荧光金示踪技术评价面神经损伤裸鼠模型

目的 建立免疫缺陷小鼠周围性面瘫模型并结合荧光金逆行示踪技术进行评价,并与相应野生型小鼠模型比较.建立稳定的免疫缺陷小鼠面神经损伤模型评价系统,为进一步揭示外伤性面瘫的神经免疫机制提供模型基础.方法 外科无菌手术方法切断裸小鼠、野生型BABL/c小鼠面神经出茎乳孔主干,分别于脑干取材前2天行面神经断端涂抹荧光金示踪剂.面瘫第14天灌注固定动物后,标本自头侧至尾侧行连续冰冻切片,荧光显微镜下观察面神经运动神经元情况.用Image Pro Plus5.1软件计数神经元数量.结果 面神经轴切损伤后14天,荧光切片面神经运动神经元核团显示清晰,便于计数;裸小鼠组与野生型组神经元数目有显著性差异(分别为2423±20,2748±60,P=0.0011).结论 荧光金逆行示踪技术结合裸鼠面神经损伤模型评价系统是有效、易行的,为进一步揭示外伤性面瘫中以T细胞行为研究为中心的神经免疫机制提供模型基础.     

靶肌肉注射胶质细胞源性神经营养因子对面神经损伤修复的作用

目的 通过靶肌肉注射胶质细胞源性神经营养因子(GDNF),观察其对面神经压榨损伤后大鼠功能恢复、神经形态学及GDNF在中枢面神经元中表达的影响,探讨经靶肌肉注射GDNF治疗周围性面瘫的可行性及作用机理。方法 SD大鼠随机分为假手术组(只暴露右侧面神经主干)、模型组(面神经主干压榨)、实验对照组(面神经主干压榨+颊肌注射生理盐水)和实验组(面神经主干压榨+颊肌注射GDNF),通过颊肌电生理、面瘫症状评分观察大鼠的神经功能恢复, Masson染色观察颊肌纤维形态学变化、甲苯胺蓝染色观察面神经形态学变化、Western Blot检测面神经元中GDNF的表达。结果 ①大鼠面瘫症状评分：假手术组无面瘫表现,评分为0分,造模后各组大鼠均出现周围性面瘫表现,评分均为5分;术后第28天,实验组大鼠面瘫症状已基本完全恢复,模型组及实验对照组较前有不同程度改善但未完全恢复,评分均＞3分;②颊肌电生理：各组造模后与假手术组相比,峰潜伏期有不同程度延长、最大振幅有不同程度下降;随时间的推移,实验组峰潜伏期较模型组及实验对照组明显缩短(P<0.05),最大振幅较其明显上升(P<0.05);③甲苯胺蓝染色：模型组、实验对照组、实验组术后均出现神经纤维形态不规则,外膜不连续不清晰,轴突数量减少。术后第28天,实验组面神经形态与假手术无明显差异,较模型组及实验对照组有明显恢复;④Masson染色：各组造模后肌纤维数量减少,肌肉组织占比面积减少;实验组肌纤维形态较模型组及实验对照组恢复快,至术后第28天,肌纤维形态接近正常(P<0.05);⑤Western Bolt检测：各组造模后中枢面神经元组织GDNF的蛋白表达下降,观察期内逐渐增强;与模型组及实验对照组相比,术后各时间点,实验组中枢面神经元组织GDNF的蛋白表达显著增强(P<0.01)。结论 靶肌肉注射GDNF可作为改善周围神经损伤的有效给药方式之一,促进神经纤维修复、靶肌肉功能的恢复及中枢神经系统对周围损伤神经的修复。     

10例中耳和乳突术后迟发性面神经麻痹的临床观察

目的探讨中耳和乳突术后迟发性面瘫的病因、治疗及转归.方法对10例中耳、乳突术后迟发性面瘫进行诊断、治疗和预后观察,患者均采用激素、营养神经和扩血管药物及理疗等综合治疗.结果迟发性面瘫多发生于术后第4天左右.面神经功能Ⅱ～Ⅲ级,绝大部分病例在3周左右完全恢复,且无任何后遗症.结论慢性中耳炎中耳乳突术后迟发性面瘫的发生可能为局部面神经或鼓索神经微创伤引起局限性反应性水肿所致;也可能与并发单纯疱疹病毒感染有关.     

