Vigili M G, Ducci M, Marzetti F, Galfano G M
Istituto Nazionale Tumori Regina Elena, Roma.
Acta Otorhinolaryngol Ital. 1991 Jul-Aug;11(4):385-94.
The rare diagnosis of parotid malignant tumors, the different clinico-biological behavior of each histological type and the lack of agreement concerning surgical procedures to be followed in treating the facial nerve led the Authors to carry out a national survey on malignant parotid tumors and their treatment. A questionnaire concerning problems inherent to facial nerve treatment in malignant tumors of the parotid gland was sent to 69 ENT Departments. Data on 139 patients (69 females and 70 males, mean age--59.9 years) were collected for this study. Facial nerve function deficits occurred in 25.9% of the patients, primarily in cases of adenoid cystic carcinoma, adenocarcinoma and undifferentiated carcinoma. Clinical findings were not a good guide in choosing the best surgical procedure to be used with the VII nerve. In fact, in 17% of the cases with no facial deficit, a neural infiltration was found intraoperatively. Total parotidectomy with facial nerve sacrifice (PTST or PTSP) was performed in 87.6% of the patients with complete facial deficit and in 80% of the patients with partial deficit. A more conservative approach was followed when the facial nerve was compressed but not infiltrated. Only 71.7% of the patients with facial nerve infiltration underwent post-operative radiotherapy, a fact which is probably explained by the few departments of radiotherapy in existence. While the functional results reported in Literature are good, facial nerve repairs were carried out in this study in only 9% of the cases. The present study, which supplies interesting data on the treatment of the facial nerve in parotid gland malignant tumors, confirms the need of a multidisciplinary approach and a more frequent use of neural repair techniques in order to preserve the aesthetic and functional aspects of the facial nerve.
腮腺恶性肿瘤的诊断罕见，各组织学类型的临床生物学行为不同，且在面神经治疗的手术方法上缺乏共识，这促使作者开展了一项关于腮腺恶性肿瘤及其治疗的全国性调查。一份关于腮腺恶性肿瘤面神经治疗相关问题的问卷被发送至69个耳鼻喉科。本研究收集了139例患者（69例女性和70例男性，平均年龄59.9岁）的数据。25.9%的患者出现面神经功能缺损，主要见于腺样囊性癌、腺癌和未分化癌病例。临床检查结果并非选择与面神经相关最佳手术方法的良好指导。事实上，在17%无面部缺损的病例中，术中发现了神经浸润。87.6%完全面部缺损的患者和80%部分缺损的患者接受了牺牲面神经的全腮腺切除术（PTST或PTSP）。当面神经受压但未受浸润时，采用了更为保守的方法。仅71.7%面神经受浸润的患者接受了术后放疗，这一情况可能是由于现存放疗科室较少所致。虽然文献报道的功能结果良好，但本研究中仅9%的病例进行了面神经修复。本研究提供了关于腮腺恶性肿瘤面神经治疗的有趣数据，证实了多学科方法的必要性以及更频繁地使用神经修复技术以保留面神经美学和功能的重要性。
