摘要
目的探讨经乳突-上鼓室入路的面神经次全程减压术在颞骨外伤性面瘫中的应用。方法收集8例9侧颞骨外伤性面瘫患者临床资料,回顾分析术中面神经损伤部位及损伤性质、颞骨骨折类型、术中听骨链探查情况,对比术前术后的听力及术前术后面神经功能,评估手术疗效。结果 8例(9侧)患者横行骨折2侧、纵行骨折7侧,术中探查面神经损伤部位均位于膝状神经结至茎乳孔间。除1例锤砧关节下移外,其他听骨链链接完整;术前3耳出现感音神经性耳聋,2耳混合性耳聋,4耳传导性耳聋。术后随访2~6个月,患者气骨导差均消失,骨导听力未见进一步下降。术前面神经功能HBⅤ1侧,HBⅥ8侧,术后面神经功能恢复至HBⅠ—Ⅱ级8侧,HBⅢ级1侧。结论经乳突-上鼓室入路可行面神经迷路段远段至茎乳孔处次全程减压,同期可对听骨链进行探查,若听骨链正常,可在保留听骨链完整下行面神经减压术,减少术后听力损失,是治疗颞骨外伤性面瘫的一种行之有效的手术方式。
Objective To explore the application of subtotal facial nerve decompression surgery via mastoid-epitympanum approach in facial nerve paralysis due to temporal bone trauma.Methods Clinical data of 8 patients with facial nerve paralysis due to temporal bone trauma(9 sides)were collected,and intraoperative facial nerve injury site,injury nature,temporal bone fracture type and intraoperative ossicular chain exploration were analyzed retrospectively.The audition and facial nerve function were measured before and after operation,and the efficacy was evaluated.Results Of the 9 sides of temporal bone fractures,transverse fractures occurred in 2 and longitudinal fractures in 7.Intraoperative exploration showed that facial nerve was injured between genicular ganglion and stylomastoid foramen.Ossicular chains were preserved completely except a case of malleus-incus joint shift.Before operation,sensorineural hearing loss occurred in 3 ears,mixed deafness in 2 ears,and conductive deafness in 4 ears.After 2 to 6 months of follow-up,the air-bone gap disappeared and no further decline in bone-conduction hearing occurred in all patients.Before operation,facial nerve function displayed House-Brackmann(HB)GradeⅤin 1 side and GradeⅥin 8 sides.After operation,facial nerve function recovered to HB GradeⅠ-Ⅱin 8 sides and GradeⅢin 1 side.Conclusion Subtotal facial nerve decompression surgery can be performed via mastoid-epitympanum approach,and ossicular chain exploration may be carried out simultaneously.The facial nerve can be decompressed without disturbing the ossicular chain.Therefore,this procedure is effective for treating traumatic facial paralysis and reducing postoperative hearing loss.
出处
《实用临床医学（江西）》
CAS
2017年第12期59-61,75,108,共5页
Practical Clinical Medicine
关键词
颞骨骨折
面神经麻痹
面神经减压术
temporal bone fracture
facial nerve paralysis
facial nerve decompression
