temporal bone resection

The humeral resection can completely remove the humerus that is invaded by the cancer, and is suitable for cases with advanced or radiotherapy failure. The characteristic of this technique is that if it is not properly controlled, it is quite dangerous. Serious complications may occur after operation and facial paralysis caused by facial nerve resection. Therefore, it is necessary to strictly select the indications and select appropriate cases for surgery. Treatment of diseases: temporal lobe tumor Indication 1. Radiation therapy or radiation therapy plus mastoidectomy failed, and the tumor range was basically limited to the tibia. 2, has been complicated by facial paralysis, the tumor is basically within the scope of the tibia. 3, the tumor range is wider, beyond the scope of the tibia, but no important tissue violations (such as internal carotid artery, other cranial nerves, internal jugular vein and brain tissue, etc.). Preoperative preparation Including clinical examination, x-ray film, neurological consultation, etc., it is necessary to correctly estimate the scope of cancer invasion, and strictly control the indications, in order to minimize the patient's pain and improve the effect. Preoperative or postoperative combined with radiation therapy is also necessary. Surgical procedure 1. Make a skin incision in front of the ear, behind the ear, and on the leading edge of the sternocleidomastoid muscle, and connect them into a "y" shape. After the ear incision is slightly offset, at least 3-4 mm from the attachment of the auricle to facilitate suturing and wound healing. The incision in the ear can meet the superficial temporal artery and should be separated and ligated. The flap is turned down and the external auditory canal is broken at the junction of the cartilage segment and the bony segment of the external auditory canal. 2. Carefully separate the soft tissue from the posterior margin of the parotid gland, and find the facial nerve on the outside of the equivalent stem. Tracking along the facial nerve, cutting the facial nerve close to the stem of the stem, and centrifuging the end of the suture with a thin line as a marker to prepare for the face-adjacent or facial-sublingual nerve anastomosis. 3, self-squatting scales up the muscle layer, cut the zygomatic arch forward, free mandibular condyle in the temporomandibular joint concave, saw it off with a wire. Thereby, the soft tissue is separated to the medial side of the jugular vein, so be careful not to damage the jugular bulb. 4. Use an intracranial or osteotome to open a hole above the external auditory canal line (the bone is thin and easy to open), and then use the skull clamp to bite part of the scale, and the anterior aspect of the temporomandibular joint is concave. Until the concave side of the jugular vein, backwards along the posterior edge of the mastoid (can also directly bite the mastoid and tip, but be careful not to touch the cancer tissue in the mastoid) to the lower part of the occipital. At this time, you can encounter the thick sigmoid sinus, and you should be careful when you bite the skull. The sigmoid sinus has several veins connected to the adjacent skull. It is inevitable that the vein is broken when the skull is bitten off. Therefore, the bleeding is often more. The gelatin sponge can be used to attach the surface pressure saline film. After the above treatment, the bleeding can be Stop, such as vascular sinus or electrocautery caused by sigmoid rupture. 5, with the blunt stripper to open the dura mater from the rock, inside the inner ear canal, if necessary, first remove the auditory nerve, facial nerve. At this time, the various parts of the tibia are separated from the surrounding tissue, and only the remaining part of the tibia needs to be cut. The location of the disconnection is determined based on the depth of the tumor's invasion to the rock. Usually, first use a flat chisel around the rock bone to cut into the ring, do not "single knife straight into" caused the fracture line near the inner end of the internal carotid artery tube, it is difficult to remove. When drilling, because the rock's "fulcrum" is only a rock tip, it is often felt that the entire rock bone is moving. At this time, the assistant can use the instrument to hold the rock bone in the opposite direction of the chisel, so that the surgeon can easily cut it. After the rock bone is broken, the rock bone section should be inspected for any residual cancerous tissue. If there is any doubt, it can be ground with electric drill. Small blood vessels in the meninges may be bleeding, and can be electrocautery to stop bleeding. 6. Find the accessory nerve in the deep side of the sternocleidomastoid muscle or loosen the hypoglossal nerve under the second abdominal muscle. After the disconnection, the proximal brain and the facial nerve are anastomosed. 7, careful hemostasis, auricle reduction, as close as possible to the meninges to reduce the surgical cavity, filling the gauze, one end from the ear canal.