中耳乳突手术后迟发性面瘫

Delayed facial paralysis after tympanomastoid operation

目的探讨中耳乳突手术后迟发性面瘫的原因、预防方法和处理措施。方法分析总结1990～2004年中耳乳突手术后迟发性面瘫病例17例。结果15例为不完全性面瘫，2例为完全性面瘫。1例术后14h出现面瘫，2例术后第2天发病，第3—7天发病者11例，第9、11、13天发病者各1例。均保守治疗，一般在发病后1—2周即开始恢复，4—6周达恢复高峰。完全恢复12例，均在8周内完成，不完全性恢复5例，3—6个月仍有恢复现象。全部病例随访1年，超过6个月未恢复者，未再见有恢复迹象.结论中耳乳突手术后迟发性面瘫多发生于术后第2—13天．一般为部分麻痹．大部分完全恢复。多数难以肯定确切的致瘫原因，有可能与填塞物的压迫和刺激，鼓索神经受过度牵拉、撕裂或刺激，面神经骨管先天性缺损，术中术后各种不怠刺激、血管收缩刑的影响、手术操作技术方面等因素有关。预防的方法是避免上述可能的原因。以保守治疗为主。一般预后较好，但也有恢复不全者，临床上还需予以重视。

Objective To study the cause,preventive measure and treatment of delayed facial paralysis after tympanomastoid operation. Methods 17 cases of delayed facial paralysis after tympanomastoid operation during 1990 - 2004 were analyzed. Results There were 15 cases of uncomplete facial paralysis and 2 cases of complete facial paralysis. The occurence of facial paralysis was in the 14th hour （1 case）,in the 2nd day（2 cases）, in the 3rd to 7th day （11 cases）, in the 9th day （1 case）, in the 11 th day （1 case） and in the 13th day （ 1 case） after tympanomastoid operation respectively. The convalescence often began in the 1 st or 2rid week and approached a climax in the 4 to 6 weeks after all facial paralysis patients were taken conservative treatment. In all patients, 12 cases were fully recovered during 8 weeks and 5cases were partially recovered, which still had indications of recovery in the 3 and 6 monthes. No indications of rehabilitation were found in unrecovered cases over 6 months after all cases were followed up 1 year. Conclusion The delayed facial paralysis cases, which often occurred in the 2 to 13 days after tympanomastoid operation ,were usually uncomplete paralysis and mostly fully recovered. It was often difficult to find the clear and definite reason for the facial paralysis,which may relate to the constriction and stimulation of wadding, the excessive pull and stimulation to chorda tympani nervr, the congenital deficiency of fallopian canal, all kinds of intra and postoperative pessimal stimulations, the influence of vasoconstrictor and the operator＇s techniques etc. The key to prevention from postoperative facial paralysis was to avoid above possible factors. All cases were mainly taken conservative treatment and often had good prognosis, but there were unfully recovered cases which clinically should be attached importance to.