乳突-颞下迷路外径入路面神经减压术治疗颞骨骨折面瘫

Facial nerve decompression through transmastoid,extralabyrinthine,subtemporal approach for management of facial paralysis in temporal bone fracture

目的:探讨乳突-颞下迷路外径入路面神经减压术治疗颞骨骨折面瘫的临床疗效。方法:对2006-01-2008-04收治的26例外伤性面瘫患者行乳突-颞下迷路外径入路面神经减压术。面神经功能House-Braek-mann分级:Ⅴ级12例,Ⅵ级10例,Ⅲ级4例。术前纯音测听检查示:16例纵行骨折语频气导平均听阈为52dB,10例混合性骨折均为重度感音神经性聋。颞骨轴位CT示:13例可见骨折线。虚拟耳镜观察9例听骨链中断,面神经曲面重建显示膝状神经节区、鼓室段及乳突段骨管不规整。结果:全部患者术后一期愈合,无手术并发症发生。术后随访0.5～3.0年,平均1.2年。面神功能恢复达House-BrackmannⅠ级15例,Ⅱ级6例,Ⅲ级5例;语频气导听力平均提高33dB。结论:乳突-颞下迷路外径入路面神经减压术治疗颞骨骨折面瘫高位面神经减压保全和重建听骨链效果满意。

Objective：To investigate the clinical outcomes of facial nerve decompression via transmastoid,extralabyrinthine,subtemporal approach for management of facial paralysis in temporal bone fracture.Method：Twenty-six cases of traumatic facial paralysis（House-Brackmann grade Ⅲ-Ⅴ） hospitalized between January 2006 and April 2008 received facial nerve decompression surgery. There were 4 patients diagnosed as House-Braekmann Grade Ⅲ, 12 as Grade Ⅴ in and 10 as Grade Ⅵ,The preoperative mean air conduction threshold was 52 dB in 16 cases with longitudinal temporal bone fracture and serious sensorineral heating loss in 10 cases with transverse temporal bone fracture.The fracture lines were detected in 13 cases by temporal bone axial CT scans and ossicular disruption could be determined in 9 cases by virtual endoscopy.The geniculate ganglion,the tympanic and mastoid segment of the facial nerve displayed an irregular morphology in curved planar reformation images of the facial nerve cana1.Result：All cases had primary healing and no complication occurred. At following-up times ranging from 0.5 to 3 years （average 1.2 years）, facial nerve function recovereyed to House-Brackmann Grades Ⅰ in 15,Ⅱin 6, Ⅲ in 5. Overall air conduction pure tone averages improved 33 dB.Conclusion：Facial nerve decompression with rebuilding of ossicular chain through transmastoid,extralabyrinthine,subtemporal approach is a good approach for the treatment of facial paralysis in temporal bone fracture.