Temporal bone transverse fracture and peripheric facial paralysis: our surgical approach and results

Year 2009, Volume: 19 Issue: 5, 259 - 262, 23.10.2009

Çağatay Han Ülkü Yavuz Uyar Gökhan Kurnaz

Abstract

Objectives: In this study, our surgical approaches in temporal bone transvers fracture cases with facial paralysis and their results were evaluated. Patients and Methods: Five temporal bone transverse fracture cases 2 females, 3 males; mean age 32.8 years; range 4 to 62 years with facial paralysis which were treated in our clinic between July 1998 and July 2008 were included in this study. Radiologic, audiologic, topographic and electrodiagnostic investigations were made preoperatively. The evaluation of facial nerve function was performed by using House-Brackmann HB classification. Tympanic segment, ganglion geniculi and labyrinthine segment were exposed by translabyrinthine approach in all cases. Integrity of the facial nerve was achieved via re-routing and end-to-end anastomosis or n. auricularis major interpositional graft. The cases were evaluated regarding complications and facial nerve function postoperatively. Results: In the audiologic investigation ipsilateral total neurosensorial hearing loss was determined in all cases. In four cases facial paralysis was recognized immediately and in one patient it was recognized when the patient was discharged from the intensive care unit. Facial nerve function was HB stage V in all cases. Surgery was performed in the first six weeks and it was observed that integrity of the labyrinthine segment was distorted in all cases. Reconstruction was performed by re-routing and end-to-end anastomosis in three cases and n. auricularis major interpositional graft in two cases. There were no postoperative complications. Facial nerve function was HB stage II in three cases re-routing and HB stage III in two cases graft . Conclusion: In temporal bone fracture cases with neurosensorial hearing loss and facial paralysis, we achieved good exposure via translabyrintine approach. Better functional results were obtained in re-routing and end-to-end anastomosis technique when compared to interpositional grafting.

Keywords

Temporal bone, translabyrinthine approach, transvers fracture

Temporal kemik transvers kırığı ve periferik fasiyal paralizi: Cerrahi yaklaşım ve sonuçlarımız

Abstract

Amaç: Bu çalışmada fasiyal paralizinin eşlik ettiği temporal kemik transvers kırıklı olgulardaki cerrahi yaklaşım ve sonuçları değerlendirildi.Hastalar ve Yöntemler: Kliniğimizde Temmuz 1998-Temmuz 2008 tarihleri arasında tedavi edilen, fasiyal paralizinin eşlik ettiği beş temporal kemik transvers kırığı olgusu 2 kadın, 3 erkek; ort. yaş 32.8 yıl; dağılım 4-62 yıl çalışmaya alındı. Ameliyat öncesi dönemde radyolojik, odyolojik, topografik ve elektrodiyagnostik incelemeler yapıldı. Fasiyal paralizi değerlendirmesi House-Brackmann HB sınıflamasına göre yapıldı. Tüm olgularda, translabirentin yaklaşım ile fasiyal sinir timpanik segmenti, gangliyon genikuli ve labirentin segment ortaya kondu. Fasiyal sinir bütünlüğü re-routing ile uç uca anastamoz ya da n. aurikülaris majör interpozisyonel grefti ile sağlandı. Olgular, ameliyat sonrası dönem komplikasyon ve fasiyal sinir fonksiyonu yönünden değerlendirildi.Bulgular: Odyolojik incelemede, tüm olgularda aynı taraf total nörosensöriyel işitme kaybı belirlendi. Dört olguda paralizi travma sonrası hemen, bir olguda ise hasta yoğun bakım ünitesinden çıktığı dönemde fark edildi. Tüm olgularda fasiyal sinir fonksiyonu HB evre V idi. Cerrahi girişimler ilk altı hafta içerisinde yapıldı ve bütün olgularda sinir bütünlüğünün labirentin segmentte bozulduğu izlendi. Üç olguda re-routing ile uç uca anastamoz, iki olguda ise n. aurikularis majör interpozisyonel grefti kullanılarak onarım yapıldı. Ameliyat sonrası herhangi bir komplikasyon gelişmezken, fasiyal sinir fonksiyonu üç olguda re-routing HB evre II, iki olguda greft ise HB evre III idi.Sonuç: Nörosensöriyel işitme kaybı ve fasiyal paralizi birlikteliği olan temporal kemik transvers kırıklı olgularda, translabirentin yaklaşım ile yeterli görüş sağlandı. İnterpozisyonel greft ile yapılan onarımla karşılaştırıldığında, re-routing ve uç uca anastamoz tekniğinde daha iyi fonksiyonel sonuç elde edildi

Keywords

Temporal kemik, translabirentin yaklaşım, transvers kırık

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