腮腺切除术中沿面神经总干顺行解剖面神经的效果及安全性

目的探讨腮腺切除术中应用沿面神经总干顺行解剖面神经的治疗效果及安全性。方法选取我院2016年2月至2019年3月收治的60例择期行腮腺切除术的患者,随机分为观察组与对照组各30例。对照组沿面神经总干逆行解剖面神经,观察组沿面神经总干顺行解剖面神经,观察两组患者术后1个月面神经功能及术后并发症发生情况。结果术后1个月,两组患者的面神经功能分级比较无统计学差异(P>0.05);观察组的术后并发症发生率为10.00%,明显低于对照组的33.33%(P <0.05)。结论临床行腮腺切除术中,沿面神经总干顺行解剖面神经可降低术后并发症发生率,值得推广。     

腮腺浅叶良性肿瘤功能性切除术与全切术治疗比较分析

目的比较腮腺浅叶良性肿瘤功能性切除术与全切术两种手术治疗方式的临床效果。方法 60例腮腺浅叶良性肿瘤患者,32例行腮腺浅叶良性肿瘤的功能性切除术,28例行肿瘤及全部浅叶切除面神经解剖术。观察手术伤口愈合情况、术后涎瘘发生率、术后1周面瘫率、术后两年内肿瘤复发率。结果手术伤口均为甲级愈合,两组患者术后均无涎瘘、面瘫并发症;所有病例随访2年,行肿瘤功能性切除术患者的复发率为6.25%（2/32）,行肿瘤及全部浅叶切除面神经解剖术者的复发率为7.14%（2/28）,两组肿瘤的复发率无明显差异（P〉0.05）。结论腮腺浅叶良性肿瘤功能性切除术在不增加肿瘤术后复发率基础上,保留了腮腺分泌唾液的功能,减少了术后面部味觉性出汗综合征的发生,不会造成大块切除后的面部畸形。     

OMS-710型手术显微镜下面神经解剖腮腺肿瘤切除的临床探讨

目的 探讨OMS-710型手术显微镜下面神经解剖在腮腺肿瘤中的应用及效果.方法 回顾性分析在OMS-710型手术显微镜下面神经解剖腮腺肿瘤切除治疗的66例患者临床资料.结果 沃辛瘤35例,多形性腺瘤18例,基底细胞腺瘤4例,肌上皮瘤3例,血管瘤1例,鳞状细胞癌2例,腺导管癌1例,肌上皮癌1例,腺样囊性癌1例.术后无永久性面瘫病例,4例(6.06％)出现暂时性面瘫,经药物治疗后恢复.随访0.5～2.0年,无一例复发.结论 OMS-710型手术显微镜下面神经解剖腮腺肿瘤切除,面神经损伤小,面瘫发生率低,手术效果较好.     

精细解剖技术在腮腺良性肿瘤手术中的应用

目的 探讨精细解剖技术在腮腺良性肿瘤手术中的应用及效果.方法 回顾性分析2008年1月至2011年1月初次接受手术治疗的57例腮腺良性肿瘤患者的临床资料,均应用精细解剖技术.结果 57例腮腺良性肿瘤患者术后2例(3.5％)出现暂时性面瘫,经激素、营养神经等治疗后均于3个月内恢复,无永久性面瘫.随访6个月至3年,无一例肿瘤复发.结论 应用精细解剖技术行腮腺良性肿瘤切除有助于减少术中面神经损伤的概率,减少术后面瘫的发生.     

区域性切除术在腮腺浅叶良性肿瘤治疗中的临床应用

目的：探讨区域性切除术在腮腺浅叶良性肿瘤治疗中的临床应用价值。方法：选取2011年5月-2013年3月入住本院的70例腮腺浅叶良性肿瘤首发患者（肿瘤直径均≤3 cm）,按照随机数字表法将其分为观察组和对照组各35例,观察组采用区域性切除术,对照组采用传统腮腺浅叶切除术,术后所有患者随访6个月~2年,观察记录两组患者手术时间、切口长度、术中出血量及解剖面神经分支数,并发症的发生率及肿瘤的复发情况。结果：观察组患者的平均手术时间、平均切口长度、平均术中出血量、解剖面神经分支数均明显优于对照组,比较差异均有统计学意义（P〈0.05）。观察组患者术后暂时性面瘫、面部畸形、涎液潴留、耳垂麻木、Frey综合征和口干等并发症的发生率均明显低于对照组,比较差异均有统计学意义（P〈0.05）。而两组患者的肿瘤复发率相比较差异无统计学意义（P〈0.05）。结论：区域性切除术用于治疗腮腺浅叶良性肿瘤,创伤小、术后并发症少、肿瘤复发率低,值得在临床推广应用。     

听神经瘤显微外科手术中面神经保留技术的探讨

目的：探讨听神经瘤显微外科手术中面神经的保留技术。方法：回顾性分析在面神经功能监测下采用枕下乙状窦后入路显微切除的22例听神经瘤的临床资料。结果：肿瘤全切除19例，次全切除3例。面神经解剖成功保留20例，未能保留2例,其中1例术中行面神经端-端吻合。结论：面神经功能监测，娴熟的显微外科技术、病理解剖知识对面神经保留是至关重要的。     

