腮腺切除术后面神经功能损伤

目的　分析腮腺切除术后面神经功能损伤的发生率及其与腮腺切除的范围、病理诊断及临床特点的关系。方法　对 16 4例腮腺区病损的病案资料进行回顾性分析。结果　 16 4例治疗手术中 ,有 85例术后出现面神经功能损害 ,约占 5 1.8%。良性病损术后多为暂时性面神经损伤 ;恶性病损 ,由于采用切除受累神经分支术式 ,术后面神经损伤多为永久性的。结论　面神经受损的危险性与手术切除范围、疾病性质是密切相关的。     

腮腺手术中面神经解剖术式与面神经功能损伤的临床研究

目的:探讨腮腺手术中不同的面神经解剖术式与面神经功能损伤之间的相关性。方法:通过对120例临床腮腺肿瘤患者进行随机分3组,分别采用不同的面神经解剖术式,观察面神经功能损伤的发生率及恢复时间。结果:经面神经总干的顺行法、经颧支或下颌缘支的逆行法面神经解剖术式,其神经功能损伤的发生率及神经功能恢复时间分别是:5%,2.58月;12.5%,2.82月;70%,6.52月。前2种术式之间,神经损伤发生率及恢复时间差异均无显著性,而前2种术式与经下颌缘支的逆行法之间比较,神经损伤的发生率(P<0.01)及恢复时间(P<0.05)差异均存在显著性。结论:经面神经总干及颧支解剖面神经,运用逆行和顺行解剖法相结合,是一种较好的减少面神经损伤的手术方式。     

腮腺切除术后面神经损伤的临床分析

目的　分析 6 0例腮腺切除术病人的面神经损伤原因。方法　对 6 0例病人从手术方式、肿瘤类型、面神经解剖方式等方面进行分析。结果　行浅叶及肿瘤切除手术比行全叶及肿瘤切除手术损伤面神经的概率低。良性肿瘤术后面神经损伤的机会较恶性肿瘤低。结论　手术方式、切除范围、肿瘤性质、面神经解剖方法是影响面神经功能的主要因素。     

腮腺肿瘤手术致面神经损伤的相关因素分析

目的：探讨腮腺肿瘤手术相关因素与面神经损伤间的关系。方法：总结1995~2005年间腮腺肿瘤手术96例,在肿瘤性质、神经游离和腮腺切除范围等方面对面神经的影响进行回顾性分析。结果：良性肿瘤较恶性肿瘤术中损伤面神经机率小,术中不游离面神经较完全或部分游离面神经损伤机率小,腮腺部分切除较全切除术中损伤面神经机率小。结论：腮腺区肿瘤在不影响愈后的前提下,选择恰当的切除范围,尽可能保护面神经在筋膜间的位置而不将其分离出来,可减少面神经损伤的发生。     

腮腺切除术解剖面神经所致面神经核超微结构的病理变化

目的:了解腮腺切除术中面神经外血管系破坏与否对面神经核的影响.方法:选用健康家兔,采用同体对照的方法,模拟人腮腺全切术.实验侧于手术显微镜下腮腺全切,解剖面神经,保护面神经外血管系;对照侧镜下完成相同手术,但破坏面神经外血管系.术后2、3、4 周分别取面神经核透射电镜下观察其超微结构的病理变化.结果: 术后3 组动物实验侧面神经核细胞超微结构正常,未见明显变化;对照侧面神经核内线粒体变性,大部分细胞器失去正常结构,随时间延长出现明显病理变化.结论: 在腮腺切除术中解剖面神经破坏其外血管系,可导致面神经核细胞超微结构发生明显的病理变化,这可能是腮腺切除术后患者发生面瘫的原因之一.     

腮腺肿瘤切除术中面神经解剖路径临床研究

在腮腺切除术40例中,顺行法（总干法）解剖显露面神经17例,逆行法（周围支法）解剖显露面神经23例,术后顺行法有1例、逆行法中有8例出现不同程度的暂时性面瘫症状（P ＜0．05）,提示顺行法更加安全可靠、快速简便。     

