of_temporal bone 耳鼻咽喉科学课件.ppt

Fracture of temporal bone Chunfu Dai M.D Ph.D Otolaryngology Department Fudan University Classifications Longitudinal fractures Transverse fractures Mixed fractures Longitudinal fractures 80% of Temporal Bone Fractures Lateral Forces along the petrosquamous suture line 15-20% Facial Nerve involvement EAC laceration Transverse fractures 20% of Temporal Bone Fractures Forces in the Antero-Posterior direction Inner ear injury 50% Facial Nerve Involvement EAC intact Physical Examination Tuning Fork exam Pneumatic Otoscopy Imaging HRCT MRI Angiography/ MRA symptoms Hearing Loss tinnitus Dizziness CSF Otorrhea and Rhinorrhea Facial Nerve Injuries Hearing loss Formal Audiometry vs. Tuning Fork 71% of patients with Temporal Bone Trauma have hearing loss TM Perforations CHL 40db suspicion for ossicular discontinuity Hearing loss Longitudinal Fractures Conductive or mixed hearing loss 80% of CHL resolve spontaneously Transverse Fractures Sensorineural hearing loss Less likely to improve Dizziness Otic capsule fracture, labyrinthine concussion, Perilymphatic Fistula Perilymphatic Fistulas Fluctuating dizziness and/or hearing loss Tulio’s Phenomenon Management 40% spontaneously close Surgical management Dizziness BPPV Acute, latent, and fatigable vertigo Can occur any time following injury Dix Hallpike Epley Maneuver CSF Otorrhea and Rhinorrhea Temporal bone Fractures are the most common cause of CSF Otorrhea Beta-2-transferrin HRCT CSF Otorrhea and Rhinorrhea Management Conservative therapy Lie in bed with Head elevated 30-45° Antibiotics Surgery CSF Otorrhea and RhinorrheaSurgical Management Surgical approach Status of hearing Meningocele/encephalocele Fistula location Transmastoid Middle Cranial Fossa Facial Nerve Injuries Evaluation Previous status Time Onset and progression Complete vs. Incomplete House Brackman grading system I Normal Normal facial function II Mild Slight synkinesis/weakness IIIModerate Complete eye closure, noticeable synkinesis, sli