Megerian C A, McKenna M J, Ojemann R G
Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, USA.
Am J Otol. 1996 Jul;17(4):630-3.
Patients with satisfactory facial nerve function [House-Brackmann (HB) grade I or II] immediately after acoustic neuroma surgery are at risk for delayed facial paralysis. To study this problem, 255 consecutive patients who underwent acoustic neuroma excision with facial nerve preservation were identified. Delayed facial paralysis occurred in 62 (24.3%) patients; 90% ultimately recovered to their initial postoperative HB grade, and 98.3% recovered to within one grade of their initial HB level. Paralysis occurred at an average of 3.65 postoperative days (range, 1-16 days). The average time to maximal recovery for those with changes of 1, 2, 3, and 4 HB grades was 5.6, 21.5, 39.8, and 50.5 weeks, respectively. The early onset of paralysis (< 48 h after surgery) resulted in shorter average recovery times. Of patients who demonstrated nerve deterioration to grades IV-VI, 20 of 38 required tarsorrhaphy or gold-weight placement. We conclude that the over-whelming majority of patients with delayed facial paralysis after acoustic neuroma surgery do eventually recover to their postoperative HB grade. The magnitude and timecourse of delayed facial paralysis are predictive factors for subsequent recovery.
听神经瘤手术后即刻面神经功能满意[House-Brackmann（HB）分级为I或II级]的患者存在迟发性面瘫风险。为研究这一问题，我们确定了255例连续接受听神经瘤切除并保留面神经的患者。62例（24.3%）患者发生迟发性面瘫；90%最终恢复至术后初始HB分级，98.3%恢复至距初始HB分级相差一个等级以内。面瘫平均发生在术后3.65天（范围1 - 16天）。HB分级变化1、2、3和4级患者的平均最大恢复时间分别为5.6、21.5、39.8和50.5周。早期面瘫（术后<48小时）导致平均恢复时间较短。在神经功能恶化至IV - VI级的患者中，38例中有20例需要睑裂缝合或植入金片。我们得出结论，听神经瘤手术后迟发性面瘫的绝大多数患者最终确实恢复至术后HB分级。迟发性面瘫的严重程度和病程是后续恢复的预测因素。
