Jacobson Joel, Rihani Jordan, Lin Karen, Miller Phillip J, Roland J Thomas
Skull Base. 2011 Jan;21(1):7-12. doi: 10.1055/s-0030-1261263.
Lesions of the temporal bone and cerebellopontine angle and their management can result in facial nerve paralysis. When the nerve deficit is not amenable to primary end-to-end repair or interpositional grafting, nerve transposition can be used to accomplish the goals of restoring facial tone, symmetry, and voluntary movement. The most widely used nerve transposition is the hypoglossal-facial nerve anastamosis, of which there are several technical variations. Previously we described a technique of single end-to-side anastamosis using intratemporal facial nerve mobilization and parotid release. This study further characterizes the results of this technique with a larger patient cohort and longer-term follow-up. The design of this study is a retrospective chart review and the setting is an academic tertiary care referral center. Twenty-one patients with facial nerve paralysis from proximal nerve injury at the cerebellopontine angle underwent facial-hypoglossal neurorraphy with parotid release. Outcomes were assessed using the Repaired Facial Nerve Recovery Scale, questionnaires, and patient photographs. Of the 21 patients, 18 were successfully reinnervated to a score of a B or C on the recovery scale, which equates to good oral and ocular sphincter closure with minimal mass movement. The mean duration of paralysis between injury and repair was 12.1 months (range 0 to 36 months) with a mean follow-up of 55 months. There were no cases of hemiglossal atrophy, paralysis, or subjective dysfunction. Direct facial-hypoglossal neurorrhaphy with parotid release achieved a functional reinnervation and good clinical outcome in the majority of patients, with minimal lingual morbidity. This technique is a viable option for facial reanimation and should be strongly considered as a surgical option for the paralyzed face.
颞骨和桥小脑角病变及其处理可导致面神经麻痹。当神经缺损无法进行一期端端修复或置入移植时，可采用神经转位术来实现恢复面部张力、对称性和自主运动的目标。应用最广泛的神经转位术是舌下神经-面神经吻合术，该术式有多种技术变体。此前我们描述了一种使用颞内面神经游离和腮腺松解的单端-侧吻合技术。本研究通过纳入更多患者并进行更长时间的随访，进一步阐述了该技术的效果。本研究设计为回顾性病历审查，研究地点为学术性三级医疗转诊中心。21例因桥小脑角近端神经损伤导致面神经麻痹的患者接受了面神经-舌下神经吻合术并进行了腮腺松解。采用面神经修复恢复量表、问卷调查和患者照片对结果进行评估。21例患者中，18例成功实现神经再支配，恢复量表评分为B或C级，这意味着口腔和眼部括约肌闭合良好，仅有轻微的随意运动。损伤至修复的平均麻痹持续时间为12.1个月（范围0至36个月），平均随访时间为55个月。未出现半侧舌萎缩、麻痹或主观功能障碍的病例。面神经-舌下神经直接吻合术并进行腮腺松解在大多数患者中实现了功能性神经再支配并取得了良好的临床效果，舌部并发症极少。该技术是面部功能重建的可行选择，应作为面瘫手术的有力备选方案予以充分考虑。