10例中耳和乳突术后迟发性面神经麻痹的临床观察

目的 :探讨中耳和乳突术后迟发性面瘫的病因、治疗及转归。方法 :对 10例中耳、乳突术后迟发性面瘫进行诊断、治疗和预后观察 ,患者均采用激素、营养神经和扩血管药物及理疗等综合治疗。结果 :迟发性面瘫多发生于术后第 4天左右。面神经功能Ⅱ～Ⅲ级 ,绝大部分病例在 3周左右完全恢复 ,且无任何后遗症。结论 :慢性中耳炎中耳乳突术后迟发性面瘫的发生可能为局部面神经或鼓索神经微创伤引起局限性反应性水肿所致 ;也可能与并发单纯疱疹病毒感染有关。     

T细胞免疫缺陷小鼠创伤性面瘫模型的建立及其形态学评价

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。     

鼻腔后部出血选译性颌内动脉栓塞术

作者以选择性颌内动脉栓塞术治疗难制止的鼻腔后部出血5例:其中3例按Seldinger 氏法自右股动脉插管,管径6.5F;高龄者2例,70～75岁,考虑有动脉硬化而自颈总动脉插管,管径5F。均先做出血侧颈外动脉造影,然后将导管送入颌内动脉。在透视下将小片明胶海绵约1×2×5mm 混于造影剂中,作颌内动脉造影的同时将之栓塞。有出血性素质、造影剂过敏、严重高血压或肾功能不良者禁用。本组5例原因不明特发性鼻出血经血管栓塞后观察2～9个月,无一例再出血。本法无需外科手术,颈外动脉造影尚可发现异常血管找到出血点。上颌窦术后、上颌窦发育不良者作颌内动脉结扎有困难,采用本法则简便有效。但将导管插入颌内动脉需专门训练。合并症有面神经部分麻痹、牙关紧闭、面部疼痛     

中耳术后迟发性面瘫相关因素分析

目的 分析中耳手术后迟发性面瘫的可能发病原因和预防方法。方法 回顾性分析1995-2005年来8例中耳乳突术后迟发性面瘫患者的临床资料。结果 术中发现面神经骨管缺损3例，术中鼓索神经受到明显牵拉2例，不明原因3例；7例在术后1月内面瘫完全恢复，1例在术后3月内面瘫完全恢复。结论 迟发性面瘫多发生于术后7～8d，一般为不完全性面瘫，均可完全恢复。其病因可能与牵拉鼓索神经、面神经解剖异常、填塞物过紧、血肿压迫等有关。     

血管结扎治疗鼻出血:60例观察

作者报导1965年到1971年颌内动脉结扎治疗严重鼻出血60例,除4例作双侧结扎外,其余均行单侧结扎。手术指征:严重鼻出血曾作后鼻孔栓塞或赛罗卡因加副肾素腭大孔注射无效者。作者认为:确定出血部位对结扎血管的选择至为重要,并指出颌内动脉和筛前动脉在鼻腔内有丰富的侧支循环,对来自鼻腔后上部的出血,有时需要同时结扎这两个血管。颌内动脉结扎手术以全麻插管下进行较为安全,可以避免误吸胃内容物,本组病例除11例外均行全麻手术,作者介绍先行咽喉局部表面麻醉.清醒插入带囊插管,等套囊吹起后再全麻。手术采取柯-陆氏径路,术中注意血管解削关系,颌内动脉不但弯弯曲曲并且分支较多,结扎必须准确,不要损伤,一般上颌窦腔内不作充填。     

