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1.
面神经瘤的诊断与处理   总被引:4,自引:0,他引:4  
目的探讨面神经鞘瘤和面神经纤维瘤的临床和病理特点以及影像学表现,为面神经瘤的早期诊断和不同类型面神经瘤的治疗提供经验。方法采用回顾性方法,对20例面神经鞘瘤和2例面神经纤维瘤的诊断和治疗过程进行分析。面神经瘤的手术入路为:颅中窝入路2例,乳突径路8例,乳突腮腺联合径路10例,腮腺径路2例。17例面神经瘤切除后同期进行面神经移植。其中耳大神经颞内段移植3例,颞内外联合移植1例;腓肠神经颞内段移植5例,颞内外联合移植8例。2例后期行面肌悬吊术。结果面神经瘤完全切除21例,20例术后无复发,失访1例。次全切除1例,次全切除者术前和术后接受1刀治疗,随访无复发。影像学表现:CT示面神经鞘瘤为呈膨胀性改变面神经管缺损。面神经纤维瘤主要表现为面神经管增粗,行走于面神经骨管内。磁共振成像可以显示所有面神经行走途经径,并显示面神经瘤从乳突扩展到腮腺的情况。病理诊断面神经鞘膜瘤20例,面神经纤维瘤2例。结论虽然面神经瘤的发生率低,但是只要了解其临床特点,借助影像学手段,可以早期诊断。对面神经瘤治疗可考虑不同径路摘除肿瘤并行面神经移植手术。  相似文献   

2.
Iatrogenic facial nerve paralysis is one of the major and drastic complications of ear surgery. We report a case of a 20-year-old female patient with simple chronic otitis media who underwent mastoidectomy and tympanoplasty. During the mastoidectomy process the facial nerve was unintentionally destroyed, leaving a gap of 8–10 mm in the third segment of the intratemporal facial nerve. The nerve was repaired with a nerve cable graft obtained from the vicinity. On the 42nd day, autologous mesenchymal stem cell transplantation was performed after facial nerve trauma. The patient’s facial nerve paralysis has recovered from House-Brackmann grade VI to IV within a week and then to III in the fifth month. The rapid, postoperative progress, and the early follow-up results are discussed. This case represents the first bone marrow stem cell application in a peripheral nerve, namely the facial nerve.This case was presented at the XXXth World Congress of the International Society of Hematology, Istanbul, 28 September–2 October 2005.  相似文献   

3.
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.  相似文献   

4.
Summary In the last 10 years authors have decompressed the facial nerve of 20 patients, having been treated previously for Bell's Palsy. They have found at six cases intrapyramidal cholesteatomas, at one case a meningioma, at five cases neurinomas of the facial nerve, at two cases metastases of malignant tumours, at one case a diffuse haemangiomatose, and at one case an ectopic tissue from the parotid gland, both, in the Fallopp channel, at two cases an aspecific granulation, at one case a malignant tumour of the deep lobe of the parotid gland, and at one case an extra- and intratemporal neurinome. Authors discuss separately their last two cases, which seemed to be for a long time in spite of exact examinations a typical clinical form of Bell's Palsy.  相似文献   

5.
While identification of the intratemporal portion of the facial nerve is mandatory in most otologic surgical procedures, inadvertent instrumentation, traction, or thermal injury may still result from inaccurate delineation, purposeful avoidance, or false protection of this critical structure. Improved functional preservation of the facial nerve has been achieved in acoustic neuroma surgery through the monitoring of evoked facial electromyographic activity. This technique may also be used during otologic procedures in which facial nerve manipulation is anticipated in the management of recurrent cholesteatoma, temporal bone trauma, congenital deformity, or purposeful access for cochlear implantation. Potential indications for using facial nerve monitoring in contemporary otologic surgery are detailed through illustrative case presentations, and necessary instrumentation and techniques are briefly reviewed. Intraoperative monitoring can assist the surgeon in isolating the facial nerve when chronic inflammation, traumatic injury, or anomalous development has resulted in distortion or absence of microanatomic landmarks.  相似文献   

