外伤性面瘫的手术治疗..doc

外伤性面瘫的手术治疗许耀东　郑亿庆　龙　桦　陈洁珠(中山医科大学附属孙逸仙纪念医院耳鼻喉科;广州, 510120)摘　要　目的:探讨外伤性面瘫适当的处理方法。方法:对12例外伤性面瘫的病例施行手术治疗,损伤部位于面神经迷路段及膝状神经节周围3例次、水平段6例次、垂直段4例次、颅内段1例次。经乳突、上鼓室进路10例,经颅中窝、乳突联合进路2例。结果:术后随访半年~3年。面瘫级恢复7例,级恢复2例,级恢复2例,级恢复1例。结论:外伤性面瘫应及早手术,乳突上鼓室进路基本上可暴露膝状神经节及迷路段远端,但术野狭窄,对膝状神经节减压不够完全,且影响听力。对于损伤膝状神经节以上部位者,应采用颅中窝、乳突进路,并根据损伤性质,选取不同的手术方法。主题词　面神经麻痹/外科学;头部损伤/外科学中图号　R 745.1Surgical Treatment of Traumatic Facial ParalysisXu Yaodong　Zheng Yiqing　LongHua　Chen Jiezhu(Department of ENT, Sun Yat-sen Memorial Hospital,Sun Yat-sen University of Medical Sciences, Guangzhou,510120)Abstract　Objective:To investigate proper treatment for traumatic facial paralysis.Methods:12 cases of traumatic facial paralysis undergone surgical treatment. 3 cases showed injuries to the labyrinthine segment of nerve and geniculate ganglion, 6 cases to tympanic segment, 4 cases to mastoid segment and 1 case to intracranial segment. Among these cases trans-mastoid /attic approachwas used in 10 patients and trans-mastoid /middle cranial fossa approach in 2 cases. Results:All cases have been followed up 6 months to 3 years. Copmlete recovery appeared in 7 of the cases and partial recovery in 5 cases (gradeⅡin 2, gradeⅢin 2, grade IV in 1).Conclusions:Traumatic facial paralysis should be treated surgically in time.Trans-mastoid /attic approach can expose geniculate ganglion and distal part of the labyrinthine segment of nerve,butthe visual field in operation is narrow,the decompression togeniculate ganglion is not sufficient. To the cases injuried above the geniculate ganglion, trans-mastoid/middle cranial fossa approach is a suitable method. Subject headings　facial paralysis /surgery; head injuries/surgery　　面神经由于解剖关系的特殊决定了它是颅神经中最易受损者,受损后常引起面神经麻痹。外伤性面瘫临床上较常见,约占周围性面瘫1/3,其中最多为颞骨骨折(占80%),其次为中耳乳突手术损伤所致。随着耳显微外科技术的发展,有关手术治疗外伤性面瘫的报告逐渐增多,但治疗面瘫仍是耳科医生经常面临的棘手问题,其处理方法仍有争议[1,2]。我们对12例外伤性面瘫病例行手术治疗,以探讨外伤性面瘫的合适处理方法。1　材料与方法1.1　临床资料 1993年1月~1998年9月我科共收治12例外伤性面瘫患者。男8例,女4例。年龄2~47岁,平均27岁。右侧5例,左侧7例。本组病例均在外伤后立即出现面瘫,外伤后面肌电图显示~Ⅲ度损伤。