目的:舌下神经-面神经吻合术(HFA)是对保守治疗无反应的严重面神经麻痹最常用的外科治疗方法。HFA的主要并发症是舌功能的丧失。作者旨在评估使用下颌下颌神经吻合切断舌下神经是否可以防止接受HFA的患者的舌头偏离和功能障碍。
方法:在这项随机试验中,对至少6个月的保守治疗无反应的重度周围性面神经麻痹(House-BrackmannV级或VI级)的成年患者以1∶1的比例随机分组,分别接受HFA单独治疗(对照组)或HFA加舌下神经间吻合术和舌下神经下降(干预组).主要终点为12个月时的舌偏角。关键的次要终点包括舌头残疾(咀嚼困难,吞咽缺陷,和关节缺陷),舌残疾指数(TDI;范围1-4,得分越高表示残疾越严重),和面部神经功能。
结果:纳入20例患者(每组10例)。12个月时,干预组的舌偏角明显低于对照组(7.8°±5.1°vs23.6°±9.6°,p<0.001)。虽然没有统计学意义,干预组咀嚼困难率较低(1/10vs3/10,p=0.58),吞咽缺陷(1/10对5/10,p=0.14),关节缺损(2/10vs6/10,p=0.17)。干预组TDI显著降低(1.5±0.6vs2.5±0.3,p<0.001)。每组达到House-BrackmannII级或III级的患者百分比为80%。
结论:在接受HFA治疗的面神经麻痹患者中,下行舌下神经与舌下神经的吻合减轻了舌偏,不损害面神经功能.临床试验登记号:ChiCTR2000034372(中国临床试验注册中心)。
OBJECTIVE: Hypoglossal-facial nerve anastomosis (HFA) is the most commonly used surgical treatment for severe facial palsy that does not respond to conservative treatments. A major complication of HFA is the loss of tongue function. The authors aimed to evaluate whether anastomosing the transected hypoglossal nerve using the ramus descendens hypoglossi could prevent tongue deviation and dysfunction in patients undergoing HFA.
METHODS: In this randomized trial, adult patients with severe peripheral facial palsy (House-Brackmann grade V or VI) who did not respond to at least 6 months of conservative treatment were randomized at a 1:1 ratio to undergo either HFA alone (control group) or HFA plus anastomosis between the hypoglossal nerve and descendens hypoglossi (intervention group). The primary endpoint was tongue deviation angle at 12 months. Key secondary endpoints included tongue disability (chewing difficulty, swallowing defect, and articulation defect), tongue disability index (TDI; range 1-4, with a higher score indicating more severe disability), and facial nerve function.
RESULTS: Twenty patients were enrolled (10 in each group). At 12 months, the tongue deviation angle was significantly lower in the intervention group than in the control group (7.8° ± 5.1° vs 23.6° ± 9.6°, p < 0.001). Although not statistically significant, the intervention group had lower rates of chewing difficulty (1/10 vs 3/10, p = 0.58), swallowing defect (1/10 vs 5/10, p = 0.14), and articulation defect (2/10 vs 6/10, p = 0.17). TDI was significantly lower in the intervention group (1.5 ± 0.6 vs 2.5 ± 0.3, p < 0.001). The percentage of the patients achieving House-Brackmann grade II or III was 80% in each group.
CONCLUSIONS: Anastomosis of the descendens hypoglossi to the transected hypoglossal nerve attenuated tongue deviation in patients undergoing HFA for facial palsy, without compromising facial nerve function. Clinical trial registration no: ChiCTR2000034372 (Chinese Clinical Trials Registry).