Fan Shuhang, Sun Jianbin, Wang Qin, Sai Na, Ji Qi, Zhu Yuhua, Shen Weidong, Dai Pu, Yang Shiming, Han Dongyi, Han Weiju
Medical School of Chinese PLA，Beijing，100853，China.
Senior Department of Otolaryngology Head and Neck Surgery，Chinese PLA General Hospital，Chinese PLA Medical School.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2024 May;38(5):395-399. doi: 10.13201/j.issn.2096-7993.2024.05.009.
To investigate the characteristics and prognosis of two anastomosis techniques in repairing facial nerve defects. A retrospective analysis was conducted on 30 patients who underwent facial nerve anastomosis（direct or rerouting） for facial nerve defects in our department from January 2012 to December 2021. Among them, 21 were male and 9 were female, with an average age of（37.53±11.33） years, all with unilateral onset. Preoperative House-Brackmann（H-B） facial nerve function grades were Ⅳ in 2 cases, Ⅴ in 9 cases, and Ⅵin 19 cases. The duration of facial paralysis before surgery was within 6 months in 21 cases, 6-12 months in 6 cases, and over 1 year in 3 cases. The causes of facial paralysis included 14 cases of cholesteatoma, 6 cases of facial neurioma, 6 cases of trauma, and 4 cases of middle ear surgery injury. Surgical approaches included 9 cases of the middle cranial fossa approach, 8 cases of labyrinthine-otic approach, 7 cases of mastoid-epitympanum approach, and 6 cases of retroauricular lateral neck approach. All patients were followed up for more than 2 years. The direct anastomosis was performed in 10 cases: 6 cases with defects located in the extratemporal segment and 4 cases in the tympanic segment. Rerouting anastomosis was performed in 20 cases: 11 cases with defects located in the labyrinthine-geniculate ganglion, 4 cases from the internal auditory canal to the geniculate ganglion, 3 cases in the internal auditory canal, and 2 cases in the horizontal-pyramid segment. Postoperative H-B facial nerve grades were Ⅱ in 2 cases, Ⅲ in 20 cases, and Ⅳ in 8 cases, with 73.3%（22/30） of patients achieving H-B grade Ⅲ or better. Both direct and rerouting anastomosis techniques can effectively repair facial nerve defects, with no significant difference in efficacy between the two techniques. Most patients can achieve H-B grade Ⅲ or better facial nerve function recovery. Preoperative facial nerve function and duration of facial paralysis are the main prognostic factors affecting the outcome of facial nerve anastomosis.
探讨两种面神经吻合技术修复面神经缺损的特点及预后。对2012年1月至2021年12月在我科因面神经缺损行面神经吻合术（直接或改道）的30例患者进行回顾性分析。其中，男性21例，女性9例，平均年龄（37.53±11.33）岁，均为单侧发病。术前House-Brackmann（H-B）面神经功能分级：Ⅳ级2例，Ⅴ级9例，Ⅵ级19例。术前面瘫时间：21例在6个月以内，6~12个月6例，超过1年3例。面瘫原因包括胆脂瘤14例、面神经瘤6例、外伤6例、中耳手术损伤4例。手术入路包括中颅窝入路9例、迷路-耳内入路8例、乳突-上鼓室入路7例、耳后外侧颈部入路6例。所有患者均随访2年以上。直接吻合10例：颞外段缺损6例，鼓室段缺损4例。改道吻合20例：迷路-膝状神经节缺损11例，内耳道至膝状神经节缺损4例，内耳道缺损3例，水平-锥段缺损2例。术后H-B面神经分级：Ⅱ级2例，Ⅲ级20例，Ⅳ级8例，73.3%（22/30）的患者达到H-BⅢ级或更好。直接吻合和改道吻合技术均能有效修复面神经缺损，两种技术疗效差异无统计学意义。大多数患者可实现H-BⅢ级或更好的面神经功能恢复。术前面神经功能及面瘫时间是影响面神经吻合术效果的主要预后因素。