选择性血管内栓塞治疗难治性鼻出血的临床分析

目的：了解选择性血管内栓塞治疗难治性鼻出血的疗效及影响疗效的因素。方法：23例难治性鼻出血患者在颈动脉数字减影血管造影(DSA)的基础上行选择性颌内动脉末梢病变血管内栓塞，其中5例同时栓塞面动脉。结果：DSA证实23例患者均存在颌内动脉末梢发育不良或畸形，15例伴有出血征象，6例并面动脉形态异常。治愈22例，其中l例24h内复发鼻出血者证实有新侧支供血，经补加栓塞后出血停止，治愈率为95．6％。l例治疗失败，与栓塞前去除鼻腔填塞物有关，且不能除外有面动脉出血。结论：难治性鼻出血与颌内动脉发育不良及畸形有关，选择性血管内栓塞治疗能收到迅速而满意的疗效。治疗失败与潜在侧支开放或面动脉出血有关，过早去除鼻腔填塞物也是影响栓塞疗效的因素。     

面神经实时监测在耳神经外科手术中的应用

目的 探讨面神经实时监测在耳神经外科手术中的应用价值.方法 41例耳神经外科手术中使用面神经监测仪,观察术中面神经实时监测情况,并随访术后面神经功能.结果 采用House-Brackmann面神经功能分级标准对所有患者进行面神经功能评估.11例听神经瘤患者术前坷无面瘫,术后2例出现Ⅲ级面瘫,2个月内恢复;6例外伤性面瘫,术后1年恢复至I级者4例;1例贝尔面瘫,术后1年恢复至Ⅲ级;7例颞骨恶性肿瘤,4例术前、术后均无面瘫,3例术前有面瘫者术后恢复至Ⅰ-Ⅲ级;5例岩尖胆脂瘤,2例术前、术后均无面瘫,3例术前有面瘫者Ⅱ-Ⅲ级,术后9个月恢复正常;2例梅尼埃病患者,1例术后无面瘫,1例术后出现Ⅲ级面瘫,术后半年完全恢复;5例第一鳃沟瘘管及4例颈静脉孔区肿瘤患者术前、术后均无面瘫.结论 耳神经外科手术中使用面神经监测可提高面神经保全率,面神经肌电图描记(EMG)刺激电流阈值的大小可为面神经大致走向及功能状况提供参考.     

Facial palsy after glomus jugulare tumour embolization.

Facial palsy after pre-operative embolization of glomus tumours is a rare complication. In our case, complete facial palsy occurred within four hours after embolization with polyvinyl alcohol foam. Three days later, embolization material was found in the perineural vessels of the facial nerve in its mastoidal segment. Six months after complete tumour removal, facial decompression with perineural incision, and steroid therapy, facial function recovered completely. In cases of embolization of both stylomastoid and branches of the middle meningeal artery with resorbable material, temporary facial palsy can occur.     

Facial palsy after neck arteriovenous fistula embolization

Facial palsy after embolization of neck arteriovenous fistula is an extremely rare complication. In our case, complete facial palsy occurred after embolization and was successfully treated with superficial parotidectomy, vessel ligation, and plug removal. We report the first case of unusual facial palsy that developed 13 days after neck arteriovenous fistula embolization. As a result of our findings, we recommend, when a patient suffers from acute ipsilateral facial palsy after arteriovenous fistula embolization, the clinician should consider the possibility of complications of embolization, and immediate and appropriate management should be performed. Laryngoscope, 125:2125–2128, 2015     

Expression of bcl-2 in facial motoneurons and its ultrastructural localization following facial nerve injury]

OBJECTIVE: To explore the expression of bcl-2 in facial motoneurons and its subcellular distribution. METHODS: Wistar rats were used in this study. Facial nerve transection was performed at stylomastoid foramen or internal acoustic meatus. Facial nerve crush was made at stylomastiod foramen. The animal survived for 1, 3, 7, 15, 30 and 60 days respectively. Facial nucleus was treated with bcl-2 monoclonal antibody or bcl-2 DIG-labelling probe and studied with immunohistochemistry and in situ hybridization. The bcl-2 positive motoneuron was investigated with immuno-electron microscope. RESULTS: It was demonstrated that bcl-2 protein level was corresponded with bcl-2 mRNA expression. The level of bcl-2 expression in facial motoneurons was high in normal facial nerve. It increased on the first day and declined on the third day post-transection in facial motoneuron. It reached the lowest level on the 15th days following facial nerve injury (P < 0.05). The expression recovered to normal level in two months (P > 0.05). After facial nerve transected, the reduction of bcl-2 expression was more significant when facial nerve transected close to facial nucleus than that far from facial nucleus (P < 0.05). Comparing to facial nerve transection in stylomastoid foramen, there was more intensive bcl-2 expression following facial nerve crush (P < 0.05). Further study showed that bcl-2 primarily resided in the nuclear envelop, endoplasmic reticulum and mitochondrial membrane. CONCLUSIONS: These data indicated that high level bcl-2 protein may prevent facial motoneuron death following facial nerve injury. It is suggested that overexpression bcl-2 by transgene may prevent facial motoneurons death.     

