-
摘要: 目的 总结外伤性面神经麻痹的临床特点及治疗效果。方法 对2015年1月至2023年5月间68例(69耳)外伤性面神经麻痹病例进行回顾性分析。结果 就诊时中位病程33 d；就诊时患者的面神经功能HB-Ⅱ级2例，HB-Ⅲ级4例，HB-Ⅳ级16例，HB-Ⅴ级37例(38耳)，HB-Ⅵ级9例；42例为伤后即刻发生，26例为迟发性；纵行骨折51例(52耳)，横行骨折6例，混合型骨折4例，7例未发现明确颞骨骨折线；损伤节段49例(50耳)为膝状神经节及邻近，7例为垂直段，7例为水平段，2例为水平段、垂直段，3例无法评估。23耳采用以糖皮质激素为主的保守治疗，46耳采用手术治疗。治疗后6~24个月对患者进行随访，HB-Ⅰ级20例，HB-Ⅱ级19例，HB-Ⅲ级23例(24耳)，HB-Ⅳ级4例，HB-Ⅴ级1例；失访1例。治疗前后，患者面神经功能明显改善(P < 0.05)，保守治疗组和手术治疗组患者在面神经麻痹病程、伤后即刻面瘫比率、治疗前面神经功能、治疗后面神经功能差异有统计学意义(P < 0.05)；年龄、性别、听力情况、颞骨骨折情况、面神经损伤节段、面神经功能良好率差异无统计学意义(P>0.05)；对神经变性>90%和≤90%的病例比较显示治疗前神经变性>90%的患者面神经功能明显更差(P < 0.05)，但两者治疗后的面神经功能差异无统计学意义(P>0.05)；颅中窝入路组和乳突入路组治疗前后面神经功能差异无统计学意义(P>0.05)。结论 外伤性面神经麻痹病例应进行个体化的评估，面神经麻痹程度轻、神经变性比率低、病程短的患者可先行保守治疗并严密随访，对于面神经麻痹程度重、神经变性率高、病程超过6周的患者可积极考虑手术治疗；正确的评估、治疗可获得良好预后。Abstract: Objective To summarize the clinical characteristics and therapeutic effect of traumatic facial nerve palsy.Methods Sixty-eight cases of traumatic facial nerve palsy were retrospectively analyzed from January 2015 to May 2023.Results The median course of disease was 33 days. The facial nerve function of the patients was grade HB-Ⅱin 2 cases, grade HB-Ⅲ in 4 cases, grade HB-Ⅳin 16 cases, grade HB-Ⅴ in 37 cases(38 ears), and grade HB-Ⅵ in 9 cases. 42 cases occurred immediately after injury and 26 cases were delayed. CT examination of temporal bone revealed longitudinal fractures in 51 cases(52 ears), transverse fractures in 6 cases and mixed fractures in 4 cases. No definite temporal bone fracture was found in the remaining 7 cases. The segments of facial nerve injury in 49 cases(50 ears) were geniculate ganglion and adjacent, in 7 cases were vertical segment, in 7 cases were horizontal segment, in 2 cases were horizontal segment and vertical segment; and the other 3 cases could not be evaluated. Conservative treatment with glucocorticoids was used in 23 ears and surgery was used in 46 ears. Patients were followed up 6-24 months after treatment, including 20 cases of grade HB-Ⅰ, 19 cases of grade HB-Ⅱ, 23 cases(24 ears) of grade HB-Ⅲ, 4 cases of grade HB-Ⅳ, and 1 case of grade HB-Ⅴ.One patient was lost to follow-up. After treatment, the facial nerve function of patients was significantly improved(P < 0.05), and there were significant differences between conservative treatment group and surgical treatment group in the course of facial nerve palsy, the ratio of facial palsy immediately after injury, the nerve function before treatment and the nerve function after treatment(P < 0.05). There were no significant differences in age, sex, hearing condition, temporal bone fracture, facial nerve injury segment and rate of favorable neurologic outcomes(P>0.05). The comparison of patients with neurodegeneration rate>90% and ≤90% showed that the facial nerve function of patients with neurodegeneration rate>90% before treatment was significantly worse(P < 0.05), but there was no significant difference between the facial nerve function after treatment(P>0.05). There was no significant difference in facial nerve function between middle fossa approach group and mastoid approach group(P>0.05).Conclusion Patients with traumatic facial nerve palsy should be evaluated individually. Patients with mild facial nerve palsy, low neurodegeneration rate and short course of disease can be treated conservatively and followed up closely. Patients with severe facial nerve palsy, high neurodegeneration rate and more than 6 weeks of disease can be actively considered surgery. Good prognosis can be obtained by correct evaluation and treatment.
