咬肌神经联合颞骨内面神经转位治疗听神经瘤术后面瘫

Combination of masseter nerve with the temporal segment of facial nerve transposition for the treatment of facial paralysis after acoustic neuroma resection

摘要:

目的探讨咬肌神经联合颞骨内面神经转位手术，治疗听神经瘤术后完全性面瘫的临床效果和手术适应证。方法回顾分析北京中日友好医院耳鼻咽喉科 2018年1月—2019年1月收治的 10例听神经瘤术后伴有重度以上感音神经性聋的完全性面瘫患者。所有患者均行咬肌神经联合颞骨内面神经转位手术治疗。结果术后1年面神经功能评估，1例恢复到HB Ⅱ级，9例恢复到HB Ⅲ级，手术前后面瘫分级经t检验差异具有统计学意义（P<0.01）。4例出现自发性微笑，6例为社交性微笑，无明显手术并发证。结论咬肌神经联合颞骨内面神经转位手术，避免了耳大神经损伤，减少了神经吻合口，临床疗效显著，值得进一步深入研究。

Abstract:

Objective To investigate the clinical effect and surgical indications of the masseter nerve combined with the temporal segment of facial nerve transposition for the treatment of facial paralysis after acoustic neuroma resection.MethodsA retrospective analysis was performed on 10 patients with complete facial paralysis accompanied by severe sensorineural hearing loss after acoustic neuroma surgery hospitalized in our department from Jan 2018 to Jan 2019. All the patients underwent masseter nerve combined with the temporal segment of facial nerve transposition surgery.ResultsThe facial nerve function was evaluated according to the HouseBrackmann (HB) grading system one year after surgery. One case returned to HB gradeⅡ and 9 to HB grade Ⅲ. The difference of HB grade between pre and postoperative facial nerve function was statistically significant (P<0.01). Spontaneous smile occurred in 4 cases and social smile in 6, without serious surgical complications.ConclusionsThe masseter nerve combined with the transposition of the facial nerve inside the temporal bone can avoid damage of great auricular nerve and reduce nerve anastomotic stomas. It had significant clinical effect and is worthy of further study.