先天性耳畸形患者面神经畸形的术前评估及术中防护  

Preoperative Evaluation and Intraoperative Protection of Facial Nerve in Surgery for Congenital Aural Atresia

作　　者：李洁[1] 杨劲松[2] 王丹妮[2] 任冉[2] 赵守琴[2] LI Jie;YANG Jinsong;WANG Danni;REN Ran;ZHAO Shouqin(Department of Otorhinolaryngology,Fuxing Hospital,Capital Medical University,Beijing 100038,China;Department of Otolaryngology-Head and Neck Surgery,Beijing Tongren Hospital,Key Laboratory of Otolaryngology-Head and Neck Surgery,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属复兴医院耳鼻喉科,北京100038 [2]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,北京市耳鼻咽喉科研究所,教育部耳鼻咽喉头颈科学重点实验室(首都医科大学),北京100730

出　　处：《中华耳科学杂志》2022年第6期863-868,共6页Chinese Journal of Otology

基　　金：首都医学发展科研基金(2009-2065)。

摘　　要：目的结合术前影像学及术中所见评价先天性外中耳畸形伴外耳道骨性闭锁(congenital aural atresia,CAA)患者的面神经畸形程度,并探讨面神经畸形程度对听力重建手术的影响。方法完善术前影像学及听力学检查,对符合适应证的CAA患者实施手术治疗,留取术中面神经走行相关资料,将面神经术中所见与颞骨影像学特征作对比,同时探讨面神经不同部位畸形对听力重建手术的影响。结果共入组65例(69耳)患者,术前颞骨高分辨率CT(HRCT)显示,面神经位置正常8耳(12.12%),鼓室段低位61耳(88.40%),其中部分遮窗46耳(66.67%),完全遮窗15耳(21.74%),双分支畸形2耳(2.9%),面神经骨管完整6耳(8.7%),骨管缺如63耳(91.3%)。术中见面神经位置正常6耳(8.70%),鼓室段低位63耳(91.3%),部分遮窗45耳(65.22%),完全遮窗18耳(26.09%),双分支畸形3耳(4.35%),面神经骨管完整17耳(24.64%),骨管缺如52耳(76.36%)。面神经第二膝角度变小(急转弯)及乳突段前移至前庭窗18耳,均完全遮盖前庭窗。结论颞骨HRCT对诊断面神经畸形至关重要。CAA患者Jahrsdoerfer评分越低,面神经畸形的发生率及遮窗程度也越重,对听力重建手术的影响也越大。Objective To report abnormalities of facial nerve in congenital aural atresia(CAA)confirmed by surgery and high-resolution computed tomography(HRCT)and their relevance to reconstructive ear surgery.Methods Intraoperative findings of the facial nerve in patients with CAA undergoing surgical exploration and reconstruction were compared with preoperative HRCT data,and their effects on reconstructive strategies analyzed.Results A total of 65 cases(69 ears)were included in this study.On HRCT,a lowset tympanic segment was identified in 61 ears(88.4%),with 46(66.67%)overlapping the oval window partially and 15(21.74%)completely;the facial nerve was in normal position in 8 cases(12.12%),showing bifurcation in 2 cases(2.9%)and no bon covering in 63(91.3%).Intraoperatively,the facial nerve was found to have a low-set tympanic segment in 63 ears,in normal position in 6 ears(8.7%),partially covering the oval window in 45 ears(65.22%),completely covering the oval window with an acute second genu angle and a“sharp turn”in 18 ears(26.09%),branching in 3 ears(4.35%),and showing absent bony covering in 52 ears(76.36%).Conclusions HRCT is undoubtedly of vital value in identifying the course of the facial nerve preoperatively in CAA.The lower the Jahrsdoerfer score,the greater the extent the facial nerve covers the oval window and affects reconstructive surgery.

关 键 词：耳畸形 先天性 面神经 颞骨 手术 

分 类 号：R764[医药卫生—耳鼻咽喉科]