-
Key words:
- facial nerve palsy /
- temporal bone fracture /
- facial nerve function
-
-
表 1 患者就诊时一般情况
项目 病例数 占比/% 性别 男 57 83.82 女 11 16.18 侧别 左 36 52.94 右 31 45.59 双 1 1.47 就诊年龄 ≤10岁 11 16.18 11~20岁 6 8.82 21~30岁 14 20.59 31~40岁 13 19.12 41~50岁 12 17.65 51~60岁 10 14.70 > 60岁 2 2.94 面神经麻痹病程 ≤30 d 33 48.53 31~60 d 25 36.76 61~90 d 8 11.77 > 90 d 2 2.94 伤后即刻发生 是 42 61.76 否 26 38.24 HB分级 Ⅱ级 2 2.90 Ⅲ级 4 5.80 Ⅳ级 16 23.19 Ⅴ级 38 55.07 Ⅵ级 9 13.04 
下载: 导出CSV
表 2 患者治疗前后的面神经功能配对非参数检验
项目 例数 Z P 总体 68 -7.197 < 0.001 保守治疗组 22 -4.169 < 0.001 手术治疗组 46 -5.911 < 0.001 乳突入路 31 -4.910 < 0.001 颅中窝入路 14 -3.220 0.001
下载: 导出CSV
表 3 保守治疗组与手术治疗组各因素比较
项目 保守治疗组(22耳) 手术治疗组(46耳) Z P 中位年龄/岁 27.5 37.5 -1.509 0.131 性别(男︰女)/例 19︰3 39︰7 -1.171 0.864 侧别(左︰右)/例 14︰8 23︰23 -1.048 0.294 面神经麻痹中位病程/d 7.0 43.5 -4.045 < 0.001 发病时间/例(即刻︰迟发) 6︰16 36︰10 -2.959 0.003 治疗前HB功能/例 727.000 0.001 Ⅰ 0 0 Ⅱ 2 0 Ⅲ 2 2 Ⅳ 8 8 Ⅴ 10 27 Ⅵ 0 9 治疗后HB功能/例 354.000 0.041 Ⅰ 12 8 Ⅱ 8 11 Ⅲ 2 22 Ⅳ 0 4 Ⅴ 0 1 Ⅵ 0 0 面瘫改善满意率/% 100.00 89.13 -1.595 0.111
下载: 导出CSV
表 4 不全变性组与完全变性组面神经功能比较
例 HB功能 完成面神经电图(n=60) 21 d内完成面神经电图(n=17) 治疗前 治疗后 治疗前 治疗后 不全变性组 完全变性组 不全变性组 完全变性组 不全变性组 完全变性组 不全变性组 完全变性组 Ⅰ 0 0 7 8 0 0 4 3 Ⅱ 2 0 6 11 2 0 5 1 Ⅲ 2 0 2 21 0 0 1 3 Ⅳ 4 7 0 4 3 0 0 0 Ⅴ 6 30 0 1 5 6 0 0 Ⅵ 1 8 0 0 0 1 0 0 Z 675.000 608.000 60.000 31.500 P < 0.001 < 0.001 0.014 0.740
下载: 导出CSV
表 5 不同手术入路治疗组面神经功能比较
例 HB功能 治疗前 治疗后 颅中窝入路 乳突入路 颅中窝入路 乳突入路 Ⅰ 0 0 2 4 Ⅱ 0 0 3 6 Ⅲ 0 1 6 12 Ⅳ 2 4 3 1 Ⅴ 11 11 0 0 Ⅵ 1 7 0 0 Z 126.500 181.000 P 0.284 0.546
下载: 导出CSV
-
[1] 樊忠, 樊兆民. 外伤性面瘫的外科治疗[J]. 中华耳鼻咽喉科杂志, 1999, 34(1): 52-54. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHEB901.023.htm
[2] Saraiya PV, Aygun N. Temporal bone fractures[J]. Emerg Radiol, 2009, 16(4): 255-265. doi: 10.1007/s10140-008-0777-3
[3] Sanus GZ, Tanriverdi T, Tanriover N, et al. Hearing preserved traumatic delayed facial nerve paralysis without temporal bone fracture: neurosurgical perspective and experience in the management of 25 cases[J]. Surg Neurol, 2009, 71(3): 304-310. doi: 10.1016/j.surneu.2008.02.007
[4] Coker NJ. Management of traumatic injuries to the facial nerve[J]. Otolaryngol Clin North Am, 1991, 24(1): 215-227. doi: 10.1016/S0030-6665(20)31176-2
[5] Aslan H, Songu M, Eren E, et al. Results of decompression with middle cranial fossa approach or traumatic intratemporal fascial nerve injury[J]. J Craniofac Surg, 2014, 25(4): 1305-1308. doi: 10.1097/SCS.0000000000000772
[6] 唐朝颖, 韩维举, 张纪帅, 等. 面神经减压术治疗颞骨外伤性面瘫临床分析[J]. 中华耳科学杂志, 2016, 14(2): 176-180. doi: 10.3969/j.issn.1672-2922.2016.02.010
[7] Xu P, Jin A, Dai B, et al. Surgical timing for facial paralysis after temporal bone trauma[J]. Am J Otolaryngol, 2017, 38(3): 269-271. doi: 10.1016/j.amjoto.2017.01.002
[8] Thakar A, Gupta MP, Srivastava A, et al. Nonsurgical Treatment for Posttraumatic Complete Facial Nerve Paralysis[J]. JAMA Otolaryngol Head Neck Surg, 2018, 144(4): 315-321. doi: 10.1001/jamaoto.2017.3147
[9] 迪丽努尔·加列. 外伤性面瘫的手术最佳时机选择的Meta分析[D]. 乌鲁木齐: 新疆医科大学, 2019.
