中耳慢性炎症伴周围性面神经麻痹的病因分析

Etiological factor analysis of facial nerve paralysis due to chronic inflammation of middle ear

目的探讨中耳慢性炎症伴周围性面神经麻痹的发病原因。方法回顾性分析41例中耳慢性炎症伴周围性面神经麻痹病例的临床资料。所有病例术中仔细探查面神经骨管情况及病变累及部位。全部病例的病变组织进行病理学检查。结果 4例(10%)面神经骨管完整,在面神经骨管破坏的病例中,病变累及鼓室段面神经33例(89%)。术后病理结果显示:24例(59%)为胆脂瘤,14例(34%)为肉芽,3例(7%)为结核。结论中耳慢性炎症导致周围性面神经麻痹多与胆脂瘤病变有关,面神经鼓室段是最常受累部位。其主要因素是感染沿神经组织的蔓延而不是受压萎缩。面神经骨管破裂并不是感染扩散的必要条件。

Objective To discuss the etiological factors of facial nerve paralysis due to chronic inflammation of middle ear. Methods This retrospective research included 41 patients operated for facial nerve paralysis due to chronic inflammation of middle ear. Careful exploration was made in facial canal in order to identify pathological tissue involvement. Pathological examination was performed in all operative specimens. Results Four intact fallopian canals were observed. There was a defect on the fallopian canal in 37 patients （90%） and it was most commonly located on the tympanic segment of the canal （89%）. Pathological report was cholesteatoma, granulation and tuberculosis, which was found in 24 cases （59%）, 14 cases （ 34% ） and 3 cases （7%）, respectively. Conclusions Facial nerve paralysis due to chronic inflammation of middle ear was frequently relevant with cholesteatoma, the tympanic segment of the fallopian canal was most location to be involved in. Its major factor was the infection spreading along the nerve tissue, but not atrophy due to compression. The defect on the fallopian canal was not necessary for infection diffusion.