摘要
目的 探讨经乳突面神经管次全程减压术治疗顽固性周围性面神经麻痹及面神经梳理术治疗后遗症的手术疗效。方法 回顾性分析2017年6月至2022年11月,我院神经外科经乳突面神经管次全程减压术治疗46例顽固性周围性面神经麻痹及19例面神经梳理术治疗后遗症患者的临床资料。术前面神经功能House-Brackmann(H-B)分级Ⅵ级10例,Ⅴ级10例,Ⅳ级15例,Ⅱ~Ⅲ级11例,其中,面瘫后遗症患者13例,多为Ⅱ级6例,Ⅲ级4例,Ⅳ级3例;伴随联带运动和(或)鳄鱼泪20例。术后1、3、6、12、24个月随访,大部分恢复良好,顽固性周围性面神经麻痹H-B级别降低为Ⅱ~Ⅲ级,后遗症患者H-B级别大多数降低为Ⅰ~Ⅱ级,面部发紧及联带运动明显减轻。将术后面神经功能恢复至Ⅰ、Ⅱ级为优,Ⅲ~Ⅳ级为良,Ⅴ、Ⅵ级为差。结果 术中见外伤患者面神经损伤位于膝状神经节至锥曲段,表现为神经水肿或卡压,无明显断裂伤。非外伤周围性面神经麻痹表现为神经水肿或卡压,粘连,有4例面瘫后遗症多年患者,术中见面神经仍水肿明显。46例患者中,术中出现水平半规管局部破损1例,上鼓室开放2例,眩晕2例,半月减轻,2个月痊愈,头晕10例,1周改善。术后听力下降5例,耳鸣10例,1~2个月好转。乙状窦术中轻微渗血2例,外耳道轻度破损、出血2例,鼓膜下淤血1例,1个月好转。术后无脑脊液漏,无感染等严重并发症。46例患者的随访时间为2~24个月(平均16.84个月)。至末次随访,46例患者中,H-B分级为Ⅰ级5例,Ⅱ级19例,Ⅲ级8例,Ⅳ级为5例,Ⅴ4例,Ⅵ级4例;疗效:优24例(52.17%),良13例(28.26%)。结论 经乳突面神经管次全程减压术治疗顽固性周围性面神经麻痹及面神经梳理术治疗后遗症可有效促进面神经恢复及后遗症症状改善,该方法安全、有效,值得临床推广。
Objective To investigate the surgical effect of total decompression via mastoid facial nerve canal in the treatment of intractable peripheral facial nerve palsy and facial nerve carding in the treatment of sequelae. Methods From June 2017 to November 2022, the clinical data of 46 patients with intractable peripheral facial palsy treated by mastoid facial nerve canal decompression and 19 patients with sequelae treated by facial nerve carding were retrospectively analyzed. House-Brackmann(H-B) classification of preoperative facial nerve function: 10 cases of grade Ⅵ, 10 cases of grade Ⅴ, 15 cases of grade Ⅳ, and 11 cases of grade Ⅱ-Ⅲ. Among them, 13 cases of sequelae of facial palsy, mostly 6 cases of grade Ⅱ, 4 cases of grade Ⅱ, and 3 cases of grade Ⅳ. There were 20 cases with associated movement and/or crocodile tears. After 1, 3, 6, 12, 24 months of followup, most of the patients recovered well, the H-B grade of intractable peripheral facial palsy was reduced to Ⅰ-Ⅲ, the H-B grade of sequelae patients was reduced to Ⅰ-Ⅱ, and the facial tightness and associated movement were significantly reduced. The facial nerve function was recovered to grade Ⅰ-Ⅱ as excellent, grade Ⅲ-Ⅳ as good, and grade Ⅴand Ⅵ as poor. Results The facial nerve injury was located from the geniculate ganglion to the conic curve, and the nerve edema or entrapment was observed. Non-traumatic peripheral facial palsy was manifested as nerve edema or entrapment and adhesion. In four patients with many years of posterior facial palsy, intraoperative edema of the metacarpal nerve was still evident. Among the 46 patients, there was local damage of horizontal semicircular canal in 1 case, opening of superior tympanum in 2 cases, vertigo in 2 cases, and wererelieved in half a month, recovered in 2 months;dizziness in 10 cases were improved in 1week. After operation, 5 cases of hearing loss and 10 cases of tinnitus were improved from 1 to 2 months. Slight blood oozing during ethmoid sinus surgery in 2 cases, slight dam
作者
黄大明
黄琛
HUANG Daming;HUANG Chen(Department of Neurosurgery,Huantai Hospital of Traditional Chinese Medicine,ZiBo 255000,China;Graduate Student,Nanjing University of Chinese Medicine,Jiangsu Province,Nanjing 21000,China)
出处
《中国医药指南》
2023年第4期74-76,80,共4页
Guide of China Medicine
关键词
周围性面神经麻痹
面瘫后遗症
联带运动
减压术
面神经梳理术
Peripheral facial nerve palsy
Sequelae of facial paralysis
Joint movement
Decompression
Facial nerve combing
