图解乳突根治术手术技
图-1.右颞骨。侧视图。(FromDonaldsonJA,DuckertLG,LambertPR,RubelEW,eds.Surgicalanatomyofthetemporalbone,ed4.NewYork:RavenPress;.)图-2.左颞骨。后侧视图。(FromDonaldsonJA,DuckertLG,LambertPR,RubelEW,eds.Surgicalanatomyofthetemporalbone,ed4.NewYork:RavenPress;.)图-3.耳后切口放置在耳后折痕后约1cm以促进皮肤闭合。(FromSheehyJL.Surgeryofchronicotitismedia.InEnglishGE,ed:Otolaryngology.Philadelphia:Lippincott;:1.)图-4.最初的切割沿着颞线进行，并与骨管相切。(FromSheehyJL.Mastoidectomy:theintactcanalwallprocedure.InBrackmannDE,SheltonC,ArriagaMA,eds:Otologicsurgery.Philadelphia:Saunders;.)图-5.面部凹陷显示为三角形。(FromSheehyJL.Mastoidectomy:theintactcanalwallprocedure.InBrackmannDE,SheltonC,ArriagaMA,eds:Otologicsurgery.Philadelphia:Saunders;.)图-6.面部凹部打开。(FromSheehyJL.Mastoidectomy:theintactcanalwallprocedure.InBrackmannDE,SheltonC,ArriagaMA,eds:Otologicsurgery.Philadelphia:Saunders;.)图-7.通过去除砧骨和颚窝来扩大面部凹陷。(FromSheehyJL.Mastoidectomy:theintactcanalwallprocedure.InBrackmannDE,SheltonC,ArriagaMA,eds:Otologicsurgery.Philadelphia:Saunders;.)图-8.面神经鼓室段的过程。(FromDonaldsonJA,DuckertLG,LambertPR,RubelEW,eds.Surgicalanatomyofthetemporalbone,ed4.NewYork:RavenPress;.)图-9.前鼓室上空间与开裂面神经。(FromSchuknechtHF.Pathologyoftheear,ed2.Philadelphia:LeaFebiger;.)图-10.管壁式乳突切除术。CN，颅神经。(FromBrackmannDE,SheltonC,ArriagaMA,eds.Otologicsurgery.Philadelphia:Saunders;.)图-11.组织切片显示深部窦鼓膜。EAC，外耳道;N，神经。(FromSchuknechtHF.Pathologyoftheear,ed2.Philadelphia:LeaFebiger;.)图-12.A，计算机断层扫描显示继发于慢性中耳炎和由此产生的人工耳蜗瘘（长箭头）的左耳下丘脑细胞系统（短箭头）的侵蚀。B，磁共振扫描显示钆增强的肉芽组织增强（箭头）。(FromNadolJBJr.Revisionmastoidectomy.OtolaryngolClinNorthAm;39[4]:-.)图-13.计算机断层扫描显示软组织中的胆脂瘤（箭头）低于左乳突尖端。在多次修正过程中，胆脂瘤的这个成分被忽略，直到获得该扫描。(FromNadolJBJr.Revisionmastoidectomy.OtolaryngolClinNorthAm;39[4]:-.)图-14.A，轴位计算机断层扫描显示窦和鼓室区的软组织密度（箭头）。B，与A相同水平的轴向T2加权磁共振扫描显示软组织密度。C，轴向回声平面扩散加权图像在同一水平显示耀斑“闪耀”效果。这被放射学解释为胆脂瘤。(FromEvliceA,Tarkan#;,Kiro#;luM,etal.Detectionofrecurrentandprimaryacquiredcholesteatomawithecho-planardiffusion-weightedmagneticresonanceimaging.JLaryngolOtol;[7]:-.)图-15.外科医生执行45度硬性镜的内窥镜检查。通过在先前疤痕部位处的耳后刺切口实现通路。注意这允许双手技术。(FromBarakateM,BottrillI.Combinedapproachtympanoplastyforcholesteatoma:impactofmiddle-earendoscopy.JLaryngolOtol;[2]:-).图-16.逆行乳突切除术技术涉及临时切除上腔静脉壁，伴有逆行乳突切除术。(ModifiedfromDornhofferJL.Retrogrademastoidectomy.OtolaryngolClinNorthAm;39[6]:-.)
上期：耳鼻咽喉-头颈外科「图解」--颞骨感染的并发症参考：CummingsOtolaryngology-HeadandNeckSurgery
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