后、上鼓室联合径路面神经减压术

Combined posterior tympanum and epitympanum approach for facial nerve decomprerssiom

目的 应用后、上鼓室联合径路面神经减压技术治疗损伤部位在膝状神经节及近侧端的周围性面瘫患者,并观察其疗效。材料与方法:1998年1月至2002年1月间,共有24名损伤部位在膝状神经节及远侧端的周围性面瘫患者接受后、上鼓室联合径路面神经减压术治疗,其中男16名,女8名,年龄23～67岁,平均52.65岁,颞骨纵行骨折18例,Bell面瘫3例,Hunt综合症3例。全部病例Schirmer流泪试验阳性,术前面神经电刺激试验健患侧相差均大于3.5mA,面神经电图检查患侧面神经纤维变性均大于90％。面神经功能评分(House法)面神经功能Ⅳ级14例,Ⅴ级6例,Ⅵ级4例。术前言语频率平均听阈42.33dBHL。技术关建:①耳后切口,行乳突、上鼓室切除术,达轮廓化标准;②需保留听功能者则保持听骨链完整,并保留后拱柱、充分切除迷路上隐窝及管上隐窝气房,必要时可考虑砧镫关节脱位;③如无需保留听功能则摘除砧骨,切除锤骨头及后拱柱,将后鼓室和上鼓室连为一体以利操作。结果:全部病人术后一期愈合,无手术原因导致的感音神经性聋,脑脊液漏,鼓索神经、颈静脉球、乙状窦损伤等术后近期并发症,术后随访0.5～4年,平均3.2年,其中面神经功能Ⅰ级18例,Ⅱ级4例,Ⅲ级2例,言语频率平均听阈48.17dBHL。结论:后、上鼓室联合径路面神经减压术为治疗损伤部位在膝状神?

To discuss the application of facial nerve decompression by combined posterior tympanum and epitympanum approach and to observe the outcomes. Materials and methods: Between January 1998 and January 2002, 24 patients with facial nerve paralysis due to lesions in the geniculate ganglion region or distal to the geniculate ganglion were operated through combined posterior tympanum and epitympanum approach, in which 18 patients suffered from temporal bone longitudinal fracture, 3 cases with Bell's palsy and 3 with Hunt syndrome. All patients are with positive Schirmer tearing test, preoperative nerve excitability showing more than 3.5mA difference between the lesion side and the normal side, and ENoG suggesting more than 90% nerve fiber degenerated. 14 cases had House grade IV function, 6 cases had grade V function and 4 had grade VI function. The average threshold of speech frequency was 42.33dBHL. The key technic: (1) postauricular incision and performing mastoidectomy and epytympanectomy, (2) keep intact ossicular chain in patients with seviceable hearing, keep the incus buttress and excise supral-abyrinthine and supracanal fossa air cells. If neccesary, disarculate the incudostapedial jiont; (3) in patients without serviceable hearing, the incus was removed, the head of malleus and incus buttress were excised, achieving for better surgical view. Result: All patient were healed in one stage, there wasn't short- term complication, such as sensorinueral hearing loss, cerebrospinal fluid leak, injury of chorda tympani, jugular bulb and sigrnoid sinus due to operation. The average follow- up period was 3.2 years (range, 0.5 to 4 years) . 18 cases had House grade I function, 4 cases had grade Ⅱ function and 2 had grade Ⅲfunction. The postoperative average threshold was 48.17dBHL. Conclusions: Combined posterior tympanum and epitympanum approach for facial nerve decompression is indicated and effective for facial nerve lesion in the region of geniculate ganglion or distal to the geniculate ganglion, which is of less operative injury and satisfactory function rehabilitation.