首页 | 本学科首页   官方微博 | 高级检索  
相似文献
 共查询到20条相似文献,搜索用时 31 毫秒
1.
面神经周围微血管丛分布的临床研究   总被引:4,自引:0,他引:4  
目的为尽可能避免医源性面神经麻痹,评估面神经水平段周围微血管丛是否可以作为耳显微或耳神经外科术中面神经的定位标志。方法从2002年7月至2005年7月,共311例因慢性中耳炎、周围性面神经麻痹以及外耳道闭锁合并中耳畸形者,分别行开放式鼓室成形术(291例)、面神经减压术(10例)和先天性耳道闭锁和中耳畸形手术(10例)。观察和评估水平段面神经周围的微血管丛作为术中定位面神经的手术标志的有效性。结果在全部病例中,有95.8%的病例(298例)手术中可满意地观察到水平段面神经周围微血管丛,位于面神经鼓室段表面,仅4.2%的病例(13例)难以在水平段面神经周围发现该微血管丛。用面神经微血管判断水平段面神经管阳性率的95%可信区间为93.6%~98.0%。结论围绕在水平段面神经周围或表面的微血管丛,可作为术中及早且直接定位面神经的手术标志,用它来迅速确定面神经水平段是可靠的。  相似文献   

2.
Facial paralysis presents an interesting diagnostic challenge. Etiologies ranging from facial nerve neuromas and CPA tumors to inflammatory disease and traumatic injuries need be considered and evaluated. However, an asymmetric facial appearance may result from abnormalities of facial musculature as well as facial innervation. Two cases of congenital hypoplasia of the depressor anguli oris muscle, a child and an adult, are reviewed to examine its presentation and diagnostic differentiation from other forms of facial paralysis. Photographs presenting the facial deformity and electrodiagnostic studies will be reviewed.  相似文献   

3.
BACKGROUND: Solitary intraparotid facial neurofibromas are extremely rare. These tumours arise from Schwann cells, in most cases as a manifestation of neurofibromatosis. In an intraparotid localisation, they can mimic other parotideal tumours. Due to their slow growth, they may be clinically inapparent for a long time. CASE REPORT: We present the case of a patient with a right intraparotid neurofibroma originating from the facial nerve. He noted a slight facial weakness for the last three years and dullness over the preauricular area. On operation, all facial nerve branches were incorporated in the tumour mass. A total resection via monitoring technique of facial nerve function was performed. Postoperatively, the patient suffered from an incomplete facial palsy. CONCLUSION: This case highlights particularly the importance of a concise diagnostic work-up of every facial palsy. Precise histological diagnosis is particularly essential because of the different biological behaviour of neurofibromas in contrast to neurinomas. With preoperative facial palsy the chance of facial nerve preservation decreases. Clinical and operative experience with parotid gland neurofibromas shows that recovery of facial nerve defects is mostly incomplete.  相似文献   

4.
OBJECTIVE: The terminal of the sympathetic nerve fibers of the rat facial nerve in the temporal bone region was investigated. MATERIAL AND METHODS: We used tyrosine hydroxylase (TH) and the synaptophysin antibody as markers of the sympathetic nerve fiber and the membrane of the synaptic vesicle, respectively. Using immunohistochemistry, we determined whether and where the synapse exists in the facial nerve of the Sprague-Dawley rat. RESULTS: TH-immunoreactive fibers were confirmed as being present in both the epineurium and the nerve fascicle of the facial nerve. A synaptophysin immunoreaction was found in the facial nerve in a region of the temporal bone. These reaction products looked like varicosities. Most TH-positive fibers in the facial nerve disappeared after superior cervical ganglionectomy. CONCLUSIONS: As the synaptophysin immunoreaction indicates the existence of a synapse, we speculate that the sympathetic fibers affect the facial nerve in the region of the temporal bone. Further studies may be needed to elucidate the function of the sympathetic system in the facial nerve.  相似文献   

5.
The pressure lowering effect of glycerol and mannitol on the interstitial fluid pressure of the facial nerve was studied in normal guinea pigs. The effect of low-molecular dextran on the interstitial fluid pressure of the facial nerve was also studied. Both peroral administration of glycerol and intravenous administration of mannitol lowered the interstitial fluid pressure of the facial nerve as well as the cerebrospinal fluid pressure. The pressure decrease in the facial nerve may be the result of a decreased cerebrospinal fluid pressure, caused by the administration of glycerol or mannitol. Low-molecular dextran did not cause significant pressure changes in the facial nerve.  相似文献   

