鼓室成形术中避免面神经损伤的体会

Clinical experience with the protection of facial nerve during tympanoplasty

目的总结鼓室成形术中避免面神经损伤的经验与体会。方法将不同时期完成的鼓室成形术病例分为早期组和后期组,重点分析术中发现面神经解剖变异情况与术后面瘫发生率的关系。结果早期组患者86例,术中发现乳突段面神经裸露2例,术后发生完全性面瘫7例(8.1%);后期组患者106例,术中发现乳突段和水平段面神经裸露者分别为4例和9例,术后发生不完全性面瘫2例(1.9%)。结论术者对面神经解剖及其变异情况的熟悉程度和耳显微手术操作经验,是避免术中发生面神经损伤的最大保证。

Objective To sum up the clinical experience with the protection of facial nerve during tympanoplasty based on a review on a group of cases received such an operation. Methods The studied cases included here were those received tympanoplasty in our Hospital from Jan., 2000 to Dec. 2006. They were divided into two sub-groups for better clarifying the causes associated with facial nerve injury during the operation, possibly dependent upon operator＇s clinical experience with the procedure. In this regard, the cases operated on from Jan, 2000 to Dec., 2003 were taken as the earlier group, while those operated on from Jan., 2004 to Dec. 2006 were taken as the later group, with the emphasis of discussion focused on the possible association of abnormality of facial nerve anatomy found during the operation with the occurrence of facial paralysis developed after the surgery. Results Among the 86 cases in earlier group, two were found with facial nerve exposed to the tympanum at the mastoid segment in its travel in temporal bone and seven （8.1%） were suffered from complete facial paralysis following the operation. However, 13 were found with facial nerve exposed to the tympanum, 4 at the mastoid segment and 9 at the horizontal segment, and only two （1.9%） were suffered from incomplete facial paralysis following the surgery. Conclusions The most important factors favorable to avoid facial nerve injury during tympanoplasty include surgeons＇ knowledge level with the possible abnormality of facial nerve anatomy during its journey in temporal bone and their clinical experience with the performance of otomicrosurgery.