有广阔的应用前景，对于设计手术入路和减少并发症发生具有重要意义。     

Bilateral longitudinal temporal bone fractures: A retrospective review of seventeen cases

The types of temporal bone fractures, longitudinal and transverse, are reviewed. All cases of bilateral temporal bone fractures at Parkland Memorial Hospital in Dallas over a 10-year period from 1968 to 1978 are reviewed and discussed by the authors. One hundred sixty patients with the diagnosis of base of skull fractures were studied. Fifty-nine of these were temporal bone fractures and 17 of the 59 were bilateral. Of all the base of skull fractures, 10% were bilateral temporal bone fractures and 29% of all temporal bone fractures were bilateral. For each case the method of injury, the extent of damage to hearing and facial nerve function, presence of CSF otorrhea, X-ray findings, and additional complications are summarized and the results discussed. The operative findings of facial nerve decompressions are carefully reviewed. The authors' method of caring for temporal bone fractures is presented.     

Adenoid cystic carcinoma of the parotid gland with temporal bone invasion

OBJECTIVE: To present our series of 16 patients with adenoid cystic carcinoma (ACC) of the parotid gland with temporal bone invasion. PATIENTS: All patients treated at our institution between July 1988 and July 2004 with parotid gland ACC with temporal bone invasion. INTERVENTIONS: Preoperative radiographic assessment with combined surgical and radiation therapy treatment. MAIN OUTCOME MEASURES: Postoperative- or radiation-related complications and overall 2-, 5-, and 10-year survival. RESULTS: The most common surgically related complications were new-onset cranial nerve deficits, whereas osteoradionecrosis of the bony external auditory canal was the most frequently noted complication associated with radiation therapy. The overall survival rates at 2, 5, and 10 years were 94, 75, and 60%, respectively. CONCLUSION: Lateral cranial base access should be used in the extirpation of ACC of the parotid gland with temporal bone involvement.     

双侧耳郭软骨骨化1例并文献复习

目的 探讨耳郭软骨骨化的发病机制、临床表现、诊断依据、鉴别诊断、治疗方法。方法 回顾性分析1例耳郭软骨骨化患者的临床资料并复习相关文献进行总结。结果 耳郭软骨骨化的发病机制暂不明确,通常无明显不适症状,少数患者可伴有局部疼痛、听力下降等症状。颞骨CT可辅助诊断,最终确诊依赖于组织病理检查。症状不明显时可暂予观察,若症状严重影响了生活和工作,可予手术治疗。结论 耳郭软骨骨化在临床上较为少见,目前尚无有效逆转耳郭骨化的办法。积极寻找病因,及早干预,有利于避免病情进一步发展。     

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.     

Characteristics of osteoma of the temporal bone in young adolescents

The author conducted a retrospective review of the clinical presentation, management, and complications of temporal bone osteoma in young adolescents. The study population was made up of 9 patients-5 girls and 4 boys, aged 12 to 15 years at presentation (mean: 13.7)-who had been seen for radiologically and histopathologically proven temporal bone osteoma at the author's institution over a 9-year period. Of this group, 5 patients had extracanalicular osteoma (3 in the mastoid portion of the temporal bone, 1 in the squamous portion, and 1 in the mastoid antrum) and 4 patients had osteoma of the external auditory canal. Six of the 9 patients underwent surgical treatment; of the remainder, 1 refused surgery and 2 were managed conservatively with ongoing observation. All patients were followed for a minimum of 1 year, and no recurrences and no complications were observed during that time.     

Otological manifestations of leukemia

The authors have been fortunate to study the currently largest single series of temporal bones from patients with various forms of leukemia, including the first reported cases of erythroleukemia. Histologically, the middle ear showed leukemic infiltration and/or hemorrhage much more frequently than did the inner ear or external auditory canal. No sound relationship exists between the anatomical location of hemorrhage in the temporal bone and clinical otological symptomatology. A better relationship exists between the anatomical site of leukemic infiltration of the temporal bone and clinical otological symptomatology. Twenty percent of these patients experienced otological complications directly attributable to their leukemia. An additional 28 percent of these patients experienced clinical otological problems for which a leukemic etiology could not be definitely established by histopathological study of their temporal bones. Otological complications occurred most frequently in patients with the acute forms of leukemia, and specifically, in acute lymphocytic leukemia.