6.
Facial nerve paralysis in children may occur as a complication of infections, trauma, or rarely from benign or malignant tumors of the facial nerve. We present the first reported case of a dermoid tumor in the facial nerve causing facial paralysis in a child. Case report at a tertiary Children's Hospital. A 9-month-old was referred to our institution for evaluation of persistent, complete right sided facial paralysis three months after receiving a diagnosis of Bell's palsy. A workup at our institution including MRI and CT revealed marked widening of the facial canal in the mastoid segment consistent with facial nerve schwannoma or hemangioma. Surgical exploration via mastoidectomy and facial nerve decompression revealed keratinous material containing hair that had fully eroded the facial nerve, disrupting it completely. The entire tumor was removed along with the involved segment of facial nerve, and the missing facial nerve segment was cable grafted. Histological examination of the tumor confirmed a ruptured dermoid cyst in the facial nerve. Facial nerve tumors are rare causes of facial paralysis in children, accounting for fewer than 10% of cases of facial paralysis in the pediatric population. Dermoid cyst can occur throughout the head and neck region in children, but a dermoid tumor in the facial nerve has not been described in the literature prior to this report. This represents a new and uncommon diagnostic entity in the evaluation of facial nerve paralysis in children. Appropriate imaging studies and pathology slides will be reviewed.  相似文献   

7.
Lack of uniformity in reporting facial nerve recovery in patients with facial nerve paralysis has been a major disadvantage in comparing treatment modalities. To remove subjectivity from the analysis, we devised a facial paralysis recovery profile as a system for measuring facial motion. This profile has been used since 1968 at Kaiser Permanente Medical Center, Oakland, California. The House facial paralysis grading system was introduced in 1983 for clinical use and was modified by Brackmann in 1985. This latter system has since been accepted by the American Academy of Otolaryngology-Head and Neck Surgery in the United States as the standard used in reporting results. In a prospective study of 54 patients, we tested multiple parameters that affect accurate reporting. We tested reliability and accuracy of facial measurements by using 30 control subjects and 3 independent examiners. We used Pearson correlation coefficients to statistically analyze results. To compare our system with the House-Brackmann grading system, we measured facial motions of 24 patients randomly selected from our data bank. All had incomplete returns of facial function and facial defects associated with faulty regeneration of a partially denervated facial nerve. Our overall results show defects in the House-Brackmann system which should be addressed. We offer the Adour-Swanson grading system as a reliable, easy-to-use, suitable alternative to the House-Brackmann system.  相似文献   

8.
目的 尝试建立T细胞免疫缺陷小鼠面瘫模型,并运用形态学技术分析免疫缺陷小鼠的面神经损伤特点,深入探讨面神经修复再生的神经免疫病理机制提供实验基础。方法 切断裸鼠面神经出茎乳孔主干,于术后2周灌注固定动物,收集脑干切片,荧光金逆行示踪技术标记面运动神经元损伤情况,并结合面神经周围主干锇酸染色情况分析裸鼠面神经损伤特点。结果 术后观察免疫缺陷小鼠面瘫出现情况,如瞬目反射、触须拂动、鼻尖方向、耳廓运动等均出现典型的完全周围性面瘫,术后14d裸鼠右侧面神经损伤远端锇酸染色显示面神经重度变性。面瘫小鼠面神经核团可见“健康”、“受损”、“死亡”的各型面运动神经元。T细胞免疫缺陷小鼠与野生型小鼠面神经核团计数有显著性差异。结论 T细胞免疫缺陷的小鼠创伤性面瘫模型稳定、可行,为进一步深入揭示外伤性面瘫发生与演进过程中以T细胞行为研究为中心的神经免疫病理机制提供了实验基础。  相似文献   

