摘要
目的探讨腮腺癌、面神经肿物切除后面神经缺损修复方法的可行性，并对各种面神经缺损修复方法进行评价。方法对腮腺恶性肿物侵袭面神经扩大切除及发生在面神经的神经源性肿物切除后面神经缺损的32例患者进行了神经移植修复。其中单纯采用耳大神经移植19例，神经长度1～2cm；胸锁乳突肌携带耳大神经5例，修复腮腺恶性肿瘤扩大切除后骨面暴露的面神经缺损；携带筋膜面神经颈支修复下颌缘支缺损5例，携带筋膜面神经上颊支修复颧支缺损3例。所有手术均在双人双目手术显微镜下进行，用9-0及11-0无损伤缝合线吻合神经。结果面神经恢复标准按照刘世勋面神经损伤修复评价标准进行评价。采用单纯耳大神经移植修复面神经缺损19例，术后恢复时间为6～18个月，恢复程度多数为部分功能恢复；胸锁乳突肌携带耳大神经移植修复面神经缺损5例，术后恢复时间为6～12个月，恢复效果比较理想；携带筋膜面神经颈支、上颊支修复下颌缘支、颧支缺损8例，术后恢复时间为6个月左右，恢复效果均比较理想。结论几种神经移植修复面神经缺损，均是可行的。但采用面神经次要神经修复主要神经，修复效果比较理想。对于腮腺癌扩大切除后局部骨面外露者，采用胸锁乳突肌携带耳大神经移植修复是一种比较理想的修复方法。
Objective To study the feasibility of surgical repair of facial nerve defects after tumoreetomy in parotid region and evaluate these kinds of methods. Methods We grafted nerves to repair the 32 patients with facial nerves defects, which caused by expanding excision of parotid malignant tumors with facial nerves invaded and excisions of neurogenetic tumors of facial nerves. Nineteen cases were grafted simply by greater auricular nerves which length was 1 -2 cm; 5 cases which nerve defects were in the exposed bone were grafted by sternocleidomastoids with greater auricular nerves; 5 cases with nerve defects of marginal mandibular branches were grafted by ramus eolli nervi faeialis with fascias; 3 cases with zygomatie branche defects were grafted by upper buccal branches of facial nerve with fascias. We anastomosised those nerves with 9-0 and 11-0 atraumatic sutures under binocular microscopy which were opareted by two people. Results The repaired facial nerves＇were evaluated by evaluating criterion from Liu shixun. The repaired the facial nerve defects in 19 eases by grafting simplex greater auricular nerve needed about 6 to 18 months to recover, Most of them were partial functional recover. The rpaired the facial nerve defects in 5 cases by grafting sternocleidomastoid with greater auricular nerve needed about 6 to 12 months to achieve the ideal results. The repaired the marginal mandibular branches （5 cases） or zygomatic branches （3 cases） by ramus colli nervi faeialis with fascias or upper buccal branches of facial nerve with fascia needed half a year to recover in order to obtain the ideal function. Conclusion These kinds of methods for repairing the facial nerve defects were all feasibility. The major facial nerves repaired with secondary facial nerves got ideal results. It is an ideal method to repair the naked bones by sternocleidomastoids with greater auricular nerves which caused by expanding excision of parotidean carcinoma.
出处
《中国美容整形外科杂志》
CAS
2009年第1期21-23,共3页
Chinese Journal of Aesthetic and Plastic Surgery
关键词
腮腺
肿物
面神经
缺损
移植修复
Parotid
Tumor
Facial nerve
Defect
Transplanting repair
