中耳胆脂瘤合并面瘫的手术后疗效分析

目的 探讨中耳胆脂瘤合并面瘫的患者经过开放式乳突切开手术或者完壁式乳突切开手术加面神经减压手术改善面瘫的疗效。方法 面神经House-Brankmann分级显示Ⅲ级9例、Ⅳ级11例、V级5例，其中2例出现下眼睑向外翻。根据面瘫时间不同，从患面瘫至手术时间将患者分为3组，第1组：患面瘫后30 d内手术者13例，其中Ⅲ级7例、Ⅳ级5例、Ⅴ级1例；第2组：患面瘫后30～60 d内手术者8例，其中Ⅲ级2例、Ⅳ级5例、Ⅴ级1例；第3组：患面瘫后60～90 d内手术者4例，其中Ⅳ级1例、Ⅴ级3例。所有的患者分别在术后3个月与术后6个月评估并分析。结果 25例均为一次性手术成功，术后3个月的时候比术前明显恢复，其中Ⅰ级7例、Ⅱ级6例、Ⅲ级9例、Ⅳ级3例(P<0.001),术后6个月的时候比术前明显恢复，其中Ⅰ级17例、Ⅱ级3例、Ⅲ级5例(P<0.001),但是术后6个月比术后3个月没有明显的恢复(P=0.076)。第1组的治疗效果优于第2组与第3组。第2组与第3组术后3个月的时候比术前面瘫程度并没有明显改善(P=0.009),然而术后6个月的时候较术前有明显的改善(P<0.001)...

Analysis of postoperative efficacy of middle ear cholesteatoma complicated with facial paralysis

Objective This study aimed to investigate the efficacy of open mastoidectomy or complete wall tympanotomy, combined with facial nerve decompression, in improving facial paralysis among patients with middle ear cholesteatoma. Methods The facial nerve House-Brackmann classification system was used. There were 9 grade Ⅲ cases, 11 grade Ⅳ cases, and 5 grade Ⅴ cases. Among them, two patients presented with lower eyelid eversion. The patients were grouped according to the time interval between the onset of facial paralysis and the operation. Group 1 consisted of 13 patients who underwent surgery within 30 days after developing facial paralysis. There were seven grade Ⅲ cases, five grade Ⅳ cases, and one grade Ⅴ case in this group. Group 2 consisted of eight patients who underwent surgery within 30 to 60 days after developing facial paralysis. This group had two grade Ⅲ cases, five grade Ⅳ cases, and one grade Ⅴ case. Group 3 consisted of four patients who underwent surgery 60 to 90 days after developing facial paralysis. The group included one grade Ⅳ case and three grade Ⅴ cases. All patients were evaluated three and six months postoperatively. Results All 25 patients had successful surgeries with significant improvement noted three months postoperatively. There were seven grade Ⅰ cases, six grade Ⅱ cases, nine grade Ⅲ cases, and three grade Ⅳ cases(P<0.001). Further improvement was noted six months postoperatively with 17 grade I cases, three grade Ⅱ cases, and five grade Ⅲ cases(P<0.001). However, the improvement from the third postoperative month to the sixth postoperative month was insignificant(P=0.076). The treatment effect of group 1 was better than those of groups 2 and 3. No significant improvement in facial paralysis was observed three months after the operation in groups 2 and 3. However, a significant improvement was noted during the sixth postoperative month for these groups(P<0.001). The improvement from the third postoperative month to the sixth postoperative month was insignificant (P=0.223). Conclusion Surgery within 30 days from the onset of facial paralysis resulted in the most favorable outcomes in patients with middle ear cholesteatoma, complicated with facial paralysis. The treatment effect peaked within 30-90 days postoperatively. However, the improvement was gradual, and a drastic improvement was noted six months postoperatively. Favorable outcomes were still achieved within three months postoperatively among surgically treated patients with middle ear cholesteatoma.