腮腺切除术中面神经的解剖和观测

为了探讨面神经颅外段的走行，对１２０例由于各种原因进行保留面神经的腮腺腺叶切除术的患者，在术中对其面神经出颅后的走行，分支及其与邻近组织的关系等进行了解剖测量观察，观测包括面神经主干的长度，宽度以及各个分支发出的部位，各个分支的解剖特点，结果表明，颞支位置深在，分支较多；颧支位置深在，较粗大，分支相对较少，位置恒定，颊支分为（１）上下颊支型；（２）融主一支型；（３）一支再分型三种情况，下颌缘支位置     

腮腺切除术中面神经的解剖和观测

为了探讨面神经颅外段的走行，对１２０例由于各种原因进行保留面神经的腮腺腺叶切除术的患者，在术中对其面神经出颅后的走行、分支及其与邻近组织的关系等进行了解剖测量观察。观测包括面神经主干的长度、宽度以及各个分支发出的部位，各个分支的解剖特点。结果表明：颞支位置深在，分支较多；颧支位置深在，较粗大，分支相对较少，位置恒定；颊支分为①上下颊支型；②融为一支型；③一支再分型三种情况；下颌缘支位置较表浅，较细且走行长，分支多为２～３支。对手术时如何利用邻近解剖关系正确地寻找面神经进行了分析。     

腮腺切除术中面神经的解剖和观测

为了探讨面神经颅外段的走行,对120例由于各种原因进行保留面神经的腮腺腺叶切除术的患者,在术中对其面神经出颅后的走行、分支及其与邻近组织的关系等进行了解剖测量观察。观测包括面神经主干的长度、宽度以及各个分支发出的部位,各个分支的解剖特点。结果表明:颞支位置深在,分支较多;颧支位置深在,较粗大,分支相对较少,位置恒定;颊支分为①上下颊支型;②融为一支型;③一支再分型三种情况;下颌缘支位置较表浅,较细且走行长,分支多为2～3支。对手术时如何利用邻近解剖关系正确地寻找面神经进行了分析。     

腮腺混合瘤手术治疗临床体会

腮腺肿瘤占唾液腺肿瘤中的80％，腮腺混合瘤（多型性腺瘤）在唾液腺肿瘤中最为常见。我科自1998年3月-2008年3月共收集107例初发的腮腺混合瘤患者进行手术治疗，85例采用传统的术式即面神经解剖、腮腺肿瘤及腮腺浅叶或全叶切除术。另外22例采用较新的术式即切除肿瘤及肿瘤周围腮腺组织并保留面神经。比较两种方法的优缺点及并发症，进行分析总结。现将临床体会报道如下。     

口腔内造瘘治疗腮腺混合瘤术后腮腺漏5例临床分析

腮腺漏是腮腺混合瘤切除手术的常见并发症之一，大多能自愈，但也有部分长期迁延不愈，甚至在颈部形成窦道，给患者带来极大的痛苦。我院自1997年4月～2005年7月收治此类患者5例，采用口腔内造瘘术治疗取得良好疗效。现报告如下。     

黑色素瘤误诊为腮腺混合瘤1例

黑色素瘤也称恶性黑色素瘤，是一种少见肿瘤，死亡率高且发病率有逐渐增加趋势，现将笔者收治1例黑色素瘤误诊为腮腺混合瘤患者的资料总结分析如下。     

腮腺区肿物切除后面神经缺损的手术修复

目的 探讨腮腺癌、面神经肿物切除后面神经缺损修复方法的可行性,并对各种面神经缺损修复方法进行评价.方法 对腮腺恶性肿物侵袭面神经扩大切除及发生在面神经的神经源性肿物切除后面神经缺损的32例患者进行了神经移植修复.其中单纯采用耳大神经移植19例,神经长度1～2 cm;朐锁乳突肌携带耳大神经5例,修复腮腺恶性肿瘤扩大切除后骨面暴露的面神经缺损;携带筋膜面神经颈支修复下颌缘支缺损5例,携带筋膜面神经上颊支修复颧支缺损3例.所有手术均在双人双目手术显微镜下进行,用9-0及11-0无损伤缝合线吻合神经.结果 面神经恢复标准按照刘世勋面神经损伤修复评价标准进行评价.采用单纯耳大神经移植修复面神经缺损19例,术后恢复时间为6～18个月,恢复程度多数为部分功能恢复;胸锁乳突肌携带耳大神经移植修复面神经缺损5例,术后恢复时间为6～12个月,恢复效果比较理想;携带筋膜面神经颈支、上颊支修复下颌缘支、颧支缺损8例,术后恢复时间为6个月左右,恢复效果均比较理想.结论 几种神经移植修复面神经缺损,均是可行的.但采用面神经次要神经修复主要神经,修复效果比较理想.对于腮腺癌扩大切除后局部骨面外露者,采用胸锁乳突肌携带耳大神经移植修复是一种比较理想的修复方法.     

