[Craniotomy and the temporal branch of the facial nerve]. / Kraniotomie ve vztahu k temporální vetvi lícního nervu.

The surgical anatomy of the temporal branch of the facial nerve was studied in the anatomical laboratory. The temporal branch divides into an anterior, middle (frontal), and a posterior ramus after it pierces the parotid fascia. The anterior ramus innervates orbicularis oculi and corrugator supercilii muscles; the middle branch is for the ipsilateral frontalis muscle. The posterior branch innervates the anterior and superior auricular and tragus muscles. Below the zygomatic arch, the temporal branch of the facial nerve is located in the subcutaneous tissue. Above the arch, it continues in the subgaleal space with the superficial temporal fascia deeply. The terminal twigs of the temporal branch penetrate the galea to reach their target muscles that are all located superficial to the galea. There is a significant variability in the course of the temporal branch of the facial nerve. Occasionally, the terminal twigs of the middle ramus may penetrate superficial layer of superficial temporal fascia and run in the intrafascial fat pad before entering the frontalis muscle. There are four available operative techniques in this anatomical location. The subgaleal dissection of a temporofrontal scalp flap is associated with a high incidence of postoperative palsy of the temporal branch of the facial nerve and cosmetically bothersome results. Reflecting the scalp and temporalis muscle together as a single layer is the safest procedure. Unfortunately, this technique can not be used for the transzygomatic approaches and the bulky temporalis muscle may compromise basal exposure in the pterional route. Third technique was described and propagated by Yasargil. He proposed a subgaleal dissection up to the anterior one-fourth of the temporalis muscle where the dissection has to be deepened between the two layers of the superficial temporal fascia (in the interfascial fat pad). This approach may also infrequently injure the temporal branch in case of anatomical variation. The last available operative technique raises the superficial temporal fascia together with the scalp.

[Mucoceles of paranasal sinuses]. / Mukokely vedlejsích dutin nosních.

In a retrospective study authors refer to the treatment results in four patients with mucocele of the paranasal sinuses, who were hospitalized during a 30-months period at the Department of Otorhinolaryngology of the Charles University Hospital, in Prague, Czech Republic. In all patients the frontal sinus was involved, in three cases the involvement was unilateral, in one case bilateral. In the medical history of all patients, an injury, inflammation, or surgery of the paranasal sinus in the past (5-30 years ago) were present. In three patients, proptosis of the eye, swollen upper eyelid, and diplopia were discovered firstly by ocular examination. All patients underwent external approach surgical treatment, in four cases it was the frontoethmoidectomy sec. Jansen-Ritter, in one case the osteoplastic frontal craniotomy was performed. The postoperative follow-up period is 2-30 months.

[Problems in craniocerebral injuries]. / Problematika kraniocerebrálních poranení.

Considering the number of patients hospitalized for craniocerebral injuries, the authors found, that it is the second highest of all wound injuries, and that in the age group to 44 years, these injuries, mostly treated in the surgical departments of hospitals, are also the most frequent cause of death. Both the correct diagnosis and timely cure are essential for lowering the mortality rate and alleviating the post-injury impairment. Even thought inebriety in a larger number of patients makes the diagnosis and treatment difficult, it seems possible that in many other cases shorter hospitalization as well as a treatment on the out-patient basis, mostly by a neurologist, should be considered. This contribution focuses on isolated craniocerebral injuries. In the years 1981-90, this group of patients hospitalized in our department, reached the number 1, 135. Of which 208 (18.3%) suffered the structural damage of the brain tissue diagnosed as cerebral contusion or intracranial bleeding, 927 (81.7%) brain concussion, and 68 (6.0%) simultaneously had polytrauma.