40例腮腺混合瘤临床分析

目的探讨腮腺混合瘤手术方法及术后并发症的防治。方法对笔者所在医院2000至2007年收治的经病理证实为腮腺混合瘤的40例患者进行混合瘤腮腺部分切除术，并防治术后并发症。结果40例腮腺混合瘤腮腺部分切除术后随访1-3年，下颌缘支暂时性面瘫6例，无永久性面瘫，涎瘘1例，味觉出汗综合征3例，2例复发。结论腮腺混合瘤经临床检查、B超及CT检查可作出初步诊断。术前根据肿瘤大小及与邻近组织，制定合理的手术方案，术中面神经解剖显露充分，尽量彻底摘除残余腺体，可减少术后并发症的发生。     

神经电生理监测在桥小脑角肿瘤切除术中对面神经的保护意义

目的探讨在桥小脑角肿瘤切除术中神经电生理监测对面神经的保护意义。方法 16例桥小脑角肿瘤患者均采用神经电生理监测仪进行面神经监测,通过枕下乙状窦后入路,在显微镜下切除肿瘤,术后对面神经解剖和功能保留情况进行评估。结果面神经解剖保留15例(约93.8%),6个月后面神经功能Ⅰ级+Ⅱ级共占81.3%。结论术中面神经监测技术可以有效提高面神经解剖和功能的保留率。     

听神经鞘瘤术中面神经电生理监测的应用

目的：探讨听神经鞘瘤术中电生理监测对面神经功能保护和评估的作用,提高肿瘤全切率、面神经解剖和功能保留率。方法：对27例听神经鞘瘤患者行术中电生理监测,研究其变化与术后面神经功能的关系。结果：肿瘤全切除24例（88.9%）,次全切除3例（11.1%）,面神经解剖保留26例（96.3%）,面神经功能保留17例（63.0%）,无死亡病例,术末与术前经颅电刺激运动神经（面神经）诱发电位的比值〈60%者术后可能面神经功能差。结论：听神经鞘瘤术中电生理监测对于安全切除肿瘤,保护、评价面神经功能有重要价值,该比值〈60%是面神经功能可能严重损伤的警示。     

腮腺良性肿瘤的保守性手术治疗

腮腺肿瘤中良性肿瘤约占80％。过去文献报告表明,局部切除术后复发率高,因此近年来多主张采用腮腺次全切除术(肿瘤及腮腺浅层切除)或腮腺全切除术。但由于腮腺局部解剖的特点,在手术中作腮腺较彻底的切除时,往往造成面神经损伤。为了彻底切除肿瘤降低复发率,同时尽量减少面神经损伤的机会,我们采用了     

Stimulation electromyography as a method of intraoperative localization and identification of the facial nerve during parotidectomy: review of 15 consecutive parotid surgeries

INTRODUCTION: It has been widely recognized that one of the major hazards during operation of the parotid gland, mainly in tumor resection, is the injury of the facial nerve. Facial nerve monitoring has achieved wide application in otologic and neurotologic procedures to help localization and protection of the facal nerve in the temporal bone. MATERIAL AND METHODS: The authors analyze localization and identification of 15 nerves in 15 patients who underwent parotid gland surgery in the Department of Ear Nose and Throat Diseases of the Medical University in Plovdiv from September 15, 2000 to December 15, 2000. Nerve integrity monitor Neurosign 100 and specially designed electromyographic electrodes were used. RESULTS: In all patients stimulation electromyography of the facial nerve was successfully used to locate, identify and evaluate the integrity of the facial nerve during and at the end of the operation. No postoperative facial nerve injury was detected clinically. In two patients with parotid gland cancer the inferior division of the facial nerve was found infiltrated by the cancer growth. CONCLUSION: The results indicate that identification of the facial nerve by electromyography is a safe, effective and simple method of electrophysiologic monitoring during parotid gland surgery. This method allows assessment of the nerve integrity at the end of the operation.     

Subtotal parotidectomy for a parotid gland tumour in two players of wind instruments, with preservation of facial nerve function

Two professional musicians, a 55-year-old clarinet player and a 58-year-old trumpet player, presented to the surgical outpatient clinic with a Warthin's tumour and a pleomorphic adenoma in the deep lobe of the parotid gland, respectively. The several branches of the facial nerve form the virtual plane between the superficial and deep lobes of the parotid gland. Due to the localisation of this nerve, parotid surgery entails a significant risk of neurapraxia of the facial nerve branches. Before the operation, both patients were informed carefully about both the necessity and the risks of surgical excision of parotid tumours. Even slight damage to the facial nerve during parotidectomy could have severe implications for their careers. Both underwent subtotal parotidectomy. Postoperatively, there was clinically a temporary minor marginal branch dysfunction in one patient. Pre- and postoperative electromyography did not indicate asymmetrical function of the facial muscles. A few weeks after the operations, both musicians could resume playing; subtotal parotidectomy can apparently be safely performed in players of wind instruments.     

