Chen L J, Han W J, Shen W D, Liu J, Dai P, Yang S M, Han D Y
Department of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, 100853, China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2017 Aug 20;31(16):1247-1250. doi: 10.13201/j.issn.1001-1781.2017.16.007.
To summarize the clinical characteristics, the surgical methods and the recovery of facial nerve function outcomes in patients with the middle ear cholesteatoma complicated with peripheral facial paralysis.Retrospective analysis method was used on patients treated for middle ear cholesteatoma associated with peripheral facial paralysis. Facial nerve decompression and great auricular nerve grafting were performed for restoration of facial nerve. Facial nerve function was assessed with the House-Brackmann (H-B) grade scale. Spearman test was employed for statistic analysis.Surgical exploration revealed that the cholesteatoma was mainly located in epitympanic cavity, mastoid and sinus tympani, which mainly damaged the tympanic segment of facial nerve. Nineteen cases with facial nerve edema, including complete sheath (n=15) and sheath defect (n=4), were performed decompression. Among which 15 recovered to H-B Ⅰ, 3 recovered to H-B Ⅱ, 1 recovered to H-B Ⅳ. Three cases with facial nerve disrupt underwent great auricular nerve grafting, 1 recovered to H-B Ⅳ, 2 recovered to H-BⅤ. The rate of recovery to H-B Ⅰ or Ⅱ in patients underwent surgery within 2 weeks was 92.3%(12/13).When the middle ear cholesteatoma complicated with peripheral facial paralysis, surgery should be carried out as soon as possible. After removed the cholesteatoma completely, facial nerve decompression could acquire a better facial nerve function recovery compared to great auricular grafting.
总结中耳胆脂瘤合并周围性面瘫患者的临床特征、手术方法及面神经功能恢复情况。对接受治疗的中耳胆脂瘤合并周围性面瘫患者采用回顾性分析方法。行面神经减压及耳大神经移植以修复面神经。采用House-Brackmann（H-B）分级量表对面神经功能进行评估。采用Spearman检验进行统计学分析。手术探查发现胆脂瘤主要位于上鼓室、乳突及鼓室窦，主要损伤面神经鼓室段。对19例面神经水肿患者进行减压，其中包括完整神经鞘（n = 15）和神经鞘缺损（n = 4）。其中15例恢复至H-B Ⅰ级，3例恢复至H-B Ⅱ级，1例恢复至H-B Ⅳ级。3例面神经断裂患者行耳大神经移植，1例恢复至H-B Ⅳ级，2例恢复至H-BⅤ级。2周内行手术治疗的患者恢复至H-B Ⅰ或Ⅱ级的比例为92.3%（12/13）。当中耳胆脂瘤合并周围性面瘫时，应尽早进行手术。彻底清除胆脂瘤后，面神经减压相比耳大神经移植可获得更好的面神经功能恢复。
