中耳术后周围性面瘫8例临床特点及诊治分析  

Clinical Features,Diagnosis and Treatment of Peripheral Facial Paralysis Following Middle Ear Surgery:A Report of 8 Cases

作　　者：何星辰 来育斌 刘红生[3] 杨润琴 李瑞 杜苗苗[1,2] 查定军 韩宇 HE Xingchen;LAI Yubin;LIU Hongsheng;YANG Runqin;LI Rui;DU Miaomiao;ZHA Dingjun;HANYu(Department of Otolaryngology-Head and Neck Surgery,Xijing Hospital,Air Force Medical University,Xi'an 710032,China;不详)

机构地区：[1]空军军医大学西京医院耳鼻咽喉头颈外科,西安710032 [2]国家耳鼻咽喉疾病临床医学研究中心陕西分中心 [3]西安交通大学附属西安市中心医院放射科 [4]延安大学医学院研究生院

出　　处：《中华耳科学杂志》2024年第1期88-92,共5页Chinese Journal of Otology

基　　金：国家自然科学基金(81870719);空军军医大学教学改革研究项目(KJJYDXYB025);西京医院学科助推计划项目(XJZT21CM10)。

摘　　要：目的分析和探讨中耳炎性疾病手术后发生周围性面瘫的病因、临床特点及诊治过程。方法回顾性分析2018年1月—2021年6月于空军军医大学西京医院耳鼻咽喉头颈外科收治的因中耳炎性病变手术且术后发生周围性面瘫的8例患者,分析其面瘫原因、术中面神经情况及面瘫治疗效果。结果8例周围性面瘫患者中,迟发性面瘫6例、术腔感染致面瘫1例、抗中性粒细胞胞浆抗体相关性血管炎中耳炎1例;术中面神经骨管完整者4例、有面神经管骨质缺损者4例;给予保守治疗6例,保守治疗联合手术治疗1例,免疫治疗1例。面瘫持续时间,最短5 d、最长3年;随访至今,6例恢复至面神经功能HB I级,2例恢复至HBⅡ级。结论周围性面瘫为中耳术后少见并发症之一,以迟发性面瘫最为多见,保守治疗效果好;部分患者则为术后术腔感染、病变残留或复发导致面神经炎而出现面瘫;尚有少见免疫相关疾病。临床医师需仔细鉴别,避免误诊,并针对性提供治疗方案。Objective To summarize the etiology,clinical features,diagnosis and treatment of peripheral facial paralysis following middle ear surgery for inflammatory diseases.Methods Data from 8 patients who experienced postoperative peripheral facial paralysis after middle ear surgery for inflammatory diseases at the Xijing Hospital from January 2018 to June 2021 were reviewed for the cause of facial paralysis,intraoperative facial nerve condition and outcomes of facial paralysis treatment.Results Of the 8 cases,delayed facial palsy was seen in 6,infection as potential cause in 1 and antineutrophil cytoplasmic antibody-associated vasculitis in 1.Four cases had complete facial nerve canal was.The facial nerve intact in 4 cases.Management included conservative treatments in 6 cases,conservative treatment combined with surgery in 1 case,and immunotherapy in 1 case.Facial paralysis lasted from 5 days to 3 years.At the writing of this report,facial function recovered to Grade HB I in 6 cases and Grade HB II in 2 cases.Conclusion Peripheral facial palsy is one of the rare complications after middle ear surgery,with delayed facial palsy being the most common and often responsive to conservative treatments.However,facial paralysis can be attributed to postoperative cavity infection,residual lesions or recurrence with facial neuritis in some patients.Occasionally,immune-related diseases can be the cause.Management include identification of the cause,accurate diagnosis and targeted treatments.

关 键 词：周围性面瘫 中耳炎性疾病 手术 诊断 治疗 

分 类 号：R764.92[医药卫生—耳鼻咽喉科]