Facial nerve course in the temporal bone: Anatomical relationship between the tympanic and mastoid portions for safe ear surgery
Facial nerve course in the temporal bone: Anatomical relationship between the tympanic and mastoid portions for safe ear surgery
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DOI：
10.1016/j.anl.2020.05.002
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发表时间：
2020-10-01
影响因子：
1.7
通讯作者：
Kawata, Ryo
中科院分区：
文献类型：
--
作者：
Ozaki, Akiko;Haginomori, Shin-Ichi;Kawata, Ryo
目的：在耳部手术期间避免面神经医源性损伤至关重要。使用多层计算机断层扫描 (CT) 扫描分析面管 (FC) 鼓室部分和面神经乳突部分之间的解剖关系，以避免医源性面神经损伤。 方法：总共纳入 351 名接受 CT 扫描的患者的 364 只耳朵。 364只耳朵被分为两组：281只患有中耳炎症（MEI）的耳朵和83只没有中耳炎症（非MEI）的耳朵。在多层 CT 图像上分析 FC 鼓室部分和面神经乳突部分之间的解剖关系。根据面神经乳突部分到 FC 鼓室部分的走向，将耳朵分为三个亚组：（“横向走行路线”，LRC）、“沿鼓室路线”（OL）和“内侧走行路线”（MRC）。比较 MEI 组和非 MEI 组各亚组中耳朵的比例。结果：总体而言，15% 的耳朵属于 LRC，30% 属于 OL，55% 属于 MRC。在MEI组中，LRC、OL和MRC耳的比例分别为17%、32%和51%，而非MEI组中分别为7%、24%和69%。 MEI组LRC耳比例显着高于非MEI组。结论：尤其是MEI患者，面神经LRC较多会增加后鼓室切开术或耳管壁下乳突切除术中面神经损伤的风险。术前应通过多层 CT 图像评估面神经在颞骨中的走行。 (C) 2020 日本耳鼻喉科学会 Inc. 由 Elsevier B.V 出版。保留所有权利。
Objective: Avoidance of iatrogenic injury to the facial nerve is crucial during ear surgery. The anatomical relationship between the tympanic portion of the facial canal (FC) and the mastoid portion of the facial nerve was analyzed using multi-slice computed tomography (CT) scans to avoid iatrogenic facial nerve injury.Methods: In total, 364 ears of 351 patients who underwent CT scans were enrolled. The 364 ears were divided into two groups: 281 ears with middle ear inflammation (MEI) and 83 ears without middle ear inflammation (non-MEI). The anatomical relationship between the tympanic portion of the FC and mastoid portion of the facial nerve was analyzed on multi-slice CT images. The ears were categorized into three subgroups based on the course of the mastoid portion of the facial nerve to the tympanic portion of the FC: ("lateral running course", LRC), "on the tympanic line course" (OL), and "medial running course" (MRC). The proportions of ears in each subgroup were compared between the MEI and non-MEI groups.Results: Overall, 15% of ears were categorized as LRC, 30% were OL, and 55% were MRC. In the MEI group, the proportions of LRC, OL, and MRC ears were 17%, 32%, and 51%, respectively, whereas they were 7%, 24%, and 69% in the non-MEI group. The proportion of LRC ears in the MEI group was significantly higher than that in the non-MEI group.Conclusions: Especially in patients with MEI, a more LRC for the facial nerve increases the risk of facial nerve injury during posterior tympanotomy or canal wall down mastoidectomy. The course of the facial nerve in the temporal bone should be evaluated before surgery on multi-slice CT images. (C) 2020 Oto-Rhino-Laryngological Society of Japan Inc. Published by Elsevier B.V. All rights reserved.