最新 Fracture of temporal bone 课件医学课件

1、Fracture of temporal bone2021/4/261Classifications Longitudinal fracturesTransverse fracturesMixed fractures2021/4/262Longitudinal fractures80% of Temporal Bone FracturesLateral Forces along the petrosquamous suture line15-20% Facial Nerve involvementEAC laceration2021/4/263Transverse fractures20% o

2、f Temporal Bone FracturesForces in the Antero-Posterior directionInner ear injury50% Facial Nerve InvolvementEAC intact2021/4/264Physical ExaminationTuning Fork examPneumatic Otoscopy2021/4/265Imaging HRCTMRIAngiography/ MRA2021/4/266symptomsHearing Loss & tinnitus DizzinessCSF Otorrhea and Rhinorrh

3、eaFacial Nerve Injuries2021/4/267Hearing lossFormal Audiometry vs. Tuning Fork71% of patients with Temporal Bone Trauma have hearing lossTM PerforationsCHL 40db suspicion for ossicular discontinuity2021/4/268Hearing lossLongitudinal FracturesConductive or mixed hearing loss80% of CHL resolve spontan

4、eouslyTransverse FracturesSensorineural hearing lossLess likely to improve2021/4/269Dizziness Otic capsule fracture, labyrinthine concussion, Perilymphatic FistulaPerilymphatic FistulasFluctuating dizziness and/or hearing lossTulios PhenomenonManagement40% spontaneously closeSurgical management2021/

5、4/26109、 人的价值，在招收诱惑的一瞬间被决定。2022/7/122022/7/12Tuesday, July 12, 202210、低头要有勇气，抬头要有低气。2022/7/122022/7/122022/7/127/12/2022 8:58:54 PM11、人总是珍惜为得到。2022/7/122022/7/122022/7/12Jul-2212-Jul-2212、人乱于心，不宽余请。2022/7/122022/7/122022/7/12Tuesday, July 12, 202213、生气是拿别人做错的事来惩罚自己。2022/7/122022/7/122022/7/122022/7/

6、127/12/202214、抱最大的希望，作最大的努力。12 七月 20222022/7/122022/7/122022/7/1215、一个人炫耀什么，说明他内心缺少什么。七月 222022/7/122022/7/122022/7/127/12/202216、业余生活要有意义，不要越轨。2022/7/122022/7/1212 July 202217、一个人即使已登上顶峰，也仍要自强不息。2022/7/122022/7/122022/7/122022/7/12Dizziness BPPVAcute, latent, and fatigable vertigoCan occur any time

7、 following injuryDix HallpikeEpley Maneuver2021/4/2612CSF Otorrhea and RhinorrheaTemporal bone Fractures are the most common cause of CSF OtorrheaBeta-2-transferrinHRCT2021/4/2613CSF Otorrhea and RhinorrheaManagementConservative therapyLie in bed with Head elevated 30-45AntibioticsSurgery2021/4/2614

8、CSF Otorrhea and RhinorrheaSurgical ManagementSurgical approachStatus of hearing Meningocele/encephaloceleFistula locationTransmastoidMiddle Cranial Fossa2021/4/2615Facial Nerve InjuriesEvaluationPrevious statusTimeOnset and progressionComplete vs. Incomplete2021/4/2616House Brackman grading systemI

9、NormalNormal facial functionIIMildSlight synkinesis/weaknessIIIModerate Complete eye closure, noticeable synkinesis, slight forehead movementIVModerately SevereIncomplete eye closure, symmetry at rest, no forehead movementVSevereAssymetry at rest, barely noticeable motionVITotalNo movement2021/4/261

10、7Electrophysiologic TestingNETMSTENoG2021/4/2618Nerve Excitability TestMaximal Stimulation Test3.5mA difference suggests a poor prognosis for return of facial function2021/4/2619ElectroneuronographyMost accurate, qualitative measurementReduction of 90% amplitude correlates with a poor prognosis for

11、spontaneous recovery2021/4/2620ElectromyographyLimited use until 10-14 daysPolyphasic potentials= Good2021/4/2621Facial Nerve InjuriesDecision to treat is primarily based on whether there is complete vs. incomplete paralysis2021/4/2622TreatmentConservative treatment candidatesSurgical candidates2021

12、/4/2623Conservative Treatment CandidatesChang and CassNormal Facial Function regardless of progressionIncomplete paralysis and no progression to complete paralysisLess than 95% degeneration by ENoG2021/4/2624Surgical CandidatesCritical Prognostic factorsImmediate vs. DelayedComplete vs. Incomplete p

13、aralysisENoG criteria2021/4/2625Algorithm for Facial Nerve Injury2021/4/2626Surgical ApproachSuspect location of neural injuryPresence or absence of hearing2021/4/2627Surgical ApproachLateral to the geniculate gangliontransmastoidMedial to the Geniculate GanglionNo useful hearingTransmastoid-transla

14、byrinthineIntact hearingTransmastoid-trans-epitympanicMiddle Cranial Fossa2021/4/2628Surgical findingsNerve repairDirect anastomosisNerve graftDecompression2021/4/2629Case Report32 yr old fisherman was wadingMinding his own businessHit in head by a flying fishImmediate profound vertigo, hearing loss

15、CT scan revealed longitudinal Temp bone fracture2021/4/26302021/4/26312021/4/26329、 人的价值，在招收诱惑的一瞬间被决定。12-7月-2212-7月-22Tuesday, July 12, 202210、低头要有勇气，抬头要有低气。*7/12/2022 8:58:54 PM11、人总是珍惜为得到。12-7月-22*Jul-2212-Jul-2212、人乱于心，不宽余请。*Tuesday, July 12, 202213、生气是拿别人做错的事来惩罚自己。12-7月-2212-7月-22*12 July 202214

16、、抱最大的希望，作最大的努力。12 七月 2022*12-7月-2215、一个人炫耀什么，说明他内心缺少什么。七月 22*12-7月-22*12 July 202216、业余生活要有意义，不要越轨。*7/12/202217、一个人即使已登上顶峰，也仍要自强不息。*12-7月-22谢谢大家2021/4/26339、 人的价值，在招收诱惑的一瞬间被决定。2022/7/122022/7/12Tuesday, July 12, 202210、低头要有勇气，抬头要有低气。2022/7/122022/7/122022/7/127/12/2022 8:58:54 PM11、人总是珍惜为得到。2022/7/122022/7/122022/7/12Jul-2212-Jul-2212、人乱于心，不宽余请。2022/7/122022/7/122022/7/12Tuesday, July 12, 202213、生气是拿别人做错的事来惩罚自己。2022/7/122022/7/122022