面神经修复手术中影响疗效的相关因素分析

Factors Load on Functional Outcomes of Facial Nerve Surgery

目的通过对38例面神经修复手术临床资料的回顾,探讨影响面神经功能恢复的可能的相关因素。方法对38例患者的临床资料进行采集。依据Sunnv-Brook量表中面部神经动态功能的评价表,对所有患者手术前后的动态影像资料进行评价。依据神经受损的不同情况,分为颞支组(7例)、颧支组(8例)、颊支组(18例)、下颌缘支组(4例)、面神经总干组(7例)和颅内神经损伤组(6例)。手术方法有神经直接吻合、神经移植、跨面神经移植和寄养。各个组中,分别对性别、瘫痪时间、神经移植、瘢痕和神经损伤位置等因素对结果的影响进行分析,并用SPSS13.0软件来进行统计学分析。结果颞、颧和颊支经手术修复后功能改善明显,而下颌缘支的功能恢复较差;同侧3 cm内的神经移植对疗效无不利影响;神经人肌处和面神经出颅区域的瘢痕会对最终的功能恢复带来不良的影响;在面神经总干位置损伤后的修复疗效不及分支处损伤后的修复效果;咬肌神经作为寄养的神经,可以明显提高面部功能的恢复。结论健康的神经两端,无张力的神经移植修复,以及咬肌神经的寄养将会给疗效的提高带来帮助。

Objective To explore the possible factors influencing the functional outcomes of facial nerve surgery. A retrospective study was conducted on the 38-case series. Methods Patients information was collected from medical charts. Using Sunnybrook＇s evaluation scale, facial functional outcomes as depicted in standardized videos were graded. According to the involved different injury sites, it was divided into 6 groups： group of temporal branch （7 cases）; group of zygomatic branch （8 cases）; group of buccal branch （18 cases）; group of mandibular branch （4 cases）; group of trunk （7 cases） and group of intracranial injury （6 cases）. Several types of procedures were performed： direct end-to-end coaptation, nerve grafting and cross-facial nerve grafting or combined with baby-sitter. Several issues were documented： gender, nerve denervation time, nerve grafting, scar, sites of injury, et al. SPSS 13.0, T-test and one-way ANOVA were used to test these factors on the outcomes. Results Except of mandibular branches, the function of the other branches improved the final functional outcomes significantly. Length of nerve graft that less than 3cm did not influence the outcomes. If severe scar located on the sites of the entry of nerve ends or the nerve exit of stylomastoid foraman, it would be prone to poor results. And the repair of facial nerve trunk was more difficult to recover than that of facial nerve branches. Baby-sitter with partial masseter nerve may improve the outcomes of cross-facial nerve grafting. Conclusion Health nerve stumps, tensionless nerve grafting and babysitter with partial masseter nerve can improve the outcomes of facial function.