面神经解剖的腮腺浅叶部分切除术在儿童第一鳃裂畸形治疗中的价值  

The Value of Partial Parotidectomy with Facial Nerve Explore in the Treatment of First Branchial Cleft Malformation in Children

作　　者：明澄 张铁松[1] 黄锐 毛志勇[1] 高燕[1] 刘秀芬 孙美华[1] 马静[1] MING Cheng;ZHANG Tiesong;HUANG Rui;MAO Zhiyong;GGO Yan;LIU Xiufeng;SUN Meihua;MA Jing(Department of Otolaryngology,Head and Neck Surgery,Kunming Children’s Hospital;Head and Neck Disease Diagnosis and Treatment Center,Kunming 650228,China)

机构地区：[1]昆明市儿童医院(昆明医科大学附属儿童医院)耳鼻咽喉头颈外科,昆明市儿童医院头颈疾病诊治中心,昆明650228

出　　处：《中华耳科学杂志》2018年第5期684-687,共4页Chinese Journal of Otology

基　　金：云南省卫生系统高层次人才培养项目(D-201637)。

摘　　要：目的探讨行面神经解剖的腮腺浅叶部分切除术在第一鳃裂畸形治疗中应用的价值。方法回顾性分析我科2014年1月至2017年1月收治的24例第一鳃裂瘘管患者的临床资料。患儿年龄12个月～15岁,平均6岁,其中男10例,女14例,病史1-60个月不等。16例以颌下瘘管及腐臭分泌物为首发症状,5例以耳后肿痛为首发症状,3例以耳道底壁流脓为主。复发病例6例,在外院行鳃裂畸形切除术,术后复发。患儿于全麻下行沿下颌缘支逆向法解剖面神经。行腮腺浅叶部分切除和瘘管切除术。结果 5例瘘管位于腮腺浅面,未解剖面神经,完整切除瘘管。17例患儿瘘管穿经腮腺腺体,解剖面神经后,切除部分腮腺浅叶、瘘管和部分耳廓软骨,切口均I期愈合。2例患者术后出下颌缘支损伤,轻度口角歪斜,术后1-3月基本完全恢复。行外耳道部分皮肤和软骨切除的患者术后均无外耳道狭窄及听力下降。随访10个月～4年,24例患者均未见复发。结论第一鳃裂畸形临床表现多样化,可表现为窦道、瘘管及囊肿,与外耳道和面神经关系密切,行面神经解剖的腮腺浅叶部分切除术,可彻底根治第一鳃裂畸形,防止其复发,并有效保护面神经。Objective To study the value of partial parotid gland resection in the treatment of first branchial fistula.Methods Clinical data of 24 patients with first branchial fistula admitted to our department from Jan.2014 to Jan.2017 were retrospectively analyzed.The children were 12 months to 15 years old(average age=6 years)and included 10 boys and 14 girls,with a disease history of 1 to 60 months.Submandibular fistula with rancid secretions was the presenting complaint in 16 cases,postural painful swelling in 5 cases and purulent ear canal drainage in 3 cases.Six patients complained of recurrent symptoms.All patients had undergone fistulectomy in other hospitals.The patients received partial superficial parotidectomy and fistulectomy with retrograde dissection of the mandibular facial nerve branch under general anesthesia.Results The fistula was located in the superficial parotid gland in 5 cases,and completely removed without facial nerve dissection.The fistula went through the parotid gland in 17 cases,in which the superficial parotid lobe,fistula and part of the auricle cartilage were removed following facial nerve dissection.The mandibular facial nerve branch was injured in two cases with mild mouth corner drooping postoperatively that resolved in one to three months.There was no external auditory canal stenosis or hearing loss in patients with partial ear canal skin and cartilage resection.There was no recurrence during the 10 months to 4 years follow-up.Conclusion Clinical presentations of first branchial fistula can be variable and may include sinuses,fistulas or cysts closely related to the external auditory canal and facial nerve.Partial resection of the superficial parotid gland with facial nerve dissection can provide cure,prevent recurrence and effectively protect the facial nerve.

关 键 词：面神经 外科手术 第一鳃裂畸形 腮腺浅叶部分切除术 

分 类 号：R764[医药卫生—耳鼻咽喉科]