面神经监护在复杂第一鳃裂瘘切除术中的应用  

Facial nerve monitoring in complex first banchial fistula resection

作　　者：何慧媛[1] 赵昱[2] 陈晓栋[2] 王军[1] 

机构地区：[1]西安医学院第一附属医院口腔科,710077 [2]第四军医大学西京医院耳鼻咽喉头颈外科

出　　处：《现代口腔医学杂志》2013年第4期196-199,共4页Journal of Modern Stomatology

摘　　要：目的探讨面神经监护在复杂性第一鳃裂瘘切除术中的应用价值。方法对2007年1月至2011年12月接受第一鳃裂瘘切除术的17例复杂患者进行回顾性分析,男9例,女8例,左侧11例,右侧6例。病程1月至33年,全部具有反复切开引流和/或手术史。均在全麻下实施手术,术中应用Medtronic公司生产的Nim-Response 2.0系统进行面神经监护。结果全部病例随访12个月以上,切口均Ⅰ期愈合,面形无明显改变,外观满意,无涎瘘及Frey综合征发生;8例患者出现一过性唇角歪斜,无永久性面瘫发生;1例术后3月局部复发感染,再次手术后随访15月未见复发,其余患者未发现复发。结论术中面神经监护的应用,可以帮助术者在复杂状态下从瘢痕组织中快速探查、识别面神经的走行,迅速限定手术范围,从而避免在变形组织中盲目的反复牵拉探查,减少术中面神经损伤的机会,缩短手术时间,进一步提高手术的安全性。Objective To investigate the application value of facial nerve monitoring in complex resection of the first branchial fistula.Methods The clinical data of 17 patients who undertook complex resection of the first branchial fistula between Jan.,2007 and Dec.,2011 were analyzed retrospectively,including 9 males,8 females.11 cases were on the left side and 6 were on the right-side.The illness course ranged from 1 month to 33 years.All patients had a history of repeated incision and drainage or surgery.All operations were performed with general anesthesia.Nim-Response 2.0 facial nerve monitoring system produced by Medtronic was applied during operation.Results All patients were followed for more than 2 years and incisions were healed by 1st intention in all patients with satisfied appearance;There were no cases of salivary fistula or frey＇s syndrome;Transient deviated mouth occured in 8 cases but no permanent facial paralysis happened;1 patient experiences local recurrence 3 months after operation and no recurrence happened after 15 months of following after reoperation;there were no relapse after the operation in other cases.Conclusion Facial nerve monitoring in complex resection of the first branchial fistula helps surgeons to distinguish and probe the facial nerve and its branches＇ anatomic position so as to determine the extent of surgery in a relatively short period of time.This avoids dragging and probing of facial nerves blindly.It reduces the incidence of facial nerve injury thereby shortens operation time.As a result,the operation safety is further enhanced.

关 键 词：面神经监护 第一鳃裂瘘管 面神经 手术 并发症 

分 类 号：R651.3[医药卫生—外科学]