迷路上间隙和后鼓室联合径路面神经减压术治疗颞骨骨折所致周围性面瘫的临床分析  

Combined supralabyrinthine and posterior tympanum approach for management of facial paralysis in temporal bone fracture

作　　者：王晋超[1] 吾买尔.牙生 唐亮[1] 张劲[1] 

机构地区：[1]新疆维吾尔自治区人民医院耳鼻咽喉科,新疆乌鲁木齐833000

出　　处：《中国耳鼻咽喉颅底外科杂志》2016年第3期203-206,共4页Chinese Journal of Otorhinolaryngology-skull Base Surgery

摘　　要：目的 探讨迷路上间隙和后鼓室联合径路面神经减压术治疗颞骨骨折面瘫的临床疗效.方法 对2013年5月-2015年7月收治的11例颞骨骨折引起的周围性面瘫患者进行迷路上间隙、后鼓室联合径路面神经减压术.按House-Brackmann分级标准进行面神经功能评价,术前Ⅲ级1例,Ⅳ级6例,Ⅴ级4例;术前平均听阈为（54.4 ±9.6）dB;术中见听骨链中断者5例,所有病例镫骨未见损伤.结果 11例均在受伤后4周内手术,术后随访0.5 -2年均获得较好的恢复.术后面瘫恢复至Ⅰ、Ⅱ、Ⅲ级的分别为4、4、3例.术后平均听阈为（38.0±12.0） dB.5例听骨链中断患者中3例用自体听小骨,2例应用钛合金听小骨,其余6例患者听骨链活动良好,5例保留了后拱柱.结论 迷路上间隙和后鼓室联合径路面神经减压术对面神经功能及听力恢复均获满意疗效.Objective To investigate the therapeutic effect of facial nerve decompression via combined supralabyrinthine and posterior tympanum approach for management of facial paralysis in temporal bone fracture. Methods From May 2013 and July 2015, 11 cases of traumatic facial paralysis received facial nerve decompression via combined supralabyrinthine and posterior tympanum approach. According to the House-Brackmann grade system, 4 were graded as Grade V, 6 as IV and one as III. Their preoperative mean air conduction threshold was 54.4 ± 9.6 dB. Ossicular disruption could be determined in 5 cases, and there was no damage with stape in all cases. Results 11 patients underwent surgery within 4 weeks after injury, had primary healing and no complication occurred. During following-up period ranging from 0.5 to 2 years, facial nerve function recovered to House-Brackmann Grade I in 4, II in 4 and III in 3. The postoperative mean air conduction threshold was 38.0 ± 12.0 dB. Sculpted incus was used for ossicular reconstruction in 3 patients, and PORP in 2 patients. The posterior arch column was preserved in 5 of the other 6 patients who had integral ossicular chain. Conclusion The clinical outcomes concerning the facial nerve function and hearing recovery are satisfactory via a combined supralabyrinthine and posterior tympanum approach for facial nerve decompression in temporal bone fracture patients with facial paralysis.

关 键 词：迷路上间隙 面神经减压术 面瘫 颞骨骨折 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]