神经传导检测对急性面神经炎预后的临床价值

目的：分析面神经炎患者早期面神经传导检测（NCS）指标,探讨其在急性面神经炎早期诊断及预后评估中的临床价值。方法：68例面神经炎患者在发病1周内进行双侧面神经传导检测,并比较患侧、健侧的潜伏期与振幅,并对所有患者进行随访6个月,评估其面肌恢复情况。结果：68例患者患侧潜伏期不同程度延长,振幅不同程度降低,其中2例患者诱发不出运动传导振幅,呈病理电静息状态,患侧与健侧相比,差异有统计学意义（P〈0．05）;随访6个月后,43例痊愈,18例显效,5例有效,2例无效,总有效率97．06％。结论：面神经传导检测可作为面神经损伤早期评价的客观指标之一,并可帮助判断预后,有着重要的临床价值。     

Successful reanimation of facial paralysis with an indirect anastomosis between hypoglossal nerve and facial nerve, without loss of function of the tongue

OBJECTIVE: To describe the surgical procedure and the results of the indirect hypoglossal-facial nerve anastomosis using a free nerve graft in patients with facial nerve paralysis. This technique leaves the tongue function intact. DESIGN: Prospective study. METHODS: Tongue function was assessed in 39 consecutive patients who underwent this procedure and facial reanimation was assessed in 29 of these patients who had completed at least 24 months follow-up. Facial nerve function was judged using the House-Brackmann (HB) facial nerve grading system. RESULTS: Tongue movements were normal in all operated patients; one patient had mild homolateral atrophy. Initial facial movements occurred on average 7.5 months postoperatively (range 4 to 18 months) in all but one patient. The results were graded HB II in 6 patients (20.9%), HB III in 13 (44.6%), HB IV in 7 (24.1%), HB V in 2 (6.8%) and HB VI in 1 patient (3.4%). Hemifacial synkineses were noticeable but no mass movements or gross hypertonia were observed (as are often present in direct hypoglossal-facial anastomosis). The results of facial reanimation were significantly better in young patients and when a short time interval between paralysis and surgery existed. HB grade II was achieved only if the duration of paralysis was less than 12 months. CONCLUSION: Indirect hypoglossal-facial anastomosis with interposition of a nerve graft allows preservation of tongue function together with good overall facial reanimation, and is therefore to be preferred to the classical direct hypoglossal-facial anastomosis.     

Our experience with surgical dissection of the facial nerve in parotid gland tumours. (A preliminary report)

Conservative parotidectomy is a primary method in the surgical treatment of parotid gland tumours. The classic parotid gland surgery uses the styloid process as a landmark for dissection of the facial nerve. The anatomical variations of the styloid process, however, prevent it from being always used as a reference landmark in this operative approach. This requires finding reliable invariable anatomical landmarks to be applied in the facial nerve dissection. The author presents his experience from the surgical treatment of 37 patients (25 females and 12 males) with tumours of the parotid gland. Adenoma was verified in 31 patients and 6 patients had a low malignancy carcinoma stage I. The mean age of the patients was 52 +/- 2.4 years. Conservative parotidectomy was performed in 28 patients (75.67%) and lateral parotidectomy in 9 patients (24.32%). The insertion of the posterior belly of digastric muscle on the mastoid process and tympanomastoid fissure were the primary landmarks used in the conservative parotidectomy. The proposed surgical technique was assessed as more reliable and less traumatic. Transient paralysis of the facial nerve occurred in 7 patients (18.9%) and subsided without treatment within 6-8 months. Based on his experience the author finds these anatomical landmarks easily recognizable and reliable start-points in facial nerve dissection that reduce the risk of traumatic injury of the facial nerve.     

颞骨骨折面瘫患者行面神经减压术后的护理

目的探讨颞骨骨折致面瘫患者行面神经减压术治疗后的护理方法和注意事项。方法对16例颞骨骨折面瘫患者行面神经减压术治疗后进行术后常规及并发症相应护理,分析术后护理的作用和意义。结果 16例患者全部一期愈合,面神经功能恢复率高达81.25%,无护理并发症。结论对颞骨骨折面瘫行面神经减压术后的科学护理对患者的尽快康复、疗效提高有重要的临床意义。     

Parotid gland Warthin's tumor combined with actinomycosis

The authors describe the diagnostic problems and difficulties of treatment of Warthin's tumor combined with actinomycosis. A 48-year-old woman was presented with a mass in the left parotid region and paresis of the lower left palpebra. The CT, echography, parotid X-ray findings supposed a neoplasm of the left parotid gland which was proved by intraoperative freezing histology. The ramus of the mandible was involved in the process. Total parotidectomy and partial mandiblectomy were performed, with sacrifice of the facial nerve, followed by nerve reconstruction. The final histological evaluation was Warthin's tumor with actinomycosis. Eight years after treatment the patient is free of disease.