Chong K W, Chung Y F, Khoo M L, Lim D T, Hong G S, Soo K C
Department of Surgery, Singapore General Hospital, Singapore.
Aust N Z J Surg. 2000 Oct;70(10):732-4. doi: 10.1046/j.1440-1622.2000.01941.x.
The purpose of the present paper was to review the management of intraparotid facial nerve schwannoma so as to discuss its clinical presentation, evaluate the various possible diagnostic investigations, and compare the various surgical options and outcome.
Case series was undertaken of five (1.3%) patients with facial nerve schwannoma out of 400 consecutive parotidectomies at Singapore General Hospital.
There were three men and two women with an age range of 29-65 years. Three patients presented with painless parotid lumps while two had painful parotid swellings. None had facial nerve paresis. Only one patient had preoperative diagnosis suspicious of schwannoma by fine-needle aspiration cytology (FNAC). Diagnoses were made intraoperatively. Four patients had excision with cable grafting of the nerve defect. achieving facial nerve grade II-IV (House-Brackmann scale). One patient who underwent enucleation of tumour with nerve preservation achieved grade II.
Preoperative diagnosis is difficult but it is important for discussion of the extent and options of surgery. Fine-needle aspiration cytology holds promise in making a preoperative diagnosis. Enucleation with nerve preservation where possible seems to offer better facial function whereas nerve excision with cable graft can give satisfactory results.
本文旨在回顾腮腺内面神经鞘瘤的治疗方法，以探讨其临床表现，评估各种可能的诊断性检查，并比较各种手术选择及结果。
在新加坡总医院连续进行的400例腮腺切除术病例系列中，纳入了5例（1.3%）面神经鞘瘤患者。
患者中男性3例，女性2例，年龄范围为29至65岁。3例患者表现为腮腺无痛性肿块，2例有腮腺疼痛性肿胀。均无面神经麻痹。仅1例患者通过细针穿刺细胞学检查（FNAC）术前诊断怀疑为神经鞘瘤。诊断均在术中确定。4例患者行肿瘤切除并对神经缺损进行电缆移植，面神经功能达到House-Brackmann量表II-IV级。1例行肿瘤剜除术并保留神经的患者面神经功能达到II级。
术前诊断困难，但对手术范围和选择的讨论很重要。细针穿刺细胞学检查在术前诊断方面有前景。尽可能保留神经进行剜除术似乎能提供更好的面神经功能，而神经切除并电缆移植也能取得满意结果。
