Song Xinyu, Wang Line, Gong Shusheng
Department of Otorhinolaryngology Head and Neck Surgery，Beijing Friendship Hospital，Capital Medical University，Beijing，100050，China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020 Dec;34(12):1112-1114. doi: 10.13201/j.issn.2096-7993.2020.12.013.
To investigate the possible causes, prevention, treatment and recovery of delayed facial paralysis after middle ear surgery. A retrospectively analysis of the data of 8 patients with delayed facial paralysis after middle ear surgery under general anesthesia, including one case of tympanoplasty （type Ⅰ） , one case of tympanotomy+tympanoplasty c（type Ⅰ） , one case ofepitympanotomy+reconstruction of attic lateral wall+tympanoplasty （type Ⅱ ）, four cases of canal wall down+tympanoplasty （ type Ⅱ） and one case of canal wall up mastoidectomy. After discovering the facial paralysis, the stuffing in the surgical cavity was released and removed for all patients immediately. Necessary stuffing was replaced by dexamethasone gauze （not press hardl）. Meanwhile, patients took methylprednisolone orally and were intramuscularly injected with mecobalamine. Among eight patients, there were six patients with horizontal exposure of facial nerve and two patients with pyramis exposure of facial nerve. There was one case, five cases and two cases of delayed facial paralysis at five days, one week and two weeks after operation respectively. There were six patients suffering from the facial paralysis of HB Ⅱ grade and two patients suffering from the facial paralysis of HB Ⅲ grade. Four patients recovered four weeks and the remaining four patients returned to normal six weeks after surgery. Delayed facial paralysis is one of complications of the middle ear surgery, and most of patients can recover completely after conservative treatment.
探讨中耳手术后迟发性面瘫的可能原因、预防、治疗及恢复情况。回顾性分析8例全麻下中耳手术后发生迟发性面瘫患者的数据，其中包括1例Ⅰ型鼓室成形术、1例鼓室切开+Ⅰ型鼓室成形术、1例上鼓室切开+上鼓室外侧壁重建+Ⅱ型鼓室成形术、4例开放式乳突根治+Ⅱ型鼓室成形术及1例完壁式乳突根治术。发现面瘫后，立即为所有患者松解并清除术腔填充物。必要的填充物用含地塞米松的纱布替代（不要用力按压）。同时，患者口服甲泼尼龙并肌肉注射甲钴胺。8例患者中，6例面神经水平段暴露，2例面神经锥段暴露。术后5天、1周及2周分别有1例、5例及2例发生迟发性面瘫。6例患者为HBⅡ级面瘫，2例患者为HBⅢ级面瘫。4例患者术后4周恢复，其余4例患者术后6周恢复正常。迟发性面瘫是中耳手术的并发症之一，大多数患者经保守治疗后可完全恢复。
