House Ear Clinic, 2100 West Third Street, Los Angeles, CA, 90057, USA.
University of California, Los Angeles, USA.
J Neurooncol. 2020 Dec;150(3):493-500. doi: 10.1007/s11060-020-03635-0. Epub 2020 Oct 28.
The course of the facial nerve through the cerebellopontine angle, temporal bone, and parotid gland puts the nerve at risk in cases of malignancy. In contrast to Bell's palsy, which presents with acute facial paralysis, malignancies cause gradual or fluctuating weakness.
We review malignancies affecting the facial nerve, including those involving the temporal bone, parotid gland, and cerebellopontine angle, in addition to metastatic disease. Intraoperative management of the facial nerve and long term management of facial palsy are reviewed.
Intraoperative management of the facial nerve in cases of skull base malignancy may involve extensive exposure, mobilization, or rerouting of the nerve. In cases of nerve sacrifice, primary neurorrhaphy or interposition grafting may be used. Cranial nerve substitution, gracilis free functional muscle transfer, and orthodromic temporalis tendon transfer are management options for long term facial paralysis.
Temporal bone, parotid gland, and cerebellopontine angle malignancies pose a tremendous risk to the facial nerve. When possible, the facial nerve is preserved. If the facial nerve is sacrificed, static and dynamic reanimation strategies are used to enhance facial function.
面神经在经过小脑脑桥角、颞骨和腮腺时的走行位置使神经在恶性肿瘤病例中面临风险。与表现为急性面肌瘫痪的贝尔氏麻痹不同，恶性肿瘤导致逐渐或波动性无力。
我们回顾了影响面神经的恶性肿瘤，包括涉及颞骨、腮腺和小脑脑桥角的肿瘤，以及转移性疾病。还回顾了面神经的术中管理和面瘫的长期管理。
颅底恶性肿瘤病例中面神经的术中管理可能涉及广泛暴露、神经移位或改道。在神经牺牲的情况下，可采用直接神经吻合或中间移植。对于长期面瘫，可以采用颅神经替代、股薄肌游离功能性肌转移和顺行颞肌肌腱转移等治疗方法。
颞骨、腮腺和小脑脑桥角恶性肿瘤对面神经构成巨大威胁。在可能的情况下，面神经被保留。如果面神经被牺牲，将使用静态和动态再神经化策略来增强面部功能。
