創傷後膽脂瘤—病例報告

創傷後膽脂瘤是頭部外傷可能的遲發性後遺症之一，形成原因主要是由於上皮經骨折線植入中耳腔或乳突腔中；此外，鼓膜或外耳道上皮經由鼓膜破洞植入中耳腔亦是原因之一。創傷後膽脂瘤的特色為具有頭部外傷史、遲發性、體積大，且常是發生於氣化良好的中耳腔或乳突腔中。本科經歷一15歲男性病患，主訴左側漸進性聽力障礙有一年之久。病患左耳於二年多前曾遭受掌摑而造成鼓膜破損。理學檢查顯示正常鼓膜及外聽道，純音聽力檢查顯示左側傳音性聽障及A型鼓室圖。顳骨電腦斷層未發現明顯骨折線，左側中鼓室有軟組織質塊，而鼓室及乳突氣化良好。手術中發現膽脂瘤位於聽小骨內側面並向上鼓室延伸，聽小骨及顔面神經管均部分遭受破壞。我們清除膽脂瘤後施行鼓室成型術及全聽小骨重建術(TORP)，病人至今恢復良好。

關鍵字

顳骨外傷；創傷後膽脂瘤；傳音性聽力障礙

並列摘要

Post-traumatic cholesteatoma is one of the delayed complications of temporal bone fracture. The etiology may be implantation of epithelium into the middle ear or mastoid cavity through the fracture line or ear drum perforation. A history of head injury, delayed onset and large size are the characteristics of post-traumatic cholesteatoma and it usually develops in well-pneumatized temporal bone. Our department encountered a 15-years-old boy who complained of progressive hearing loss in his left ear for one year. He had a history of a slap injury-induced ear drum perforation on the left side. Physical examination showed a normal ear drum and external auditory canal. Audiometry showed left side conductive hearing loss and type A tympanogram. High resolution temporal bone CT scan showed soft tissue density in the left mesotympanum and a well pneumatized mastoid without a fracture line. During surgery, cholesteatoma was found medial to the ossicles, extending toward the attic; ossicles and facial canal were found partially destroyed. We removed all the cholesteatoma material and performed a tympanoplasty and ossiculoplasty with a total ossicular replacement prosthesis (TORP). The patient recovered very well, and his air-bone gap was reduced to 15 dB.

並列關鍵字

temporal bone fracture ； post-traumatic cholesteatoma ； conductive hearing loss

國際替代計量

創傷後膽脂瘤—病例報告

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