Nilssen E L, Wormald P J
Department of Otolaryngology, Groote Schuur Hospital, Cape Town, R.S.A.
J Laryngol Otol. 1997 Feb;111(2):113-6. doi: 10.1017/s0022215100136618.
The risk of facial nerve injury during mastoid surgery has decreased substantially since the advent of the microscope and the otological drill. However, the facial nerve remains at risk during mastoid surgery with the present day incidence suggested to be one per cent. Despite the severity of this complication there are no recent studies that accurately quantify the incidence or discuss its management. The aims of this study were to identify the risk of facial nerve injury for both the specialist as well as the trainee specialist and to review a management protocol for this complication. During the 10-year period from 1985 to 1994, 1024 consecutive mastoidectomies were reviewed. A total of 17 palsies was identified, seven were complete and 10 were incomplete. Of the seven complete palsies, four patients had decompression only and recovered to House Brackmann Grade 2 or better while three patients had decompression and grafting, of these, two were available for follow-up and recovered to House Brackmann Grade 4 only. All the partial palsies, barring one lost to follow-up, who were treated conservatively with pack removal, toilet and topical therapy recovered to House Brackmann Grade 2 or better. A management protocol followed for the above patients is presented and the results analysed. Specific operations and manoeuvres which may put the facial nerve at risk intra-operatively are also discussed.
自显微镜和耳科钻问世以来，乳突手术中面神经损伤的风险已大幅降低。然而，在当今的乳突手术中，面神经仍有受损风险，目前报道的发生率约为1%。尽管这种并发症很严重，但近期尚无研究能准确量化其发生率或探讨其处理方法。本研究的目的是确定专科医生和专科培训生在乳突手术中面神经损伤的风险，并回顾针对该并发症的处理方案。在1985年至1994年的10年期间，对连续1024例乳突切除术进行了回顾。共发现17例面神经麻痹，其中7例为完全性麻痹，10例为不完全性麻痹。在7例完全性麻痹中，4例患者仅接受了减压手术，恢复至House - Brackmann 2级或更好；3例患者接受了减压和移植手术，其中2例可进行随访，仅恢复至House - Brackmann 4级。除1例失访外，所有不完全性麻痹患者均采用保守治疗，包括取出填塞物、清理术腔和局部治疗，均恢复至House - Brackmann 2级或更好。本文介绍了上述患者所遵循的处理方案并分析了结果。还讨论了术中可能使面神经处于危险中的具体手术操作。
