Rudert H
HNO. 1975 Oct;23(10):297-306.
Intratemporal lesions of the facial nerve can be divided into operative lesions, lesions due to birth trauma, trauma through the external auditory canal, gunshot injuries, lesions caused by fractures of the temporal bone and lesions due to intratemporal tumours. Bell's palsy and palsies due to inflammation are not included in this paper. The lesions caused by fractures are discussed in more detail. In longitudinal fractures the nerve is always damaged at the site of the geniculate ganglion and not at the pyramidal segment, as accepted until now. Of the lesions caused by tumours the neurinomas are discussed. A very rare case of a combined extra- and intra-temporal neurinoma is presented. The progress of the electrophysiological findings (nerve excitability test, electroneurography) are most important for the indication for exploration of the nerve, especially in lesions due to fracture. Surgery is necessary only in cases of imminent or complete denervation and not in cases of neuropraxia. The methods of intratemporal facial nerve surgery are: 1. anastomoses (cross-over) between the facial nerve and other cranial nerves (IX, XI, XII), 2. decompression, 3. suture (including rerouting), and 4. nerve grafting. The oldest method of anastomosing with the hypoglossal nerve, is a useful technique if other techniques of nerve repair have failed. Since the introduction of transtemporal surgery of the internal canal decompression can bedone from the stylomastoid foramen to the porus acousticus. The end-to-end suture of a severed nerve gives good results. Nerve defects can be corrected by shortening the nerve bed. The following methods are used: 1: rerouting of the pyramidal segment (Bunnel, Martin), 2. rerouting at the stylomastoid foramen (Mundnich), 3. transtemporal rerouting of the first genu (Ganglion geniculi) with preservation of the labyrinth (one case is demonstrated). 4. transmastoidal-translabyrinthine rerouting in cases of a destroyed labyrinth. Nerve grafting is the method of choice with large defects. In the temporal bone special suture techniques are unnecessary. The approximation of the stumps must be free of tension.
颞骨内面神经病变可分为手术性病变、产伤性病变、经外耳道创伤性病变、枪伤性病变、颞骨骨折所致病变以及颞骨内肿瘤所致病变。本文不包括贝尔面瘫和炎症性面瘫。骨折所致病变将进行更详细的讨论。在纵行骨折中，神经总是在膝状神经节部位受损，而非如目前所认为的在锥曲段受损。对于肿瘤所致病变，将讨论神经鞘瘤。本文介绍了1例非常罕见的颞骨内外联合神经鞘瘤病例。电生理检查结果（神经兴奋性试验、神经电图）的进展对于神经探查指征至关重要，尤其是在骨折所致病变中。仅在即将发生或完全失神经的情况下才需要手术，而在神经失用症情况下则无需手术。颞骨内面神经手术方法有：1. 面神经与其他颅神经（IX、XI、XII）之间的吻合（交叉）；2. 减压；3. 缝合（包括改道）；4. 神经移植。与舌下神经吻合的最古老方法，若其他神经修复技术失败则是一种有用的技术。自经颞骨内耳道减压手术开展以来，可从茎乳孔至内耳道进行减压。切断神经的端端缝合效果良好。可通过缩短神经床来纠正神经缺损。采用以下方法：1. 锥曲段改道（邦内尔、马丁法）；2. 在茎乳孔处改道（蒙迪希法）；3. 保留迷路经颞骨改道第一膝状神经节（展示1例）；4. 在迷路破坏的情况下经乳突 - 迷路改道。对于大的神经缺损，神经移植是首选方法。在颞骨内无需特殊的缝合技术。断端的对合必须无张力。
