Borress Ryan Seth, Maccabee Paul, Har-El Gady
Department of Otolaryngology--Head and Neck Surgery, State University of New York Downstate Medical Center, Brooklyn, NY 11201, USA.
Am J Otolaryngol. 2007 Sep-Oct;28(5):321-4. doi: 10.1016/j.amjoto.2006.10.003.
Common peroneal nerve (CPN) paresis or paralysis presents with weakness of the toe extensors as well as of the ankle dorsiflexors and evertors, causing foot drop and hypesthesia or paresthesia in the CPN distribution. Previous studies have shown associations with weight loss and leg crossing. Although CPN neuropathy has been described in cancer patients, it has not been described in head and neck cancer (HNC) patients specifically. Our objective was to describe a series of patients who developed CPN neuropathy during the course of their disease.
A retrospective review of the charts of patients with HNC and CPN neuropathy who were seen at our institution between 1995 and 2004 was performed.
Four HNC patients with CPN neuropathy were identified. All had significant weight loss. One patient became symptomatic before treatment, 2 patients became symptomatic during treatment, and 1 patient developed foot drop 4 years after treatment when his free jejunal flap developed a stricture. Two patients had electrodiagnostic study findings that revealed conduction block at the fibular head and denervation of peroneal innervated muscles. Imaging studies revealed no evidence of metastatic disease in the lumbosacral region. All 4 patients improved after weight gain.
Common peroneal nerve neuropathy may be seen in HNC patients. The CPN may be susceptible in weight loss because of the associated loss of subcutaneous tissue, which cushions the nerve from the fibular head. Consideration should be given to prevention, appropriate neurologic consultation, and patient counseling.
腓总神经（CPN）轻瘫或麻痹表现为趾背伸肌以及踝关节背屈肌和外翻肌无力，导致足下垂，并在CPN分布区域出现感觉减退或感觉异常。既往研究表明其与体重减轻和交叉双腿有关。尽管CPN神经病变在癌症患者中已有描述，但尚未专门针对头颈癌（HNC）患者进行描述。我们的目的是描述一系列在疾病过程中发生CPN神经病变的患者。
对1995年至2004年期间在我们机构就诊的HNC合并CPN神经病变患者的病历进行回顾性研究。
确定了4例患有CPN神经病变的HNC患者。所有患者均有显著体重减轻。1例患者在治疗前出现症状，2例患者在治疗期间出现症状，1例患者在治疗4年后因游离空肠瓣出现狭窄而发生足下垂。2例患者的电诊断研究结果显示腓骨头处存在传导阻滞以及腓总神经支配肌肉失神经支配。影像学研究未发现腰骶部区域有转移性疾病的证据。所有4例患者在体重增加后病情均有改善。
HNC患者中可能会出现腓总神经病变。由于皮下组织减少，CPN可能在体重减轻时易受影响，皮下组织可使神经免受腓骨头的压迫。应考虑预防、适当的神经科会诊以及对患者的咨询。
