咬肌神经-面神经转位术治疗听神经瘤术后面瘫  

Masseter- to- facial nerve transfer, a novel effective technique for facial functional reconstruction after acoustic neuroma resection

作　　者：杨娴娴[1] 杨川[1] 王炜[1] 李伟[1] 李青峰[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院整复外科,200011

出　　处：《中华神经外科杂志》2014年第4期331-334,共4页Chinese Journal of Neurosurgery

基　　金：上海市教委整复外科创新团队项目子课题（2012BA111B03）

摘　　要：目的探讨应用咬肌神经-面神经转位术修复颅内段面神经损伤所致面瘫的疗效和术后并发症。方法16例听神经瘤术后面瘫患者均行咬肌神经-面神经转位术。面瘫时间为2—18个月；年龄为22～70岁。所有患者在术后3个月、12个月接受随访，2次随访结果作为本次研究的分析资料。结果患者手术前后相比、术后早期随访与晚期随访相比，面肌上唇上提功能均获得显著改善（P〈0．05）。16例中9例微笑动作获得最佳或良好的效果，5例达到中等程度恢复，2例疗效较差。4例出现腮腺咬肌区凹陷，但咀嚼功能未受显著影响。本组患者面肌联动畸形评分均为轻微。结论咬肌神经-面神经转位术通过较小的供区损伤，使听神经瘤术后面神经损伤患者获得有效的神经修复。Objective To determine the effects of masseter - to - facial nerve transfer for patients who acquired a proximal injury to the facial nerve and to analyze the associated morbidities after the operation. Methods A total of 16 patients underwent tumor resection in cerebellopontine angle （CPA） received the masseter -to -facial nerve transfer from November 2010 to February 2013 in our center with continuously follow - up. Terzis＇s smile grading and Metha＇s synkinetic movements scales were used to evaluate the preoperative and postoperative mimetic muscle functiorr The periods between the operation and the onset of mimetic muscle contraction were also documented. A questionnaire was introduced to assess the donor - site morbidity and the ability to smile without bitin~ Results All patients had restored the smile function with biting（ P 〈 0. 05）. 9 of 16 patients had excellent or good results, 5 had moderated results and 2 had poor results. 4 patients complained about moderate degree of masseter atrophy and required further revision. The synkinetic movements were observed in all patients and were rated as mild. Conclusions Masseter - facial nerve transfer was a highly efficient technique to reanimate the paralytic muscle in patients who acquired intracranial facial nerve injury with minor deformities. After continued physical therapy, some patients were able to regain a symmetrical and effortless smile with mild synkinetic movements.

关 键 词：面神经 神经瘤 听 神经转位 咬肌神经 

分 类 号：R739.4[医药卫生—肿瘤]