Pons Y, Clément P, Crambert A, Conessa C
Hôpital du Val de Grâce, Service d'ORL et de Chirurgie Cervico-Faciale, 74, Boulevard de Port Royal, 75230 Paris cedex 05, France.
Rev Laryngol Otol Rhinol (Bord). 2010;131(4-5):253-6.
Facial palsy (FP) is a feared complication of parotidectomy. Facial nerve monitoring (FNM) has been poorly evaluated since it was created at the beginning of the 90's. The authors described a retrospective series and discussed it reviewing the literature data.
From January 2002 to January 2009, 75 parotidectomies were performed in 72 patients (34 males, 38 females), without FNM in 28 cases (group 1) and with FNM in 47 cases (group 2).
In group 1, 9 FP were noted, 5 were transient and 4 were definitive. In group 2, 12 FP were noted, 9 were transient and 3 were definitive. Both one month and six months after parotidectomy, the FP rate was significatively higher in group 1 than in group 2 for the reoperations.
Facial nerve monitoring is an adjunctive method available to a surgeon during parotid surgery to assist with the functional preservation of the facial nerve. It did not allow to improve the facial prognosis in benign tumours removal but it improved the facial prognosis in reoperations. Its interest should be tested for malignant tumour removal.
面瘫是腮腺切除术令人担忧的并发症。自20世纪90年代初面神经监测(FNM)技术出现以来,对其评估一直不足。作者描述了一组回顾性病例并结合文献数据进行讨论。
2002年1月至2009年1月,72例患者接受了75次腮腺切除术,其中28例(第1组)未采用面神经监测,47例(第2组)采用面神经监测。
第1组出现9例面瘫,5例为暂时性,4例为永久性。第2组出现12例面瘫,9例为暂时性,3例为永久性。腮腺切除术后1个月和6个月,再次手术时第1组的面瘫发生率显著高于第2组。
面神经监测是外科医生在腮腺手术中可采用的辅助方法,有助于面神经功能的保留。在切除良性肿瘤时它未能改善面部预后,但在再次手术中改善了面部预后。其在恶性肿瘤切除中的作用有待进一步验证。