背景:医源性面神经损伤是中耳手术最严重的并发症之一,本研究旨在评估手术器械改进时代的手术管理和预后。
方法:回顾性收集2000年1月至2019年12月中耳手术后面神经麻痹患者。人口特征,原发疾病和手术,分析了翻修手术的细节.
结果:收集了45例患者,其中8人在我们中心受伤,37人被转移。在我们中心受伤的8个病人,在翻修手术前,有七个(87.5%)排名为House-Brackmann(H-B)V级,一个(12.5%)排名为H-BVI级;术后,两名(25.0%)患者恢复到H-BI级,四个(50.0%)恢复到H-BII,另外两个(25.0%)恢复为H-BIII。对于转移的37名患者,术前有13名(35.1%)被列为H-BV级,24名(64.9%)被列为H-BVI级,术后终级从H-BI级到V级,H-BI6例(16.2%),H-BII6例(16.2%),H-BIII18例(48.6%),H-BIV5例(13.5%),H-BV2例(5.4%)。最脆弱的部位是鼓室段(分别为5、62.5%和27、73.0%)。21例(46.7%)患者遭受轻度损伤,24例(53.3%)遭受部分或完全神经横断。对于手术管理,21名(46.7%)病人接受减压,19例(42.2%)接受了移植物,5例(11.1%)接受了吻合。瘫痪后2个月内减压者H-BⅠ级或Ⅱ级恢复的可能性较高(P=0.026),在6个月内接受移植的患者更有可能获得H-BIII级恢复(P=0.041),对于在6个月内进行吻合的患者,全部恢复至H-B三级。
结论:鼓段是易损部位。如果发生面神经麻痹,高分辨率计算机断层扫描可以帮助识别受伤部位.及时治疗很重要,瘫痪后2个月内减压,移植和吻合在6个月内导致更好的恢复。
BACKGROUND: Iatrogenic facial nerve injury is one of the severest complications of middle ear surgery, this study aims to evaluate surgical management and prognosis in the era of improved surgical instruments.
METHODS: Patients suffered from facial nerve paralysis after middle ear surgery between January 2000 and December 2019 were retrospectively collected. Demographic characters, primary disease and surgery, details of revision surgery were analyzed.
RESULTS: Forty-five patients were collected, of whom 8 were injured at our center and 37 were transferred. For 8 patients injured at our center, seven (87.5%) ranked House-Brackmann (H-B) grade V and one (12.5%) ranked H-B VI before revision surgery; postoperatively, two (25.0%) patients recovered to H-B grade I, four (50.0%) recovered to H-B II, and the other two (25.0%) recovered to H-B III. For 37 patients transferred, thirteen (35.1%) ranked H-B grade V and 24 (64.9%) ranked H-B VI preoperatively, final postoperative grade ranked from H-B grade I to grade V, with H-B I 6 (16.2%) cases, H-B II 6 (16.2%) cases, H-B III 18 (48.6%) cases, H-B IV 5 (13.5%) cases and H-B V 2 (5.4%) cases. The most vulnerable site was tympanic segment (5, 62.5% and 27, 73.0% respectively). Twenty-one (46.7%) patients suffered from mild injury and 24 (53.3%) suffered from partial or complete nerve transection. For surgical management, twenty-one (46.7%) patients received decompression, nineteen (42.2%) received graft and 5 (11.1%) received anastomosis. Those decompressed within 2 months after paralysis had higher possibility of H-B grade I or II recovery (P = 0.026), those received graft within 6 months were more likely to get H-B grade III recovery (P = 0.041), and for patients underwent anastomosis within 6 months, all recovered to H-B grade III.
CONCLUSIONS: Tympanic segment is the vulnerable site. If facial nerve paralysis happens, high-resolution computed tomography could help identify the injured site. Timely treatment is important, decompression within 2 months after paralysis, graft and anastomosis within 6 months lead to better recovery.