鼓室成形术后迟发性面瘫临床分析(附23例报告)

Clinical Analysis of Delayed Facial Palsy after Tympanoplasty(with 23 cases)

目的探讨分析鼓室成形术后迟发性面瘫的发病机理,治疗方法及预后。方法选择2009年3月至2012年3月解放军总医院耳鼻咽喉头颈外科鼓室成形术后发生的迟发性面瘫病例,回顾性分析手术后发生面瘫的时间、程度、发病相关因素、治疗方法、面瘫的恢复情况。结果 2009年3月至2012年3月1992例鼓室成形术后发生迟发性面瘫23例,发病率为1.15%;面瘫出现在术后5～14天,平均为术后7.39±1.95天;患者年龄在13～56岁,平均40.3±12.02岁,40～49岁发病率最高;性别、侧别发病率无明显差异。发现梅毒特异性抗体阳性者发生鼓室成形术后迟发性面瘫的危险性为阴性者的32.65倍。面瘫后面神经功能按House-Brackmann分级方法评估,Ⅲ级2例,Ⅳ级13例,Ⅴ级8例;面瘫后均口服激素及抗病毒药物治疗,于面瘫后3周至2个月面神经功能恢复至I级。结论迟发性面瘫与贝尔面瘫有相似的发病机制,治疗方法为面瘫后尽早口服激素及抗病毒药物等,其预后良好。

Objective To analyze the pathogenesis, treatment and prognosis of delayed facial palsy after tympanoplasty. Methods The occurrence time, classification, contribt, tory factors, treatment and facial nerve function outcomes in cases with delayed facial palsy after tympanoplasty treated from March 2009 to March 2012 at the Department of Otolaryngology Head and Neck Surgery, PLA General Hospital were reviewed. Result The incidence of delayed facial palsy after tympano- plasty was 1.15% （23/1992）. Facial palsy happened between 5 and 14 days （average 7.39-＋ 1.95 days） after surgery. Patients with positive syphilis specific antibodies were 32.65 times more likely to have facial palsy than those without. Facial nerve function was House-Brackmann （HB） Grade Ill in 2 cases, IV in 13 cases and V in 8 cases. In the patients who were treated with glucocorticoid steroids and anti-virus drugs after onset of facial palsy, faeial nerve function recovered to Grade HB-I af- ter 3 weeks to 2 months. Conclusion The pathogenesis of delayed facial palsy ＇after tympanoplasty is similar to Bell＇s pal- sy. Facial nerve function can restored to normal in the patients treated with corticosteroids and anti-virus drugs when treated early.