面神经减压术对颞骨骨折面瘫的治疗

Decompression surgery in the treatment of facial paralysis following temporal bone fracture

目的评价颞骨骨折面瘫面神经减压术的临床疗效及相关问题。 方法回顾性总结并分析颞骨骨折伤及膝状神经节面瘫病人的临床资料。16例面瘫13～96日后经中颅窝一乳突联合进路及乳突迷路外径路面神经减压术。面神经功能恢复评定标准按House-Brackmann(H-B)分级法。结果手术后临床随访6～1 8月,面神经功能均有不同程度的恢复,面瘫2月内手术恢复满意或较满意均达H-B Ⅱ级以上占70％(11/16);面瘫3月后手术的5例病人获得一定好转效果。结论面神经全程减压术有效治疗颞骨骨折引起的面瘫;伤后2月内手术为较佳时机。

OBJECTIVE To estimate the clinical effect of decompression surgery of facial nerve paralysis in temporal bone fracture (TBF) and to address some of the unanswered questions regarding management of facial nerve paralysis in TBF. METHODS A consecutive clinical series was reviewed retrospectively. 16 cases, who underwent decompression surgery for facial nerve paralysis due to TBF involving the perigeniculate ganglion region, were analyzed. Patients were operated on 13-96 days after trauma. A transmastoid estralabyrinthine and media cranial fossa-mastoid approach were used in all cases. House -Brackmann facial nerve gra ding system was employed for estimating facial nerve function. RESULTS Normal or subnormal facial nerve function (H-B1 or H-B 2) was achieved in 11/16 cases (70 %) treated in 2 months and good functional results were also obtained in 5 patients operated on 3 months after trauma evaluated at 0.5~1.5year after surgery. CONCLUSION Facial nerve decompression is effective on facial palsy caused by temporal bone fracture. Decompression surgery should be carried out as soon as possible within 8 weeks after trauma.