摘要
目的探讨耳内镜术后迟发周围性面神经麻痹的可能机制及预后。方法2015年8月~2019年4月共1243例患者施行耳内镜下中耳炎手术,其中8例患者发生迟发周围性面瘫,对这8例患者进行回顾性分析。面瘫发生的时间在术后3~8天,平均5.8天;面瘫按House-Brackmann(H-B)法评级为Ⅱ级4例,Ⅲ级2例,Ⅳ级2例;面瘫发生后,均立即予以激素、扩血管及营养神经药物治疗。结果8例患者经治疗后面神经功能1~2周开始恢复,4周恢复达高峰,8周内全部痊愈。结论耳内镜下中耳手术有0.64%面瘫发生率,其可能原因为鼓索神经牵拉、离断,逆行性引起面神经水肿,或面神经刺激,或手术刺激疱疹病毒重新激活,或耳内镜光源的热损伤,或术后继发感染等所致。所有的面瘫均能完全恢复,面瘫恢复时间和发生面瘫等级有关,等级越低,恢复时间越快。
Objective To explore the possible mechanism and prognosis of delayed peripheral facial paralysis after exclusive endoscopic ear surgery for otitis media.Methods From August 2015 to April 2019,a total of 1243 patients underwent endoscopic ear surgery.Among them,8 patients developed delayed peripheral facial paralysis,then retrospectively analyze these 8 patients.The occurrence of facial paralysis occurred 3 to 8 days post-surgery,with an average of 5.8 days,facial paralysis was classified with the House Brackmann with 4 gradeⅡcases,2 gradeⅢcases,and 2 gradeⅣcase.After the occurrence of facial paralysis,hormone,vasodilation and nutritional nerve drugs were immediately performed.Results After the treatment,the nerve function of 8 patients began to recover within 1-2 weeks,reached a peak in 4 weeks,and recovered within 8 weeks.Conclusion Under the endoscopic middle ear surgery,there was still a 0.64%incidence of facial paralysis.The possible causes were tympanic nerve pulling,disconnection,retrograde facial nerve edema,or facial nerve stimulation or herpes simplex virus,or the endoscopic light source heat damage,or postoperative secondary infection.In the latent state of sleep,surgery causes viral activation,or secondary infection after surgery.All facial paralysis was fully restored,and the recovery time of facial paralysis was related to the level of facial paralysis.The lower the grade,the faster the recovery time.
作者
周琴双
汪静波
金兰兰
黄益灯
Zhou Qinshuang;Wang Jingbo;Jin Lanlan(Department of Otolaryngology,The First Affiliated Hospital of Wenzhou Medical University,Zhejiang 325000,China)
出处
《医学研究杂志》
2020年第7期73-76,共4页
Journal of Medical Research
基金
浙江省自然科学基金资助项目(LY19H130003)
浙江省温州市基础性科研项目(Y20180091)。
关键词
中耳炎
耳内镜外科手术
面神经麻痹
并发症
Otitis media
Endoscopic ear surgery
Facial paralysis
Complication