解剖面神经颧支在腮腺切除术中的临床应用

目的：总结解剖面神经颧支在腮腺良性肿瘤切除术中的临床应用。方法：采用经典的面部除皱手术切口,在腮腺嚼肌筋膜下翻瓣,先在耳屏前颧弓下解剖显露面神经的颧支,然后沿该支显露面神经的颞面干及面神经总干,再根据肿瘤的位置沿总干选择性地解剖面神经颈面干及各分支,行肿瘤及腮腺部分切除术。最后采用蒂在上方的胸锁乳突肌肌瓣转移填塞腮腺切除后的凹陷区,避免了常规术式术后耳前区的凹陷畸形。结果：采用该术式对19例患者行腮腺良性肿瘤切除术,所有手术均顺利完成,术后随访3～4年,患者面部疤痕不明显,外形恢复良好,面神经损伤均完全恢复。结论：本术式更易于显露和保护面神经,改善术后面部畸形。     

腮腺切除术对面神经损伤和恢复的影响

目的：分析腮腺切除术后面神经功能损伤的发生率及其与腮腺切除的范围,临床特点的关系。方法：对62例腮腺混合瘤的病案资料进行回顾性分析。结果：62例治疗手术中,面神经损伤22例,占35．48％。其中腮腺区域性切除32例,术后即刻出现面神经颧支及颊支暂时性麻痹2例(6．3％),下颌缘支暂时性麻痹3例(9．4％),1个月后自行恢复。腮腺浅叶摘除20例中,术后即刻出现面神经颧支及颊支暂时性麻痹2例(10％),下颌缘支暂时性麻痹5例(25％)。腮腺全切解剖面神经的10例,术后全部即刻出现面神经暂时性面瘫(100％),所有麻痹均在1～2个月恢复。结论：面瘫的发生率与手术术式、瘤体与面神经的位置关系、以及面神经的解剖形态密切相关。     

腮腺癌手术中面神经处理方式的探讨

腮腺癌手术中面神经处理方式的探讨ＡＮＡＰＰＲＯＡＣＨＯＮＨＯＷＴＯＤＯＷＩＴＨＦＡＣＩＡＬＮＥＲＶＥＩＮＴＨＥＣＯＵＲＳＥＯＦＰＡＲＯＴＩＤＣＡＮＣＥＲＯＰＥＲＡＴＩＯＮ张军生孙国洪张彬牛怀恩作者单位：山东聊城地区医院口腔科（２５２０００）孙国洪：武...     

腮腺内面神经鞘瘤的诊断与治疗

腮腺内面神经鞘瘤（IFNS）较为罕见,术前诊断困难,多在手术中得以发现,其治疗极具挑战性。本文复习了1958-2014年PubMed收录的IFNS相关文献,详细介绍了IFNS的临床表现、诊断与鉴别诊断以及治疗方法的选择。IFNS主要依赖术中诊断和术后组织学检查,对其治疗必须参考患者术前的面神经功能,肿瘤与面神经的关系,以及患者的主观要求;对于面神经功能为House-Brackmann分级为3级以上的患者可选择手术治疗,否则宜选择保守治疗。     

Indications for partial parotidectomy using retrograde dissection of the marginal mandibular branch of the facial nerve for benign tumours of the parotid gland

The aims of this study were to evaluate the efficacy of partial parotidectomy using retrograde dissection of the marginal mandibular branch of the facial nerve for benign tumours of the parotid gland and to establish the indications for its use. We examined 106 consecutive patients with previously untreated benign tumours in the lower portion of the parotid gland who were treated by parotidectomy. The first group (anterograde group, n=52) consisted of those who had standard anterograde parotidectomy. The remaining patients, who underwent retrograde parotidectomy, were further divided into two groups: those in whom the upper edge of the tumour was located below the mastoid tip (below mastoid group, n=46) or those in whom it was above the mastoid tip (above mastoid group, n=8). The operating time was significantly shorter in the below mastoid group (141.2, 127.5, and 98.1 minutes, respectively) as was intraoperative blood loss (41.1, 53.0, and 24.4 ml, respectively), compared with the other two groups. There was a higher incidence of facial nerve dysfunction in the above mastoid group postoperatively (4/8) than in the other two groups. The results suggested that the presence of a tumour of any size located below the mastoid tip is a good indication for parotidectomy using retrograde dissection of the marginal mandibular branch of the facial nerve.     

