Su Diya, Wang Jieqing, Zhang Chen
Department of Plastic Surgery, Dalian University Affiliated Xinhua Hospital, Dalian Liaoning, 116000, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2022 Mar 15;36(3):315-321. doi: 10.7507/1002-1892.202111069.
To investigate the effectiveness of facial nerve-sublingual nerve parallel bridge anastomosis for facial nerve injury resulting from closed temporal bone fractures.
Between January 2017 and December 2019, 9 patients with facial nerve injury resulting from closed temporal bone fracture caused by head and face trauma were treated. Among them, 5 patients were treated with facial nerve-sublingual nerve parallel bridge anastomosis (operation group), and 4 patients were treated with neurotrophic drugs combined with rehabilitation exercise (conservative group). There was no significant difference in gender, age, side, cause of injury, duration of facial nerve injury before surgery, House-brackmann grading (hereinafter referred to as HB grading) of facial nerve injury, and other general information between 2 groups ( >0.05). HB grading was used to evaluate the improvement of facial nerve function before and after treatment. At the same time, facial nerve neuroelectrophysiological test was performed to evaluate the electrical activity of facial muscles before and after treatment. Tongue function, atrophy, and tongue deviation were evaluated after nerve anastomosis according to the tongue function scale proposed by Martins .
Patients in both groups were followed up 12-30 months, with an average of 25 months. None of the 5 patients in the operation group showed symptoms such as tongue muscle atrophy, tongue extension deviation, hypoglossal nerve dysfunction (mainly including slurred speech, choking with water), postoperative infection, bleeding, lower limb muscle atrophy or lower limb motor dysfunction after sural nerve injury. Postoperative skin sensory disturbance in lateral malleolus area was found, but gradually recovered to normal. During the follow-up, facial nerve and sublingual motor neurons were innervated to paralyzed facial muscle in the operation group. At last follow-up, the HB grading of 5 patients in the operation group improved from preoperative grade Ⅴ in 2 cases, grade Ⅵ in 3 cases to grade Ⅱ in 3 cases, grade Ⅲ in 1 case, and grade Ⅳ in 1 case. And in the conservative group, there were 1 patient with grade Ⅴ and 3 patients with grade Ⅵ before operation, facial asymmetry continued during follow-up, and only 2 patients improved from grade Ⅵ to grade Ⅴ at last follow-up. There was significant difference in prognosis HB grading between the two groups ( =5.693, =0.001). In the operation group, the amplitude and frequency of F wave were gradually improved, and obvious action potential could be collected when the facial muscle was vigorously contracted. On the contrary, there was no significant difference in neuroelectrophysiological results before and after treatment in the conservative group.
Facial nerve-sublingual nerve parallel bridge anastomosis can effectively retain the integrity of the facial nerve, while introducing the double innervation of the sublingual nerve opposite nerve, which is suitable for the treatment of severe incomplete facial nerve injury caused by closed fracture.
探讨面神经-舌下神经平行桥式吻合术治疗闭合性颞骨骨折所致面神经损伤的疗效。
选取2017年1月至2019年12月因头面部外伤致闭合性颞骨骨折引起面神经损伤的患者9例。其中，5例采用面神经-舌下神经平行桥式吻合术治疗（手术组），4例采用神经营养药物联合康复锻炼治疗（保守组）。两组患者在性别、年龄、患侧、受伤原因、术前面神经损伤持续时间、面神经损伤的House-brackmann分级（以下简称HB分级）等一般资料方面比较，差异无统计学意义（>0.05）。采用HB分级评估治疗前后面神经功能的改善情况。同时，进行面神经神经电生理测试，评估治疗前后面部肌肉的电活动情况。根据Martins提出的舌功能量表，在神经吻合术后评估舌功能、萎缩情况及舌偏斜情况。
两组患者均随访12 - 30个月，平均25个月。手术组5例患者术后均未出现舌肌萎缩、伸舌偏斜、舌下神经功能障碍（主要包括言语不清、饮水呛咳）、术后感染、出血、腓肠神经损伤后下肢肌肉萎缩或下肢运动功能障碍等症状。术后发现外踝区皮肤感觉障碍，但逐渐恢复正常。随访期间，手术组面神经和舌下运动神经元对面瘫面部肌肉进行了神经支配。末次随访时，手术组5例患者的HB分级从术前2例Ⅴ级、3例Ⅵ级改善为3例Ⅱ级、1例Ⅲ级、1例Ⅳ级。而保守组术前1例Ⅴ级、3例Ⅵ级，随访期间面部不对称持续存在，末次随访时仅2例从Ⅵ级改善为Ⅴ级。两组预后HB分级比较，差异有统计学意义（=5.693，=0.001）。手术组F波的波幅和频率逐渐改善，面部肌肉用力收缩时可采集到明显的动作电位。相反，保守组治疗前后神经电生理结果差异无统计学意义。
面神经-舌下神经平行桥式吻合术可有效保留面神经的完整性，同时引入舌下神经对面神经的双重神经支配，适用于闭合性骨折所致重度不完全性面神经损伤的治疗。
