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

Treatment of Facial Paralysis Following Temporal Bone Fracture

Objective To explore the ideal treatment of facial paralysis (FP)following temporal bone fracture.Methods The surgical approaches were chosen in terms of the sites of facial nerve injury,which were decided by varieties of tests;such as,pure tone test,acoustic impedance measurement,Shirmer's test,electromyogram ,temporal bone CT scan,et al.Results Decompression was performed for intratemporal facial nerve injury.Parotid gland approach,in which end to end anastomosis or nerve grafting was performed ,was taken for extratemporal injury of facial nerve.Ossicular reconstruction was implemented in conductive hearing loss (4 cases),among which hearing threshold of pure tone was restored to less than 30 dB in 3 cases ,air-bone gap less than 15 dB in 1 case.Conclusion It is suggested that middle fossa approach should be taken,when the site of nerve injury is adjacent the geniculate ganglion and great petrous superficial nerve in the longitudinal fractrue of temporal bone.