面神经畸形附250例先天性外、中耳畸形手术分析

Anomalies of facial nerve(Surgical analysis of 255 ears with congenital aural atresia)

本文回顾１９７７年４月～１９９０年９月２５０例（２５５耳）先天性外、中耳畸形术中所见进行分析。其中面神经畸形６８耳（２６．７％）；鼓索神经异常１５１耳（５９．２％）。面神经畸形在先天性外、中耳畸形Ⅰ级中为２４／６９（３４．８％）；Ⅱ级中为２３／４３（５３．５％），Ⅲ级中为２４／１４３（１６．８％）。Ⅰ、Ⅱ级中面神经畸形主要表现为水平部骨管缺损和前位（掩盖前庭窗），Ⅲ级中则以面神经降部异常走行为著。８耳（３．１％）鼓索神经异常在先天性外、中耳畸形Ⅰ级中为５耳（７；２％），Ⅱ级中为３耳（７．Ｏ％），Ⅲ级中为１４３耳；术中鼓索神经均未被发现。在Ⅰ、Ⅱ级中鼓索神经呈低位或高位为主。全组有２例（Ⅲ级）因术中误伤闭锁板内异常走行的面神经，经立即减压处理，其不完全性面瘫均于术后２～３月内逐渐恢复。

Abstract Anomalies of facial nerve were observed in 250 cases of congenital aural atresia(255 ears)from April,1977 to September,1990.The grades of congenital aural atresia were gradeⅠ(69 ears),grade Ⅱ(43 ears)and grade Ⅲ(143 ears).Of 255 ears the anomalies of facial nerve was 26.7%(68 in 255). There were 34.8%(24/69)in grade 1,53.5%(23/43)in grade Ⅱ and 14.7%(21/143)in grade Ⅲ.Anomaly of Fallopian canal and anterior location were predominant in grade Ⅰand Ⅱ.Anomaly of the de- scending segment of facial nerve was predominant in grade Ⅲ.The anomaly of chor- dae tympani nerve was found in 5 ears in grade Ⅰ(7.2%)and 3 in grade Ⅱ(7.0%). Low and high location of chordae tympani nerve were identified in grade Ⅰ and Ⅱ. However,it was not found in all of the grade Ⅲ. The facial nerves were dernonstrated through the atresic plate in 2 cases,and were damaged during surgery. With immedi- ate surgical decompression the facial muscle recovered perfectly from paralysi 2 to 3 months after operation. The correlation between auricular malformation and facial nerve paralysis was discussed.