面神经瘤的临床诊治分析

Analysis on clinical diagnosis and treatment of facial neuroma

摘要:

目的 分析与探讨面神经瘤的临床诊治方案，加强对本病的认识，以避免误诊误治。方法 收集2012年9月—2022年12月诊治的8例面神经瘤患者的临床资料，面神经功能评估使用House-Brackmann(H-B)分级系统，对其临床诊治过程进行回顾性分析。结果 8例面神经瘤患者中，3例伴有周围性面瘫病史，7例伴有腮腺区肿物病史。3例患者术前诊断为面神经瘤；5例患者术前无面瘫症状，其中1例误诊为中耳胆脂瘤，4例误诊为腮腺肿物。3例术前Ⅴ~Ⅵ级面瘫患者行肿瘤全切除术，其中1例Ⅴ级面瘫时间＜1周者术中同期行面神经-舌下神经吻合术，术后面神经功能恢复至Ⅲ级。4例腮腺区肿物行肿瘤剥离术，术后面神经功能1例Ⅰ级，3例Ⅴ级。1例颞骨内鼓室段肿物行肿瘤部分切除术，术后面神经功能Ⅰ级。肿瘤位于颞骨外段腮腺区5例，颞骨内段1例，跨颞骨内外2例。术后病理检查显示6例为面神经鞘瘤，2例为面神经纤维瘤。结论 面神经瘤临床表现隐匿，无面瘫症状者极易误诊。腮腺深叶区肿物需警惕面神经瘤可能，术前高分辨率影像学检查对定位及定性诊断至关重要。术前面神经功能评估(H-B分级)是制定手术方案的核心依据，术中需权衡肿瘤切除与神经功能保留的利弊，术后密切随访可降低复发风险。

Abstract:

Objective To analyze and discuss the clinical diagnosis and treatment strategies for facial neuroma, enhance understanding of the disease, and avoid misdiagnosis and mismanagement.Methods Clinical data of 8 patients with facial neuroma treated in our department from September 2012 to December 2022 were collected and retrospectively analyzed. Facial nerve function was evaluated using the House-Brackmann(H-B) system.Results Among the 8 patients, 3 had a history of peripheral facial paralysis, and 7 presented with parotid gland masses. The 3 patients with facial paralysis were correctly diagnosed with facial neuroma before operation, while the 5 cases without any facial paralysis symptoms were all misdiagnosed (1 was misdiagnosed as middle ear cholesteatoma and 4 as parotid tumors). Total tumor resection was performed in the 3 patients with preoperative facial paralysis (H-B grade V-VI). Among them, one case of facial paralysis (H-B grade V) with a duration of less than one week underwent simultaneous facial-hypoglossal nerve anastomosis, and the facial nerve function achieved postoperative improvement to grade III. Tumor dissection was performed in 4 patients with parotid gland tumors resulting in postoperative facial nerve function of grade I in one case and grade V in 3. One case with the tumor involving the intratemporal segment (tympanic portion) underwent partial tumor resection with postoperative nerve function preserved at grade I. Tumors were located in the extratemporal segment (parotid region) in 5 cases, the intratemporal segment in one, and both segments in 2 cases. Postoperative pathology revealed that 6 cases were schwannomas and 2 were neurofibromas.Conclusion The clinical manifestations of facial neuroma are usually subtle, and patients without facial paralysis symptoms are prone to being misdiagnosed. A mass in the deep parotid lobe should raise suspicion of facial neuroma, and preoperative high-resolution imaging examinations are critical for localization and qualitative diagnosis. Preoperative H-B grading is pivotal for surgical planning, a balance must be struck intraoperatively between tumor resection and nerve function preservation. Close postoperative follow-up may reduce the risk of recurrence.