面神经中段解剖法在区域性腮腺切除术中的应用

目的 提出经腮腺实质内面神经中段解剖法并评价其在区域性腮腺切除术中的应用效果。方法 回顾性统计了自2016年1月至2017年12月行腮腺良性肿瘤手术患者136例,按照面神经解剖方法分类,分为顺行总干解剖法（顺行组,70例）、逆行分支解剖法（逆行组,34例）、实质内中段解剖法（中段组,32例）,比较3组的手术时间,面神经损伤和耳垂感觉状况,涎瘘、Frey’s综合征发生率,并进行美学评价。结果 中段组手术时间较其他两组明显缩短（P<0.05）;中段组术后未出现涎瘘患者,顺行组涎瘘发生的比例较高（9例,12.9%）（P<0.05）;中段组和顺行组术后面神经损伤率均较低（顺行组3例,4.3%;中段组1例,3.1%）,逆行组面神经损伤比例偏高（7例,20.6%）（P<0.05）;中段组和逆行组均未出现耳垂感觉减退情况,而顺行组出现比例较高（12例,17.1%）（P<0.05）;术后中段组及顺行组患者对术后面部外形比较满意,而逆行组对美观评价一般（P<0.05）。结论 面神经中段解剖法在技术上是可以实行的,在腮腺良性肿瘤的区域性切除术中,可以取得较好的临床效果,具有一定的临床应用价值。     

Comparison of postoperative complications and facial nerve recovery rates after conventional and partial superficial parotidectomy of benign parotid tumours: a prospective study

The aim of this study was to compare postoperative complications and facial nerve (FN) recovery rates between conventional superficial parotidectomy (CSP) and partial superficial parotidectomy (PSP) as surgical treatment for benign parotid tumours. A prospective study was conducted on 55 consecutive patients who underwent either CSP (n = 35) or PSP (n = 20) for benign parotid tumours. The primary outcomes were FN injury, FN recovery rates, and Frey syndrome. Secondary outcomes were operative time, hospital stay, sialocele, haematoma, and auricular numbness. The degree of FN injury was evaluated at 1 week, 1, 3, 6, and 12 months postoperative using the House–Brackmann grading system. Frey syndrome was assessed using a subjective clinical questionnaire and objective Minor starch–iodine test. No patient in either group experienced permanent FN paralysis. There was a significantly higher incidence of temporary FN weakness in the CSP group (P = 0.007). The respective FN recovery rates at 1, 3, 6, and 12 months were 60%, 88.6%, 94.3%, and 100% in the CSP group and 90%, 95%, 100%, and 100% in the PSP group. No significant difference was observed between the groups regarding the incidence of Frey syndrome, sialocele, and haematoma. The operative time and hospital stay were both shorter in the PSP group. Although the PSP is a more conservative procedure with significantly reduced FN injury, operative time, and hospital stay compared to CSP, the CSP procedure shows a comparable FN recovery rate to the PSP.     

两种手术切口治疗腮腺肿瘤的对比研究

目的介绍一种腮腺肿瘤切除的改良式手术切口,并与传统方法进行临床对比。方法改良的腮腺切除术采用耳屏前面部除皱切口及耳后延续入发髻内切口,在嚼肌筋膜(SMAS)下翻瓣,减少了术后Frey综合征的发生;先解剖面神经总干减少了周围支的损伤,暴露面神经总干后,根据肿瘤的位置,选择性解剖面神经颈面干行腮腺部分切除术,保护腮腺的部分功能;采用蒂在上方的胸锁乳突肌填塞局部减少了术后畸形。结果应用传统术式的36例患者,38.8%出现面神经功能损害,16.2%出现涎瘘,8.3%出现Frey综合征;应用改良术式的6例患者中,无1例出现涎瘘及面神经损伤,随访3～6个月无1例出现Frey综合征,并且局部凹陷轻微,面容美观。结论改良式手术方法切口隐蔽,容易操作,不易损伤面神经周围支,术后并发症少。     

Immediate compared with late repair of extracranial branches of the facial nerve: a comparative study

The best outcomes after injury to the facial nerve are seen after immediate direct coaptation, but in practice, this happens infrequently. We ask whether late repair (between 3 weeks and 18 months) is comparable to immediate repair. In this prospective observational study over a two-year period (2016–18), we identified 18 patients (11 male and 7 female, mean (range) age 58 (23–94) years), who had sustained extracranial injuries to the facial nerve. Eight were identified in the acute phase (within 72 hours of injury) and repaired (immediate repair group). Ten presented in the late phase beyond six months (late repair group), and had direct coaptation, neurolysis, nerve transfer, or non-vascularised or vascularised nerve grafts. Patients were followed up clinically with photographic or video analysis every three months using the Sunnybrook facial grading scale and Terzis scores as quantitative tools. In the immediate repair group six patients had direct nerve coaptations, one had a free vascularised nerve graft, and one a fascicular nerve flap. In the late repair group six patients had coaptations, two had nerve transfers, one had neurolysis, and one nerve transfer and a free vascularised nerve graft. The null hypothesis that there was no difference between immediate and late repair of the facial nerve in terms of clinical improvement was accepted. The overall facial grading scale between the two groups showed no significant difference (mean 97 compared with 87; 95% CI: −25.61 to 5.32; p = 0.18). However, the individual volitional facial grading score for the affected division showed that immediate repair fared significantly better than late repair (mean 4.55 compared with 3.14; 95% CI: −2.5 to −0.3; p = 0.027). Supermicrosurgical techniques, together with advanced systems for nerve identification allow for coaptation of the maximum number of injured nerve branches. These factors accounted for a 97% mean return of function after immediate repair and an 87% recovery in the late repair group. While quantitatively, immediate repair is best, the re-establishment of nerve-muscle continuity before degeneration of the motor endplate confers the best possible physiological outcome, and is far superior to any of the techniques used to treat chronic facial paralysis.     

