Liu Wei, Chen Min, Hao Jinsheng, Yang Yang, Zhang Jie, Ni Xin
Department of Otolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, 100045, People's Republic of China.
Eur Arch Otorhinolaryngol. 2017 Sep;274(9):3465-3470. doi: 10.1007/s00405-017-4648-y. Epub 2017 Jun 20.
The objective of this study is to make a clinical analysis for first branchial cleft anomalies (FBCAs), especially introduce the relationship between the Type I/II FBCA with the facial nerve and to demonstrate the importance of using intraoperative microscope and facial nerve monitoring. This is a retrospective review of patients with FBCAs treated in Beijing Children's Hospital, from Jan 2013 to Dec 2015. Clinical data of patients, including sex, age, chief complains, history of surgery, incision and drainage, the relationship with the facial nerve, pre and post-operative facial paralysis, recurrent rate and complications were recorded. FBCAs were divided into two subtypes according to Work's Classification. All patients had an MRI examination for diagnosis and to locate the lesions before surgery. Both microscope and facial nerve monitors were routinely used for detecting and protecting the facial nerve. The study cohort included 42 patients with ages ranging from 10 months to 14 years. The chief complaint was recurrent swelling or abscess near the ear or angle of mandibular. 76.2% of them (32/42) had incision and drainage histories. Two of them had suffered from facial palsy during the infectious period. Seven patients had undergone surgeries once or twice in other hospitals. Four patients with Type II FBCAs developed temporary facial palsy. We had follow-ups for each patient from 3 months to 3 years. 4 (9.5%) patients with Type I FBCA had got postoperative external auditory canal (EAC) stenosis. There were no cases of recurrence. Type II FBCAs has closer relationship with facial nerve than Type I FBCAs. The facial nerve of Type II FBCAs may lie more superficially and ascending to the fistula. Intraoperative microscope and facial nerve monitoring were necessary for protecting the facial nerve and decreasing the recurrent rate.
本研究的目的是对第一鳃裂畸形（FBCAs）进行临床分析，特别介绍I/II型FBCA与面神经的关系，并证明术中使用显微镜和面神经监测的重要性。这是一项对2013年1月至2015年12月在北京儿童医院接受治疗的FBCAs患者的回顾性研究。记录患者的临床资料，包括性别、年龄、主要症状、手术史、切开引流史、与面神经的关系、术前和术后面瘫情况、复发率及并发症。FBCAs根据Work分类法分为两个亚型。所有患者术前均行MRI检查以明确诊断和定位病变。常规使用显微镜和面神经监测仪来检测和保护面神经。研究队列包括42例年龄在10个月至14岁之间的患者。主要症状为耳周或下颌角附近反复肿胀或脓肿。其中76.2%（32/42）有切开引流史。其中2例在感染期出现面瘫。7例患者曾在其他医院接受过一到两次手术。4例II型FBCAs患者出现暂时性面瘫。我们对每位患者进行了3个月至3年的随访。4例（9.5%）I型FBCA患者术后出现外耳道狭窄。无复发病例。II型FBCA与面神经的关系比I型FBCA更密切。II型FBCA的面神经可能位置更表浅且向瘘管走行上升。术中使用显微镜和面神经监测对于保护面神经和降低复发率是必要的。
