面神经减压术治疗周围性面瘫15例临床分析  

Results of Facial Nerve Microsurgery for Peripheral Facial Palsy in 15 Patients

作　　者：方瑾[1] 潘军燕[1] 陈晓红[1] 周水洪[2] 柴亮[2] 杨雪明[1] 王媚[1] 鲍洋洋[2] 钱林荣[1] 李海同[1] 

机构地区：[1]嘉兴学院附属第二医院耳鼻咽喉科,嘉兴314000 [2]浙江大学医学院附属第一医院耳鼻咽喉科,杭州310003

出　　处：《中华耳科学杂志》2014年第2期296-299,共4页Chinese Journal of Otology

基　　金：嘉兴市科技计划项目(2011AY10494)

摘　　要：目的：探讨不同面神经疾病致周围性面瘫行面神经减压手术的疗效。方法对9例外伤性面瘫、3例贝尔氏面瘫及3例中耳胆脂瘤所致的周围性面瘫，经乳突-颞下迷路上隐窝进路面神经显微减压手术，术后随访0.5～2年，按面瘫H-B分级法评估面神经功能恢复程度。结果9例颞骨骨折面瘫（Ⅳ级2例，V级6例，Ⅵ级1例），伤后2～4周手术5例，术后面神经功能恢复I级4例，Ⅱ级1例；伤后5～8周手术3例，面神经功能恢复Ⅱ级2例，Ⅲ级1例；伤后9～12周手术1例，恢复Ⅳ级。3例贝尔面瘫（Ⅳ级1例，V级2例）,9～12周手术2例，均Ⅱ级恢复，12周后手术1例，为Ⅲ级恢复；3例中耳胆脂瘤（Ⅲ级2例，Ⅳ1例）在1～2周内手术，均I级恢复。结论对于不同原因所致周围性面瘫患者，选择合适的时机行面神经减压术，多能取得良好疗效。Objcetive To report results of facial nerve decompression for peripheral facial palsy caused by different facial never diseases.Methods Etiologies in this group included trauma （n=9）, Bell’s palsy （n=3） and cholesteatoma in middle ear （n=3）.All patients were treated with facial nerve decompression via transmastoid, subtemporal or supralabyrinthine approach-es.The House-Brackmann facial nerve grade was assessed during the 0.5 to 2 years follow up.Results Among the 9 traumat-ic facial palsy patients caused by temporal bone fracture, 5 received surgery within 2 to 4 weeks and achieved grade I （n=4） or II （n=1） facial function;3 received surgery within 5 to 8 weeks and achieved gradeⅡ（n=2） orⅢ（n=1） facial function;and 1 received the operation within 9 to 12 weeks after the injury and achieved only gradeⅣfacial function.Two patients with Bell ’s palsy were operated on within 9 to12 weeks and achieved grade Ⅰ or Ⅱ facial function. One Bell’s palsy patient achieved gradeⅢfacial function after receiving surgery 12 weeks after disease onset. The 3 cases of middle ear cholesteatoma were oper-ated upon in 1 to 2 weeks and all achieved grade Ⅰ facial function. Conclusions Appropriate timing and facial nerve decom-pression operations based on the etiologies can lead to good facial function results.

关 键 词：面神经 减压 面神经麻痹 颞骨骨折 中耳胆脂瘤 

分 类 号：R322.922[医药卫生—人体解剖和组织胚胎学]