The surgical procedures for tension-free anterior rerouting of facial nerve in infratemporal fossa type A approach
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摘要: 颞下窝A型径路是切除颈静脉孔区肿瘤的经典入路, 面神经前移位是术中充分暴露肿瘤的重要步骤, 然而面神经前移位后患者面神经功能出现不同程度受损, 这对手术医生和患者都是一个巨大的挑战。本文作者基于自己的临床经验改进术中面神经前移位的处理方式, 将面神经从面神经管中游离出来, 在二腹肌嵴处剪断二腹肌, 游离茎突, 然后将二腹肌连同腮腺与颞肌下缘缝合; 45°放置长撑开器, 将腮腺和二腹肌后腹推向前上方, 进一步缩短膝状神经节到腮腺内面神经主干的距离。以上处理使得面神经无张前移位, 不仅减轻了面神经前移位的张力, 而且能最大程度保留面神经的血供, 有利于术后面神经功能的恢复。Abstract: Infratemporal fossa type A approach is the classical approach for resection of tumors in the jugular foramen, and the anterior rerouting of the facial nerve is an important procedure to facilitate tumor exposure. Dysfunction of facial nerve in patients following anterior facial nerve rerouting is great challenge to surgeons and patients. The author made great efforts to modify the surgical management of the facial nerve to improve facial nerve function. After dissection the facial nerve from the fallopian canal and the digastric muscle from the digastric ridge and styloid process, then the digastric muscle and parotid gland were suture with the inferior margin of temporal muscle. A long articulated retractor was placed at an angle of 45° to push the posterior belly of the digastric muscle and the parotid gland anteriorly and superiorly to further minimize the distance from the genicular ganglion to the main trunk of the facial nerve in the parotid gland. All the procedures resulted in tension free anterior rerouting of the facial nerve. Tension-free anterior rerouting of facial nerve not only reduces the tension of the facial nerve, but also preserves the maximal blood supply of the facial nerve, which are beneficial with the recovery of facial nerve function, postoperatively.
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