腮腺多形性腺瘤手术治疗152例

腮腺多形性腺瘤是口腔涎腺疾病中发生率最高的肿瘤，其特点为：（1）肿瘤组织没有完整包膜，与邻近正常组织没有明显界限；（2）呈膨胀性生长，可侵犯包膜和向包膜外生长；（3）肿瘤为多中心来源，特别是复发性肿瘤，常见到多中心性或多结节状生长，以手术治疗为首选。1988～2006年本院口腔科治疗152例，现对临床资料进行分析。     

大型听神经瘤术中面神经保护

听神经瘤是常见的颅内良性肿瘤，约占颅内肿瘤的8％～10％，占桥小脑角肿瘤的80％。随着显微神经外科技术的发展，听神经瘤全切除已成为可能，但面神经损伤仍是听神经瘤尤其是大型听神经瘤手术最常见的并发症，彻底切除肿瘤而完整保留面神经甚至耳蜗神经功能是听神经瘤手术的理想结果。     

耳后隐蔽切口逆向解剖面神经在腮腺部分切除术中的临床应用

目的:探讨耳后隐蔽切口沿下颌缘支逆向解剖面神经在腮腺部分切除术中的临床疗效。方法:选取2015年1月-2018年1月收治的62例腮腺肿瘤患者进行观察,随机分为观察组和对照组,对照组采用传统“S”形手术方法,观察组采用耳后隐蔽切口沿下颌缘支逆向解剖面神经方法,术后对患者进行随访,比较两组术后面神经功能、手术并发症、切口瘢痕评分及患者对术后切口美容效果的满意度。结果:术后随访6~12个月,两组面神经功能分级情况比较,观察组面神经功能分级以Ⅰ~Ⅲ级为主,明显优于对照组,差异有统计学意义(P<0.05)。观察组涎瘘、Frey综合征、耳垂麻木以及口干等并发症发生率低于对照组,差异有统计学意义(P<0.05)。术后6个月和术后12个月观察组评分均明显低于对照组,差异有统计学意义(P<0.05)。术后12个月,观察组患者满意度大于对照组,差异有统计学意义(P<0.05)。结论:耳后隐蔽切口沿下颌缘支逆向解剖面神经的腮腺部分切除术面神经功能保护较好,并发症少,切口美容效果好,值得临床推广应用。     

Superficial parotidectomy: Antegrade versus retrograde facial nerve dissection

Aim: Classically, parotidectomy is performed by the antegrade facial nerve dissection technique. However, a significant amount of normal parotid parenchyma is mobilized and killed needlessly, without enhancing the oncological outcome, as most tumours do not reside in the proximity of the facial nerve trunk. We investigate whether retrograde facial nerve dissection (the facial nerve branches were identified and dissected proximally) is a safe or better alternative. Patients and Methods: Patients who underwent parotidectomy for clinically‐benign parotid tumours from September 2000 to December 2009 were enrolled. From 2007, we adopted retrograde parotidectomy as the form of surgery for treating parotid masses. A comparison was made between the antegrade and retrograde facial nerve dissection groups regarding the operation time, hospital stay and surgical complications. Results: The patient and tumour characteristics were comparable between the two groups. The mean operation time was shorter in the retrograde group: 144 min versus 176.2 min (P = 0.002). The postoperative stay was also shorter for the retrograde group: 3.3 days versus 4.1 days (P = 0.037). There was no tumour relapse in either group. More great auricular nerves were divided in the antegrade group: 59 per cent versus 10.3 per cent (P = 0.009). A consistent trend of a lower rate of transient facial palsy, pinna numbness, sialocele/salivary fistula and Frey's syndrome was seen in the retrograde group, although they were statistically insignificant. Conclusion: Retrograde parotidectomy can be performed safely without compromising the oncological outcome.     

