Kim Jin, Moon In Seok, Shim Dae-Bo, Lee Won Sang
Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea.
J Trauma. 2010 Apr;68(4):924-9. doi: 10.1097/TA.0b013e3181a8b2d9.
The optimal timing for surgical exploration of traumatic facial paralysis to best preserve facial function is currently controversial. This article reviews the final outcomes of facial function in patients with traumatic intratemporal facial nerve injury according to the timing of surgical exploration.
We performed a retrospective review of 58 patients with complete facial nerve paralysis caused by temporal bone fractures as a result of head trauma between 1998 and 2007. Patients were divided into three groups according to the type of trauma. The only difference between patients in each group was the timing of the surgical exploration. Characteristics assessed in the study included type of trauma, location of facial nerve injury, timing of surgical intervention, audiometric findings, surgical approach, and long-term follow-up of recovery of facial nerve function, as assessed by two facial nerve grading systems.
The final functional gains in early-operated patients were 3.7 +/- 0.59 on the House-Brackmann (HB) scale and 75.6 +/- 10.88 on the Sunnybrook scale. The outcome in late-operated patients was 2.17 +/- 0.52 on the HB scale and 34.7 +/- 16.95 on the Sunnybrook scale, and that of nonoperated patients was 2.0 +/- 0.63 on the HB scale and 26.8 +/- 6.27 on the Sunnybrook scale.
This study demonstrated that some patients with traumatic facial nerve paralysis who had nerve conduction studies consistent with a poor prognosis regained considerable facial function after early surgical intervention. However, late exploration after facial nerve paralysis did not result in positive outcomes, regardless of the type of temporal bone fracture or the site of injury, and no difference was observed compared with conservative treatment.
创伤性面瘫手术探查以最佳保留面部功能的最佳时机目前存在争议。本文根据手术探查时机回顾了创伤性颞骨内面神经损伤患者的面部功能最终结果。
我们对1998年至2007年间因头部外伤导致颞骨骨折而出现完全性面瘫的58例患者进行了回顾性研究。根据创伤类型将患者分为三组。每组患者之间唯一的差异是手术探查的时机。研究中评估的特征包括创伤类型、面神经损伤部位、手术干预时机、听力测定结果、手术入路以及通过两种面神经分级系统评估的面神经功能恢复的长期随访情况。
早期手术患者在House-Brackmann（HB）量表上的最终功能增益为3.7±0.59，在Sunnybrook量表上为75.6±10.88。晚期手术患者在HB量表上的结果为2.17±0.52，在Sunnybrook量表上为34.7±16.95，未手术患者在HB量表上为2.0±0.63，在Sunnybrook量表上为26.8±6.27。
本研究表明，一些创伤性面瘫且神经传导研究显示预后不良的患者在早期手术干预后恢复了相当程度的面部功能。然而，面神经麻痹后的晚期探查无论颞骨骨折类型或损伤部位如何均未产生积极结果，与保守治疗相比也未观察到差异。
