Alicandri-Ciufelli Matteo, Marchioni Daniele, Mattioli Francesco, Trani Margherita, Presutti Livio
Otolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy.
Eur Arch Otorhinolaryngol. 2009 Apr;266(4):475-9. doi: 10.1007/s00405-008-0893-4. Epub 2008 Dec 19.
Management of intraparotid facial nerve schwannomas (IFNS) is very challenging because the diagnosis is often made intra-operatively and in most cases, resection could lead to severe facial nerve (FN) paralysis, with important aesthetic consequences. Articles in the English language focused on the management of FN schwannoma have been selected and critically reviewed. A decision-making algorithm is proposed. In the case of type A or B neoplasms, or in case of a pre-operative FN House-Brackmann (HB) grade IV or worse, the authors would favor a resection of the IFNS and (where necessary) a reconstruction of the nerve. In the case of pre-operative HB grade III or better and type C or D neoplasms, patients would undergo an intra-operative biopsy to rule out malignancy, and a possible conservative management could be adopted. Localization and adherences of IFNS, as well as pre-operative FN function are important factors that must be considered in the decision-making process for IFNS to optimize the functional outcomes.
腮腺内面神经鞘瘤（IFNS）的治疗极具挑战性，因为诊断往往在手术中才能做出，而且在大多数情况下，切除肿瘤可能导致严重的面神经（FN）麻痹，产生重要的美学后果。我们挑选并严格审查了聚焦于FN鞘瘤治疗的英文文章。提出了一种决策算法。对于A型或B型肿瘤，或术前FN House-Brackmann（HB）分级为IV级或更差的情况，作者倾向于切除IFNS并（必要时）进行神经重建。对于术前HB分级为III级或更好且为C型或D型肿瘤的患者，将进行术中活检以排除恶性肿瘤，并可采取可能的保守治疗。IFNS的定位和粘连情况以及术前FN功能是IFNS决策过程中必须考虑的重要因素，以优化功能结果。
