陳旧性外傷性中耳髄液漏

A case of old traumatic cerebrospinal fluid leakage of the middle ear

Ⅰ．はじめに

　耳性髄液漏は，何らかの原因により，くも膜下腔と鼓室，乳突蜂巣との間に交通が生じて脳脊髄液が中耳に貯留したり，外耳から漏出する現象である^1）。今回われわれは交通事故による側頭骨骨折が原因となり，一過性顔面神経麻痺と伝音難聴をきたした小児の陳旧性外傷性中耳髄液漏の症例を経験したので，若干の文献的考察を加えて報告する。

□Abstract

　A 10-year-old boy received right-sided longitudinal temporal bone fracture in a motor vehicle accident. He manifested ipsilateral facial nerve palsy and middle ear fluid with conductive hearing loss immediately after injury. Complete recovery of facial nerve palsy was achieved by conservative treatment in 9 months, however, the middle ear fluid was remained. Because the fluid collected by myringotomy was positive for glucose, cerebrospinal fluid leakage was strongly suspected, and the patient was referred to our department 2 years after the onset. Computed tomography revealed a fracture of the anterior epitympanic tegmen, which was thought to be a fistula. He underwent surgical closure of the fistula via transmastoid and middle cranial fossa approaches. His postoperative clinical course was uneventful, and the patient was discharged 16 days after surgery. The diagnosis and treatment of cerebrospinal fluid leakage of the middle ear were bibliographically reviewed.