摘要
目的 研究胆脂瘤型中耳炎患者鼓索神经的超微结构并测定其味觉功能。方法 19例行开放式鼓室成形术的胆脂瘤型中耳炎患者。①术中取的鼓室段鼓索神经作透射电镜观察 ;②手术前和手术后用区域性化学味阈法测定患者的味觉功能 ,测定部位分别为两侧之舌尖菌状乳头、舌侧叶状乳头、舌后部轮廓乳头以及软腭 ,所用的味觉刺激液为 1mol L氯化钠 ,1mol L蔗糖 ,0 .0 32mol L柠檬酸 ,0 .0 0 1mol L盐酸奎宁 ,统计方法为单因素方差分析 ;③手术前和手术后用House Brackman面神经评级标准评定患者的面神经功能。结果 ①所有患者鼓索神经的超微结构均有不同程度的变化 ,如有髓神经纤维髓鞘肿胀 (10 0 % ) ,排列紊乱 (10 0 % ) ,Schwann细胞肿胀 (95 % )、细胞内空泡形成(89% ) ,髓鞘间胶原组织增生 (89% ) ;② 19例患者中 2例术后发生味觉障碍 ,手术前和手术后每一味觉刺激液于术侧舌部和软腭引起的味觉反应的差异在统计学上无显著意义 (P >0 .0 5 ) ;③手术后无一例患者发生面神经麻痹。结论 胆脂瘤型中耳炎患者鼓室段鼓索神经的超微结构发生了病理性改变 ,手术中切除鼓索神经 ,术后基本不影响患者的味觉功能和面神经功能。
Objective To investigate the ultrastructure of the chorda tympani nerve and analyze the taste and facial nerve functions in patients with cholesteatoma. Methods ①The tympanic segments of chorda tympani nerves were collected for ultrastructural investigations in 19 cholesteatoma cases who underwent canal wall down tympanoplasty. ②All these patients received a spatial (regional) taste test preoperatively and postoperatively,respectively. Multiple loci were tested in a given order (front of the tongue, foliate papillae, circumvallate papillae, and soft palate). The solutions used in this study were 1.0mol/ L sodium chloride (salty), 1.0 mol/ L sucrose (sweet), 0.032 mol/ L citric acid (sour) and 0.001 mol/ L quinine hydrochloride (bitter). The analyses of variance was used. ③House Brackmann facial nerve grading system was conducted to evaluate the facial nerve function preoperatively and postoperatively. Results ①There were obvious ultrastructural damages in all the chorda tympani nerves, such as swelling (100%), disarrangement (100%), vacuoles formation of myelin (89%), edema of Schwann cells (95%), intracytoplasmic vacuoles in Schwann cell (89%) and proliferation of the collagen tissue (89%). ② Two patients complained of change of taste after operation. The analyses of variance showed that the taste function of the ipsilateral side of tympanoplasty were not statistically altered for each stimulus at each locus ( P >0.05). ③ No facial palsy occurred postoperatively. Conclusion This research suggested that the chorda tympani nerves underwent ultrastructural changes in patients with cholesteatoma. The dissection of chorda tympani nerve would not affect the taste and facial nerve functions.
出处
《中华耳鼻咽喉科杂志》
CSCD
北大核心
2001年第2期123-125,T008,共4页
Chinese Journal of Otorhinolaryngology
关键词
中耳胆脂瘤
鼓索神经
味觉
面神经
超微结构
Cholesteatoma, middle ear
Chorda tympani nerve
Taste
Facial nerve