Primary paraganglioma in the facial nerve canal

Objective

To describe primary paraganglioma in the facial nerve canal and discuss the characteristics of facial nerve paraganglioma in contrast with other tumors.

Case report

A 23-year-old man developed gradually progressive right facial palsy as the initial symptom. One year later, he exhibited hearing loss without tinnitus in his right ear. CT demonstrated an enlarged facial nerve canal with irregular bony erosion of the circumference. MRI showed a well-enhanced heterogeneous mass with hypo-intensity spots inside it. During surgery, a blood-rich tumor was observed along the facial nerve: however, extensive bleeding interfered with tumor removal. The surgical specimen demonstrated paraganglioma. The tumor was completely removed in the second surgery in combination with arterial embolization. Facial nerve function was reconstructed with a free muscle flap more than one year following resection.

Conclusion

Because paraganglioma is a blood-rich tumor, it is important to perform angiography and embolization. If preoperative facial nerve palsy is demonstrated, careful management of facial nerve function is needed. Paraganglioma must be considered in the differential diagnosis of a facial nerve tumor.     

bcl-2在受损面神经运动神经元中的表达与定位

目的研究面神经损伤后其运动神经元胞体bcl-2表达同胞体损伤的关系。方法行面神经高位、低位断伤和茎乳孔压榨伤,术后饲养1、3、7、15、30和60d,取面神经核团,利用免疫组化、原位杂交和免疫电镜技术,并用图像分析仪分析bcl-2表达程度。结果正常未损伤面神经运动神经元胞体bcl-2高表达,受损后1d的bcl-2表达增强,但在损伤后3d表达下降,15d表达最弱(P<0.05),以后有所恢复,到损伤后2个月(60d)基本恢复到正常水平(P>0.05)。bcl-2的表达同损伤程度和损伤部位有关(0.01<P<0.05)。bcl-2mRNA和bcl-2蛋白表达一致。免疫电镜发现bcl-2蛋白主要定位于神经元胞体中的线粒体、内质网和核膜上。结论bcl-2转录和翻译可能同面神经核团中运动神经元胞体的死亡相关。通过转基因技术调节bcl-2基因的表达,可能为临床面瘫的治疗提供新的手段。     

小鼠单纯疱疹病毒性面瘫的预防和复发模型的建立

目的建立1型单纯疱疹病毒（herpes　simplex　virus　type1，HSV-1）潜伏感染再激活导致小鼠面瘫的模型，观察免疫球蛋白（IgG）和干扰素对单纯疱疹病毒性小鼠面瘫的预防效果。方法64只4周龄雌性Balb／c小鼠，用26G针头搔刮小鼠耳廓背面近耳根部皮肤，左耳接种HSV．125山，总剂量1．7×10^7空斑形成单位（plaque　forming　unit，PFU）／ml，右耳接种25山磷酸盐缓冲液作为对照，制作小鼠面瘫潜伏模型。按数字表法将小鼠随机分为3组：第一组20只，每天腹腔注射IgG1ml／kg，连续注射3d，待出现面瘫后，面瘫小鼠继续注射3d；第二组20只，腹腔注射干扰素1．5×10’IU／kg，连续3d，待出现面瘫后，面瘫小鼠继续注射3d；第三组24只，腹腔注射相应量的生理盐水作为对照。观察小鼠面瘫情况，8周后取面瘫恢复的小鼠，腹腔注射环孢素50mg／kg，建立面瘫复发模型。处死小鼠，分离双侧面神经和三叉神经节，多聚酶链反应（polymerase chain reaction，PCR）检测HSV-1 DNA的表达。结果第一组小鼠面瘫率50％，面瘫持续时间（7．2±2．2）d（x±s，下同）；第二组小鼠面瘫率30％，面瘫持续时间（4．5±1．8）d；第三组小鼠面瘫率67％，面瘫持续时间（8．9±2．6）d。经统计学分析，IgG不能有效降低面瘫发生率及缩短面瘫持续时间（P值均〉0．05），而干扰素可以有效降低面瘫发生率并缩短面瘫持续时间（P值均〈0．05）。注射环孢素后3只面瘫恢复小鼠（3／28）再次出现面瘫，复发率11％。所有面瘫复发小鼠均检测到HSV-1DNA，而未复发小鼠均未检测出HSV-1DNA。结论HSV-1潜伏感染再激活可能是单纯疱疹病毒性小鼠面瘫复发的原因之一，潜伏病毒的再激活与免疫力低下有关。干扰素可以有效降低单纯疱疹病毒性面瘫发生率和缩短面瘫持续时间；免疫球蛋白（IgG）不能有效降低面瘫发生率和缩短面瘫持续时间。     

