面神经减压治疗周围性面瘫32例临床分析  

Peripheral facial paralysis in temporal bone trauma and cholesteatoma otitis media

作　　者：沈志森[1] 张宇园[1] 赵侃[1] 沈毅[1] 

机构地区：[1]宁波市医疗中心李惠利医院耳鼻咽喉-头颈外科,浙江宁波315040

出　　处：《临床耳鼻咽喉头颈外科杂志》2009年第1期21-23,共3页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨面神经减压治疗周围性面瘫的临床疗效。方法:对32例不同原因所致周围性面瘫患者行CT扫描,根据扫描结果行不同进路的面神经减压手术,术后随访0.5～2年,按H-B分级法评判面神经功能恢复程度。结果:32例中17例颞骨骨折面瘫(Ⅴ级2例,Ⅵ级15例),伤后2周内手术者13例,术后面神经功能恢复H-BⅠ～Ⅱ级11例,达84.6%;伤后3周手术者3例,恢复Ⅱ级2例、Ⅲ级1例;伤后8周手术者1例,仅Ⅳ级恢复。2例医源性面瘫(Ⅵ级)患者,分别在伤后2周和3周手术并为Ⅱ级和Ⅲ级恢复。13例中耳乳突病变者均在1周内手术,Ⅰ、Ⅱ、Ⅲ级恢复者分别为8、2、3例。结论:选择合适的术式及时机,绝大多数外伤性或中耳胆脂瘤等所致周围性面瘫患者经面神经减压术均能取得良好效果,外伤性面瘫手术尽量在伤后2周内进行。Objective：To investigate into the surgical approaches and clinical curative effect of peripheral facial nerve paralysis in different causes and injury location. Method：Thirty-two cases of peripheral facial paralysis were treated with selective facial nerve decompression via different surgical approaches. After 0.5 year to 2 years＇ follow up, the recovered functions of facial nerve were judged by House and Brackmann grading system. Result：In all pa tients, 17 cases of peripheral facial paralysis caused by trauma were underwent facial nerve decompression in two weeks, 11 cases reached degree Ⅰ （84.6%） according to House-brackmann（H-B） facial nerve function scores, 3 cases were treated in the third week, 2 cases reached degree Ⅱ and other 1 cases reached degree Ⅲ. One patient was treated after 8 weeks and facial nerve function scores only reached degree Ⅵ. Thirteen cases of otomastoiditis in middle ear were underwent facial nerve decompression iri one week, postoperative House-Brackmann grade was Ⅰ in 8 cases, Ⅱ in 2, and Ⅲ in 4. Conclusion：Majority of patients with peripheral facial paralysis were treated with facial nerve decompression have better clinical curative effect by suitable operation and juncture due to trauma or cholesteatoma otitis media, but operation for traumatic peripheral facial paralysis shoud be undertaken in two weeks.

关 键 词：面神经麻痹 减压术 胆脂瘤中耳炎 

分 类 号：R762[医药卫生—耳鼻咽喉科]