Management of the facial nerve in parotid gland surgery

Sacrifice of the facial nerve leaves a severe cosmetic deformity, but is necessary in the management of some malignant tumors of the parotid gland. Of 1,600 patients with tumors of the parotid gland seen at the Mayo Clinic over a twenty-two year period, 296 had malignant tumors of this gland; part or all of the facial nerve was sacrificed in 102 patients. Removal of the nerve was more often necessary in patients who had had previous operation for tumor of the parotid gland or who had tumors of high degree of malignancy; it also was necessary in some cases of cylindroma. In general, it is concluded that for tumors of a moderate degree of malignancy (mucoepidermoid carcinoma, acinic cell carcinoma, and cylindroma [adenocystic carcinoma]) the nerve may be preserved; the need for partial or total sacrifice of the nerve is determined on a selective basis depending on the anatomic findings in the course of the operation. For more undifferentiated tumors, the nerve almost always should be sacrificed and the gland with the tumor can be removed en bloc. If the nerve has to be removed, a free nerve graft should be considered to bridge the defect; good results can be expected in more than 70 per cent of these cases.     

Problems with reoperation of the parotid gland and facial nerve

The decision as to how to handle recurrent benign disease in the parotid gland can be a perplexing problem. It may cover the gamut of clinical observation, through conservative surgery to radical ablation. The situation is a balance between the nature of the biological process, the possibility of cure or control, and the status of the facial nerve. These problems can be exceptionally difficult in analysis and philosophical management, and are frequently pinioned between technical craftsmanship, curability, and deformity. An understanding, however, of the variety of possibilities--and particularly their relationship to the facial nerve--will help to position these cases within the realm of surgical reality. A new technique of interfascicular dissection is proposed in certain instances.     

Injury of the facial nerve during surgery of the parotid gland.

The notes of 158 patients who had undergone surgery of the parotid gland for benign and malignant disease were studied to discover the circumstances in which the facial nerve might be injured. Limited surgery carried as great a risk of injury to the facial nerve as during extended surgery. Extended surgery provided greater risk of injury to the facial nerve on secondary exploration (71 per cent) than on primary exploration (6-5 per cent). It is concluded that every primary exploratory procedure of the parotid gland should be a formal conservative parotidectomy unless the tumour is obviously malignant.     

Patterns of use of facial nerve monitoring during parotid gland surgery.

OBJECTIVE: To determine current patterns of use of facial nerve monitoring during parotid gland surgery by otolaryngologists in the United States. STUDY DESIGN AND SETTING: A questionnaire encompassing surgeon training background, practice setting, patterns of facial nerve monitor usage during parotid gland surgery, and history of permanent facial nerve injury or legal action resulting from parotid surgery was mailed to 3139 otolaryngologists in the United States. Associations between facial nerve monitor usage and dependent variables were examined by using the chi(2) test. Magnitudes of the associations were determined from odds ratios calculated using logistic regression. RESULTS: A 49.3% questionnaire response rate was achieved. Sixty percent of respondents who perform parotidectomy employed facial nerve monitoring some or all of the time. Respondents were 5.6 times more likely to use the monitor in practice if they used it in training and 79% more likely to use it if they performed more than 10 parotidectomies per year. Respondents were 35% less likely to have a history of inadvertent nerve injury if they performed more than 10 parotidectomies per year. Surgeons who employed monitoring in their practice were 20.8% less likely to have a history of a parotid surgery-associated lawsuit. Additional information regarding surgeon demographics, types of nerve monitors used, and reasons for and against monitor usage are discussed. CONCLUSION: Permanent facial nerve paralysis after parotidectomy occurs in 0-7% of cases. Currently, a majority of otolaryngologists in the United States are employing facial nerve monitoring during parotid surgery some or all of the time, even though no studies to date have demonstrated improved outcomes with its use. Physician training background and surgery caseload were significant factors influencing usage of facial nerve monitoring in this study.