枪伤引起的颞骨损伤并不常见,但却是毁灭性的,关键神经血管结构受损的风险很高。颞骨的高电阻,人体内最致密的骨头,有时可以避免致命的结果。然而,并发症在许多情况下是毁灭性的,包括听力损失,面瘫,脑脊液漏,颅内损伤,和血管损伤。我们的目标是报告一例颞骨弹道损伤,并描述治疗所采取的手术方法。一名74岁的男子被转到我们三甲医院的急诊室,插管和镇静,在一起持枪自杀未遂之后.CT扫描显示金属弹丸卡在右侧颞骨内,听骨链和骨迷宫的破坏。稳定后,镇静被逆转,耳鼻喉科团队被叫来了.在检查中,入口伤口位于孔腔,无活动性出血,但表现为脑脊液活动性耳漏。患者右侧有完全性周围性面瘫,左侧有自发性水平性眼球震颤。经验性抗生素治疗开始。进行了次全岩石切除术,随着异物的去除,脑脊液瘘的修复,用腹部脂肪封闭腔,和外耳道的闭合。他在术后第11天出院,保持完全性面神经麻痹和右侧肛门,但在帮助下能够走路。总之,颞骨穿透性创伤是一种潜在的危及生命的情况,存活下来的病人有一个谨慎的预后,因为即使及时管理,它也会导致永久的后遗症。
Temporal bone injuries due to gunshot wounds are uncommon but devastating, with a high risk of damage to critical neurovascular structures. The high resistance of the temporal bone, the densest bone in the human body, can sometimes avoid a fatal outcome. However, the complications are in many cases devastating and include hearing loss, facial paralysis, cerebrospinal fluid leakage, intracranial damage, and vascular injuries. Our goal was to report a
case of ballistic injury to the temporal bone and describe the surgical approach taken for treatment. A 74-year-old man was transferred to the emergency room of our tertiary hospital, intubated and sedated, after an attempted suicide with a firearm. The CT scan showed the metal projectile lodged within the temporal bone on the right side, with the destruction of the ossicular chain and bony labyrinth. After stabilization, sedation was reversed, and the otolaryngology team was called. On examination, the entry wound was located in the cavum concha, with no active bleeding but presenting active otorrhea of cerebrospinal fluid. The patient had complete peripheral facial paralysis on the right side and spontaneous horizontal nystagmus toward the left side. Empirical antibiotic therapy was initiated. A subtotal petrosectomy was performed, with the removal of the foreign body, repair of the cerebrospinal fluid fistula, obliteration of the cavity with abdominal fat, and closure of the external auditory canal. He was discharged on the 11th-day post-surgery, maintaining complete facial paralysis and right-side anacusis, but was able to walk with assistance. In conclusion, penetrating trauma of the temporal bone is a potentially life-threatening situation, and patients that survive have a guarded prognosis, as it often leads to permanent sequelae even when managed promptly.