颞骨肿瘤性面瘫的临床诊治分析  

The clinical analysis and treatment of facial paralysis causedby temporal bone tumors

作　　者：杨东辉[1] 梁敏志[1] 谭向杲[1] 夏广生[1] 

机构地区：[1]广东高州市人民医院耳鼻咽喉科,广东高州525200

出　　处：《临床耳鼻咽喉头颈外科杂志》2013年第16期884-889,共6页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨引起面瘫的颞骨肿瘤的临床特点、影像学表现及治疗方法。方法:回顾分析23例引起周围性面瘫的颞骨肿瘤临床资料,包括面神经瘤11例(面神经鞘瘤8例、面神经纤维瘤3例),颞骨恶性肿瘤12例(颞骨鳞状细胞癌9例、软骨肉瘤1例、横纹肌肉瘤2例)。全部患者行CT及MRI检查。手术治疗23例,其中11例行面神经瘤切除术(经乳突径路6例、乳突颅中窝联合径路3例、乳突腮腺联合径路2例,8例肿瘤切除后同期进行面神经移植);12例行颞骨恶性肿瘤切除术(扩大乳突根治术5例、颞骨次全切6例、颞骨全切除术1例),术后均加放疗。结果:影像学上肿瘤是否沿面神经走向分布是面神经源性及非面神经源性肿瘤的主要鉴别方法。随访3～8年,10例面神经瘤全部切除无复发,1例面神瘤残留。12例颞骨恶性肿瘤(Stell分期:T2期5例,T3期7例)复发率为41.7%(5/12),5年生存率66.7%(8/12)。结论:引发面瘫的颞骨肿瘤中面神经源性肿瘤多为良性,非面神经源性肿瘤以恶性肿瘤多见。CT及MRI对诊断有重要价值。手术为主要治疗手段,手术方式根据肿瘤类型及范围而定,面神经源性肿瘤多可同期行面神经移植改善面神经功能。恶性肿瘤需行放疗等综合治疗。Objective： To explore the clinical features, pathologic characteristics and treatments of the facial paralysis caused by temporal bone tumors. Method：Retrospective analyzed the 23 clinical data of peripheral facial paralysis caused by temporal bone tumors, including 11 cases of facial nerve tumor： facial nerve nerilemmoma in 8 cases, facial nerve neurofibroma in 3 cases;12 cases of temporal bone malignant tumor： temporal bone squamous cell carcinoma in 9 cases, chondrosarcoma in 1 case, rhabdomyosarcoma in 2 cases, All the patients accepted the CT scan examination and MRI examination. Twenty-three cases were surgically treated： facial nerve tumor resec tion were performed in 11 cases, among those, through mastoid approach in 7 cases, combined mastoid with mid- dle cranial fossa approach in 3 cases, combined mastoid with parotid approach in 2 cases. Eight cases underwent facial nerve graft following the surgical removal of tumors. Twelve cases were temporal bone malignant tumor re section： among those, extened mastoidotym panectomy in 5 cases, subtotal temporal bone resection in 6 cases, to- tal temporal hone resection in 1 case, all were treated by radiotherapies after surgeries. Result：Whether the tumors go along the facial nerve in imaging is the major identification method to identify the facial nerve tumors or nofacial nerve tumors. During the 3--8 years follow-up, 10 patients who were totally removed the facial nerve tumor were no recurrence, 1 patient had tumors present. The recurrence rate of temporal bone malignancy was 41. 7% （5/ 12）, 5 cases of Stell stage T2 and 5 cases of stage T3. The 5-year survival rate was 66.7% （8/12）. Conclusion： Most of facial nerve tumors that cause the facial palsy are benign, and nofacial nerve tumors are most common a mong the malignant tumors. CT and MRI films are valuable for the diagnosis. Operation is the major treatment, the manner of the operation bases on the type and the extent of the tumors. Facial nerve grafting can improve the facial neuro

关 键 词：颞骨肿瘤 面瘫 面神经瘤 

分 类 号：R745.12[医药卫生—神经病学与精神病学]