面神经显微手术治疗周围性面瘫47例  

Therapeutic effects of facial nerve microsurgery on peripheral facial palsy in 47 patients

作　　者：沈志森[1] 张宇园[1] 关亚峰[1] 王凯[1] 沈毅[1] 

机构地区：[1]浙江省宁波市医疗中心李惠利医院耳鼻喉科,宁波315040

出　　处：《中国眼耳鼻喉科杂志》2009年第1期29-30,共2页Chinese Journal of Ophthalmology and Otorhinolaryngology

摘　　要：目的探讨不同面神经疾病致周围性面瘫显微手术方式的选择及其疗效。方法对21例外伤性面瘫、2例医源性面神经损伤、2例面神经瘤、9例贝尔面瘫及13例中耳胆脂瘤所致的周围性面瘫,行不同进路面神经显微减压、改道或移植手术,术后随访1～5年,按面瘫H-B分级法评判面神经功能恢复程度。结果21例颞骨骨折面瘫,伤后1～2周手术15例,术后面神经功能恢复Ⅰ级13例(86.7%),Ⅲ级2例;伤后3～4周手术5例,面神经功能恢复Ⅱ级3例,Ⅲ级2例;伤后8周手术1例,仅Ⅳ级恢复。医源性面瘫2例,术后面神经功能分别为Ⅱ和Ⅱ～Ⅲ级恢复。2例面神经瘤切除后所致者,术后面神经功能恢复Ⅰ～Ⅱ级1例,Ⅲ级1例。9例贝尔面瘫8～12周手术后I级2例,Ⅱ级4例,Ⅲ级3例。13例中耳胆脂瘤在1周内手术,Ⅰ、Ⅱ、Ⅲ级恢复例数分别为9、3、1例。结论对于不同原因所致周围性面瘫患者,选择合适的时机及术式,经面神经减压、移植或改道吻合术后,均能取得良好效果,但应严格掌握适应证。Objective To investigate the alternative and the effects of facial nerve mierosurgery on peripheral facial palsy caused by different facial nerve diseases. Methods Twenty-one patients with peripheral facial palsy caused by traumatic facial palsy, 2 cases by iatrogenic injury, 2 eases by facial neuroma, 9 cases by Bell palsy and 13 cases by cholesteatoma in middle ear were included in the study. All patients were treated with facial nerve decompression, nerve rerouting or nerve transplantation. The House-Brackmann facial nerve grade was assessed, with 1- to 5-year＇s follow up. Results Among 21 traumatic facial palsy patients caused by temporal bone fracture, 15 cases were operated in 1 to 2 weeks, in which recovery of normal function（grade Ⅰ） was achieved in 13 eases（86.7% ）, grade Ⅲ in 2 cases; 5 cases were operated in 3 to 4 weeks, in which recovery of facial nerve function of grade Ⅱ was achieved in 3 cases, grade m in 2 cases; 1 case accepted the operation 8 weeks after the injury, achieving grade Ⅳ according to the House-Brackmann facial nerve grade. Two cases of facial palsy caused by iatrogenic injury were treated with nerve rerouting or nerve decompression, achieving grade Ⅱ and Ⅱ to Ⅲ. Two cases of facial neuroma were reinnervated by great auricular nerve after resecting the neroma, achieving grade Ⅰ to Ⅱ and Ⅲ. Nine cases of Bell palsy were operated in 8 to 12 weeks, achieving grade Ⅰ in 2 cases, grade Ⅱ in 4 cases, grade Ⅲ in 3 cases. Thirteen cases of cholesteatoma of middle ear were operated in 1 week, achieving grade Ⅰ in 9 cases, grade Ⅱ in 3 cases, grade Ⅲ in 1 cases. Conclusions Alternative of appropriate time and operations such as facial nerve decompression, nerve rerouting or nerve transplantation according to the different etiologies could achieve good effects in treating peripheral facial palsy, with strict prehension of operation indications.

关 键 词：面神经 显微外科手术 面神经麻痹 

分 类 号：R651.3[医药卫生—外科学]