最新Fracture of temporal bone 耳鼻咽喉科学课件教学讲义PPT.ppt

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1、Fractureoftemporalbone耳鼻咽喉科学课件ClassificationsLongitudinalfracturesTransversefracturesMixedfracturesLongitudinalfractures80%ofTemporalBoneFracturesLateralForcesalongthepetrosquamoussutureline15-20%FacialNerveinvolvementEAClacerationsymptomsHearingLoss&tinnitusDizzinessCSFOtorrheaandRhinorrheaFac

2、ialNerveInjuriesHearinglossFormalAudiometryvs.TuningFork71%ofpatientswithTemporalBoneTraumahavehearinglossTMPerforationsCHL>40dbsuspicionforossiculardiscontinuityHearinglossLongitudinalFracturesConductiveormixedhearingloss80%ofCHLresolvespontaneouslyTransverseFracturesSensorineuralhearinglossLe

3、sslikelytoimproveDizzinessOticcapsulefracture,labyrinthineconcussion,PerilymphaticFistulaPerilymphaticFistulasFluctuatingdizzinessand/orhearinglossTulio’sPhenomenonManagement40%spontaneouslycloseSurgicalmanagementDizzinessBPPVAcute,latent,andfatigablevertigoCanoccuranytimefollowinginjuryDixHall

4、pikeEpleyManeuverCSFOtorrheaandRhinorrheaTemporalboneFracturesarethemostcommoncauseofCSFOtorrheaBeta-2-transferrinHRCTCSFOtorrheaandRhinorrheaManagementConservativetherapyLieinbedwithHeadelevated30-45°AntibioticsSurgeryCSFOtorrheaandRhinorrheaSurgicalManagementSurgicalapproachStatusofhearingMe

5、ningocele/encephaloceleFistulalocationTransmastoidMiddleCranialFossaFacialNerveInjuriesEvaluationPreviousstatusTimeOnsetandprogressionCompletevs.IncompleteHouseBrackmangradingsystemINormalNormalfacialfunctionIIMildSlightsynkinesis/weaknessIIIModerateCompleteeyeclosure,noticeablesynkinesis,sligh

6、tforeheadmovementIVModeratelySevereIncompleteeyeclosure,symmetryatrest,noforeheadmovementVSevereAssymetryatrest,barelynoticeablemotionVITotalNomovementElectrophysiologicTestingNETMSTENoGNerveExcitabilityTestMaximalStimulationTest>3.5mAdifferencesuggestsapoorprognosisforreturnoffacialfunctionEl

7、ectroneuronographyMostaccurate,qualitativemeasurementReductionof>90%amplitudecorrelateswithapoorprognosisforspontaneousrecoveryElectromyographyLimiteduseuntil10-14daysPolyphasicpotentials=GoodFacialNerveInjuriesDecisiontotreatispr