Facial nerve schwannomas. Report of a case

Facial nerve schwannomas are relatively uncommon lesions. The clinical features depend upon the localization and extent of the lesion. The most common presenting symptom is that of a slowly progressive facial nerve palsy, because of facial schwannoma usually are located near the geniculate ganglion. A case of facial schwannoma is reported: a woman presenting a sudden facial palsy did not respond to medical and rehabilitation treatment. First, a Bell's palsy was diagnosed and then the facial nerve schwannoma with imaging techniques. A review about facial nerve schwannomas is reported.     

Delayed facial nerve palsy following uneventful stapedectomy

Facial nerve palsy is a rare complication of stapedectomy. Its onset may be immediate or delayed by several days. The authors present a case of a 59-year-old man who developed right delayed peripheral facial nerve palsy occurring after uncomplicated ipsilateral stapedectomy. The incidence, treatment and prognosis of this complication are discussed.     

Continuous facial nerve monitoring during pleomorphic adenoma recurrence surgery

OBJECTIVES: Surgery of recurrent pleomorphic adenoma (RPA) is known to lead to a high facial nerve complication rate. The efficacy of the continuous facial nerve monitoring (CFNM) technique remains to be proven in RPA surgery. The goal was thus to evaluate facial nerve palsy rates and the recovery period after parotidectomy for RPA using CFNM by way of continuous electromyography and to compare these rates and the operation time with those of patients who had undergone surgery without facial nerve monitoring. DESIGN: Cohort study. PATIENTS: Forty-seven patients were referred for RPA (1981-2003). Among them, 32 (18 unmonitored and 14 monitored) patients displayed no preoperative facial palsy, and histologic analyses revealed evidence of recurrence. The operation time and the extent and duration of postoperative facial nerve palsy were examined in both groups (monitored vs. unmonitored). Both groups had a similar clinical appearance distribution. RESULTS: Facial nerve paralysis was estimated using the House-Brackmann grading scale. CFNM reduced the intensity of facial nerve paralysis independently of the kind of surgery performed. The complete deficit rates were 0% for the monitored group and 5.6% for the unmonitored group. Postoperative facial nerve paralysis was significantly lower (P = .01) in the monitored group than in the unmonitored group. CFNM improved the duration of facial paralysis (P = .001) in the monitored group. The operation time was significantly lower in the monitored group than in the unmonitored group (P = .001). CONCLUSIONS: Routine use of CFNM during RPA surgery improves the surgical outcome. The facial nerve deficit can be reduced, and the recovery of facial nerve function is faster.     

Silent intratemporal facial nerve schwannoma associated with Chronic Suppurative Otitis Media: A rare presentation

Facial palsy is a common manifestation of intratemporal facial nerve schwannoma. Review of English literature describes intratemporal facial nerve schwannoma presenting as vertigo, tinnitus (without facial palsy) which were diagnosed on CT scan or MRI of temporal bone. We are presenting two cases of asymptomatic facial nerve schwannoma without facial palsy presenting only as Chronic Suppurative Otitis Media (CSOM), which were diagnosed incidentally during surgery.