9.
Lesions producing facial nerve palsy may occur within the temporal bone anywhere between the internal auditory canal and the stylomastoid foramen. Surgical exposure of this nerve may be necessary for decompression, grafting, rerouting, or removal of such lesions as acoustic tumour, meningioma, facial nerve neuroma, and cholesteatoma. Contemporary surgical exposure of the facial nerve has as its aim adequate exposure of the facial nerve at any point in its course, with preservation of hearing and vestibular function, without further injury to the facial nerve and the necessity for producing a mastoid cavity. When hearing and balance function are present, the transcanal-transtympanic approach to the horizontal segment of the facial nerve offers limited access to the facial nerve in its tympanic course. Wider exposure is obtained by postauricular transmastoid exposure of the tympanic and mastoid portions of the facial nerve. The middle fossa approach to the facial nerve offers access to the internal auditory canal and labyrinthine portions of the nerve, whereas the retrolabyrinthine approach offers access to the facial nerve in the posterior fossa. Total facial nerve exposure with preservation of hearing and balance function is obtained by the combined transmastoid and middle cranial fossa approach. In individuals who have lost all function of hearing and balance, the postauricular translabyrinthine approach offers total exposure of the facial nerve within the temporal bone and posterior fossa. The aim of this discussion was to present in succinct fashion a systematized approach to surgical exposure of the facial nerve within the temporal bone and posterior fossa.  相似文献   

10.
Clin. Otolaryngol. 2012, 37 , 181–187 Objectives: To evaluate the Glasgow Facial Palsy Scale as a tool to assess facial reanimation surgery in facial palsy. Software analysis of digital video data is used to measure facial movements, comparing the affected to the normal side. We present the first use of the Glasgow Facial Palsy Scale following facial re‐animation surgery. Design: A comparison of the Glasgow Facial Palsy Scale against the Nottingham scoring system. Subjects undergoing unilateral surgical smile reanimation procedures were selected. Comparison was made with the Nottingham facial palsy scale and the House‐Brackmann Scale pre‐ and postoperatively. Setting: Patients were recruited in the facial palsy clinic of Canniesburn Plastic Surgery Unit, Glasgow. Participants: Seven consecutive patients were selected who were due to undergo unilateral facial reanimation. Main outcome measures: The difference in pre‐ and post‐surgical facial movement as measured using the Glasgow Facial Palsy Scale with this value being compared to that obtained using the Nottingham scoring system. Note was also taken of the correlation with House‐Brackmann system and clinical correlation. Results and Conclusions: Statistical analysis indicated a linear relationship between the Glasgow Facial Palsy Scale and the Nottingham System. The Pearson correlation test was used to confirm the relationship between the two methods giving a result of ?0.587, which indicates significant correlation between the two methods. We conclude that the Glasgow Facial Palsy Scale is a standardised objective method of assessing the change in facial movement following smile reanimation surgery. We commend it as a useful tool to objectively assess surgical results in this challenging field.  相似文献   

11.
Temporalis muscle transposition is a reliable surgical technique for the reanimation of patients with long-standing facial paralysis. It is often employed when facial nerve reinnervation via crossover or cable grafting is not possible. Temporalis muscle transposition can also be used for the immediate treatment of complete facial paralysis due to insults leaving the facial nerve anatomically intact but requiring a prolonged recovery time (more than 1 year). Because temporalis muscle transposition does not interfere with neuronal regeneration, it may be employed early in the management of complete facial paralysis when recovery is predicted to be extended and incomplete. The authors report their experience with early temporalis muscle transposition in the management of facial paralysis in 56 patients with an anatomically intact facial nerve. More than 90% of these patients achieved improved symmetry at rest as well as purposeful movement at the corner of the mouth. In the last 30 patients, the temporoparietal fascial flap was simultaneously harvested and successfully used to obliterate the donor site defect. In conjunction with the immediate implantation of a gold weight in the ipsilateral upper eyelid, this approach to the early management of facial paralysis helps reduce the period of facial disability from years to weeks in a select group of patients.  相似文献   

12.
Facial nerve schwannoma is a very rare benign tumor representing less than 1% of intrapetrous lesions. Our patient is a forty-one year old female who has suffered from recurrent right facial palsy for the last six years. She was first misdiagnosed as having Bell’s palsy and received corticosteroids which resulted in little improvement. She then had facial nerve decompression surgery which resulted in a partial improvement. Since then, she has suffered from recurrent attacks of facial palsy. Two years ago, she came to our hospital seeking further treatment options. The final diagnosis made by MRI was a possible facial nerve tumor. To obtain a better facial outcome, total tumor removal was performed through the middle cranial fossa approach along with facial-hypoglossal nerve end-to-side anastomosis through transmastoid approach. Her hearing was preserved, and she obtained a better facial outcome than that of her preoperative level. In conclusion, facial nerve schwannoma has the potential to be misdiagnosed as Bell’s palsy which might lead to a delay in diagnosis, and end-to-side neurorrhaphy may be an effective alternative in a selected case.  相似文献   

