Pulec J L
Pulec Ear Clinic, University of Southern California School of Medicine, Los Angeles 90017.
Ear Nose Throat J. 1994 Oct;73(10):721-2, 725-39, 743-52.
Facial nerve neuromas are uncommon, slow-growing neoplasms that may occur anywhere along the course of the facial nerve from the brainstem to the facial muscles. The signs and symptoms are characteristic and vary with the anatomic site of origin. Surgery should not be attempted until a complete and thorough diagnostic examination has been completed. The surgeon should be prepared to perform a middle-cranial fossa or translabyrinthine approach in all cases, and must expect to do a nerve graft. The results of 37 patients treated by the author reveal that, under optimal conditions, patients who have had a facial nerve graft, can be expected to regain an average of 80% facial nerve strength in almost every case. All patients who have had a facial nerve graft will have some degree of synkinesis. No graft was required in 3 patients, and a hypoglossal facial anastomosis was used for one. Facial function was completely normal in 2 patients, 16 had 80-90% return, 5 patients had 50-80% return, 4 had 20-50% return, one had no recovery at all and 9 recent patients have not reached the time for their expected recovery. Early diagnosis, prompt surgical removal and VII-VII Nerve graft for facial paralysis of ten or fewer years duration offers patients the best opportunity to avoid a permanent facial palsy.
面神经神经瘤并不常见，生长缓慢，可发生于从脑干至面部肌肉的面神经走行的任何部位。其体征和症状具有特征性，并因起源的解剖部位而异。在完成全面彻底的诊断检查之前，不应尝试手术。外科医生在所有病例中都应准备好采用中颅窝或经迷路入路，并且必须预期要进行神经移植。作者治疗的37例患者的结果显示，在最佳条件下，接受面神经移植的患者几乎在每种情况下平均可恢复80%的面神经功能强度。所有接受面神经移植的患者都会有一定程度的联动。3例患者无需移植，1例采用舌下-面神经吻合术。2例患者面部功能完全正常，16例恢复80%-90%，5例恢复50%-80%，4例恢复20%-50%，1例完全未恢复，9例近期患者尚未达到预期恢复时间。早期诊断、及时手术切除以及对病程在十年或更短时间的面瘫患者进行VII-VII神经移植，为患者提供了避免永久性面瘫的最佳机会。
