中耳胆脂瘤并发面瘫患者术后疗效分析

目的 探讨中耳胆脂瘤并发面瘫患者的病程和程度对术后面神经功能恢复的影响.方法 回顾性分析30例(30耳)中耳胆脂瘤并发面瘫患者的临床资料,男17例,女13例,年龄21~77岁,平均54.7±8.9岁;面瘫时间9天~5个月,方法 回顾性分析30例(30耳)中耳胆脂瘤并发面瘫患者的临床资料,男17例,女13例,年龄21~77岁,平均54.7±8.9岁;面瘫时间9天~5个月,其中,术前面瘫≤2个月14例,>2个月16例;术前不完全面瘫组(III-IV级)14例,完全面瘫组(V-VI级)16例;用Fisher确切概率检验方法分析术前面瘫病程和程度对术后面神经功能恢复的影响.结果 30例患者中,3例行开放式乳突根治术,术中探查见面神经骨管先天性缺损,无面神经受损,术后面瘫完全恢复;27例面神经骨管受损,伴有面神经充血、水肿或肉芽形成,其中20例面神经受损部位累及鼓室段;行开放式乳突根治术和局部面神经减压术,术后14例(46.67%,14/30)面瘫恢复良好.面瘫病程≤2个月者面神经功能恢复良好率(78.57%,11/14)高于>2个月者(18.75%,3/16)(P<0.05),不完全面瘫者面神经功能恢复良好率(71.43%,10/14)高于完全面瘫者(25%,4/16)(P<0.05).结论 本组中耳胆脂瘤并发面瘫者面神经受损多位于面神经鼓室段,开放式乳突根治术和局部面神经减压术是治疗中耳胆脂瘤并发面瘫的有效方法.术前面瘫病程越短、程度越轻,术后面神经功能恢复越好.

The Analysis of Postoperative Curative Effects of Facial Paralysis Caused by Middle Ear Cholesteatoma

Objective To study the effects of the duration and degree of the peripheral facial paralysis due to middle ear cholesteatoma on the recovery of postoperative nerve functions.Methods The clinical data of 30 cases (single ear) of patients with cholesteatoma complicated with facial paralysis were retrospectively analyzed.The mean age was 54.7±8.9 years old (range 21~77years old) including 17 males and 13 females.The duration of facial paralysis, degree and location of facial nerve injury,surgical timing of facial nerve decompression,recovery of facial paralysis after surgery were followed up.According to the course of paralysis, the patients were divided into ≤2 months group (14 cases) and >2 months group (16 cases).According to the degree of paralysis, the patients were divided into the incomplete facial paralysis group (III-IV grade,14 cases) and the complete facial paralysis group (V-VI grade,16 cases).The influence of the course and degree of paralysis on the postoperative recovery of neurological function were analyzed by the Fisher exact probability test.Results Three cases underwent open radical surgery with no facial nerve damage confirmed by intraoperative exploration, and their postoperative facial nerve functions were fully restored.Facial nerve canal damage was found in 27 cases, accompanied by facial nerve congestion, edema or granulation formation.Among them, the facial nerve damage location was the tympanic segment in 20 cases.The open radical operation and local facial nerve decompression were carried out, and the postoperative facial paralysis recovery rate was 46.67%(14/30).The facial nerve function recovery rate in less than 2 months group was higher than the >2 months group (P<0.05).The facial nerve function recovery rate of the incomplete paralysis group was higher than the complete facial paralysis group (P<0.05).Conclusion This study suggests that facial nerve damage most occurred in the tympanic segment of the facial nerve.Radical mastoidectomy and local facial nerve decompression are effective for the treatment of middle ear cholesteatoma complicated with facial paralysis.The shorter course and lighter degree of paralysis lead to the better postoperative recovery of neurological function.