Thielker Jovanna, Kouka Mussab, Guntinas-Lichius Orlando
Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
Fazialis-Nerv-Zentrum, Universitätsklinikum Jena, Jena, Deutschland.
HNO. 2023 Apr;71(4):232-242. doi: 10.1007/s00106-022-01148-y. Epub 2022 Mar 14.
Handling of the facial nerve during surgery for parotid cancer is relevant for the patient's long-term quality of life. In about two thirds of cases, the facial nerve is not affected by the tumor. In these cases, in addition to complete tumor resection, identification and preservation of the facial nerve are important components of a successful operation. If the nerve is infiltrated by the tumor, the affected part must be resected during radical parotidectomy. When possible, primary nerve reconstruction leads to the best long-term cosmetic and functional outcomes. Individual selection of the optimal treatment concept is based on clinical examination of facial muscle mobility, preoperative imaging to understand the positional relationship between tumor and nerve, and on the basis of an electrophysiological examination of nerve function. Intraoperatively, standardized dissection helps to identify and preserve the facial nerve. If radical parotidectomy is indicated, in addition to one-step reconstruction, preoperative diagnostic tests can help to plan postoperative adjuvant therapy. The aim of rehabilitation is restoration of facial tone, facial symmetry, and movement of the paralyzed face. Restoration of eye closure is of high importance. The surgical treatment of facial paralysis has seen many improvements in recent years. The present work provides an overview of the most recent advances in diagnostics, surgical techniques, and further possibilities for preventing damage to the normal facial nerve during parotid cancer treatment. Furthermore, the options for rehabilitation of the tumor-infiltrated facial nerve in the context of treatment of salivary gland malignancies are described.
在腮腺癌手术中处理面神经与患者的长期生活质量相关。在大约三分之二的病例中，面神经未受肿瘤影响。在这些病例中，除了完整切除肿瘤外，识别和保留面神经是成功手术的重要组成部分。如果神经被肿瘤浸润，在根治性腮腺切除术中必须切除受影响的部分。在可能的情况下，一期神经重建可带来最佳的长期美容和功能效果。最佳治疗方案的个体化选择基于对面部肌肉活动度的临床检查、术前影像学检查以了解肿瘤与神经的位置关系，以及基于神经功能的电生理检查。术中，标准化解剖有助于识别和保留面神经。如果需要进行根治性腮腺切除术，除了一期重建外，术前诊断测试有助于规划术后辅助治疗。康复的目的是恢复面部张力、面部对称性以及瘫痪面部的运动。恢复闭眼功能至关重要。近年来，面瘫的外科治疗有了许多改进。本研究概述了腮腺癌治疗中诊断、手术技术的最新进展以及预防正常面神经损伤的更多可能性。此外，还描述了在唾液腺恶性肿瘤治疗背景下对肿瘤浸润面神经进行康复治疗的选择。
