颞骨外面神经切断伤部位与功能康复的关系

Relationship between mutilation injury site of facial nerve outside temporal bone and functional recovery

目的探讨颞骨外面神经不同部位切断伤术后与功能康复的关系。方法将颞骨外面神经分成三级:一级面神经分支为主干面神经包括颞面干及颈面干;二级面神经分支为主干之后的面神经,大致范围是上缘自耳屏角至外眦的连线,腮腺前缘15 mm左右至下颌角前10 mm左右,此处面神经分支较多,互有交通支常见,神经干明显较一级分支细;三级面神经分支为二级面神经分支范围以远的远心段面神经分支,该处面神经离一级分支更远,神经干较二级分支更细。对31例颞骨外面神经切断伤患者部位按上述分级,均行面神经吻合术,随访3～12个月,观察面神经功能恢复程度。结果一级伤和二级伤患者分别与三级伤康复患者比较,三级伤患者康复率低,差异具有统计学意义。结论对于不同部位颞骨外面神经切断伤患者,选择面神经吻合术后,远心段的三级面神经伤患者神经功能康复效果差。

【Objectives】 To discuss about relationship between mutilation injury site of facial nerve outside temporal bone and functional recovery.【Methods】 Facial nerve outside temporal bone is divided into branches of three levels： The level Ⅰ branch of facial nerve is the trunk of facial nerve,including temporal facial trunk and cervical facial trunk;level Ⅱ branch of facial nerve refers to the facial nerve distal to the trunk,and the general scale is from the line between antilobium angle and outer canthus at the superior margin to 15 mm site at anterior margin of parotid gland till about 10 mm site anterior to mandibular angle.There are more branches of facial nerve here,with communicating branches often seen,and the nerve trunk is thinner than level Ⅰ branch;level Ⅲ facial nerve branch is that distal to level Ⅱ branch of facial nerve,farther from level Ⅰ branch of facial nerve,with nerve trunk thinner than Ⅱ branch of facial nerve.Injury sites of 31 cases with mutilation of facial nerve outside temporal bone were graded as above,who all received anastomosis of facial nerve and were followed up for 3 to 12 months,with their recovery conditions of facial nerve observed.【Results】 Recovery number of cases with level I injury or level II injury was compared with that of cases with level Ⅲ injury,and recovery rate of cases with level Ⅲ injury was lower,with significant difference.【Conclusions】 Functional recovery of cases with distal segment of level Ⅲ facial nerve injury was poor after anastomosis of facial nerve for cases with mutilation injury of facial nerve at diverse sites outside temporal bone.