程序化功能性腮腺切除术的初步探讨

目的探讨改良腮腺切除术的临床应用。方法从手术切口、耳大神经保留、面神经解剖、区域性腮腺切除、凹陷性畸形整复和端侧神经吻合术的运用等多个方面对腮腺切除术进行改良。结果随访肿瘤均未见复发,无面瘫及明显味觉出汗综合征,耳周的感觉恢复正常,颌面部基本对称,无明显凹陷性畸形,瘢痕隐蔽。结论可根据患者的个性化情况,程序化地采用功能性腮腺切除术。     

Thoracodorsal nerve graft for reconstruction of facial nerve branching

ObjectSurgical treatment of parotid malignancies may frequently involve facial nerve amputation to achieve oncological radical resection. The entire facial nerve branching from its exit from the stylomastoid foramen to the periphery of the gland is often sacrificed. The first reconstructive strategy is the immediate reconstruction of the facial nerve by directly anastomosing the trunk of the facial nerve to its distal branches by interpositional nerve grafting.The present study was performed to determine the adequacy of thoracodorsal nerve grafting for immediate repair of the facial nerve. The anatomical features of the thoracodorsal nerve make it particularly appropriate to match its trunk to the stump of the facial nerve at its exit from the stylomastoid foramen. Up to seven branches of the thoracodorsal nerve may be distally anastomosed to the severed distal branches of the facial nerve. More complex reconstruction may be addressed simultaneously by contemporary harvesting a de-epithelialized free flap from the same site based on thoracodorsal vessel perforators and preparing a rib graft from the same donor site.MethodsBetween October 2003 and August 2010, seven patients affected by parotid tumors (6 with parotid malignancies and 1 with multiple recurrences of pleomorphic adenoma) underwent radical parotidectomy with intentional sacrifice of the facial nerve to obtain oncological radical resection. In all patients, the facial nerve was reconstructed with an interpositional thoracodorsal nerve graft. In four patients, a de-epithelialized free flap based on the latissimus dorsi was transposed to cover soft tissue defects. Moreover, two of these patients also required a rib graft to reconstruct both the condyle and ramus of the mandible. With the exception of one patient affected by recurrent pleomorphic adenoma, all patients underwent radiotherapy after surgical treatment.ResultsAll patients in our study recovered mimetic facial function. Facial muscles showed clinical signs of recovery within 5–14 (mean: 7.8) months, with varying degrees of mimetic restoration, and almost complete facial symmetry at rest in all patients. The House–Brackmann final score was I in two patients, II in two patients, and III in three patients.ConclusionsA thoracodorsal nerve graft to replace extratemporal facial nerve branching is a valid alternative technique to multiple classical nerve grafts, with good matching at both the proximal and distal anastomoses.     

Conservation of salivary secretion and facial nerve function in partial superficial parotidectomy

Conventional total superficial parotidectomy (TP) has commonly been used, but partial superficial parotidectomy (PP) offers the possibility of better preserving glandular function and avoiding palsy of the facial nerves. In this study, the extent to which saliva secretion and facial nerve function were conserved in patients who received TP vs. PP was compared. Data were collected from patients who received a PP (n = 163) or a TP (n = 105) for benign primary tumours in the superficial lobe of the parotid glands between 1995 and 2009 at a single hospital. The incidence of transient facial paralysis was significantly lower in patients who received PP than in those who received TP. Secretory function was preserved for patients with a conserved Stensen's duct, whereas patients in whom the duct had been ligated lost secretory function. Partial superficial parotidectomy reduces the incidence of postoperative facial nerve dysfunction and is conducive to preserving Stensen's duct and saliva secretion.