6.
Every structure contained within the temporal bone in close proximity to the facial nerve is at risk during intratemporal bone surgery on the facial nerve. We present a review of the causes of injuries to these structures and of ways to prevent such injuries. This review includes information drawn from pertinent literature, from the author's experience managing 139 patients undergoing temporal bone surgery for a variety of facial nerve disorders between 1974 and 1981, from an analysis of 43 of our patients whose hearing was evaluated before transmastoid facial nerve surgery and again 6 months after surgery, and from the experiences of colleagues. We found that the most frequent complication of intratemporal facial nerve surgery is auditory involvement. An air-bone gap of 15 dB or greater was noted in 14% of the 43 patients studied and a sensorineural loss, primarily at the 4000 and 8000 cycles, occurred in 51% of these patients. A decrease in discrimination of 15% or greater was noted in 7% of patients, and a shift in speech reception threshold of 15 dB or greater was noted in 16% of the patients. Twelve percent of the patients had tinnitus following surgery and 5% required a hearing aid as a result of a combined sensorineural and conductive hearing loss which occurred in their better hearing ear as a result of surgery. Structures less commonly injured during transmastoid decompression of the facial nerve included the facial nerve itself, the chorda tympani nerve, the balance function of the labyrinth, the cochlea, the ossicles, the sigmoid sinus and superior petrosal vein, the middle meningeal artery and the stylomastoid artery, the dura, and the brain. We review all of these complications, as well as discuss the incidence of cerebrospinal fluid leak and infection which also may result from this type of surgery.  相似文献   

7.
OBJECTIVE: To describe a case of cavernous hemangioma arising from the inferior vestibular nerve, limited to the internal auditory canal. STUDY DESIGN: Retrospective case review and review of literature. SETTING: A tertiary referral clinic. INTERVENTIONS: Extended middle cranial fossa surgery. RESULTS: The hemangioma was completely resected through the extended middle cranial fossa approach. No serious complications occurred, and the hearing and the facial nerve function were preserved. CONCLUSIONS: Originating from the capillary plexus surrounding Scarpa's ganglion, this hemangioma has to be differentiated from intratemporal hemangioma at the geniculate ganglion. Because of extrinsic growth pattern, the potential for preservation of the facial nerve function is high if surgery is performed early. Complete resection through the extended middle fossa approach is the treatment of choice for cavernous hemangioma with limited extension into the cerebellopontine angle. It remains difficult to distinguish preoperatively from the more common tumors, and surgery is usually planned on assumption of vestibular schwannoma.  相似文献   

8.
Eight patients with intratemporal hemangiomas involving the facial nerve are reported to present their symptoms, pathology, surgical management, and results. These unusual tumors have a predilection to involve the facial nerve, usually at the geniculate ganglion, internal auditory canal, or middle ear. Patients presented with facial palsy that was sudden, gradual in onset, recurrent, or associated with hemifacial spasm. Symptoms often progressed for years before the diagnosis was made. In two cases the tumor caused bony remodeling with an expansile honeycombed appearance, but no neoplastic production of bone. The facial nerve was comprised either by tumor compression or nerve invasion, as seen in two of our patients. Complete removal of the tumor and rehabilitation of the facial nerve function was attained in each case. Because of the destructive nature of these benign tumors, intratemporal facial nerve grafting was required in five of the eight cases. Results of facial nerve repair were good except in cases of long-standing facial dysfunction.  相似文献   

9.
目的探讨颞骨内微型面神经鞘瘤的原发部位和病理行为。方法用光镜对815人(1526侧)颞骨连续切片进行面神经颞骨内全程组织病理学观察。结果发现未诊断的无症状微型AntoniA型面神经鞘瘤15人(17耳),占1.84%。依其病理行为特征分为外生性(13耳,起自面神经管裂处神经束膜,并向管外生长)和内生性(4耳,起自面神经主干)两种类型。肿瘤起自迷路段者2耳,水平段12耳,第二膝段1耳,垂直段2耳。结论将颞骨内面神经鞘瘤分为内生性和外生性两种类型有重要的病理和临床意义,有助于手术目的的确定和手术方法的设计  相似文献   

10.
颞骨内微型面神经鞘瘤病理研究   总被引:10,自引:1,他引:9  
目的 探讨颞骨内微型面神经鞘瘤的原发部位和病理行为。方法 用光镜对815人(1526侧)颞骨连续切 片进行面神经颞骨内全程组织病理学观察。结果 发现未诊断的无症状微型Antoni A型面神经鞘瘤15人(17耳),占1.84%,依其病理行为特征分为外生性和内生性两种类型。肿瘤起自迷路段者2耳,水平段12耳,第二膝段1耳,垂直段2耳。结论 将颞骨内面神经鞘瘤分为内生性和外生性两种类型有重要的病理和临床  相似文献   

