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《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:

期数:

2018年12期

页码:

1619-1622

栏目:

临床研究

出版日期:

2018-12-31

文章信息/Info

Title:

Clinical study on the treatment of facial nerve paralysis after temporal bone fracture by facial never decompression via middle cranial fossa approach and transmastoid extralabyrithine and subtemporal approach

文章编号:

DOI:10.3969/j.issn.1000-7377.2018.12.030

作者:

刘 志1; 霍 玲2

1.西安市第三医院耳鼻喉科（西安710018）；2.中航工业西安医院耳鼻喉科（西安710077）

Author(s):

Liu Zhi;  Huo Ling.

Department of Otolaryngology，Xi’an No. 3 Hospital( Xi’an 710018)

关键词:

颞骨 骨折/并发症 面神经麻痹/外科学 神经减压术/外科

Keywords:

Key words 〖WT5BZ〗 〖HT5”SS〗Temporal Fracture;  bone/complications Facial paralysis/surgery Decompression; surgical

分类号:

R762

文献标志码:

A

摘要:

摘 要 目的：探讨经颅中窝及经乳突颞下迷路外入路面神经减压术在治疗颞骨骨折性面瘫中的应用及其效果。方法:收集颞骨骨折性面瘫患者58例。按不同手术入路分为两组，其中37例患者采用经乳突颞下迷路外入路面神经减压术，21例采用经颅中窝入路面神经减压术。其中4例锤砧关节脱位导致传导性耳聋，术中取出砧骨，面神经减压术后，行人工听骨植入听力重建术。手术前、手术后不同时间按H-B面神经功能分级评估面神经功能，以面神经功能恢复至H-BⅠ级或Ⅱ级者为临床治愈进行观察分析。结果：经颅中窝入路组21例患者术前面神经功能分级，Ⅴ级15例，Ⅵ级6例；经乳突颞下迷路外入路组37例患者中，Ⅴ级26例，Ⅵ级11例。术后随访6~22个月，患者面神经功能均有不同程度恢复，经颅中窝入路组临床治愈率85.71%；经乳突颞下迷路外入路组临床治愈率83.78%。两组治愈率之间比较，差异无统计学意义。全部患者术后听力无下降，3例听力重建患者术后听力恢复正常。结论：经颅中窝和经乳突颞下迷路外入路面神经减压术均是治疗颞骨骨折性面瘫的有效手段，可以达到保护听力的目的。相对于经颅中窝入路而言，经乳突颞下迷路外入路面神经减压术操作简单易掌握，安全性更高，可作为颞骨骨折性面瘫手术治疗的首先术式。

Abstract:

Abstract Objective: To investigate the clinical outcomes of facial never decompression via middle cranial fossa approach and transmastoid extralabyrithine and subtemporal approach for management of facial nerve paralysis after temporal bone fracture.Methods: To collect 58 patients with facial nerve paralysis after temporal bone fracture. All patients were undergone facial never decompression via transmastoid extralabyrithine and subtemporal approach (37) or via middle cranial fossa approach (21) . In addition to 4 cases of conductive hearing loss, PORP was used for ossicular reconstruction. The House-Brackmann (H-B) grading scale was used to evaluatefacial nerve function pre- and post-operation. Results: Varying degrees of facial function improvement were noticed during following up. The rate of good recovery to H-B 1 or 2 was 83.78% (31/37)in patients undergoing decompression surgery via transmastoid extralabyrithine and subtemporal approach and 85.71%(18/21)in patients undergoing decompression surgery via middle cranial fossa approach. There were no hearing loss in all cases postoperative. Conclusion:This study demonstrated that facial never decompression via middle cranial fossa approach and transmastoid extralabyrithine and subtemporal approach are effective on the patients with facial nerve paralysis after temporal bone fracture. At the same time can achieve the purpose of protecting hearing. Compared with the transcranial middle cranial fossa approach, the operation of facial nerve decompression via transmastoid extralabyrithine and subtemporal approach is simpler and easy to master, and the safety is higher. It should be used as the first surgical treatment for facial nerve paralysis after temporal bone fracture.

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更新日期/Last Update: 2019-01-21