经乳突面神经减压术治疗贝尔氏面瘫

Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences

目的探讨经乳突面神经减压治疗贝尔氏面瘫的手术适应症、手术方式、手术时机及疗效。方法回顾性分析33例经乳突面神经减压手术治疗的贝尔氏面瘫病例,比较分析手术时机、减压部位对术后面神经功能恢复的影响。结果经乳突面神经次全程减压手术有效率为77.3%,恢复至H-BⅠ、Ⅱ级的占总数的54.5%。其中发病3个月内接受减压的病人术后恢复至Ⅰ级、Ⅱ级所占比例62.5%(10/16),2个月内接受减压手术的10例病人中7例恢复至H-BⅠ、Ⅱ级,占总数70%。恢复至H-BⅢ级的3例,占总数30%,无Ⅳ级或更差病例。结论对面神经变性超过90%的发病3个月内的贝尔氏面瘫患者行面神经次全程减压手术治疗可有效降低患者预后至Ⅲ级或更差的几率。

Objective To assess the value of transmastoid facial nerve decompression for patients with Bell’s palsy. Methods Thirty three patients who displayed more than 90%degeneration on ENoG were offered transmastoid facial nerve decompression. The timing, site and outcomes of the surgery were discussed. Results Transmastoid facial nerve decompres-sion involving the geniculate ganglion and distal portion of the labyrinthine segment was effective in 77.3%of the cases, of which 54.5%recovered to H-B level I or II. In patients who received decompressive surgery within 3 months after the onset of facial palsy, 62.5%recovered to H-B level I or II, although this ratio was 70% when decompression took place within 2 months after symptom onset, with no grade IV or worse outcomes. Conclusions Within 3 months after facial palsy onset, surgi-cal decompression medial to the geniculate ganglion significantly lowered the chance of developing poor facial function re-sults in patients with Bell’s palsy.