total temporal bone resection

All patella resections, including the sacral scaly, mastoid and the entire rock, are mainly suitable for a wide range of cancer invasion in the tibia, but not to the intracranial invasion. If the cancer has invaded the parotid or intracranial part of the tibia, an enlarged humeral resection should be performed. Treatment of diseases: middle ear cancer Indication 1. Middle ear mastoid cancer lesions are advanced, but no intracranial or distant metastasis. 2. The cancer has invaded the rock tip, but did not exceed the sphenoid sulcus, and the dura mater, jugular bulb, and internal carotid artery were not destroyed. 3. There are facial paralysis, but no other brain nerves are violated. 4. The neck has been metastasized, but there is no extensive adhesion fixation, and neck dissection can be performed at the same time. The cancer invades the surrounding tissue and the meninges can be removed together. 5. The general condition is good and can tolerate this major operation. Contraindications 1. The skull base bone destruction has exceeded the sphenoid sulcus, and the surgery cannot be completely removed. 2. In addition to peripheral facial paralysis, there are other brain nerves invaded or distant organs. 3. The neck metastasis has been widely adhered to the fixation. 4. The physical condition is not good enough to tolerate this major surgery. 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 Y-shaped or S-shaped incision combined with the neck should be adopted. S-shaped incision on the tip of the auricle about 5cm to make a large S-shaped turn behind the ear, down to the plane of the tongue. 2. Exposing the area The skin and subcutaneous tissue were cut at the incision, and the flap was turned forward on the surface of the diaphragm; a musculoskeletal flap was made on the surface of the mastoid, and the external auditory canal was completely traversed inside the flap, and the musculoskeletal flap was turned forward and moved into the external auditory canal. The inner end of the external auditory canal is closed, so that the external auditory canal becomes a blind tube, and the entire auricle is turned to the front and fixed by a wire. The diaphragm is cut off at the sacral line of the sacral line, and the diaphragm is turned upside down and suspended upward to cut the second abdominal muscle and the sternocleidomastoid muscle at the tip of the mastoid. Expose the parotid gland and find the distal facial nerve from the stem of the stem to the parotid gland. 3. Circumcision and open the posterior fossa Use a cutting bit to sharpen the 4cm × 4cm sacral bone groove on the sacral scallion on the sacral line (grinding with a diamond drill bit near the brain), open the squamous bone into the skull, and grind the sigmoid around the inner shaft of the iliac crest. Anterior anterior anterior wall and jugular bulb lateral bone, anterior occlusion of the iliac crest, eustachian tube bone, cut off the mandibular condyle, remove the carotid canal bone, completely expose and free the internal carotid artery, sigmoid sinus , jugular bulb, cut off the nerve outside the stem of the stem. 4. Exposing the cranial nerve and ligation of the sigmoid sinus and internal jugular vein Expose the IX, X, XI brain nerves and protect them. After ligating the sigmoid sinus, the internal jugular vein is ligated to protect the internal carotid artery. The internal carotid artery to the apex and the sphenoid bone should be completely open and free. 5. Cut off the rock Electrocoagulation or ligating the upper sinus and lower sinus of the rock, while separating the meninges of the cranial fossa and the posterior cranial fossa. The osteochondral and the bone wall of the rock and adjacent parts were separated by a bone chisel, and the exposed temporal lobe and cerebellar meninges were protected with a saline pad. Using a brain puncture needle to release cerebrospinal fluid from the subarachnoid space about 20 ~ 30ml while using mannitol 250 ~ 500ml fast input to dehydrate the brain, pull up the temporal lobe, retract the cerebellum, and gently lift the back end of the rock bone to peel off The brain is carefully removed from the meninges under the rock bones and the rock, and after the inner ear canal is found, the internal auditory arteries, veins, and nerves are ligated. The bone grasping pliers grasp the back of the rock bone and gently rock it to the left and right, causing the rock tip to fracture in the shale rock joint and take out the whole piece of the rock. At the same time, neck dissection (the same "second humerus resection"). 6. Stitching and repairing the meninges During the operation, the meninges should be protected as much as possible without damage. In case of damage, the fascia or diaphragmatic fascia should be repaired, and the dura mater at the end of the auditory nerve should be tightly sutured. 7. Surgery and suturing After thorough hemostasis, the antibiotic solution is flushed into the cavity. The iliac muscle flap and the sternocleidomastoid flap were used to invert the filling cavity (sometimes the abdominal fat filling cavity), and the soft tissue and skin were layered and sutured. complication It is basically the same as partial humeral resection. There are mainly meningitis, cerebral hemorrhage, cerebrospinal fluid leakage and pneumonia, and facial paralysis and severe dizziness can occur.

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