第一鳃裂瘘管切除术中面神经解剖的临床意义

Dissection of facial nerve in the surgical management of the first branchial cleft fistula

目的探讨面神经解剖在第一鳃裂瘘管切除术中的意义。方法回顾性分析我科2005～2010年收治的23例第一鳃裂瘘管患者的临床资料。所有病例均在明视面神经的情况下完整切除病变及周围瘢痕组织。10例无手术史的患者行面神经总干解剖法;13例有术前切开引流及瘘管切除史的患者行面神经下颌缘支解剖法。结果所有患者手术切口均I期愈合。1例患者术后出现一过性面瘫,术后1周时完全恢复。5例行外耳道部分皮肤和软骨切除的患者术后均无外耳道狭窄及听力下降。随访9个月～6年,23例患者均未见复发。结论第一鳃裂瘘管与面神经关系密切,面神经解剖在第一鳃裂瘘管切除术中可有效防止面神经不可逆损伤。

OBJECTIVE To evaluate the significance of dissection of facial nerve in the surgical management of the first branchial cleft fistula.METHODS A number of 23 cases suffered from the first branchial cleft fistula were treated in our department from 2005 to 2010.All patients received the surgical management,in which facial nerve was routinely dissected and protected.In 13 cases with surgical history,marginal madibular branch was dissected and then retrograde to main facial nerve.The other 10 cases without surgical history received the main facial nerve dissection procedure.A flap from sternocleidomastoid was used to eliminate the dead space in 5 cases after the excision of the infected skin and cartilage of the external ear canal.RESULTS No recurrence was found in all 23 patients with a following-up period from 9 months to 6 years.Temporary facial palsy was found in 1 patient and completely recovered within the following week after the surgery.CONCLUSION Relations between facial nerve and the first branchial cleft fistula are various.The dissection of facial nerve plays a vital role in the excision of the lesion and avoiding injury of facial nerve.