Lauda Lorenzo, Sykopetrites Vittoria, Caruso Antonio, Maddalone Enrico, Di Rubbo Vittoria, Copelli Chiara, Sanna Mario
Department of Otology and Skull Base Surgery, Gruppo Otologico, Casa Di Cura "Piacenza" S.P.A, Piacenza-Rome, Italy.
Mario Sanna Foundation, Piacenza, Italy.
Eur Arch Otorhinolaryngol. 2024 Dec;281(12):6653-6659. doi: 10.1007/s00405-024-08866-9. Epub 2024 Aug 2.
Lateral skull base (LSB) and middle ear pathologies often involve the facial nerve (FN), and their treatment may require FN sacrifice. Cases with unidentifiable proximal stump or intact FN with complete FN palsy, necessitate FN anastomosis with another motor nerve in order to restore innervation to the mimicking musculature. The results of hypoglossal-to-facial nerve anastomosis (HFA) and masseteric-facial nerve anastomosis in patients with facial paralysis after middle ear and LSB surgeries, are presented and compared.
Adult patients with total definitive facial paralysis after middle ear or LSB surgery undergoing facial nerve reanimation through hypoglossal or masseteric transfer anastomosis were enrolled. The facial nerve function was graded according to the House Brackmann grading system (HB). The facial function results at 3 months, 6 months, 12 months, 18 months and at the last follow up (more than 18 months) are compared.
153 cases of LSB and middle ear surgery presented postoperative facial palsy and underwent facial nerve reanimation surgery with HF in 85 patients (55.5%) and MF in 68 patients (44.5%). The duration of the FN palsy before reconstructive surgery was inversely associated to better FN results, in particular with having a grade III HB (p = 0.003). Both techniques had significantly lower HB scores when an interval between palsy onset and reanimation surgery was 6 months or less (MF p = 0.0401; HF p = 0.0022). Patients who underwent a MF presented significant improvement of the FN function at 3 months from surgery (p = 0.0078). At the last follow-up, 63.6% recovered to a grade III HB and 22.7% to a grade IV. On the other hand, the first significant results obtained in the HF group were at 6 months from surgery (p < 0.0001). 67.8% of patients had a grade III HB after a HF at the last follow-up, 28.8% a grade IV. FN grading at 6 months from surgery was significantly lower in the MF group compared to the HF (p = 0.0351). The two techniques had statistically similar results at later follow-up evaluations.
DISCUSSION/CONCLUTION: MF was associated to initial superior results, presenting significant facial recovery at 3 months, and significantly better functional outcomes at 6 months from surgery compared to HF. Although later results were not significantly different in this study, earlier results have an important role in order to limit the duration of risk of corneal exposure.
侧颅底（LSB）和中耳病变常累及面神经（FN），其治疗可能需要牺牲面神经。对于近端残端无法辨认或面神经完整但出现完全性面神经麻痹的病例，需要将面神经与另一运动神经进行吻合，以恢复表情肌的神经支配。本文展示并比较了中耳和侧颅底手术后面神经麻痹患者行舌下神经-面神经吻合术（HFA）和咬肌神经-面神经吻合术的结果。
纳入成年患者，这些患者在中耳或侧颅底手术后出现完全性确定性面神经麻痹，并通过舌下神经或咬肌神经移位吻合术进行面神经重建。根据House Brackmann分级系统（HB）对面神经功能进行分级。比较术后3个月、6个月、12个月、18个月及最后一次随访（超过18个月）时的面部功能结果。
153例侧颅底和中耳手术患者术后出现面神经麻痹，其中85例（55.5%）患者接受了舌下神经-面神经吻合术（HF），68例（44.5%）患者接受了咬肌神经-面神经吻合术（MF）。重建手术前面神经麻痹的持续时间与更好的面神经恢复结果呈负相关，尤其是HB分级为III级时（p = 0.003）。当麻痹发作与重建手术之间的间隔为6个月或更短时，两种技术的HB评分均显著较低（MF，p = 0.0401；HF，p = 0.0022）。接受咬肌神经-面神经吻合术的患者在术后3个月时面神经功能有显著改善（p = 0.0078）。在最后一次随访时，63.6%的患者恢复到HB III级，22.7%恢复到IV级。另一方面，舌下神经-面神经吻合术组在术后6个月时首次取得显著效果（p < 0.0001）。在最后一次随访时，67.8%接受舌下神经-面神经吻合术的患者达到HB III级，28.8%达到IV级。与舌下神经-面神经吻合术组相比，咬肌神经-面神经吻合术组在术后6个月时的面神经分级显著更低（p = 0.0351）。在后期随访评估中，两种技术的结果在统计学上相似。
讨论/结论：咬肌神经-面神经吻合术与早期更好的结果相关，在术后3个月时面部恢复显著，与舌下神经-面神经吻合术相比，术后6个月时功能结果显著更好。尽管在本研究中后期结果无显著差异，但早期结果对于限制角膜暴露风险的持续时间具有重要作用。
