Suzuki Yosuke, Noda Kosumo, Ota Nakao, Kondo Tomomasa, Haraguchi Kenichi, Miyoshi Norio, Kiko Katsunari, Yoshikawa Kohei, Ono Shun, Mizuno Hiroyuki, Okada Yasuaki, Takano Takuma, Yasuda Soichiro, Oda Jumpei, Kamiyama Hiroyasu, Tokuda Sadahisa, Tanikawa Rokuya
Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan.
Surg Neurol Int. 2023 Feb 10;14:47. doi: 10.25259/SNI_995_2022. eCollection 2023.
Several treatments for traumatic facial paralysis have been reported, but the role of surgery is still controversial.
A 57-year-old man was admitted to our hospital with head trauma due to a fall injury. A total body computed tomography (CT) scan showed a left frontal acute epidural hematoma associated with a left optic canal and petrous bone fractures with the disappearance of the light reflex. Hematoma removal and optic nerve decompression were performed immediately. The initial treatment was successful with complete recovery of consciousness and vision. The facial nerve paralysis (House and Brackmann scale grade 6) did not improve after medical therapy, and thus, surgical reconstruction was performed 3 months after the injury. The left hearing was lost entirely, and the facial nerve was surgically exposed from the internal auditory canal to the stylomastoid foramen through the translabyrinthine approach. The facial nerve's fracture line and damaged portion were recognized intraoperatively near the geniculate ganglion. The facial nerve was reconstructed using a greater auricular nerve graft. Functional recovery was observed at the 6-months follow-up (House and Brackmann grade 4), with significant recovery in the orbicularis oris muscle.
Interventions tend to be delayed, but it is possible to select a treatment method of the translabyrinthine approach.
已有多种治疗创伤性面瘫的方法被报道，但手术的作用仍存在争议。
一名57岁男性因跌倒致头部外伤入院。全身计算机断层扫描（CT）显示左侧额部急性硬膜外血肿，伴有左侧视神经管及岩骨骨折，光反射消失。立即进行了血肿清除和视神经减压术。初始治疗成功，意识和视力完全恢复。药物治疗后面神经麻痹（House-Brackmann分级6级）未改善，因此在受伤3个月后进行了手术重建。左侧听力完全丧失，通过经迷路入路从内耳道至茎乳孔手术暴露面神经。术中在膝状神经节附近识别出面神经骨折线和受损部分。使用耳大神经移植重建面神经。6个月随访时观察到功能恢复（House-Brackmann分级4级），口轮匝肌有明显恢复。
干预往往延迟，但经迷路入路的治疗方法是可行的。
