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摘要: 目的 通过颞骨高分辨率CT(HRCT)及手术观察面隐窝外侧管状气房的位置、形态及其临床意义。方法 本研究纳入30例(32耳)患有胆脂瘤和(或)粘连性中耳炎且需要行开放式乳突根治术和鼓室成形术的患者。通过颞骨HRCT扫描和手术观察面隐窝外侧管状气房的形态，并详细分析其与面神经的关系。结果 经颞骨HRCT及手术探查，19耳(59.4%)存在管状气房，长度为1.5~6.5 mm，中位数2.5 mm，均开口于面隐窝，走行于面隐窝后壁，甚至可达下鼓室底部，或外耳道下壁水平(矢状面及手术所见)。自内向外探查，管状气房位于面神经第二膝和鼓索神经之间，即面神经外侧壁(面神经嵴)的一部分。当管状气房被肉芽组织占据时，易被视为面神经。充分磨除管状气房有助于充分削低面神经嵴。所有患者在手术期间或经术后随访，均未发生面瘫。结论 术前颞骨高分辨率CT可清晰显示面隐窝外侧存在的管状气房，全面、准确地识别这些结构有助于充分削低面神经嵴，清除后鼓室隐匿病灶。Abstract: Objective To observe the position and morphology of tubular cell in lateral facial recess by CT scanning and surgical finding, and its clinical significance.Methods Thirty patients(32 ears) with cholesteatoma and/or adhesive otitis media requiring radical mastoidectomy and tympanoplasty were included in this study. To observe the morphology of the tubular cell in the lateral facial recess cavity through temporal bone HRCT and surgery, and to analyze its relationship with the facial nerve.Results Tubular cell were found in 59.4%(19/32) ears by temporal bone HRCT and through surgeon. The length ranged from 1.5-6.5 mm, with median length of 2.5 mm. All of them opened in the facial recess, ran on the posterior wall of the facial recess, and even reached the bottom of the inferior tympanic cavity or the level of the inferior wall of the external auditory canal(sagittal view and surgical findings). Probing from the inside out, the tubular cell located between the second genu of the facial nerve and the chorda tympani, which was a part of the lateral wall of the facial nerve(facial crest). When the tubular cell is occupied by granulation tissue, it is easy to be regarded as the facial nerve. Fully drilling out the tubular cell is helpful to cut down the facial nerve crest. In the study, the follow-up and/or postoperative no facial paralysis happens during the operation and in the follow up.Conclusion Preoperative temporal bone HRCT can clearly show the tubular cell in the lateral facial recess cavity. Comprehensive and accurate identification of these structures is helpful to fully cut down the facial nerve crest and remove the hidden lesions in the posterior tympanic cavity.
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Key words:
- temporal bone /
- high resolution computed tomography /
- tubular cell /
- facial nerve /
- mastoidectomy
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