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題 名 | 顳骨骨折時經中腦窩乳突顏面神經解壓術=Transmastoid and Middle Cranial Fossa Decompression of the Facial Nerve in Temporal Bone Fracture |
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作 者 | 蘇茂昌; 林肇穗; 辛宗翰; 劉乃文; 黃志堅; | 書刊名 | 中華民國耳鼻喉科醫學會雜誌 |
卷 期 | 32:6 1997.12[民86.12] |
頁 次 | 頁28-34 |
分類號 | 416.844 |
關鍵詞 | 顳骨骨折; 面神經麻痺; 經中窩腦; Temporal bone fracture; Facial palsy; Middle cranial fossa approach; |
語 文 | 中文(Chinese) |
中文摘要 | 背景:由顳骨骨折所引起的外傷性顏面神經麻痺, 其治療方法仍是一個值得討論 的課題, 尤其是手術的適應症,時間和方法更是主要的爭論所在。 方法:收集本科從民國 75 年至 80 年間共 7 例因顳骨骨折而要做顏面神經解壓手術的病人,討論其發病情形、術 前檢查、手術發現及預後。全部病人的流淚試驗皆為有意義的減少。手術適應症是以神經刺 激試驗在 10 mA 毫無反應或些微反應,或神經電圖有 90 %以上的變性為依據。其中 6 個 病人因為聽小骨沒有受傷,所以經由中腦窩、乳突做解壓手術。1 例因為有聽小骨受傷,所 以經由乳突、迷路外手術。結果:受傷部位在膝狀神經節附近最多,術中神經變化有水腫、 血腫、骨片插入和肉芽組織。 2 例輕度感音性失聽的病人術後聽力恢復正常。其餘 5 例沒 有改變。 術前顏面神經麻瘤分級第 6 級 4 人,第 5 級 3 人。術後 1 例恢復正常的第 1 級;5 例恢復正常的第 2 級;1 例恢復為第 3 級。結論:我們建議因顳骨骨折引起的顏面 神經麻痺如果需要做手術時則越早做越好。假使沒有傳音性失聽可以使用經由中腦窩、乳突 手術。如果合併有傳音性失聽則可以試著經由乳突、迷路外手術。 |
英文摘要 | Background: The management of facial nerve injury resulting from temporal bone fracture continues to be a topic of discussion. The indications for surgery as well as the proper timing and extent of surgical exploration are the principal questions debated. Methods: A retrospective review of 7 cases of intratemporal facial nerve injuries following longitudinal temporal bone fracture. This paper discusses pre-operative examination, intra-operative findings and post-operative evaluation. All of them had a positive Schirmer test. Surgery was indicated for patients because they had no response or only a barely discernible response to 10 mA from the Hilger stimuiator or greater than 90% degeneration of the facial nerve fibers as measured by electroneuronography. Six patiens underwent total facial nerve decompression using transmastoid and middle cranial fossa approach. One patient with a significant conductive hearing loss underwent transmastoid-extralabyrinthine-subtemporal approach. Results: The most frequent site of injury was the area of the geniculate ganglion. Findings of the facial nerve were swelling, edema, intramural hematoma and bone chip. The injury to the facial nerve was often severe. Conclusions: We recommend early exploration in these cases when electrical studies indicate a severe injury. In most cases a combined mastoid and middle fossa apporach is required. |
本系統中英文摘要資訊取自各篇刊載內容。