11.
颞骨骨折性面瘫手术减压时机的实验研究   总被引:2,自引:1,他引:1  
目的制作颞骨骨折性面瘫的动物模型,初步探讨大鼠面瘫的自然发展过程,了解不同手术减压时机面瘫的治疗效果及减压后面瘫的恢复变化过程。方法选用Wistar大鼠32只,制作颞骨骨折性面瘫动物模型。将完全面瘫的大鼠随机分成4组:对照组即不减压组,2周减压组,4周减压组,8周减压组。分别于以上不同的时间行面神经减压术,并于不同时间测定面神经刺激阈值,以观察面神经的恢复情况。结果对完全面瘫的大鼠于面瘫后1周行面神经阈值检查,对最大电流刺激(3mA)无反应。4组大鼠面神经刺激阈值的恢复速度相比,2周、4周减压组比不减压组及8周减压组快;2周减压组面神经的恢复速度比4周减压组快。结论通过血管钳钳夹大鼠的面神经骨管,可以造成颞骨骨折性面瘫的大鼠模型。面神经减压术在面神经受损后4周内进行,可缩短其面神经阈值的恢复时间;且减压时间越早,面神经的恢复速度越快。  相似文献   

12.
MR images of the intratemporal portion of the facial nerve were obtained with a 1.5 Tesla permanent magnet whole-body imaging system. The facial nerve was followed from the internal auditory through the temporal bone to the styloid foramen. MR promises to be a sensitive method for the evaluation of intratemporal facial nerve diseases.  相似文献   

13.
Summary Anatomical, histological and electrophysiological features of the rabbit facial nerve in the temporal bone are described for research purposes. Based upon the findings the rabbit intratemporal facial nerve is surgically accessible and consists of a constant axon number and myelin sheath thickness. As a valid model the rabbit intratemporal nerve can be readily utilized for research studies in nerve regeneration pertinent to the facial nerve in this region.  相似文献   

14.
The facial nerve is often injured in head trauma. Computed tomography (CT) is the diagnostic study most frequently used to evaluate temporal bone fractures, but it does not demonstrate all soft tissues well. Recently, magnetic resonance imaging (MRI) has been used to evaluate certain soft tissues, including cranial nerves. Experience with MRI evaluation of temporal bone trauma is limited and consists primarily of anecdotal reports. This study assesses the accuracy of MRI in evaluating experimentally induced acute intratemporal facial nerve lesions. The tympanic segments of the right facial nerve in nine rabbits were contused, and MRI scans were performed without and with gadolinium-diethyl-triamine-pentaacetic acid (Gd-DTPA) at varying intervals after surgery. MRI with Gd-DTPA accurately identified the lesion site in eight of nine subjects. Gd-DTPA-enhanced MRI appears to be useful in the evaluation of traumatic facial nerve injuries.  相似文献   

15.
CONCLUSIONS: Data about the recovery course of facial function after intratemporal facial nerve reconstruction using interposition nerve graft would provide useful information for clinicians to understand the regenerative process of the facial nerve after this type of surgery. It would also enable them to obtain informed consent from the patients by preoperatively explaining the predicted outcome of the postoperative facial paralysis. OBJECTIVE: The purpose of this study was to describe the recovery course of facial movement and electrophysiological findings after intratemporal facial nerve reconstruction using interposition graft. PATIENTS AND METHODS: Five patients who underwent reconstruction of the facial nerve using interposition nerve graft immediately after facial nerve excision during surgery for temporal bone lesions were included in this study. Each patient was evaluated for facial movement (Yanagihara score), blink reflex (BR), and electroneurography (ENoG) preoperatively and postoperatively. RESULTS: Improvement in facial movement began 8-10 months postoperatively. The score then gradually increased, and reached a plateau level by 2 years following surgery. The final score in four of the five patients ranged from 20 to 24 points, while the facial score of one patient only reached 12 points even at 3 years after surgery. All patients demonstrated moderate to severe synkinesis. The reappearance of R1 in BR occurred 7-10 months postoperatively, almost simultaneously with the beginning of recovery of facial movement. The latency of R1 on the operated side became shortened with increasing postoperative time, although it remained considerably longer than that on the unoperated side, even after 2 postoperative years. The onset of recovery of ENoG value (10-12 months postoperatively) was always delayed compared with the actual facial movement recovery and never returned to the level in the unoperated side.  相似文献   

16.
Conventional hypoglossal-facial anastomosis and the interposition jump graft variation are the most popular techniques for facial nerve reconstruction resulting from proximal facial nerve injury. We present a modification of this technique, the hemi-hypoglossal facial intratemporal side to side anastomosis, which overcomes many of the failings of previous techniques. The method involves mobilization of the intratemporal facial nerve, which is anastomosed to a partially incised hypoglossal nerve. It is especially indicated in patients with multiple cranial nerve palsies.  相似文献   