13.
Lesnik DJ  Boey HP 《Ear, nose, & throat journal》2004,83(12):824, 826-824, 827
We report a case of perineural invasion of the facial nerve by a cutaneous squamous cell carcinoma in a 59-year-old man who presented with a slowly progressive facial paralysis. We performed a distal facial nerve dissection and a simple mastoidectomy with facial recess exposure for resection to negative margins. We also performed a simultaneous facial reconstruction and reanimation procedure with excellent results. External-beam radiation completed the treatment regimen. In addition to describing this case, we review current concepts in diagnosis and therapy, as well as the historical background of malignant perineural invasion of the cranial nerves.  相似文献   

14.
Surgical dimensions of the facial recess in adults and children   总被引:6,自引:0,他引:6  
The facial recess approach permits surgical access to the round window area. This route is used in patients who are undergoing cochlear implantation. To evaluate the feasibility of this procedure in children as compared with adults, serial sections of temporal bones were used to measure the surgical dimensions of the facial recess. No statistically significant differences in the dimensions of the facial recess or the extended facial recess approaches were found between children and adults. The relationship of the facial and chorda tympani nerves to the annular plane exhibited no change with postnatal growth. These structures translate posteriorly and laterally toward the annular plane as they descend within the temporal bone. Therefore, the facial recess approach represents no greater hazard in a child than in an adult.  相似文献   

15.
Transection and reanastomosis of the facial nerve with microsurgical sutures in rats (facial-facial anastomosis) results in the complete regeneration of the facial nucleus, whereas resection of a 10 mm length of the peripheral facial nerve leads to degeneration and loss of neurons in the nucleus. Nerve sutures or resections were performed in 84 female Wistar rats, and the time course and differences between regenerative and degenerative reactions in the facial nuclei were compared after survival times of 4–112 days. The volume of the facial nucleus, number of facial motoneurons and motoneuron density were estimated stereologically by the physical dissector method. Synaptic plasticity, activation of astroglia and microglia were studied cytochemically with anti-synaptophysin, anti-glial fibrillary acidic protein and the isolectin Griffonia simplicifolia I-B4 (GSA I-B4). After facial-facial anastomosis the volume of the facial nucleus and its number of motoneurons remained constant, whereas resection of the facial nerve caused shrinkage of the facial nucleus and loss of one-third of facial motoneurons within 112 days post-operation. Synaptic stripping, activation of microglia and astroglia occurred in the same sequence and were reversible after both operations, but these reactions were more severe and prolonged after resection, i.e. without suture of the facial nerve. It appears to be most important clinically that differences between de- and regeneration become clear within 7 days post-axotomy. Our results strongly support reconstruction of the facial nerve as early as possible after a nerve lesion.  相似文献   

16.
We routinely identify the facial nerve to avoid facial nerve injury during most otologic surgery. Since 1985, we have used a facial nerve stimulator/monitor as an added safety feature in 383 consecutive otologic and neurotologic cases. In our last 30 middle-ear, 8 retrolabyrinthine vestibular neurectomy, and 14 acoustic neuroma cases we used the monopolar stimulator probe-tip to determine threshold currents needed to produce facial twitch. Stimulation thresholds varied according to the amount of soft tissue or bone overlying the facial nerve. The stimulator was useful for predicting dehiscences in the bony facial canal during middle-ear and mastoid surgery. The exposed facial nerve usually stimulated at a level less than 0.1 mA (mean 0.05 mA), and the horizontal facial nerve covered by bone stimulated at 0.25 mA or greater (mean 0.6 mA). The stimulator was also used to predict the amount of bone overlying the vertical facial nerve at the annulus. An approximate relationship of 1.0 mA of threshold current to 1.0 mm of bony covering was found. After acoustic neuroma surgery, the stimulation threshold of the facial nerve at the brain stem helped predict postoperative facial function. Cases with current thresholds of 0.3 mA or less resulted in normal facial function. During ear surgery, routine identification of the facial nerve with the aid of a facial nerve stimulator will help avoid facial nerve injury.  相似文献   

