手术治疗面神经瘫痪的疗效分析

Surgical treatment of facial nerve palsy：an analysis of the operation efficacy in 29 patients

目的分析外科手术治疗由化脓性中耳炎、外伤、颞骨肿瘤引起的面神经瘫痪的疗效。方法对29例面神经瘫痪患者临床资料作回顾性分析，其中化脓性中耳炎所致面瘫18例，外伤性面瘫9例，颞骨肿瘤所致面瘫2例。面神经水平段或垂直段减压术8例，面神经膝状神经节至茎乳孔减压术19例，全程面神经减压2例，其中面神经端-端吻合1例，神经移植2例。结果随访6～18个月，面神经功能（House-Brackman分级标准）由术前的Ⅱ级6．9％、Ⅲ级17．2％、Ⅳ级34．5％、Ⅴ级31．0％、Ⅵ级10．3％恢复到Ⅰ级6．9％、Ⅱ级27．6％、Ⅲ级27．6％、Ⅳ级24．1％、Ⅴ级13．8％，差异有统计学意义（P〈0．005）。结论面神经减压术和神经移植仍是治疗面瘫的有效手段。化脓性中耳炎所致面瘫和外伤性面瘫手术疗效满意。

Objective To evaluate the effect of surgical treatment in facial nerve paralysis. Methods Clinical data of 29 eases in facial nerve paralysis were retrospectively analyzed. All of the 29 cases of facial paralysis, 18 cases is the suppurative otitis media,9 cases is the temporal bone fracture,2 cases is the neoplasms of the temporal bone. The 29 cases of facial nerve paralysis were surgical treatment. 8 cases by vertical segment or horizontal segment of facial nerve decompression, 19 cases by the stylomastoid foramen to the geniculate ganglion of facial nerve decompression,2 cases by the itratemporal course of facial nerve decompression, i case was underwent end-to-end anastomosis, 2 cases of the greater auricular or the sural nerve graft for repairing facial nerve defect. All data were analyzed with Rank sum test. Results Makes a follow-up visit for 6-18 months,the facial nerve function（House-Brackman grading system） before the technique Ⅱ6.9%, Ⅲ 17.2%, Ⅳ34.5%, Ⅴ31.0% , Ⅵ 10.3% ,after the technique,restores Ⅰ 6.9 %, Ⅱ27.6 % , Ⅲ27.6 %, Ⅳ24.1%, Ⅴ13.8 %, statistics analysis facial nerve function restores has the significance difference（ P 〈 0. 005）. Conclusions The facial nerve decompression and the nerve graft are useful method to treat facial paralysis. Surgical treatment of facial paralysis is satisfied in the suppurative otitis media and the temporal bone fracture.