Sun Pengcheng, Wang Haibo, Jiang Zhen, Li Li, Fan Zhaomin, Han Yuechen
Department of Otolaryngology-Head and Neck Surgery，Shandong Provincial ENT Hospital，Shandong University，Jinan，250022，China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2024 May;38(5):405-410. doi: 10.13201/j.issn.2096-7993.2024.05.011.
To summarize the clinical characteristics and therapeutic effect of traumatic facial nerve palsy. Sixty-eight cases of traumatic facial nerve palsy were retrospectively analyzed from January 2015 to May 2023. The median course of disease was 33 days. The facial nerve function of the patients was grade HB-Ⅱin 2 cases, grade HB-Ⅲ in 4 cases, grade HB-Ⅳin 16 cases, grade HB-Ⅴ in 37 cases（38 ears）, and grade HB-Ⅵ in 9 cases. 42 cases occurred immediately after injury and 26 cases were delayed. CT examination of temporal bone revealed longitudinal fractures in 51 cases（52 ears） , transverse fractures in 6 cases and mixed fractures in 4 cases. No definite temporal bone fracture was found in the remaining 7 cases. The segments of facial nerve injury in 49 cases（50 ears） were geniculate ganglion and adjacent, in 7 cases were vertical segment, in 7 cases were horizontal segment, in 2 cases were horizontal segment and vertical segment; and the other 3 cases could not be evaluated. Conservative treatment with glucocorticoids was used in 23 ears and surgery was used in 46 ears. Patients were followed up 6-24 months after treatment, including 20 cases of grade HB-Ⅰ, 19 cases of grade HB-Ⅱ, 23 cases（24 ears） of grade HB-Ⅲ, 4 cases of grade HB-Ⅳ, and 1 case of grade HB-Ⅴ.One patient was lost to follow-up. After treatment, the facial nerve function of patients was significantly improved（<0.05）, and there were significant differences between conservative treatment group and surgical treatment group in the course of facial nerve palsy, the ratio of facial palsy immediately after injury, the nerve function before treatment and the nerve function after treatment（<0.05）. There were no significant differences in age, sex, hearing condition, temporal bone fracture, facial nerve injury segment and rate of favorable neurologic outcomes（>0.05）. The comparison of patients with neurodegeneration rate>90% and ≤90% showed that the facial nerve function of patients with neurodegeneration rate>90% before treatment was significantly worse（<0.05）, but there was no significant difference between the facial nerve function after treatment（>0.05）. There was no significant difference in facial nerve function between middle fossa approach group and mastoid approach group（>0.05）. Patients with traumatic facial nerve palsy should be evaluated individually. Patients with mild facial nerve palsy, low neurodegeneration rate and short course of disease can be treated conservatively and followed up closely. Patients with severe facial nerve palsy, high neurodegeneration rate and more than 6 weeks of disease can be actively considered surgery. Good prognosis can be obtained by correct evaluation and treatment.
总结外伤性面神经麻痹的临床特征及治疗效果。回顾性分析2015年1月至2023年5月期间68例外伤性面神经麻痹患者的临床资料。疾病中位病程为33天。患者面神经功能：HB-Ⅱ级2例，HB-Ⅲ级4例，HB-Ⅳ级16例，HB-Ⅴ级37例（38耳），HB-Ⅵ级9例。伤后立即发病42例，延迟发病26例。颞骨CT检查示纵行骨折51例（52耳），横行骨折6例，混合性骨折4例，其余7例未发现明确的颞骨骨折。49例（50耳）面神经损伤部位在膝状神经节及其附近，7例在垂直段，7例在水平段，2例在水平段和垂直段，另3例无法评估。23耳采用糖皮质激素保守治疗，46耳采用手术治疗。治疗后对患者进行6～24个月随访，随访结果：HB-Ⅰ级20例，HB-Ⅱ级19例，HB-Ⅲ级23例（24耳），HB-Ⅳ级4例，HB-Ⅴ级1例。失访1例。治疗后患者面神经功能明显改善（P<0.05），保守治疗组与手术治疗组在面神经麻痹病程、伤后立即面瘫比例、治疗前神经功能及治疗后神经功能方面比较，差异有统计学意义（P<0.05）。在年龄、性别、听力情况、颞骨骨折、面神经损伤部位及神经功能良好率方面比较，差异无统计学意义（P>0.05）。神经变性率>90%与≤90%的患者比较，治疗前神经变性率>90%的患者面神经功能明显较差（P<0.05），但治疗后面神经功能差异无统计学意义（P>0.05）。中颅窝入路组与乳突入路组面神经功能差异无统计学意义（P>0.05）。外伤性面神经麻痹患者应个体化评估。面神经麻痹程度轻、神经变性率低、病程短的患者可保守治疗并密切随访。面神经麻痹程度重、神经变性率高、病程超过6周的患者可积极考虑手术治疗。正确评估及治疗可获得良好预后。
