颅中窝入路面神经减压治疗颞骨纵行骨折后周围性面瘫的临床分析并文献复习

Middle Fossa Approach Facial Nerve Decompression for Facial Paralysis after Longitudinal Temporal Bone Fracture-a Clinical Analysis and Literature Review

目的探讨颅中窝入路面神经减压治疗颞骨纵行骨折后周围性面瘫的临床疗效分析。方法回顾性分析5例颞骨纵行骨折后周围性面瘫患者的临床资料、手术方式及疗效分析。结果 5例外伤后颞骨骨折均为纵行骨折,周围性面瘫损伤的部位:4例位于膝状神经节,手术方式为颅中窝入路面神经减压术;1例位于膝状神经节及鼓室段,手术方式为颅中窝联合耳道入路面神经减压术。House-Brackmann分级作为术前、术后疗效的评价标准。术前Ⅴ级3例,Ⅳ级2例.术后随访1-2年,面神经功能恢复至Ⅱ级2例,Ⅰ级3例。结论本研究中,颞骨纵行骨折导致周围性面瘫损伤部位多见于膝状神经节,颅中窝入路面神经减压是治疗外伤后膝状神经节损伤导致的周围性面瘫的有效方法。

Objective To investigate the efficacy of middle cranial fossa approach facial nerve decompression in treating facial paralysis after longitudinal fracture of the temporal bone. Methods Clinical data, operative techniques and outcomes in 5 patients with peripheral facial paralysis after longitudinal fracture of the temporal bone were re-viewed. Results The site of facial nerve injury was located to the geniculate ganglion area in 4 cases, in which the facial nerve was decompressed via the middle cranial fossa approach alone. The site of facial nerve injury was located to both the geniculate ganglion and tympanic segment, and was decompressed by a combined middle cranial fossa and auditory canal approach. House-Brackmann classification before and after surgery was compared to evaluate treatment efficacy. Pre-operative H-B grading was V in,3 cases andⅣin 2 cases. At 1-2 years postoperative, H-B grading wasⅡin 2 cas-es an I in 3 cases. Conclusion Facial nerve injury caused by longitudinal fracture of the temporal bone occurs more of-ten in the geniculate ganglion area. Facial nerve decompression vis the middle cranial fossa is an effective management for traumatic facial paralysis when injury site involves the geniculate ganglion area.