鼓室成形术中避免面神经损伤的体会.pdfVIP

中国中西医结合耳鼻咽喉抖 查 生笠 鲞笠 塑 4l7 鼓室成形术中避免面神经损伤的体会木 蔡志毅 陶宝鸿 张朝晖。 吕静瑶 李志海 【摘要】目的 总结鼓室成形术中避免面神经损伤的经验与体会。方法 将不同时期完成的鼓室成形术病例分为早期组和 后期组，重点分析术中发现面神经解剖变异情况与术后面瘫发生率的关系。结果 早期组患者86例，术中发现乳突段面神经裸 露2例，术后发生完全性面瘫7例 (8．1％)；后期组患者106例，术中发现乳突段和水平段面神经裸露者分别为4例和9例，术后发生 不完全性面瘫2例 (1．9％)。结论 术者对面神经解剖及其变异情况的熟悉程度和耳显微手术操作经验，是避免术中发生面神经 损伤的最大保证。 【关键词】鼓室成形术；面神经；解剖变异；面瘫 Clinicalexperiencewiththeprotectionoffacialnerveduringtympanoplasty CAIZhiyi．NOBa0hong,ZHANGzhaohui．LUJingyao．LIZhihai Dept．ofOtolaryngology,YaizhouMunicipalttospital，Zhejiang,318000,China [Abstract]ObjectiveTosumuptheclinicalexperiencewihthteprotectionoffacialnerveduringtympanoplastybasedonareview onagroupofcasesreceivedsuchanoperation．Methods Thestudiedcasesincludedherewerehtosereceivedtympanoplastyinour Hospitalfrom Jan．，2000toDec．2006．111eyweredividedintotwosub—rgoupsforbetterclarifynightecausesassociatedwithfacialnerve injuryduringhteoperation，possiblydependentuponoperator’Sclinicalexperiencewihthteprocedure．Inhtisregard,htecasesoperated onfrom Jan，2000toDec．，2003weretakenas hteearliergroup，whilehtoseoperatedonrfom Jna ．，2004toDec．2006wreetakenashte laterrgoup，wiht hteemphasisofdiscussionfocusedonhtepossibleassociationofabnormalityoffacialnervenaatomyofundduringhte operationwiht hteoccurrenceoffacialparalysisdevelopedafterhtesurgery．ResultsAmonghte86casesni earlierrgoup，wt owerefoun d withfacialnerveexposedtothetympanumathtemastoidsegmentinitstravelnitemporalboneandseven(8．1％)weresufferedfrom completefacialparalysisfollownighteoperation．However,13wereofun dwithfacialnerveexposedtohtetympnaum，4athtemastoid semg entnad9atthehorizontalsemg ent，andonlytwo(1．9％)weresufferedfrom incompletefacialparalysisfollowinghtesurgery． ConclusionsThemostimportantfactorsfavorabletoavoidfacialnerveinjuryduringtympnaoplastynicludesurgeons’knowledgelevel withhtepossibleabnormalityoffacialn