镫骨手术后迟发性面瘫及机制探讨(英文)

Delayed facial paralysis after stapedectomy and discussion on its mechanism

背景:常规镫骨手术后仍偶有迟发性面瘫发生,发病机制尚不明确。目的:探讨镫骨手术后迟发性面瘫的发病率、发病机制及治疗。设计:以诊断为依据非对照研究。地点和对象:在南京大学医学院附属鼓楼医院耳鼻喉科完成,对象为该院镫骨手术后迟发性面瘫患者3例,均为女性,年龄34～48岁。方法:回顾性分析该院332例镫骨手术后发生迟发性面瘫的3例患者。主要观察指标:House-Brackmann分度。结果:3例镫骨手术后迟发性面瘫的发病时间在术后5,6d,为不完全性周围性面瘫,检测1例迟发性面瘫患者抗单纯疱疹病毒抗体,呈阳性。以大剂量激素、抗病毒药、维生素治疗为主,并配合针灸治疗,3例患者全部恢复正常。结论:常规镫骨手术后出现迟发性面瘫,除面神经骨管裂隙外,还可能与隐匿的单纯疱疹病毒激活有关。

BACKGROUND:A facial palsy appears only in rare cases a few days after uneventful stapedectomy,which has unclear pathogenesis. OBJECTIVE:To study the incidence,pathogenesis and treatment of delayed facial palsy after stapedectomy. DESIGN:A non randomized controlled study was conducted based on diagnosis. SETTING and PARTICIPANTS:The study was completed in the Department of Otorhinolaryngology,the Affiliated Drum Tower Hospital of Nanjing University Medical School.Subjects were 3 female cases aged 34-48 years with delayed facial palsy. METHODS:Three delayed facial palsy patients in 332 stapedectomy patients were retrospectively reviewed. MAIN OUTCOME MEASURES:House Brackmann facial nerve grading system. RESULTS:Delayed facial palsy occurred from 5 to 6 days after stapedectomy in three cases,who all suffered from uncompleted peripheral paralysis.Anti herpes simplex antibody titers were elevated in one patient who received the test.A high dose of hormone,antiviral drugs and vitamins were effective,which were also combined with acupuncture treatment.All three cases recovered. CONCLUSION:The probable pathogenesis of delayed facial palsy after uneventful stapedectomy might relate with the reactivation of dormant herpes simplex virus except for the dehiscence in bony facial nerve canal.