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。     

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。     

腮腺浅叶肿物切除术中四种面神经解剖方式对面神经功能的影响

目的评价腮腺浅叶肿物切除术中4种面神经解剖方式对术后面神经功能的影响。方法腮腺浅叶肿物患者70例,按面神经解剖方式分为4组,分别采取面神经主干、颈支、下颌缘支和颊支4种解剖方式行腮腺浅叶肿物切除术,随访时间1年,观察治疗效果。结果主干组术后暂时性面瘫发生率为15．0％,颈支组为12．5％,颊支组为44．0％,下颌缘支组为50．0％。主干组和颈支组术后暂时性面瘫发生率明显低于颊支组及下颌缘支组（P〈0．05）。结论腮腺浅叶肿物切除术中,面神经主干和颈支解剖的手术方式,可减少暂时性面瘫发生率。     

面神经三种解剖方法的比较研究

目的:通过比较腮腺肿物手术中3种不同的面神经逆行解剖方法,探讨通过颈支逆行解剖面神经的可行性。方法:腮腺区肿物患者83例,依据肿瘤部位及性质分别采取面神经颈支、下颌缘支和颊支的逆行解剖方法。随访时间6个月至2年,观察治疗效果。结果:面神经颈支逆行解剖组术后面瘫发生率(10.7%)明显低于下颌缘支组(37.1%)和颊支组(45.0%)。三组术式肿瘤复发率无明显差别。结论:面神经颈支逆行解剖法可有效降低面瘫的发生,并能保留颈阔肌功能,有一定的临床应用价值。     

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。     

腮腺沃辛瘤切除术式的临床研究

目的探讨腮腺沃辛瘤的合理术式。方法93例患者分成2组,A组38例患者行解剖面神经的腮腺区域性切除术;B组55例患者行传统腮腺浅叶切除术。比较2组手术出血量、手术时间、肿瘤大小、术后暂时性面瘫和再发率的差异。结果A组出血量和手术时间少于B组,组间差异有统计学意义（P〈0．01）;A组肿瘤大小、术后暂时性面瘫和再发率与B组的差异无统计学意义（P〉0．05）。结论解剖面神经的腮腺区域性切除术可以达到根治腮腺沃辛瘤的目的,并减少出血量和缩短手术时间,具有临床实用价值。     

超声刀在腮腺手术中的临床应用

目的 :探讨超声刀在在腮腺手术中的应用效果。方法 :对2015-03—2017-07期间,在苏州大学附属第一医院口腔科进行腮腺肿瘤手术的169例患者进行回顾性分析。使用超声刀完成腮腺手术94例(超声刀组),使用电刀手术75例(电刀组)。分析各项手术指标(手术时间、术中出血量、术后引流量)及术后并发症发生率(面神经损伤发生率、涎瘘发生率)。结果:超声刀组手术时间、术中出血量、术后引流量均低于电刀组,差异有统计学意义(P<0.05)。电刀组中暂时性面瘫发生率为8%,涎瘘发生率为4%,而超声刀组中暂时性面瘫发生率为2.1%,无涎瘘发生。结论:超声刀作为一种新型手术器械,在腮腺肿瘤手术中取得良好的临床应用效果,简化了腮腺的手术操作,术区视野清晰,使得手术操作更加精细化,减少了面神经损伤等术后并发症的发生。     

髁颈下骨折切开复位时两种解剖面神经方法的比较

目的:在用改良切口行下颌骨髁颈下骨折切开复位坚固内固定手术时,比较顺行和逆行2种方法解剖面神经的效果。方法:2010-06—2014-12期间收治了36例患者(均为单侧髁颈下骨折),均在三明市第一医院口腔颌面外科,采用改良切口行下颌骨髁颈下骨折切开复位坚固内固定术。其中有11例使用顺行面神经解剖方法(顺行组),有25例使用逆行面神经解剖方法 (逆行组),对比两组的双钛板固定情况和术后的面神经的损伤、涎漏方面的数据。结果:两组在双钛板固定方面有显著差异(P=0.023)。在顺行组中,有8例为双钛板固定,3例只固定1块钛板;在逆行组中,25例全部为双钛板固定。两组在面神经损伤方面差异有统计学意义(P=0.020),在顺行组中暂时性面瘫7例,而在逆行组中暂时性面瘫有5例,两组均无永久性面瘫。在术后涎漏方面差异有统计学意义(P=0.023),顺行组术后发生涎漏4例,而在逆行组发生涎漏的只有1例。结论:用改良切口行下颌骨髁颈下骨折切开复位坚固内固定手术时,逆行性面神经解剖法更好。     

腮腺区静脉畸形翻瓣激光术的操作探讨

目的:探讨翻瓣Nd:YAG激光术处理腮腺区静脉畸形时的外科操作难点及注意事项。方法:回顾总结近3a来临床诊治的84例患者,全部确诊为腮腺区静脉畸形。均采用全麻下翻瓣激光治疗,手术前后CT、MRI等影像学检查。术后作面神经评判,术中统计出血量。结果:84例患者中,有5例为暂时性面瘫,2个月后自主恢复。1例为永久性面瘫,占1.19%,平均失血约为200ml。4例接受术中、术后输血。结论:腮腺区静脉畸形翻瓣激光术中,只要注意精细解剖操作,合理运用激光照射方式,可获得保存面神经,减少出血的理想效果。     

A modified method for minimizing damage to the marginal mandibular branch (MMB) during partial superficial parotidectomy(PSP): A retrospective study

