腮腺区面神经鞘瘤的诊断与治疗(附8例报告)

THE DIAGNOSIS AND TREATMENT OF SCHWANNOMA OF FACIAL NERVE LOCATED IN PAROTID GLAND REGION (REPORT OF 8 CASES)

目的总结腮腺区面神经鞘瘤的临床特点,探讨诊断方法和治疗措施。方法回顾性总结3年期间手术治疗且病理证实的8例腮腺区面神经鞘瘤病例的临床表现、诊断和治疗的经验。结果 8例患者中首发症状最常见为腮腺区肿物(8/8),其次是面瘫(2/8)。8例面神经鞘瘤均经手术切除治疗,手术中切断面神经总干3例(其中面神经端端吻合术1例,耳大神经移植吻合术2例)。术后1年复查,面神经端端吻合者面神经功能Ⅱ级,耳大神经移植吻合者面神经功能Ⅲ级1例,Ⅵ级1例。保留面神经完整1例,术后1年复查神经功能Ⅰ级。面神经部分中断者因断端寻找困难而未处理4例(其中颞面干中断、下颊支中断、上颊支中断、上下颊支都中断各1例),术后均出现中断神经所支配区域的面瘫症状,其中下颊支中断、上颊支中断、上下颊支都中断者术后1年复查时面瘫症状明显改善和出现其他分支的代偿。颞面干中断者术后1年复查面瘫症状改善不明显。结论腮腺区面神经鞘瘤常见临床表现为腮腺区肿块和不同程度的面瘫。一旦考虑为面神经鞘瘤,应尽早手术。在切除肿瘤的同时,尽可能保留面神经的连续性或行一期面神经功能重建,若不能行一期面神经功能重建也应尽可能在短期内行二期功能蘑建手术。

Objective To summarize the clinic characteristics of schwannoma of facial nerve and discuss the diagnosis and treatment. Methods Eight cases of primary facial nerve schwannoma located in parotid gland region confirmed pathologically and treated during 2004- 2007 were reviewed. The clinic manifestation, diagnosis and treatment in this series were analyzed. Results Among the 8 cases, The most common first symptom was mass located in parotid gland region（8/8）,the next was facial paralysis （2/8）. The tumors in all 8 cases were totally resected surgically and with 1 year of following-up. End-to-end anastomosis to recover facial nerve continuity in one case and his facial nerve was in grade Ⅱ. Facial-great auricular-facial nerve cable grafting was done in 2 cases, their facial nerve were in grade Ⅲand grade Ⅵrespectively. The function of the facial nerve was grade Ⅰin one case with nerve being preserved intact during operation. Facial nerves were being preserved partly continuous in 4 cases and no anastomosis were performed because the end of interruption nerve could not be found. As a result,facial paralysis took place in special area reigned by the interruption facial nerve branch （upper-buccal branch,lower-branch,whole baccal branch one case respectively） and the symptom of facial paralysis relieved markedly one year later. In one case, the temporal facial branch was interrupted and facial nerve remained discontinuity, as a result, facial nerve function showed no recovery with 1 year of following-up. Conclusion Once the facial nerve schwannoma was diagnosed,the surgical treatment should be done as early as possible. The continuity of facial nerve should be kept or reconstructed in one stage as possible as we can when tumor resection was done, otherwise the second - stage surgery have to be conducted soon after.