颞骨骨折导致双侧面瘫的临床观察

Surgical effect for bilateral facial paralysis caused by temporal bone fracture

摘要:

目的探讨外伤性颞骨骨折导致双侧面瘫的临床特点、手术适应证及疗效。方法回顾北京电力医院收治的4例外伤致双侧颞骨骨折伴双侧面瘫患者的临床资料, 分析外伤导致颞骨骨折伴面瘫患者的临床特点，对比术前与术后面神经功能及听力的恢复情况，分析手术适应证及手术时机，并进行疗效评估。4例患者中车祸伤3例、头部挤压伤1例，均为双侧颞骨骨折同时伴有颅内外损伤，伤后全部有意识丧失史，所有患者清醒后即发现面瘫。术前面神经功能Sunnybrook评分为（9.0±2.00）分。颞骨高分辨率CT显示8侧颞骨骨折均为纵行骨折，膝状神经节局部结构紊乱6侧，砧骨长脚骨折2侧。结果8侧面瘫中1侧在保守治疗后好转，其余7侧在保守治疗5～12周无明显恢复， 行面神经减压术,其中3侧同时行人工听骨听力重建术。术后随访1年, 面神经功能评分为（78.1±3.55）分，与术前评分比较差异具有统计学意义（P<0.01）；平均听力较术前提高11.87 dBHL，与术前听力比较差异具有统计学意义（P<0.01）。结论车祸伤是造成双侧颞骨骨折伴双侧面瘫的主要原因。颞骨骨折导致双侧面瘫具有合并颅内外损伤较多、面神经骨管损伤较重等特点。面神经减压术对于保守治疗无效的患者具有积极治疗意义，手术越早疗效越好。颞骨骨折导致的传导性聋可同时行听骨链重建治疗。

关键词:耳聋|面神经麻痹|面神经减压术|颞骨骨折|双侧

Abstract:

ObjectiveTo investigate the clinical features, surgical indications and efficacy of bilateral facial nerve paralysis caused by temporal bone fracture.MethodsClinical data of 4 patients with bilateral facial paralysis caused by temporal bone fracture and surgically treated with facial nerve decompression in our hospital were analyzed retrospectively. Their clinical features were analyzed. Timing and the efficacy of surgical intervention were evaluated by comparing preoperative facial nerve function and hearing with the postoperative ones. Of the 4 cases, bilateral temporal bone fractures were caused by traffic accident in 3 and crushing injury of head in one. Intracranial trauma and posttraumatic loss of consciousness occurred in all patients. Bilateral facial nerve paralysis presented as they were awake. The preoperative average Sunnybrook score of their facial nerve function was (9.0±2.00). The preoperative highresolution computed tomography revealed longitudinal fractures of bilateral temporal bone in all of them with focal architecture distortion of the geniculate ganglion in 6 and fracture of long limb of incus in 2.ResultsOf the 4 cases (8 sides), facial nerve function got improved with conservative treatment in one side, and did not improve significantly in the remaining 7 sides. Facial nerve decompression was performed on the 7 sides with simultaneous artificial auditory reconstruction in 3. Postoperative followup of 1 year showed an average Sunnybrook score of (78.1±3.55) and hearing improvement of 11.87 dBHL,which were significantly different from the preoperative ones(both P<0.01).ConclusionsTraffic crash is the main cause of bilateral temporal bone fracture with bilateral lateral paralysis, which is characterized by craniofacial injuries and severe injury of facial nerve canal. Facial nerve decompression are effective for the management of facial paralysis failed to conservative treatment. The earlier operation, the better curative effect will be. The conduction hearing loss caused by temporal bone fracture should be treated with simultaneous ossicular chain reconstruction.

Key words:Hearing loss;Facial paralysis|Facial nerve decompression|Temporal bone fracture| bilateral