The aim of this study was to compare modified partial superficial parotidectomy (MPSP) with conventional partial superficial parotidectomy (CPSP) in a retrograde approach, and to determine whether MPSP can reduce the risk of injury to the MMB of the facial nerve and the rate of postoperative facial palsy.Patients with benign parotid gland tumors of the superficial lobe were included retrospectively in two groups: one group was treated with CPSP; the other group was treated with MPSP, in which the MMB was dissected in an anterograde direction or not dissected. The patients’ sex and age, location of tumor, size of tumor (maximum tumor diameter), histopathological distribution, operative time, and incidence of postoperative facial nerve weakness were compared.There was no significant difference in operative time between the two groups (p = 0.913). There was a significant difference (p = 0.008) in postoperative facial nerve weakness, with temporary facial nerve weakness observed in 19 and five patients in the CPSP and MPSP groups, respectively. Furthermore, there was a significant difference (p = 0.009) in MMB weakness, with temporary MMB weakness observed in 15 and three patients in the CPSP and MPSP groups, respectively. There was no significant difference (p = 0.564) in the weakness of other branches between the two groups. All cases of paresis scored ≤3 on the House-Brackmann scale, and all cases of temporary facial nerve weakness resolved within 6 months of surgery. No patient developed permanent paralysis.Within the limitations of the study, it seems that modified partial superficial parotidectomy (MPSP) should be preferred over conventional partial superficial parotidectomy (CPSP) whenever appropriate.     

腮腺区良性肿瘤术后并发症发生的相关因素分析

目的： 探讨腮腺良性肿瘤术后各类并发症发生的相关因素。方法：搜集并整理我院2010—2015年手术治疗的215例腮腺良性肿瘤患者的病例资料,回顾分析一般资料、手术治疗中不同因素及术后并发症的发生情况。采用SPSS17.0软件包对资料进行χ2检验。结果：术后积涎或涎瘘、面神经功能障碍及Frey综合征的发生与手术治疗中不同因素（手术切口、术中是否缝扎腺体残端、面神经解剖方式、手术切除范围及是否行胸锁乳突肌瓣转移修复等）之间具有显著相关性（P＜0.05）。结论：“N”形切口在解剖形态上不利于术后常规引流渗出液,需配合负压引流管,以减少术后积涎的发生。缝扎腺体残端能有效避免术后积涎及涎瘘的发生。顺行法解剖面神经及腮腺肿瘤区域性切除能加快手术速度,减少面神经的解剖量及暴露时间,从而减轻术后面神经功能障碍的发生。胸锁乳突肌瓣的转移修复能很好避免术后Frey综合征的发生。     

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.     

Superficial parotidectomy: antegrade compared with modified retrograde dissections of the facial nerve

We compared two techniques of superficial parotidectomy: conventional antegrade dissection of the facial nerve, and retrograde dissection. A total of 89 parotidectomies were included and the results presented of a retrospective case study during a six-year period. Superficial parotidectomy involves identification of the facial nerve. We present 49 parotidectomies in 45 patients using the conventional technique of antegrade dissection of the nerve, and 40 parotidectomies in 39 patients using retrograde dissection of the buccal branch of the facial nerve from 4cm in front of the alatragal line to the main trunk of the nerve. The incidence of postoperative complications (facial nerve palsy, Frey syndrome, haematoma, and wound infection) were compared. The Facial nerve function was assessed by patient complaints and clinical examination. There was no significant difference in the incidence of postoperative complications between the groups. We describe an alternative technique for identifying the main trunk of the facial nerve.     

Comparison of facial nerve injury and recovery rates after antegrade and retrograde nerve dissection in parotid surgery for benign disease: prospective study over 4 years

The facial nerve can be dissected using an antegrade or retrograde approach. Antegrade dissection is the established technique and retrograde dissection is used less often. Recent publications have drawn attention to the potential value of the retrograde technique particularly if direct identification of the nerve trunk is difficult, and in revision procedures. We prospectively studied 43 consecutive procedures in 40 patients who had parotidectomy over a 4-year period, and evaluated and compared rates of temporary and permanent nerve injury, and nerve recovery after antegrade and retrograde dissection in operations for benign parotid disease. Each patient was allocated randomly to the antegrade (n = 20) or retrograde (n = 20) groups. Three patients were excluded. All patients had peroperative nerve monitoring and were followed up at 1 week, 1 month, 3 months, or to full recovery of the nerve. The House-Brackmann (HB) grading system was used to assess the degree of injury to the nerve. A high rate of serious nerve injury (HBIII or above) was associated with retrograde dissection at 1 week. Serious nerve injuries (HBIII or above) were slow to recover after the antegrade technique at 3 months. There was no difference between groups in the rates of full nerve recovery at 6 months.     

腮腺良性肿瘤改良术式的临床探讨

目的:探讨腮腺良性肿瘤改良术式的临床效果及其合理性.方法:110例患者随机分为2组,一组行保留腮腺咬肌筋膜、保留耳大神经分支和腮腺部分切除术的腮腺良性肿瘤改良术式,另一组行传统腮腺浅叶或全叶切除术;术后随访2a.记录手术出血量、手术时间,临床检查暂时性面瘫和术后肿瘤复发,行Minor试验,问卷调查味觉出汗综合征发生率、耳垂区感觉及面部畸形情况.采用SPSS10.0软件包对数据进行t检验或X2检验.结果:2组对比,腮腺良性肿瘤改良术式的出血量和手术时间显著低于传统腮腺浅叶切除术,术后暂时性面瘫、涎瘘和术后肿瘤复发率2组无显著差异.2组味觉出汗综合征的发生率,问卷调查和微量淀粉碘试验结果,均有统计学差异(P<0.05);保留耳大神经后支,耳垂区麻木症状发生率明显降低.结论:腮腺良性肿瘤改良术式可以减少手术出血量,缩短手术时间,显著减少味觉出汗综合征、耳垂区感觉障碍的发生率,患者术后面部畸形也获得良好改善.