摘要
目的:探讨采用耳大神经移植修复面神经缺损的可行性。方法:采用耳大神经移植修复面神经缺损14例,手术方式为经乳突进路面神经移植术。以House-Brackmann(HB)分级法评估手术前和手术后面神经功能。结果:在8例颞骨骨折所致面神经麻痹的患者中,颞骨骨折的类型均为纵形骨折,面神经受累及的部位主要在第2膝及其附近,术前面神经功能均为Ⅵ级。3例面神经肿瘤中面神经呈多节段受累,病理结果均为神经鞘膜瘤,术前面神经功能Ⅲ级1例、Ⅴ级2例。医源性损伤2例患者原发病均为胆脂瘤中耳炎,损伤部位分别为面神经乳突段和第2膝。1例钢水烧伤面神经损伤部位在面神经鼓室段,术前面神经功能Ⅵ级。除3例患者失访外,其余患者术后面神经功能恢复Ⅲ级4例、Ⅳ级3例、Ⅴ级2例、Ⅵ级2例。结论:颞骨骨折是导致面神经离断的最常见原因,以耳大神经移植修复面神经缺损是一种实用有效的方法,面神经移植后神经功能恢复最佳可达HBⅢ级。
Objective：To retrospectively analysis the clinical data of facial nerve defects repair with greater auricular nerve graft.Method：The transmastoid approach was adopted to repair the facial nerve defects by means of nerve grafting. Preoperative and postoperative facial nerve functions were graded according to the House-Brackmann scale.Result：The patterns of temporal bone fracture in the 8 patients were longitudinal, most lesions occurred in the region of the second genu and its surrounding, preoperatively, all patients had Grade Ⅵ function. In 3 patients of facial nerve tumors,the tumors involved multiple nerve segments,and histologic results were all schwannomas, preoperatively, 1 case had Grade Ⅲ function,2 cases had Grade Ⅴ function. In 2 patients of iatrogenic trauma of the facial nerve,the primary disease was chronic otitis media with cholesteatoma, the lesions were localized at the mastoid segment and the second genu respectively.In 1 patient of molten steel burn, the lesions was localized at the tympanic segment, preoperative facial nerve function was Grade Ⅵ.In addition to 3 cases lost to follow-up,the remaining patients,4 recovered to a Grade Ⅲ,3 to a Grade Ⅵ, 2 to a Grade Ⅴ and 2 remained at Grade Ⅵ.Conclusion：In present study,the most common cause of facial nerve transection was temporal bone fracture. Facial nerve reconstruction by means of greater auricular nerve grafting was a practical and effective method,the best postoperative recovery of facial nerve function was Grade Ⅲ.
出处
《临床耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2010年第7期293-296,共4页
Journal of Clinical Otorhinolaryngology Head And Neck Surgery
关键词
面神经麻痹
颞骨骨折
面神经肿瘤
神经移植术
facial nerve paralysis
temporal bone fracture
facial nerve tumor
nerve grafting
