不同面神经功能重建方式治疗周围性面瘫效果分析
Postoperative effect analysis of different surgical techniques used in facial nerve reconstruction
金婷婷 1柴永川 1薛璐 1蒋刈 1薛娜 1汪照炎1
作者信息
- 1. 上海交通大学医学院附属第九人民医院耳鼻咽喉头颈外科(上海,200011);上海交通大学医学院耳科学研究所;上海市耳鼻疾病转化医学重点实验室
- 折叠
摘要
目的:探讨不同面神经重建方案的影响因素及其疗效,为面神经功能重建策略提供参考.方法:回顾性分析2016年1月至2021年1月因面神经不可逆损伤,行面神经功能重建手术的24例患者,面神经全瘫时程均＜18个月.面神经中枢端可利用的患者中,根据面神经缺失长度,行面神经吻合术6例(A组),行面神经移植术(腓肠神经或耳大神经)5例(B组);面神经中枢端无法利用时,行面神经-舌下神经桥接术(端-侧吻合)5例(C组),面神经移植术(腓肠神经或耳大神经)-舌下神经桥接术(端-侧吻合)4例(D组);联合修复术(面神经-咬肌神经桥接术联合上述方式之一)4例(E组).术后随访时程≥1年.结果:24例患者中,术后1年面神经功能HB-Ⅲ 级的百分比分别是:A 组 83.3％(5/6),B 组 60.0％(3/5),C 组 40.0％(2/5),D 组 25.0％(1/4),E 组 50.0％(2/4).非多重面神经修复患者,口眼联动发生率为15.0％(3/20),而进行面神经-咬肌神经桥接的多重面神经修复患者中无一例发生口眼联动,且微笑时口角偏斜不明显.所有面神经-舌下神经端侧吻合的患者,伸舌无偏斜,舌肌无萎缩.结论:周围性面瘫的面神经功能重建方案多样,需根据中枢端能否利用及面神经缺损长度制定个性化修复方案.在单一修复方案中,为增加术后面神经功能疗效,应尽量减少神经的吻合口,提倡面神经转位吻合,同时为避免术后舌下神经功能障碍,提倡面神经-舌下神经端侧吻合.另外,多重面神经修复能够有效提高微笑时口角活动对称性,并降低口眼联动的发生率,对患者术后生活质量的提高具有较重要的意义.
Abstract
Objective:To investigate the factors and efficacy of different surgical techniques used in facial nerve(FN)reconstruction.Methods:A retrospective analysis was conducted on 24 patients who underwent facial nerve reconstruction surgery in our department from January 2016 to January 2021.The duration of total facial nerve pa-ralysis was less than 18 months.The study included 5 surgical techniques,including 6 cases of FN anastomosis(Group A),5 cases of FN grafting(sural nerve or great auricular nerve)(Group B),5 cases of side-to-end facial-hypoglossal nerve anastomosis(Group C),4 cases of side-to-end FN grafting(sural nerve or great auricular nerve)hypoglossal nerve anastomosis(Group D),and 4 cases of dual nerve reanimation(Group E).The postoperative follow-up period was ≥1 year.Results:The HB-Ⅲ level of FN function at 1 year after surgery was 83.3％(5/6)in group A,60.0％(3/5)in group B,40.0％(2/5)in group C,25.0％(1/4)in group D,and 50.0％(2/4)in group E.In patients without multiple FN repair,the incidence of synkinesis was 15.0％(3/20),while no cases of synkinesis were observed in patients with dual nerve reanimation.The patients who underwent hypoglossal-facial side-to-end anastomosis showed no hypoglossal nerve dysfunction.Conclusion:Different FN repair techniques re-sult in varying postoperative FN function recovery,as personalized repair should be managed.Among the various techniques,FN end-to-end anastomosis after FN transposition is recommended as to reduce the number of anasto-motic stoma,while hypoglossal-facial side-to-end anastomosis is advocated as to prevent postoperative hypoglossal nerve dysfunction.Additionally,dual nerve repair can effectively improve smile symmetry and reduce synkinesis,which enhances patients'quality.
关键词
周围性面瘫/面神经功能重建/多重面神经功能重建/神经移植Key words
peripheral facial paralysis/facial nerve function reconstruction/multiple facial nerve function re-construction/nerve grafting引用本文复制引用
出版年
2024
NETL
NSTL
万方数据