鼓室硬化症与中耳胆脂瘤术中面神经暴露与暴露后面瘫的回顾分析

Exposure of Facial Nerve in Tympanosclerosis and Cholesteatoma:A Retrospective Study

目的回顾性分析面神经暴露在鼓室硬化症与中耳胆脂瘤手术中的差异,探讨面神经暴露后面瘫发生的原因及相关处理。方法对在初次手术证实存在面神经暴露的14例鼓室硬化症、41例中耳胆脂瘤进行回顾总结,其中鼓室硬化症组男性4例,女性10例,左耳7例,右耳7例,年龄40.21±14.69岁,病史17.20±14.43年,中耳胆脂瘤组男性21例,女性20例,左耳17例,右耳24例,年龄32.83±14.77岁,病史13.30±12.58年,两组均采用气管内插管全麻手术,采用卡方检验比较两组面神经颞骨内段暴露的节段和并发面瘫的差异。结果鼓室硬化症组面神经暴露几乎全部发生于鼓室段,共12例(85.7%),膝状神经节暴露1例(7.1%),膝状神经节及鼓室段暴露1例(7.1%),其术前合并面瘫1例(7.1%),术后完全恢复,术后并发面瘫2例,其中1例为迟发型面瘫,治疗后均完全恢复。中耳胆脂瘤组面神经暴露发生于鼓室段28例(68.3%),乳突段6例(14.6%),膝状神经节1例(2.4%),乳突段至鼓室段5例(12.2%),膝状神经节及鼓室段暴露1例(2.4%),其术前合并面瘫4例(9.6%),一期行面神经减压术后显著好转,术后出现面瘫1例,为迟发型面瘫(2.4%),保守治疗后完全恢复。两组之间暴露节段差别有统计学意义(P=0.048),但术前术后并发面瘫无统计学差别。结论中耳胆脂瘤中面神经暴露节段较鼓室硬化症形式多样,主要取决于病变范围,鼓室硬化症中面神经暴露主要位于鼓室段,两组面瘫发生率无明显差别。

Objective Retrospectively analyze surgically identified facial nerve exposure in tympanosclerosis and cholesteatoma, and discuss the mechanism and treatment of coexisting facial paralysis. Methods Cases of tympanosclerosis （n=14） or cholesteatoma （n=41） with confirmed facial nerve exposure during primary surgeries were compared for location of facial nerve exposure and coexisting facial paralysis. Results Facial nerve exposure in tympanosclerosis was almost always in the tympanic segment （12/14, 85.7%）. Exposure was at the genieulate ganglion in 1 case （7.1%） and involved both the ge- niculate ganglion and tympanic segments in 1 case （7.1%）. One of these cases showed facial paralysis before surgery, which fully recovered in 5 months following depression surgery. Facial paralysis was secondary to the surgery in 2 cases, with de- lay in 1 case. Both cases totally recovered after treatment. Facial nerve exposure in cholesteatoma was found in the tympan- ic segment in 28 cases （68.3%）, in the mastoid segment in 6 cases （14.6%）, at the geniculate ganglion in 1 case （2.4%）, in- volving both mastoid and tympanic segments in 5 cases （12.2%） and both geniculate ganglion and tympanic segments in 1 ease （2.4%）. Facial paralysis was present before surgery in 4 cases （9.6%）, which significantly improved after decompres- sion surgery. Facial paralysis was a surgical complilcation in 1 case （2.4%）, which recovered completely after conservative treatment. Although the exposure segments in the two groups were significantly different, the rates of preoperative and post- operative facial paralysis in the two groups were not significantly different. Conclusion Location of facial nerve exposure in cholesteatoma varies, depending on the extent of disease, whereas it presents mostly in the tympanic segment in tympano- sclerosis. Incidence of facial paralysis is not significantly different between the two groups.