HSC Section 3 - Trauma, Critical Care and Sleep Medicine

Sun et al

Attention is then turned to reconstruction. A free muscle graft is harvested from the undersurface of the temporalis muscle. This muscle is used to plug the dural defect in the IAC. Previously harvested temporalis fascia graft is then placed to resurface the entire middle fossa floor. A split-thickness calvarial graft is then harvested from the bone flap and placed over the epitympanum. The House-Urban retractor is removed and hemostasis confirmed around the area of the middle meningeal artery. Two dural elevation sutures are placed inferiorly in the craniotomy window and tacked to the temporalis muscle to close the space between the dura and bone flap. The temporalis muscle is then closed in a watertight fashion with interrupted absorbable suture. The subdermal layer is closed with galea/temporoparietal fascia in an interrupted fashion. The skin is closed with interrupted nylon sutures. A pressure dressing should be applied to the wound. Surgical Approach for Traumatic Facial Nerve Injury Surgical decompression secondary to traumatic temporal bone fracture is similar to that of Bell palsy. The segments targeted for decompression are determined by the Fig. 6. Intraoperative image of decompression of the geniculate ganglion in a patient with Bell palsy. Co, cochlea; LS, labyrinthine segment of facial nerve; SSCC, superior semicircular canal ( dotted line ).

Fig. 7. Intraoperative image of decompression of the labyrinthine segment, connecting the IAC to the GG, in a patient with Bell palsy.

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