摘要
目的探讨腮腺区面神经鞘瘤的临床特点和诊治方法。方法回顾分析2009年1月至2019年1月在河南省肿瘤医院收治的12例腮腺区面神经鞘瘤患者的临床资料,其中男5例,女7例,年龄23~72岁。12例患者均以腮腺区肿块为主诉就诊,其中4例患者有局部不适和疼痛感,6例患者在触诊时有不同程度的疼痛感。超声检查8例表现为腮腺区实性肿块,4例表现为混合性肿块。分析总结治疗方式、肿瘤与面神经的关系以及手术前后面神经功能情况[House-Brackmann(H-B)分级]。结果 12例患者均接受了手术治疗:8例行肿瘤及部分或全部腮腺浅叶切除术,1例行肿瘤及全腮腺切除术;3例仅行肿瘤切除,其中1例患者因肿瘤扩展到颅底不能完全切除。9例患者肿瘤发生于面神经的主干或主要分支,切除肿瘤后面神经完整;1例肿瘤发生于面神经终末支,术中部分粘连严重小分支被切断;1例复发二次手术患者,术中未发现面神经总干且找不到神经断端,故未行神经移植;1例由于术中无法将面神经的主干与肿瘤分开,神经切断后同时行神经移植术。术前面神经功能H-B Ⅰ级10例,Ⅱ级1例,Ⅴ级1例。术后随访1年复查面神经功能H-B Ⅰ级7例,Ⅱ级2例,Ⅲ级1例,Ⅳ级1例为神经移植患者,Ⅴ级1例为复发二次手术患者术后维持原状。结论腮腺区面神经鞘瘤临床少见,术前不易诊断,治疗以手术为主,术中应注意保护面神经。
Objective To investigate the clinical manifestation and management strategy of intraparotid facial nerve schwannoma.Methods The clinical data of 12 patients with parotid schwannoma treated in Henan Cancer Hospital from January 2009 to January 2019 were analyzed retrospectively,including 5 males and 7 females,aged from 23 to 72 years.All the 12 patients complained of a mass in the parotid region,of whom 4 patients had local discomfort and pain,and 6 patients had varying degrees of pain during palpation.Ultrasound examination showed solid mass in parotid region in 8 cases and mixed mass in 4 cases.The treatment methods,the relationship between tumor and facial nerve,the modes of treatments and the nerve functions before and after operation were analyzed and summarized with House-Brackmann grade.Results All 12 patients received surgical treatment:8 patients underwent tumor resection plus partial or total superficial parotidectomy,1 patient underwent tumor resection and total parotidectomy,and 3 patients underwent tumor resection,with 1 patient in whom tumor could not be removed completely due to tumor extention to the skull base.In 9 cases,the tumor occurred in the trunk or main branch of the facial nerve,and there was no facial nerve injury occurred after surgery;in 1 case,the tumor occurred in the terminal branch of the facial nerve,and part of the severe small branches of adhesion were cut off during the operation;in 1 case,the total trunk of the facial nerve was not found and the broken end of the nerve could not be found during the operation,so the nerve transplantation was not performed.In 1 case,nerve grafting was performed after nerve transection because it was impossible to separate the trunk of the facial nerve from the tumor during the operation.Preoperatively,House-Brackmann grade(H-B)Ⅰfacial nerve function was shown in 10 patients,H-BⅡin 1 patient and H-BⅤin 1 patient.Postoperatively,the facial nerve function recovered to H-BⅠfor 7 patients,H-BⅡfor 2 patients,H-BⅢfor 1 patient,gradeⅣfor 1
作者
吴俊福
代立媛
崔萌
王吉恒
张晓军
李刚
杜伟
刘善廷
Wu Junfu;Dai Liyuan;Cui Meng;Wang Jiheng;Zhang Xiaojun;Li Gang;Du Wei;Liu Shanting(Department of Head Neck and Thyroid Surgery,Henan Tumor Hospital,Zhengzhou 450008,China)
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2020年第7期691-694,共4页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
关键词
腮腺区
面神经
神经鞘瘤
诊断
Parotid region
Facial nerve
Neurilemmoma
Diagnosis
