简介：ObjectiveToinvestigatetheclinicaloutcomesoffacialneverdecompressionviaacombinedsubtemporal-supralabyrinthineapproachtogeniculateganglionformanagementoffacialparalysisintemporalbonefracture.MethodsEighteenpatientswithunilateralfacialparesisduetotemporalbonefractureweretreatedbetweenMarch2003andMarch2011.FacialfunctionwasHouse-Brackmann(HB)gradeⅢin6patients,HBgradeⅤin9patientsandHBgradeⅥin3patients.Thepreoperativemeanairconductionthresholdwas52dBHLforthe15caseswithlongitudinaltemporalbonefractureandshowedseveresensorineuralhearinglossinthe3caseswithtransversetemporalbonefracture.Fracturelinesweredetectedin15casesontemporalboneaxialCTscansandossiculardisruptionwasdeterminedin11casesbyvirtualCTendoscopy.Thegeniculateganglionorthetympanicmastoidsegmentofthefacialnerveshowedanirregularmorphologyoncurvedplanarreformationimagesofthefacialnervecanal.Afteranintactcanalwallmastoido-epitympanectomy,theossicularchaindamagewasevaluated.Iftheossicularchainwasintact,thesupralabyrinthinerecesswasopenedbydrillingthroughthecellsbetweenthetegmentympaniandossicularchain.Iftheossicularchainwasdisrupted,theincuswasremovedtoaccessthesupralabyrinthinerecess.Thegeniculateganglionandthedistallabyrinthinesegmentofthefacialnervewereexposed.Aftercompletingfacialnervedecompression,thedislocatedincuswasreplaced,orafracturedincuswasreshapedtobridgethespacebetweenthemalleusandthestapes.ResultsPronouncedgangliongeniculatumswellingwasfoundin15casesoflongitudinaltemporalbonefracture,withgreaterpetrosusnervesdamagein3casesandbleedingin5cases.Disruptedossicularchainswereseenin11cases,includingdislocatedincusresultingincrushingofthehorizontalportionofthefacialnervein3casesandfractureoftheincuslongprocessin1case.In3casesoftransversefractures,

简介：ObjectiveToexplorethevalueofcomputedtomographyvirtualendoscopy(VE)inassessingossicularchaindisruptionintemporalbonefractureandeartraumawithintacttympanum.MethodsHighresolutionspiralcomputerizedtomography(CT)wascompletedin35casesoftemporalbonefractureand5casesoftympanumtrauma,allwithintactorhealedtympanum.Three-dimensionalreconstructionwascompletedus-ingavirtualendoscopysoftware.Audiologicaltestswereconductedinallpatientsandevaluationoffacialnerveinjuryinpatientswithfacialparalysis.Patientswithmildconductivedeafness,ossicularchainsublux-ationonVE,andnofacialparalysisweretreatedconservativelyfor4-12weekswithrepeatedhearingevalu-ation;thosewithfacialparalysisunderwentsurgeryifnorecoveryafter4-8weeksofconservativetreat-ment.Patientswithmoderatetosevereconductivehearinglossormixedhearingloss,incuslongprocessfractureordislocationonVEandfacialparalysis,underwentossicularchainreconstructionandfacialnervedecompressionafterconservativetreatmentfor4-8weeks,orexploratorytympanotomyonlyifnofacialpa-ralysis.VE,audiologicaltestsandfacialnervefunctiontestswererepeatedin3-6monthsaftersurgery.Re-sultsOfthe6caseswithmildconductivehearingloss,ossicularchainsubluxationandnofacialparalysis,3recoveredtonormalhearingspontaneouslyand3showednosignificantimprovement,after4-12weeksofconservativetreatment.Afterconservativetreatmentfor4-8weeks,3ofthe12caseswithmildconductivedeafness,ossicularchaindislocationonVEandfacialparalysisrecoveredtonormalhearingandHouse-Brackmann(HB)gradeIfacialfunctionfromHBgradeII,4showedfacialfunctionrecoverytoHBgradeI(n=2)orII(n=2)fromHBgradeIIIbutnohearingrecovery,and5gainednorecoveryandwentontoreceiveexploratorytympanotomyandfacialnervedecompression.The11caseswithmoderatetosevereconductivedeafness,incuslongprocessfr

简介：ObjectiveToexplorethevalueofcomputedtomographyvirtualendoscopy(VE)inassessingossicularchaindisruptionintemporalbonefractureandeartraumawithintacttympanum.MethodsHighresolutionspiralcomputerizedtomography(CT)wascompletedin35casesoftemporalbonefractureand5casesoftympanumtrauma,allwithintactorhealedtympanum.Three-dimensionalreconstructionwascompletedusingavirtualendoscopysoftware.Audiologicaltestswereconductedinallpatientsandevaluationoffacialnerveinjuryinpatientswithfacialparalysis.Patientswithmildconductivedeafness,ossicularchainsubluxationonVE,andnofacialparalysisweretreatedconservativelyfor4-12weekswithrepeatedhearingevaluation;thosewithfacialparalysisunderwentsurgeryifnorecoveryafter4-8weeksofconservativetreatment.Patientswithmoderatetosevereconductivehearinglossormixedhearingloss,incuslongprocessfractureordislocationonVEandfacialparalysis,underwentossicularchainreconstructionandfacialnervedecompressionafterconservativetreatmentfor4-8weeks,orexploratorytympanotomyonlyifnofacialparalysis.VE,audiologicaltestsandfacialnervefunctiontestswererepeatedin3-6monthsaftersurgery.ResultsOfthe6caseswithmildconductivehearingloss,ossicularchainsubluxationandnofacialparalysis,3recoveredtonormalhearingspontaneouslyand3showednosignificantimprovement,after4-12weeksofconservativetreatment.Afterconservativetreatmentfor4-8weeks,3ofthe12caseswithmildconductivedeafness,ossicularchaindislocationonVEandfacialparalysisrecoveredtonormalhearingandHouseBrackmann(HB)gradeIfacialfunctionfromHBgradeII,4showedfacialfunctionrecoverytoHBgradeI(n=2)orII(n=2)fromHBgradeIIIbutnohearingrecovery,and5gainednorecoveryandwentontoreceiveexploratorytympanotomyandfacialnervedecompression.The11caseswithmoderatetosevereconductivedeafness,incuslongprocessfractureordis