中耳炎手术中面神经定位和辨认的临床研究

The Topography and Differentiation of Facial Nerve in Middle Ear Surgery

目的探讨中耳炎手术中面神经的定位和辨认。方法回顾性分析2008年1月～2010年12月185例行开放式乳突根治术或加鼓室成形术的慢性化脓性中耳炎及胆脂瘤中耳炎患者的手术资料,对术中面神经探查定位及辨认方法进行分析总结。结果①185例中,面神经探查发现58例面神经裸露;②面神经鼓室段定位标志为匙突、齿突、砧骨短突,185例中33例匙突消失,25例齿突遭到破坏,19例砧骨短突破坏或移位;乳突段定位标志为水平半规管、二腹肌脊,185例中12例水平半规管遭破坏,14例二腹肌脊被破坏;33例鼓索神经变异;③面神经与肉芽组织的关系为肉芽组织覆盖于神经表面78例,肉芽包裹神经47例,肉芽组织来自于面神经本身24例。结论中耳炎手术中面神经的定位主要根据相对固定的砧骨、水平半规管、匙突等结构,当这些结构遭破坏或观察不清时,应联合多个标志综合判断,提高面神经定位的成功率。

Objective To investigate the topography and differentiation of the facial nerves in the middle ear surgery. Methods From January 2008 to December 2010,radical mastoidectomy or tympanoplasty was administered in 185 patients with chronic otitis media and cholesteatoma otitis media,and analyzed the exploration of the surgery. Results 58 cases of exposed facial nerves were identified and the topography of the tympanic segments in facial nerve was located as the cochleariform,odontoid,and processus brevis incudis.33 cochleariform process disappeared,25 odontoid process damaged,and 19 processus brevis damaged or displated.12 cochleariform process and 14 digastric ridge damaged;chorda tympani nerve also could locate the facial nerves and 33 variations were noted.The relationship between facial nerves and granulation tissues indicated that there were 78 cases of the granulation tissue covering the surface of the nerve,47 cases of the granulation tissue enclosing the nerve and 24 cases of the granulation tissue came from the facial nerve itself. Conclusion We can reduce and prevent the occurrence of facial nerve injuries by being familiar with the practices and variations of facial nerves within the normal temporal bones,and become skilled in basic operations