镫骨手术后迟发性面瘫及机制探讨

背景常规镫骨手术后仍偶有迟发性面瘫发生,发病机制尚不明确.目的探讨镫骨手术后迟发性面瘫的发病率、发病机制及治疗.设计以诊断为依据非对照研究.地点和对象在南京大学医学院附属鼓楼医院耳鼻喉科完成,对象为该院镫骨手术后迟发性面瘫患者3例,均为女性,年龄34～48岁.方法回顾性分析该院332例镫骨手术后发生迟发性面瘫的3例患者.主要观察指标House-Brackmann分度.结果3例镫骨手术后迟发性面瘫的发病时间在术后5,6d,为不完全性周围性面瘫,检测1例迟发性面瘫患者抗单纯疱疹病毒抗体,呈阳性.以大剂量激素、抗病毒药、维生素治疗为主,并配合针灸治疗,3例患者全部恢复正常.结论常规镫骨手术后出现迟发性面瘫,除面神经骨管裂隙外,还可能与隐匿的单纯疱疹病毒激活有关.

Delayed facialparalysis after stapedectomy and discussion on its mechanism

BACKGROUND: A facial palsy appears only in rare cases a few days after uneventful stapedectomy, which has unclear pathogenesis.OBJECTIVE: To study the incidence, pathogenesis and treatment of delayed facial palsy after stapedectomy.DESIGN: A non-randomized controlled study was conducted based on diagnosis.SETTING and PARTICIPANTS: The study was completed in the Department of Otorhinolaryngology, the Affiliated Drum Tower Hospital of Nanjing University Medical School. Subjects were 3 female cases aged 34 -48 years with delayed facial palsy.METHODS: Three delayed facial palsy patients in 332 stapedectomy patients were retrospectively reviewed.MAIN OUTCOME MEASURES: House-Brackmann facial nerve grading system.RESULTS: Delayed facial palsy occurred from 5 to 6 days after stapedectomy in three cases, who all suffered from uncompleted peripheral paralysis. Anti-herpes simplex antibody titers were elevated in one patient who received the test. A high dose of hormone, antiviral drugs and vitamins were effective, which were also combined with acupuncture treatment. All three cases recovered.CONCLUSION: The probable pathogenesis of delayed facial palsy after uneventful stapedectomy might relate with the reactivation of dormant herpes simplex virus except for the dehiscence in bony facial nerve canal.