面神经隐窝的显微解剖及其临床应用

Micro-surgery anatomy and clinical uses of facial recess

目的 观察面神经隐窝的局部显微解剖结构 ,并探讨其临床应用价值。方法 对 10具 (2 0耳 )人尸颞骨进行面神经隐窝的显微解剖观察测量 ;经面神经隐窝入路 ,对 3例胆脂瘤型中耳炎患者去除鼓室病变 ,对 8例重度感音神经性耳聋患者进行了人工耳蜗置入术。结果 通过面神经隐窝可以清楚观察到镫骨、镫骨肌腱、圆窗、鼓岬、鼓室窦等中后鼓室的重要结构 ;对胆脂瘤性中耳炎者 ,经面神经隐窝入路可在保留外耳道后壁的同时 ,彻底清除病变 ,进行鼓室成形术 ;8例耳聋者均成功置入了人工耳蜗 ,术后不同程度的恢复了听感。手术后面神经功能全部正常。结论 掌握面神经隐窝的局部解剖结构 ,经面神经隐窝入路手术是安全可靠的 ,可彻底清除后鼓室病变 ,顺利置入人工耳蜗电极。

Objective To study the anatomic characteristics and the clinical uses of the facial recess.Methods 10 (20 ears) temple bone specimens were dissected to observe the dimension, shape and variation of the facial recess. 3 patients with cholesteatoma otitis media were removed safely and completely all the cholesteatoma tissue in the tympani sinus and retro-tympani, and 8 patients with severe senseneuro hearing loss were inserted the electrode of the cochlear implant by facial recess.Results With the facial recess fully opened, it could be easily visualized including the horizontal portion of the facial nerve, the lenticular process of the incus, the incudostapedial joint, the capitulum of the stapes, the stapedial tendon.The diseased tissue were removed completely with this approach by canal wall up tympanipalsty in 3 patiets with chlosteatoma otitis media, the cochlear implant electrode were inserted successfully in 8 patients. The facial nerve function were normal in all of the cases postoperatively.Conclusions With the familiar to the anatomy of the facial recess, the facial recess approach is safe. It is the route to expose and remove chlosteatoma in the tympani sinus and retrotympani completely.It is also the route to the round window for insertion of the cochlear implant electrode.