17.
Etiology, diagnosis, and surgical management of facial paralysis due to traumatic injury of the VIIth cranial nerve are discussed. Sixty patients are reviewed who underwent some type of surgical procedure for the repair of the facial nerve. These cases are categorized according to etiology, which includes temporal bone fractures, iatrogenic injuries, and penetrating wounds of the head and neck. The results of a poll of eight leading otologists on their approaches to several aspects of the surgical management of these injuries are presented in the Discussion section. The diagnostic and prognostic studies associated with facial paralysis, as well as the more common surgical procedures available for repair of the facial nerve, are briefly reviewed.  相似文献   

18.
Of 1400 temporal bones in the collection at the University of Minnesota, Minneapolis, 17 temporal bones from 15 patients were found to have tumors involving the facial nerve. The findings were as follows: one case of facial nerve schwannoma; two cases of invasion of the facial nerve by contiguous tumor; and 14 cases of metastatic tumors involving the facial nerve. Facial nerve paralysis was present in half of the cases (nine of 17). Facial nerve paralysis was present in the case of facial nerve schwannoma, in both cases of invasion of the facial nerve by contiguous tumor, and in six of 14 cases of metastatic tumors involving the facial nerve. The presence of the facial nerve paralysis correlated well with the degree of tumor infiltration into the nerve fibers and the segment of the tumor involvement in the facial nerve. In the patients with metastatic tumors, facial nerve paralysis was a sign of extensive intracranial tumor involvement and was usually accompanied by other cranial nerve palsies, most commonly involving the fifth nerve.  相似文献   

19.
The results of histopathologic examination of the temporal bone of a 71-year-old woman with squamous cell carcinoma of the tonsil and ipsilateral facial palsy are presented. The right temporal bone was directly involved by metastatic spread of the primary lesion to the right upper cervical lymph nodes. Tumor cells had invaded the canal of the facial nerve, the chorda tympani nerve, and the stapedius muscle, as well as the air cells in the mastoid region. However, although tumor cells had infiltrated the facial canal to a considerable distance from the metastatic tumor mass, the facial nerve had not been infiltrated. Slight degeneration of the facial nerve, however, was observed and appeared to have been caused by compression by the tumor.  相似文献   

20.
Liu L  Yang S  Han D  Huang D  Yang W 《Acta oto-laryngologica》2007,127(9):993-999
CONCLUSIONS: The commonest manifestation of facial nerve tumours was facial paralysis, followed by hearing loss. During tumour resection facial nerve continuity should be maintained and reconstructed in one stage wherever possible. If this is not a viable option, second-stage surgery should be performed as soon as possible after surgery. OBJECTIVE: To summarize the clinical characteristics of tumours of the facial nerve and discuss their diagnosis and treatment. PATIENTS AND METHODS: Twenty-two cases of primary facial nerve tumours were reviewed. These cases were confirmed pathologically and treated in the Chinese PLA General Hospital during the period 1986-2003, where the clinical manifestations, diagnosis and treatment of this series were analysed. RESULTS: Among the 22 cases, 14 were facial neurilemmomas, 6 were facial neurofibromas and 2 were facial nerve haemangiomas. The commonest presenting symptom in all cases was facial paralysis (14/22) followed by hearing loss (10/22). Facial paralysis was also the commonest sign of a facial nerve tumour (18/22), followed by a swollen mass in the tympanic cavity (8/22) and a swollen mass in the external auditory canal (5/22). The 22 tumours were totally resected surgically. The function of the facial nerve was normal (grade I) in two cases where the integrity of the nerve was preserved during the operation, grade II in one case and grade III in another case where it was possible to maintain partial continuity of the facial nerve. The facial nerve was reconstructed in one stage when the tumours were resected, with facial-great auricular-facial nerve cable grafting (10 cases) and facial-lateral femoral cutaneous-facial nerve cable grafting (1 case). The facial nerve function consequently recovered to grade II-IV. The second stage facial-hypoglossal nerve anastomosis was carried out in two cases, and facial function consequently recovered to grade II in one case at 3 years and grade III in another with 2 years follow-up. In five cases, the facial nerve remained discontinuous and the facial nerve function showed no recovery (grade VI).  相似文献   

设为首页 | 免责声明 | 关于勤云 | 加入收藏

Copyright©北京勤云科技发展有限公司  京ICP备09084417号