[10] 訾定京, 潘奇, 梁乐平. 外伤性面瘫患者面神经减压术不同手术时机对预后的影响[J]. 临床和实验医学杂志, 2023, 22(3): 304-307. doi: 10.3969/j.issn.1671-4695.2023.03.021
[11] Orhan KS, Sonmez S, Kara H, et al. Long-term outcomes of facial nerve decompression by transmastoid versus middle cranial fossa approach for traumatic facial paralysis[J]. Am J Otolaryngol, 2023, 44(6): 103983. doi: 10.1016/j.amjoto.2023.103983
[12] Andresen NS, Sun DQ, Hansen MR. Facial nerve decompression[J]. Curr Opin Otolaryngol Head Neck Surg, 2018, 26(5): 280-285. doi: 10.1097/MOO.0000000000000478
[13] Adegbite AB, Khan MI, Tan L. Predicting recovery of facial nerve function following injury from a basilar skull fracture[J]. J Neurosurg, 1991, 75(5): 759-762. doi: 10.3171/jns.1991.75.5.0759
[14] Takada S, Mitani K, Ichikawa T, et al. Traumatic middle meningeal arteriovenous fistula presenting with long delayed-onset facial nerve palsy without temporal bone fracture: illustrative case[J]. J Neurosurg Case Lessons, 2023, 6(14): CASE23404.
[15] 袁辉, 金延方, 岳云龙, 等. 外伤性面瘫患者的颞骨高分辨率CT表现及其术中对照研究[J]. 中国医学影像学杂志, 2013, 21(3): 184-186.
[16] 郭爱宽, 李素娟, 秦兆冰, 等. 高分辨率CT对颞骨外伤性面瘫的诊断价值[J]. 临床耳鼻咽喉头颈外科杂志, 2009, 23(22): 1011-1013. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH200922002.htm
[17] 王锦玲, 宦怡, 黄维国. 高分辨CT扫描在颞骨骨折致面神经损伤中的应用[J]. 临床耳鼻咽喉科杂志, 1999, 13(7): 293-295. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH907.002.htm
[18] 曾宪海, 林曾萍, 王鹏, 等. 颅中窝入路面神经减压治疗颞骨纵行骨折后周围性面瘫的临床分析并文献复习[J]. 中华耳科学杂志, 2018, 16(3): 348-351. doi: 10.3969/j.issn.1672-2922.2018.03.018
[19] 许嘉, 李欣, 陈雯婧, 等. 经乳突面神经减压治疗累及膝状神经节外伤性面瘫的疗效分析[J]. 山东大学耳鼻喉眼学报, 2020, 34(1): 25-27. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYU202001006.htm
[20] Ricciardiello F, Mazzone S, Longo G, et al. Our Experience on Temporal Bone Fractures: Retrospective Analysis of 141 Cases[J]. J Clin Med, 2021, 10(2): 201. doi: 10.3390/jcm10020201
[21] Darrouzet V, Duclos JY, Liguoro D, et al. Management of facial paralysis resulting from temporal bone fractures: Our experience in 115 cases[J]. Otolaryngol Head Neck Surg, 2001, 125(1): 77-84. doi: 10.1067/mhn.2001.116182
[22] Marenda SA, Olsson JE. The evaluation of facial paralysis[J]. Otolaryngol Clin North Am, 1997, 30(5): 669-682. doi: 10.1016/S0030-6665(20)30162-6
[23] Fisch U. Maximal nerve excitability testing vs electroneuronography[J]. Arch Otolaryngol, 1980, 106(6): 352-357.
[24] Gur H, Gorur K, Ismi O, et al. Surgical Outcomes of Transmastoid Facial Nerve Decompression for Patients With Traumatic Facial Nerve Paralysis[J]. J Int Adv Otol, 2021, 17(4): 294-300.
[25] 邱建华, 乔莉, 陈福权, 等. 耳内镜下中耳及面神经手术135例[J]. 第四军医大学学报, 2002, 23(14): 1323-1324. https://www.cnki.com.cn/Article/CJFDTOTAL-DSJY200214039.htm
[26] Shu W, Xue L, Wang Y, et al. Indications of and Efficacy of Facial Nerve Decompression Through Endoscopic Transcanal Approach for Patients with Traumatic Facial Paralysis[J]. J Int Adv Otol, 2023, 19(3): 199-205.
[27] Elkahwagi M, Salem MA, Moneir W, et al. Traumatic facial nerve paralysis dilemma. Decision making and the novel role of endoscope[J]. J Otol, 2022, 17(3): 116-122.
[28] Kahinga AA, Han JH, Moon IS. Total Transcanal Endoscopic Facial Nerve Decompression for Traumatic Facial Nerve Palsy[J]. Yonsei Med J, 2018, 59(3): 457-460.
-
计量
- 文章访问数: 148
- 施引文献: 0