17.
OBJECTIVE: To evaluate functional recovery after facial-hypoglossal nerve transfer with direct coaptation of the intratemporal part of the facial nerve. STUDY DESIGN: Retrospective study. SETTING: University-based tertiary referral center. PATIENTS: Nine patients who underwent facial-hypoglossal transfer surgery between 2001 and 2006 to treat a unilateral complete facial nerve palsy. INTERVENTION: The facial nerve is mobilized in the temporal bone, transsected at the second genu, transferred and directly coaptated to a partially incised hypoglossal nerve. MAIN OUTCOME MEASURES: The House-Brackmann grading system was used to evaluate facial nerve reinnervation. Tongue atrophy and movements were documented. Quality of life related to facial function was assessed using the validated Facial Disability Index. RESULTS: A House-Brackmann Grade III (86%) was achieved in six patients, and Grade IV (14%) in one patient with an average follow-up of 22 months (range, 12-48 mo). Two patients had a follow-up of less than 12 months after surgery, and reinnervation was still in progress. In none of the patients who were operated on was tongue atrophy or impaired movement observed. Postoperative Facial Disability Index scores (mean, 71.8 +/- standard deviation [SD] 10.6) for physical functioning and social functioning (mean, 85.7 +/- SD 9.8) were increased for all patients when compared with preoperative scores (mean, 28.6 +/- SD 9.0; mean, 37.7 +/- SD 14.4, respectively). CONCLUSION: The facial-hypoglossal nerve transfer with direct coaptation of the intratemporal part of the facial nerve offers good functional results with low lingual morbidity and improved quality of life. The technique is straightforward, relatively simple, and should be considered as first option for reanimation of traumatic facial nerve lesions.  相似文献   

18.
Although Ramsay Hunt syndrome is one of the most important diseases causing peripheral facial palsy, the detailed pathology of the disease in the intratemporal facial nerve remains unclear. The purpose of this study was to increase knowledge of the pathogenesis of the syndrome by means of surgical findings. Between April 1976 and March 1997 we performed subtotal decompression of the facial nerve in 74 patients with severe Ramsay Hunt syndrome. The grade of nerve swelling was assessed using a microscope and recorded in a standardized form. The relationships between nerve swelling, the timing of surgery and the swelling of each segment were analyzed. Pronounced neural swelling, involving the geniculate ganglion and the horizontal segment, was consistent finding in the acute phase. Although the incidence of pronounced swelling of the horizontal segment gradually declined with time after onset, in most cases nerve swelling persisted even beyond the 16th week after onset. These data suggest that diffuse viral neuritis occurs throughout the intratemporal facial nerve. We assume that the viral inflammatory swelling involving the geniculate ganglion and horizontal segment is mostly responsible for the acute facial palsy in the acute phase.  相似文献   

19.
目的 探讨几丁质室修复颞骨内面神经缺损神经纤维的再通以及与神经元胞体的连续性。方法 用几丁质室修复兔左侧颞骨内面神经缺损,术后1、3和5个月切断颞外段面神经主干,将辣根过氧化物酶(horseradish peroxidase,HRP)涂于其近端,同法标记正常神经对照组,观察脑桥下段的神经元细胞。结果 术后3个月在同侧腹外侧面神经运动核区出现数量不等的标记细胞。术后5个月数量增多,与正常神经的神经元胞体来源相同。结论 HRP可沿再生神经纤维逆行运输,表明神经纤维再通,周围支到中枢的解剖通路重建。  相似文献   

20.
《Acta oto-laryngologica》2012,132(3):348-352
Although Ramsay Hunt syndrome is one of the most important diseases causing peripheral facial palsy, the detailed pathology of the disease in the intratemporal facial nerve remains unclear. The purpose of this study was to increase knowledge of the pathogenesis of the syndrome by means of surgical findings. Between April 1976 and March 1997 we performed subtotal decompression of the facial nerve in 74 patients with severe Ramsay Hunt syndrome. The grade of nerve swelling was assessed using a microscope and recorded in a standardized form. The relationships between nerve swelling, the timing of surgery and the swelling of each segment were analyzed. Pronounced neural swelling, involving the geniculate ganglion and the horizontal segment, was consistent finding in the acute phase. Although the incidence of pronounced swelling of the horizontal segment gradually declined with time after onset, in most cases nerve swelling persisted even beyond the 16th week after onset. These data suggest that diffuse viral neuritis occurs throughout the intratemporal facial nerve. We assume that the viral inflammatory swelling involving the geniculate ganglion and horizontal segment is mostly responsible for the acute facial palsy in the acute phase.  相似文献   

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