上鼓室进路选择性面神经减压

Facial nerve selective decompression by epitypanum approach

目的探讨耳内切口上鼓室进路选择性减压膝状神经节及鼓室段面神经的优势。方法1999年9月至2003年5月,15名颞骨骨折、2名乳突术后和1名Ramsay-Hunt综合症所致面瘫患者接受本术式治疗;14例行锤砧关节脱位、砧骨卸装保存听力,2例砧骨已游离者则取出减压后再粘装,2例乳突术后仅存不全镫骨、咽鼓管闭塞,减压后只作鸟听骨成形。术前18例患者均行定位诊断检查,ENoG提示患侧变性纤维大于90%,House-Brackmann面神经功能分级Ⅵ级16例、Ⅴ级2例。术前平均PTA48.5dBHL、4kHz-16kHz高频平均听阈55.25dBHL。结果术后2周内面神经功能Ⅰ级14例、Ⅲ级2例、Ⅵ级2例。术后6个月随访,4例未达Ⅰ级的面神经功能Ⅰ级1例、Ⅱ级2例、Ⅴ级1例;平均PTA52.5dBHL、4kHz-16kHz高频平均听阈58.33dBHL。无明显并发症发生。结论耳内切口上鼓室进路选择面神经减压具有创伤小、通过砧骨卸装技术保存大部分患者的听力以及面神经功能恢复满意等优点。术后增大的外耳道对高频听力影响不大。

Objective To explore the advantage of facial nerve selective decompression by epitympanum approach. Methods 18 cases with facial nerve paralysis due to lesions around the genicalate ganglion were operated on by epitympanum approach between september 1999 and september 2003. Of them 15 cases suffered from temporal bone fracture, two with operative injury after mastoidectomy and one with Ramsay-Hunt syndrome. 16 cases had House-Brackmann grade Ⅵ function and two had grade Ⅴ function.The average PTA was 48.5dBHL and the average threshold of high frequency(4kHz-16kHz) was 55.25dBHL. All patients were suggested to have had more than 90% nerve fiber degenerated by ENoG. Results 14 cases had H-B grade Ⅰ function, two had grade Ⅲ function and two had grade Ⅵ function within two weeks the after the operation. At postoperative follow up for three months,15 cases obtained B-H grade Ⅰ function, two had grade Ⅱ and another, grade Ⅴ function; average PTA was 52.5dBHL and average threshold of high frequency was 58.33dBHL. All patients had no complication occurred. Conclusions Facial nerve selective decompression by epitypanum approach has the advantages of less operative injury, satisfactory functional rehabilitation and hearing preservation by ossicular chain reconstruction. <