创伤后马勒-包括复合体脱位

Philippine Journal of Otolaryngology Head and Neck Surgery Pub Date : 2021-11-11 DOI:10.32412/pjohns.v36i2.1819

N. Yang

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By what objective parameters can the presence of a malleoincudal complex dislocation be identified? \n \nMeriot et al.1 described five types of traumatic ossicular dislocation injury: incudomalleolar joint separation, incudostapedial joint separation, stapediovestibular dislocation, incus dislocation, and malleo-incudal complex dislocation. Of these, incudomalleolar joint separation would probably be the most easily identified, as it would manifest as a disruption in the distinctive ice-cream cone appearance of the malleus head and the body and short process of the incus visualized on axial CT imaging of the temporal bone. (Figure 2) In contrast, malleo-incudal complex dislocation would involve movement of both ossicles en-bloc within the tympanic cavity (usually into the mesotympanum), without disruption of the incudomalleolar joint.1 As such, the ice-cream cone configuration may be preserved in this type of injury. Proper identification of this type of injury would be based on identifying any discrepancy in the positional relationship between the ossicular complex and the other structures within the confines of the \ntympanic cavity. \n \nThe malleus head and the body and short process of the incus are located in the most superior portion of the tympanic cavity, the pneumatised area called the epitympanum. Also known as the attic or \nepitympanic recess, this region is bordered superiorly by the tegmen tympani and inferiorly by the mesotympanum. The epitympanum is divided into two compartments: the anterior epitympanic space or \nrecess, and the much larger posterior epitympanum, which houses the epitympanic portions of the malleus and incus. This division is created by a thin bony plate known as the cog, which projects downwards from the tegmen tympani and is located anterior to the malleus head.2 In the axial plane, the malleo-incudal complex is normally centered within the posterior epitympanum with the short process of the incus pointing into the incudal fossa. The position of the malleo-incudal complex may sometimes be slightly lateral, but is never medial in the normal situation.1 \n \nBased on these broader anatomical relationships, it can be seen that in the imaging study under investigation (Figure 3), the malleo-incudal complex (the ice-cream cone) has actually shifted forward - the malleus head is located not posterior to the cog, but at the same level as the cog in the antero-posterior dimension. Additionally, the malleo-incudal complex is located more medially within the posterior epitympanum, and is much closer to the tympanic segment of the facial nerve than to the lateral bony margin (the scutum) of the epitympanum. These findings clearly and unequivocally demonstrate the presence of a malleo-incudal complex dislocation. \n \nIn summary, one of the keys to the proper evaluation of post-traumatic ossicular injury is to look not only at the anatomical relationship between ossicles, but also at the relationship of the entire ossicular complex to the other structures that are also located within the confines of the tympanic cavity","PeriodicalId":33358,"journal":{"name":"Philippine Journal of Otolaryngology Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2021-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Post-traumatic Malleo-Incudal Complex Dislocation\",\"authors\":\"N. 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By what objective parameters can the presence of a malleoincudal complex dislocation be identified? \\n \\nMeriot et al.1 described five types of traumatic ossicular dislocation injury: incudomalleolar joint separation, incudostapedial joint separation, stapediovestibular dislocation, incus dislocation, and malleo-incudal complex dislocation. Of these, incudomalleolar joint separation would probably be the most easily identified, as it would manifest as a disruption in the distinctive ice-cream cone appearance of the malleus head and the body and short process of the incus visualized on axial CT imaging of the temporal bone. (Figure 2) In contrast, malleo-incudal complex dislocation would involve movement of both ossicles en-bloc within the tympanic cavity (usually into the mesotympanum), without disruption of the incudomalleolar joint.1 As such, the ice-cream cone configuration may be preserved in this type of injury. Proper identification of this type of injury would be based on identifying any discrepancy in the positional relationship between the ossicular complex and the other structures within the confines of the \\ntympanic cavity. \\n \\nThe malleus head and the body and short process of the incus are located in the most superior portion of the tympanic cavity, the pneumatised area called the epitympanum. Also known as the attic or \\nepitympanic recess, this region is bordered superiorly by the tegmen tympani and inferiorly by the mesotympanum. The epitympanum is divided into two compartments: the anterior epitympanic space or \\nrecess, and the much larger posterior epitympanum, which houses the epitympanic portions of the malleus and incus. 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Additionally, the malleo-incudal complex is located more medially within the posterior epitympanum, and is much closer to the tympanic segment of the facial nerve than to the lateral bony margin (the scutum) of the epitympanum. 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引用次数: 0

摘要

一名27岁男子因车祸中头部钝性损伤接受耳鼻喉科评估。关于右耳，相关的耳科检查结果包括耳道撕裂和迟发性面神经麻痹。音叉测试显示右侧Rinne测试异常（AC本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Post-traumatic Malleo-Incudal Complex Dislocation

A 27-year-old man undergoes otolaryngologic evaluation for blunt head trauma suffered in a vehicular accident. With regards to the right ear, pertinent otologic findings include an ear canal laceration and a delayed-onset facial nerve paresis. Tuning fork testing reveals an abnormal Rinne test on the right (AC

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来源期刊

Philippine Journal of Otolaryngology Head and Neck Surgery

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0.00%

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审稿时长

48 weeks