Hato Naohito, Nota Junpei, Hakuba Nobumitsu, Gyo Kiyofumi, Yanagihara Naoaki
Department of Otolaryngology, Ehime University School of Medicine, Ehime, Japan.
J Trauma. 2011 Dec;71(6):1789-92; discussion 1792-3. doi: 10.1097/TA.0b013e318236b21f.
In the treatment of facial nerve paralysis after temporal bone trauma, it is important to appropriately determine whether nerve decompression surgery is indicated. The aim of this study was to examine the efficacy of facial nerve decompression surgery according to fracture location and the ideal time for surgery after trauma by analyzing the therapeutic outcome of traumatic facial nerve paralysis.
In total, 66 patients with facial nerve paralysis after temporal bone trauma who were treated at our institution between 1979 and 2009 were studied retrospectively. The patients were divided into five subgroups, according to the fracture location and the period of time between trauma and surgery.
The number of patients who achieved complete recovery of House-Brackmann (H-B) grade 1 was 31 of 66 (47.0%). There was no difference in therapeutic outcomes among the subgroups classified by fracture location. The rate of good recovery to H-B grade 1 or 2 in patients undergoing decompression surgery within 2 weeks after trauma reached 92.9%, resulting in a significantly better outcome than that of patients undergoing later decompression surgery (p < 0.01).
The results of this study demonstrated that the ideal time for decompression surgery for facial nerve paralysis after temporal bone fracture was the first 2 weeks after trauma in patients with severe, immediate-onset paralysis. Our study also showed that surgery should be performed within 2 months at the latest. These findings provide useful information for patients and help to determine the priority of treatment when concomitant disease exists.
在颞骨创伤后面神经麻痹的治疗中，恰当确定是否需要进行神经减压手术很重要。本研究的目的是通过分析创伤性面神经麻痹的治疗结果，根据骨折部位及创伤后理想的手术时间来检验面神经减压手术的疗效。
回顾性研究了1979年至2009年间在我院接受治疗的66例颞骨创伤后面神经麻痹患者。根据骨折部位及创伤与手术之间的时间间隔，将患者分为五个亚组。
66例患者中，有31例（47.0%）实现了House-Brackmann（H-B）1级完全恢复。按骨折部位分类的亚组间治疗结果无差异。创伤后2周内接受减压手术的患者恢复至H-B 1级或2级的良好恢复率达92.9%，结果显著优于后期接受减压手术的患者（p < 0.01）。
本研究结果表明，对于颞骨骨折后面神经麻痹患者，减压手术的理想时间是创伤后前2周，适用于严重且即刻发病的麻痹患者。我们的研究还表明，手术最迟应在2个月内进行。这些发现为患者提供了有用信息，并有助于在存在合并症时确定治疗的优先级。
