鼓室乳突术后迟发性周围性面神经麻痹的临床诊治  

Diagnosis and treatment of patients with delayed peripheral facial nerve paralysis after tympano-mastoid surgeries

作　　者：李永奇[1] 陈愈彬[1] 尹根蒂[1] 李鹏[1] 曾祥丽[1] 

机构地区：[1]中山大学附属第三医院耳鼻咽喉头颈外科

出　　处：《中华耳科学杂志》2016年第5期629-633,共5页Chinese Journal of Otology

基　　金：广东省自然科学基金自由申请项目编号:2015A030313180~~

摘　　要：目的：分析和探讨鼓室-乳突手术后迟发性周围性面神经麻痹的临床特征、诊断和治疗要点。方法回顾性分析从2010年3月～2014年12月接受鼓室-乳突手术术后出现迟发性周围性面神经麻痹的共7例患者的临床诊治过程，包括其病史、专科查体、影像学及听力学检查、手术经过、面神经麻痹发生的时间、治疗用药及随访情况等。结果664例鼓室-乳突手术的患者中，有7例在术后出现了迟发性周围性面神经麻痹，发生率为1.05%，面神经麻痹的发生时间是术后5～14天，平均11天，面神经功能情况：HBⅣ级4例，Ⅲ级2例，Ⅱ级1例，6例术前颞骨CT检查显示面神经水平段裸露，3例伴有耳周疼痛，3例有面部受冷风刺激史，3例进行了疱疹病毒抗体检测，其中3例阳性；经抗病毒、糖皮质激素、营养神经等治疗，10天后所有患者的面神经麻痹症状明显好转，其中1例恢复正常，1月后5例恢复正常，余1例在2月后也恢复正常。结论迟发性周围性面神经麻痹是鼓室-乳突术后少见的并发症之一，多发生在术后10天左右，其发生的具体病因不明，可能与局部细菌感染或病毒感染、鼓室内填塞物刺激或鼓索神经牵拉肿胀等因素有关。经积极药物治疗，大部分患者的面瘫症状可在10天内得到明显改善，2月后均恢复正常。Objective To report clinical manifestations, diagnosis and treatment of patients with delayed peripheral fa-cial nerve paralysis following tympano-mastoid surgeries. Methods Clinical data including history, physical examination, audiologic findings, CT scan, procedure types, as well as occurrence time, treatment and outcomes of delayed peripheral fa-cial nerve paralysis after tympano-mastoid surgery in 7 cases were retrospectively reviewed. Results Among 664 patients who underwent tympano-mastoid surgeries from March 2010 to December 2014, 7 （1.05%） developed delayed peripheral fa-cial nerve paralysis. Facial paresis started between 5 and 14 days postoperative （mean = 11 days）. Facial function was House-Brackmann Grade IV in 4 cases, III in 2 cases and II in 1 case. Bony dehiscence was found in 6 cases at the horizon-tal segment of the facial nerve canal by temporal CT scanning. Three patients reported earache and 3 reported exposure of face to cold air. Herpes virus specific antibodies were tested positive in 3 patients. Patients were treated with antivirals, corti-costeroids, neurotrophic agents and other drugs for 7 to 14 days. All patients showed significant improvement after 10 days of treatment. Facial function returned to normal in 1 month in 6 patients and in 2 months in the other patient. Conclusion De-layed peripheral facial nerve paralysis is one of the rare complications after tympano-mastoid surgery, occurring mainly with-in 10 days postoperative. The etiology is still not clear. Local bacterial or viral infection, packing pressure, and stretching of the chorda tympani during surgery may be possible factors. In this series, facial function showed significant improvement af-ter 10 days treatment with antivirals, corticosteroids and neurotrophic drugs, and recovered to normal within 2 months.

关 键 词：迟发性周围性面神经麻痹 鼓室-乳突手术 并发症 诊断 治疗 

分 类 号：R764[医药卫生—耳鼻咽喉科]