以面瘫为首要表现的颞骨占位病变的诊断与外科治疗分析  

Diagnosis and Surgical Treatment of Temporal Bone Space Occupying Lesions Presenting with Facial Paralysis

作　　者：陈雯婧[1] 李欣[1] 许嘉[1] 梁思超[1] 郭振平[1] 高娟娟 卢曼林 伊海金[1] CHEN Wenjing;LI Xin;XU Jia;LIANG Sichao;GUO Zhenping;GAO Juanjuan;LU Manlin;YI Haijin(Department of Otolaryngology,Head&Neck Surgery,Beijing Tsinghua Changgeng Hospital,Tsinghua University School of Clinical Medicine,Beijing 102218)

机构地区：[1]清华大学附属北京清华长庚医院耳鼻咽喉头颈外科清华大学临床医学院

出　　处：《中华耳科学杂志》2019年第4期498-503,共6页Chinese Journal of Otology

摘　　要：目的探讨以面瘫为首要表现的颞骨占位病变的临床特点,影像学表现及治疗方式,提高对疾病的认识,减少误诊漏诊。方法对2009年至2018年诊治的19例患者的临床资料进行回顾性分析,包括面神经鞘瘤10例,面神经血管瘤1例,颞骨岩部胆脂瘤(Petrous bone cholesteatoma PBC)8例,均有长期误诊经历。对患者影像学资料及面神经功能的预后情况进行分析。结果经手术治疗,病理证实为原发性面神经肿瘤及PBC。2例术前House-Brackmann(H-B)分级Ⅲ级,术后Ⅱ级。8例术前H-B分级Ⅴ级,其中2例术后分别恢复为Ⅲ级及Ⅳ级,4例术后Ⅴ级,其中1例同期行耳大神经移植术,2例术后Ⅵ级。9例术前H-B分级Ⅵ级,其中1例行面-舌下神经吻合术,术后Ⅴ级,8例术后Ⅵ级,其中1例因面神经纤维化严重,面-舌下神经吻合术失败。随访3月-8年无复发。结论对进行性或完全性面瘫患者,尤其伴有听力下降或眩晕者,应完善影像学检查,排除原发性面神经肿瘤及PBC等颞骨占位性病变的可能。及时发现病灶并采取恰当方法干预,可降低手术难度及并发症,增加面神经功能重建的机会。Objective To report clinical characteristics,image features and treatment strategies of temporal bonespace occupying lesions with facial paralysis as the primary manifestation for the purpose of improving recognition of the diseases and reducing misdiagnosis.Methods Clinical data from 19 patients diagnosed and treated from 2009 to 2018 were retrospectively analyzed.Diagnoses included facial nerve schwannoma(n=10),facial nerve hemangioma(n=1)and petrous bone cholesteatoma(PBC,n=8).All the patients had beeen misdiagnosed elsewhere.The patients’imag-ing data and prognosis of facial nerve function were analyzed.Results After surgical treatment,primary facial nerve tu-mors and PBC were pathologically confirmed.In 2 patients,House-Brackmann(HB)grade improved from III preopera-tively to grade II postoperatively.Preoperative HB grade was V in 8 patients,of whom postoperative HB grade im-proved to grade III and IV in 2 patients,remained unchanged in 4 patients(including one patient receiving greater auric-ular nerve transplantation at the time of mass resection),and worsened to grade VI in 2 patients.Of the 9 patients with preoperative HB grade at VI,one underwent facial-hyoid nerve anastomosis with HB grade slightly improved to V post-operatively,while HB grade remained at VI in the rest 8 patients(including one patient in whom anastomosis failed due to severe facial nerve fibrosis).There was no mass recurrence during the 3 months to 8 years follow-up.Conclusion For the patients with progressive or complete facial paralysis,especially those with concurrent hearing loss or vertigo,imaging examination should be performed in a timely manner. PBC, primary facial nerve tumors and other temporal bone space-occupying lesions should be ruled out. Lesions must be detected timely and proper intervention implemented in order to reduce treatment difficulties and complications and increase the opportunity of facial nerve function restoration.

关 键 词：面神经功能 面神经鞘瘤 颞骨岩部胆脂瘤 面瘫 

分 类 号：R764[医药卫生—耳鼻咽喉科]