Ellingson Todd W, Cohen James I, Andersen Peter
Department of Otolarynology-Head and Neck Surgery, Oregon Health and Science University, Portland, 97239, USA.
Laryngoscope. 2003 Aug;113(8):1299-303. doi: 10.1097/00005537-200308000-00006.
OBJECTIVES/HYPOTHESIS: Studies of immediate postoperative facial nerve function following parotidectomy focus on benign disease. The purpose of the study was to compare facial nerve function with regard to benign or malignant disease in patients undergoing superficial parotidectomy.
Retrospective cohort study of consecutive patients undergoing parotidectomy between 1995 to 2002.
House-Brackmann (HB) grade was recorded or assigned at the first postoperative visit. For patients with HB grade of III or greater, final resolution of facial nerve function was recorded. A chi2 analysis for independence was conducted between patients with HB grade of II or less and those with HB grade of III or greater and final pathological finding (benign vs. malignant disease). Mean and median times to resolution were determined for patients with HB grade of III or greater. Times to resolution for benign and malignant disease for those with HB grade of III or greater were compared (Kaplan-Meier method).
Sixty-seven patients with benign disease and 52 with malignant disease were included. Ninety-four percent of patients with benign disease had HB grade of II or less at first postoperative visit (mean period, 11.6 d) compared with 76.9% of patients with malignant disease (mean period, 12.4 d). A chi2 analysis found this difference significant (chi2 = 7.36, P =.0067). Time to resolution for HB grade of III or greater was 253.8 days (+/-168.2 d) with median time of 229.5 days for benign disease and 182.4 days (+/-134.6 d) with median time of 138 days for malignant disease. Kaplan-Meier comparison found no significant differences in time to final resolution (P =.83). Three patients in the group with malignant disease had unresolved dysfunction (one patient for >2 y).
Patients with benign disease have a greater chance of having HB grade of II or less immediately following surgery; however, whether the disease is benign or malignant, long-term final facial nerve function is the same.
目的/假设：腮腺切除术后即刻面神经功能的研究主要集中在良性疾病方面。本研究的目的是比较接受腮腺浅叶切除术患者中，良性或恶性疾病患者的面神经功能。
对1995年至2002年间连续接受腮腺切除术的患者进行回顾性队列研究。
在术后首次随访时记录或指定House-Brackmann（HB）分级。对于HB分级为III级或更高的患者，记录面神经功能的最终恢复情况。对HB分级为II级或更低的患者与HB分级为III级或更高的患者以及最终病理结果（良性与恶性疾病）进行独立性χ²分析。确定HB分级为III级或更高的患者恢复的平均时间和中位时间。比较HB分级为III级或更高的患者中良性和恶性疾病的恢复时间（Kaplan-Meier法）。
纳入67例良性疾病患者和52例恶性疾病患者。94%的良性疾病患者术后首次随访时HB分级为II级或更低（平均时间，11.6天），而恶性疾病患者为76.9%（平均时间，12.4天）。χ²分析发现此差异具有统计学意义（χ² = 7.36，P = 0.0067）。HB分级为III级或更高的患者恢复时间为253.8天（±168.2天），良性疾病的中位时间为229.5天，恶性疾病为182.4天（±134.6天），中位时间为138天。Kaplan-Meier比较发现最终恢复时间无显著差异（P = 0.83）。恶性疾病组中有3例患者功能障碍未恢复（1例患者超过2年）。
良性疾病患者术后即刻HB分级为II级或更低的可能性更大；然而，无论疾病是良性还是恶性，长期最终面神经功能是相同的。
