电缆状耳大神经移植修复腮腺癌切除术后面神经缺损  

Immediate reconstruction of facial nerve defect using cable grafting of the greater auricualr nerve after parotid cancer resection

作　　者：李文[1] 杨柳[1] 陈敏[1] 张满满[1] 张裕科[1] 

机构地区：[1]四川大学华西医院耳鼻咽喉头颈外科,成都610041

出　　处：《临床耳鼻咽喉头颈外科杂志》2017年第16期1254-1258,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨采用电缆状耳大神经即刻移植修复腮腺癌切除术后面神经缺损的可行性。方法:因腮腺癌切除面神经后采用电缆状耳大神经移植即刻重建面神经患者11例,其中黏液表皮样癌9例,腺样囊性癌2例,均行患侧腮腺全切+肿瘤累及段面神经干及分支切除+同期电缆状耳大神经修复重建+择区性颈淋巴结清扫术。面神经缺损分为面神经干及分支、颞面干及分支和颈面干及分支3个类型;术后记录患者面部肌肉运动状态对称性及行双侧面神经肌电图检测;House-Brackmann(H-B)面神经功能分级系统评价面神经功能恢复情况。8例患者术后接受50~65Gy放疗。术后随访8~36个月,平均12个月。结果:在拟修复的面神经功能区,7例患者获得满意的闭眼功能(7/7);5例患者可见明显的皱额(5/7);9例患者静态时可获得对称的口角和鼻唇沟(9/9);4例患者放疗后3个月,面神经功能仍有明显改善。9例患者获得H-B分级Ⅱ级、2例获得Ⅲ级的康复效果。H-B分级为Ⅱ级的9例患者患侧面神经肌电活动仍较健侧轻微减弱。结论:电缆状耳大神经移植能有效修复腮腺癌切除术后面神经缺损,可作为即刻面神经缺损重建的方法。腮腺区的游离神经移植可能不是术后放疗的禁忌证。Objective：To evaluate the feasibility of immediate reconstruction of facial nerve defect by using cable grafting of the greater auricular nerve after parotid cancer resection.Method：Clinical data of 11 patients suffering from parotid cancer was reviewed.9cases were diagnosed as mucoepidermoid carcinoma and 2cases were adenoid cystic carcinoma.Total parotidectomy and elective neck dissection were performed before cable grafting of the greater auricular nerve was interposed between stumps of facial nerve trunk and its branches.The facial nerve electromyogram and symmetry of mimetic musculature were evaluated.The House-Brackmann（H-B）grading system was used to assess the functional outcome of facial nerve rehabilitation.8patients received 50-65 Gy postoperative radiotherapy.The follow-up time ranged from 8months to 36 months with the mean time of 12 months.Result：At all function-oriented facial nerve reconstructed region,satisfactory orbicularis oculi muscle function in 7patients was achieved（7/7）;5patients obtained seeable and almost symmetric frowning（5/7）;9patients obtained obvious nasolabial groove and satisfactory rest symmetry of the mouth corners（9/9）;4patients got better facial nerve function restoration when it was 3 months after radiotherapy.Nine patients got H-B grade Ⅱ,and 2patients got H-B gradeⅢfacial nerve function restoration.Facial nerve electromyogram revealed weaker amplitude nerve conduction in 9patients of H-B grade Ⅱ than the conduction at its corresponding normal side.Conclusion：Cable grafting of the greater auricular nerve is a feasible candidate for the immediate reconstruction of facial nerve defect.Free nerve transplantation is probably not a contraindication for postoperative radiotherapy in the parotid region.

关 键 词：耳大神经 移植 面神经 腮腺肿瘤 重建 

分 类 号：R781.7[医药卫生—口腔医学]