眶下神经撕脱与上颌神经切除术治疗三叉神经痛疗效观察

目的探讨对原发性三叉神经上颌支的眶下神经痛,施行眶下神经撕脱术（以下简称撕脱术）,时其术后复发单独的原发性的三叉神经上颌支痛,再施行上颌神经切除术（以下简称切除术）时两者疗效观察。方法回顾1994～2005年我们对单独的眶下神经痛35例,经口腔进路眶下神经切断并撕脱1～1．5cm,术后有24例复发出现上颌支痛,再经上颌窦．内镜下入翼腭窝。切断上颌神经并切除神经0．5～1．0cm,进行观察。结果撕脱术35例,经1～4年观察：10例术后4年眶下区麻木,无痛;1例在术后8个月出现下颌支痛,而无上颌支痛;21例术后1～2年虽眶下区麻木,但出现上上颌支其他分支痛;3例眶下区疼痛也不麻木。对复发的24例单独的上颌支无痛,施行切除术,经观察4年22例完全无痛;有2例在1年内上颌支无痛,而出现下颌支痛。结论撕脱术治疗三叉神经上颌支的单独眶下神经痛有一定疗效,手术简单可首选,值得注意的是眶下神经痛可随病程进展易扩展到上颌支的其他分支神经痛。切除术是治疗长期单独的三叉神经上颌支痛有效手术,疗效好,创伤小,出血小,可避免开颅手术的危险,更适用年老体弱的患者。

Compare the efficacy of avulsed maxillary branch of the infraorbital with that of excision of maxillary nerve to treat primary trigeminal neuralgia

Objective To investigate the efficacy of avulsed maxillary branch of the infraorbital by treating primary trigeminal neuralgia compared with（hereinafter referred to asavulsion）the efficacy of excision of maxillary nerve for those recurrence separate kprimary maxillary branch of trigeminal nerve pain patients. Methods Retrospected separated 35 cases of infraorbital neuralgia in 1994--2005. Avulsed and excised infraorbital neurotomy 1 - 1.5cm by oral taste. Twenty four cases recurrence maxillary branch of trigeminal nerve pain. Excised maxillary nerve and severed nerve 0.5 - 1.0cm through the maxillary sinus into the preygopalatine fossa by microscope. Results Ten cases appeared postoperative infraorbital area numbness, pain--free after 1-4 years later among the 35 cases. One case appeared mandible ramus pain after 8 months without maxillary branch pain; 21 cases appeared infraorbital area numbness after 1 -2 years companioned the pain in other branches of the maxillary branch; three cases appeared infraorbital area pain without numbness. The 22 cases among 24 cases who treated by excision surgery after the recurrence of a separate branch of the maxillary pain were completely painless in 4 years; Two cases suffered mandible ramus pain without maxillary branch painless in one year. Conclusions It＇s a good way by using avulsion method to treat primary infraorbital neuralgia. The surgery is easy and can be a first choice. It should be noted that infraorbital neuralgia can be extended to other branches of maxillary nerve branch. Excision is an effective way to treat the long--term single maxillary branch of trigeminal nerve pain. The operation is efficacy, less trauma, less bleeding. The risk of craniotomy can be avoided. It can also applicable to frail elderly patients .