手术治疗颞骨骨折性面瘫

Surgical treatment of facial paralysis resulted from temporal bone fractures

目的探讨手术治疗颞骨骨折性面瘫的处理方法及手术时机。方法面神经减压术治疗7例颞骨骨折性面瘫患者,其中3例行颞下颅中窝径路,2例行乳突径路,2例行颞下颅中窝乳突联合径路。结果手术中发现面神经损伤部位位于迷路段及膝状神经节周围者4例,位于水平段3例。以House-Brackmann(H-B)分级法作为疗效评价标准,术后随访6个月面神经功能分级在H-BⅠ级3例,Ⅱ级2例,Ⅲ级2例。结论颞骨骨折性面瘫患者,应尽早明确面神经受损的程度及部位,完全性面瘫者应尽早实施面神经减压术,并根据术前损伤部位确定手术经路;不完全性面瘫者倾向于保守治疗,治疗无效者可考虑手术治疗。

Aim To investigate the treatment and operative opportunity of facial paralysis resulted from temporal bone fractures. Methods Facial nerve decompression was carried out in 7 cases of facial paralysis resulted from temporal bone fractures, of which 3 were treated with transmiddle cranial fossa approach,2 with transmastoid approach and 2 with trans-mastoid and middle cranial fossa approach. Resuits During operation, injuries to the labyrinthine segment of facial nerve and geniculate ganglion were found in 4 cases, tympanic segment injuries in 3. House-Brackmann（H-B） system was used to evaluate the recovery of facial nerve function. A follow up for 6 months showed that 3 cases reached grade Ⅰ of H-B ,2 cases grade Ⅱ and 2 cases grade Ⅲ. Conclusion As for cases with facial paralysis resuited from temporal bone fractures, the extent and position of facial nerve trauma should be early confirmed. Complete facial palsy facial nerve decompression should be performed on the basis of position of facial nerve trauma determined preoperatively. Incomplete facial palsy urn to medical treatment and surgery treatment should be performed as nonresponder.