Häusler R, Caversaccio M, Zbären P
Department of Otorhinolaryngology, Head and Neck, University of Berne, Inselspital, Switzerland.
Laryngoscope. 1999 Jul;109(7 Pt 1):1094-101. doi: 10.1097/00005537-199907000-00016.
Evaluation of facial nerve function after petrosectomy in a patient series with facial nerve denudation-decompression, forward or backward rerouting, and facial nerve suture and grafting.
Fifty-six patients with petrosectomies performed for 24 benign and 9 malignant tumors of the petrous bone, 13 malignant tumors of the parotid gland or of the infratemporal spaces with infiltration of the petrous bone, 8 traumatic facial nerve disruptions, and 2 osteoradionecroses were retrospectively evaluated with respect to facial nerve function. Sixteen cases involved a partial, 25 a subtotal, and 15 an extended subtotal petrosectomy.
The treatment of the facial nerve included 15 denudation-compressions, 23 denudation-compressions with rerouting, 4 primary sutures, and 14 nerve grafts. The House-Brackmann grading system was used for facial nerve evaluation.
Normal or nearly normal facial nerve function was obtained in facial nerve denudation-decompression with and without rerouting (House-Brackmann Grade I or II) except in cases of malignant tumors and osteoradionecrosis, where preoperative impaired function remained. Satisfactory results were obtained with nerve suturing and nerve grafting after petrous bone fracture (Grade III or IV, in one case practically Grade II) except in a case of late repair 3 years after the trauma (Grade V). Variable results were obtained with nerve grafting in cases with tumor infiltration: Satisfactory results (5 of Grade III or IV) were obtained when the tumor was healed and also when postoperative radiotherapy was applied; poor results were obtained in the case of tumor recurrence (6 of Grade V or VI).
Our results show that petrosectomy with denudation-decompression of the facial nerve with or without rerouting usually results in a normal mimic of the face. When the facial nerve is disrupted by trauma or when the nerve is infiltrated by tumor, early reconstruction with nerve suture or grafting mostly leads to a partial and quite acceptable reinnervation of the face.
在一组接受岩骨切除术的患者中，评估面神经剥脱减压、向前或向后改道、面神经缝合和移植术后的面神经功能。
对56例行岩骨切除术的患者进行回顾性面神经功能评估，这些患者包括24例岩骨良性肿瘤、9例恶性肿瘤、13例侵犯岩骨的腮腺或颞下间隙恶性肿瘤、8例创伤性面神经断裂以及2例骨放射性坏死。16例为部分岩骨切除术，25例为次全岩骨切除术，15例为扩大次全岩骨切除术。
面神经治疗包括15例剥脱减压术、23例剥脱减压联合改道术、4例一期缝合术和14例神经移植术。采用House - Brackmann分级系统对面神经进行评估。
除恶性肿瘤和骨放射性坏死患者术前功能受损仍存在外，面神经剥脱减压术无论是否联合改道，均可获得正常或接近正常的面神经功能（House - Brackmann I级或II级）。岩骨骨折后行神经缝合和神经移植术可获得满意结果（III级或IV级，1例实际为II级），但创伤后3年延迟修复的1例患者为V级。肿瘤浸润患者行神经移植术结果各异：肿瘤治愈且术后接受放疗时可获得满意结果（5例为III级或IV级）；肿瘤复发时结果较差（6例为V级或VI级）。
我们的结果表明，面神经剥脱减压联合或不联合改道的岩骨切除术通常可使面部表情正常。当面神经因创伤而中断或被肿瘤浸润时，早期采用神经缝合或移植进行重建大多可使面部部分再支配，且效果尚可接受。
