面神经解剖在第一鳃裂瘘管切除术中的意义

The surgical dissection of facial nerve in resection of the first branchial fistula

目的探讨面神经解剖在第一鳃裂瘘管切除术中的意义。方法19例第一鳃裂瘘管患者术中常规解剖面神经,其中7例无单纯瘘管切除手术史者行面神经总干解剖法;12例有单纯瘘管切除手术史者行面神经下颌缘支解剖法。在直视面神经下将瘘管及其周围的瘢痕组织彻底切除。2例伴有外耳道内瘘口,切除与瘘管组织关系密切的部分外耳道软骨和皮肤,术腔缺损转移胸锁乳突肌瓣充填,外耳道填塞碘仿纱条。结果19例患者切口均Ⅰ期愈合,随访9～24个月未见复发。4例术后有轻度面神经瘫痪,术后1个月内均完全恢复正常。结论面神经解剖有利于完整切除第一鳃裂瘘管和防止面神经不可逆损伤。

Objective To evaluate the significance of dissection of the facial nerve in resection of the first branchial fistula. Methods The facial nerve was routinely dissected and protected in 1 9 cases with the first branchial fistula. Main facial nerve was dissected in 7 cases without resectional history. In 1 2 cases with surgical history, marginal branch of facial nerve was dissected then retrograde to main facial nerve. A flap from the sternocleidomastoid was used to eliminate the dead space in 2 cases after the removal of diseased skin and adjacent cartilage of the ear. Results No recurrence was found in all 19 cases with a following-up period from 9 months to 2 4 months. Slight facial nerve paralysis was met in 4 cases and completely recovered within 1 month after operation. Conclusion The dissection of facial nerve is useful to completely remove the first branchial fistula and prevent permanent injury of facial nerve.