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[耳大神经移植修复面神经缺损]

[Greater auricular nerve graft for repair of facial nerve defects].

作者信息

Lu Lianjun, Ding Yu, Lin Ying, Xu Zhan, Li Zonghua, Qu Juan, He Ya, Dai Yanruo, Chen Yang, Qiu Jianhua

机构信息

Department of Otolaryngology Head and Neck Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China.

出版信息

Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2010 Apr;24(7):293-6.

Abstract

OBJECTIVE

To retrospectively analysis the clinical data of facial nerve defects repair with greater auricular nerve graft.

METHOD

The transmastoid approach was adopted to repair the facial nerve defects by means of nerve grafting. Preoperative and postoperative facial nerve functions were graded according to the House-Brackmann scale.

RESULT

The patterns of temporal bone fracture in the 8 patients were longitudinal, most lesions occurred in the region of the second genu and its surrounding, preoperatively, all patients had Grade VI function. In 3 patients of facial nerve tumors, the tumors involved multiple nerve segments, and histologic results were all schwannomas, preoperatively, 1 case had Grade III function, 2 cases had Grade V function. In 2 patients of iatrogenic trauma of the facial nerve, the primary disease was chronic otitis media with cholesteatoma, the lesions were localized at the mastoid segment and the second genu respectively. In 1 patient of molten steel burn, the lesions was localized at the tympanic segment, preoperative facial nerve function was Grade VI. In addition to 3 cases lost to follow-up, the remaining patients, 4 recovered to a Grade III, 3 to a Grade VI, 2 to a Grade V and 2 remained at Grade VI.

CONCLUSION

In present study, the most common cause of facial nerve transection was temporal bone fracture. Facial nerve reconstruction by means of greater auricular nerve grafting was a practical and effective method, the best postoperative recovery of facial nerve function was Grade III.

摘要

目的

回顾性分析采用耳大神经移植修复面神经缺损的临床资料。

方法

采用经乳突入路,通过神经移植修复面神经缺损。术前和术后根据House-Brackmann量表对面神经功能进行分级。

结果

8例颞骨骨折类型均为纵行,多数病变位于面神经第二膝部及其周围区域,术前所有患者面神经功能均为Ⅵ级。3例面神经肿瘤患者,肿瘤累及多个神经节段,组织学结果均为神经鞘瘤,术前1例面神经功能为Ⅲ级,2例为Ⅴ级。2例面神经医源性损伤患者,原发病均为慢性胆脂瘤型中耳炎,病变分别位于乳突段和第二膝部。1例钢水烧伤患者,病变位于鼓室段,术前面神经功能为Ⅵ级。除3例失访外,其余患者中,4例恢复至Ⅲ级,3例恢复至Ⅵ级,2例恢复至Ⅴ级,2例仍为Ⅵ级。

结论

在本研究中,面神经横断最常见的原因是颞骨骨折。采用耳大神经移植进行面神经重建是一种实用有效的方法,术后面神经功能最佳恢复为Ⅲ级。

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