subtotal temporal bone resection

Subtotal sacral resection (or partial humerus resection) is mainly applied to cases where the tumor is outside the humerus and the inner ear canal and is not invaded into or around the skull. The scope of resection includes the external auditory canal, part of the temporomandibular joint, the scalp of the mastoid humerus and the 1/2 to 2/3 outside the rock. Only part of the inner ear canal, part of the internal carotid artery and the tip of the rock are retained. Otherwise, there is a danger of causing major bleeding). Treatment of diseases: otitis media Indication 1, middle ear mastoid cancer, but still limited to the middle ear mastoid and humeral part, no intracranial or distant metastasis. 2. There is no damage to the internal carotid artery. 3. Although there are facial paralysis, other cranial nerves are not violated. 4. There is no or metastatic lymph node in the neck, but there is no extensive adhesion. Radical neck dissection can be performed at the same time. 5, the general condition is good, can tolerate this operator. Contraindications 1. The tumor invades the rock tip, the range exceeds the sphenoid sulcus, and the internal carotid artery tube has been destroyed. 2. In addition to facial paralysis, other cranial nerves are also violated, and partial humeral resection is difficult to work. 3. Extensive lymph node metastasis, fixed adhesion or distant metastasis. 4. The general condition is poor and cannot be tolerated by this operator. Preoperative preparation 1. Learn more about the condition and confirm the pathology as cancer. 2. X-ray, tomography, CT examination, if necessary, MRI and digital angiography should be done to determine the extent of the tumor and the condition of the tumor. 3. Perform liver and kidney function, electrocardiogram and blood, urine and stool examination. 4. Antibiotics to prevent infection 3 days before surgery; if there is anemia, blood transfusion should be corrected. 5. 1d before the operation, the hair was completely shaved, and the skin of the ear was disinfected with 75% ethanol, and the sterile dressing was wrapped. 6. It is possible to train the common carotid artery for 1 month before surgery to prevent the internal carotid artery rupture and ligation. Surgical procedure Incision The principle of incision approach is: the surgical field should be large enough to remove the humerus and completely remove the tumor, which can preserve the function of the cranial nerve, without damaging the important parts of the internal carotid artery, brain stem, cavernous sinus, and ensuring primary healing. No cerebrospinal fluid leakage (or cerebrospinal fluid leakage can be stopped in a short period of time). A common neck incision, Y-shaped or S-shaped, is generally used. The upper branch of the Y-shaped incision is about 5cm in front of and behind the ear, and the two branches are under the earlobe. The posterior branch extends to the plane of the neck to the hyoid bone, in order to prepare to expose the internal carotid vein, vein and VII, IX, X, XI. And XII brain nerves. 2. Bone peeling After cutting the skin, muscles, fascia and periosteum, the periosteum is peeled off, the external auditory canal is cut and sutured in the cartilage, and the entire auricle and the iliac muscle flap are all suspended upwards, and the scalp is fixed by threading to expose the external surface of the tibia. 3. Circumcision opens the cranial fossa Use a cutting bit to drill the sacral scale on the sacral line about 4 cm × 4 cm (with a diamond drill bit near the meninges), and pick up the squamous bone into a window to reveal the dura mater. Apertures are wound around the humeral axis, posterior to the sigmoid sinus, and the sacral root is abraded in the front. 4. Cut off the mandibular condyle The condyle and its neck are separated, and the neck is broken with an electric drill to cause the condyle to remain in the temporomandibular joint to be resected. 5. Exposing the sigmoid sinus and jugular bulb The electric drill removes the anterior and posterior sigmoid sinus, exposes the 3 mm wide side of the dura mater before and after the sigmoid sinus, removes the mastoid tip and the keel, and exposes the jugular bulb. 6. Remove the internal carotid artery and expose the internal carotid artery Use a diamond drill bit to pass through the temporomandibular joint cavity, the gingival root, the sacral scale and its deep part, and grind the internal carotid artery bone, cut off the eustachian tube, and carefully remove the thinned internal carotid artery bone wall with a stripper to reveal Internal carotid artery. If the facial nerve is not damaged by the tumor, the continuity and integrity of the facial nerve can be maintained as much as possible, and separated and protected. 7. Separate the dura mater and cut off the rock cone Use the bone coat stripper to separate the surrounding dura mater from the rock, the upper part of the dura mater from the top of the rock bone to the sphenoid wing, cauterize or ligature the upper sinus of the rock, to completely loosen the episode of the cerebellum and the rock, carefully in the rear The sigmoid sinus is separated to the edge of the jugular fora The dura mater of the posterior cranial fossa was removed to the periphery of the inner ear canal. The anterior and posterior examination of the internal carotid artery was completely separated from the tibial rock. Then the dura mater is pulled open at the back and above, and the rock cone is removed by the electric drill at the inner ear canal. After the sphenoid wing is cut in front, the bone is cut off and connected to the lateral humeral cut. The internal carotid artery, sigmoid sinus and jugular bulb should be absolutely protected during operation. 8. Rock cone removal and neck clearance Cut off the muscles of the nucleus, including the sternocleidomastoid muscle, the posterior abdomen of the second abdominal muscle and the ligament of the styloid process, the mandibular ligament of the styloid process, the styloid scapula, the styloid muscle, and the styloid sphincter. . The truncated rock is pressed down and taken out. If the facial nerve is damaged, the length of the long enough can be used for facial nerve end-to-end anastomosis, or the auricular nerve can be used for facial nerve transplantation. If neck dissection is required, it is not necessary to cut the cervical muscles from the rock. The truncated rock bones should be removed together with the parotid gland, the submandibular gland, the cervical muscles of the Liliyan part, and the connective tissue and lymph nodes of the neck. The mastoid muscle is used to protect the internal carotid artery. 9. After suturing the cavity Stop bleeding completely. Such as meningeal rupture with fascia or diaphragmatic fascia to repair the gap, and then use the diaphragmatic flap to flip and the neck muscle flap to suture the filling cavity, layer the suture soft tissue, close the external auditory canal into a blind tube, suture the subcutaneous tissue and the skin before the release The skin tube is drained and the wound is pressure bandaged. complication Because there are important large blood vessels and cranial nerves in and around the rock bone, the facial nerve and vestibular nerve part should be interrupted or removed during surgery, which can cause peripheral facial paralysis or dizziness. If there is conditional feasible facial nerve transplantation, the facial nerve function can be partially restored, and the vertigo can be recovered after a period of time. When there are nerve damages in the IX, X, and XI brains, it can cause symptoms of nerve paralysis. Sometimes fatal serious complications can occur, such as massive internal carotid artery damage, brain damage causing hemiplegia and aphasia, and damage to the brainstem life center can lead to death. Common complications include cerebrospinal fluid leakage, meningitis, and encephalitis. For example, local wound infection may also cause the risk of major bleeding caused by secondary vascular injury, and should be strictly guarded.