【摘要】目的 探讨中耳乳突手术导致医源性面瘫的危险因素、处理方式及治疗效果。方法 对10例中耳乳突手术所致医源性面瘫病人进行手术探查和相应处理，术前、后按ｈouse－brackmann分级标准对面神经功能进行评价。结果 术中发现面神经损伤部位：鼓室段2例，鼓室段和锥段3例，鼓室段和乳突段3例，锥段和乳突段2例。术中进行面神经减压术6例，面神经-耳大神经移植术3例，面神经－舌下神经吻合术1例。手术前后按ｈouse－brackmann法对面神经功能进行分级，并随诊观察9个月～12年。面神经减压6例病人中5例面神经功能恢复至级，1例恢复到级。面神经-耳大神经移植术的3例从级恢复到级。面神经-舌下神经吻合的1例从级恢复至级。结论 面神经鼓室段是最容易损伤的部位。神经损伤时间长、面神经损伤程度重是面肌功能恢复不良的重要因素，应早期手术处理以使面神经功能早日恢复。
【关键词】 面神经； 医源性损伤； 手术； 随诊
managementstrategiesandtreatmentoutcomesofiatrogenicfacialnerveinjuryduringmastoidsurgery
zhangxian-fen,yangshi-ming,handong-yi
departmentofotolaryngology,headandnecksurgery,chineseplageneralhospital,bejing100853,china
【abstract】objective todiscusstheriskfactorsoffacialnerveinjuryduringmastoidsurgeryanditsmanagementstrategiesandtreatmentoutcomes.method tencaseswithfacialnerveparalysiscausedbymastoidsurgeryinotherhospitalsunderwentsurgicalexplorationandtheresultswereanalyzed.thefacialnervefunctionwasassessedaccordingtohouse-brackmann（hb）grade.results iatrogenicfacialnerveinjuriesoccurredatthefollowingregions:2casesinthetympanicsegment,3casesinthetympanicsegmentandpyramidsegment,3casesinthetympanicsegmentandmastoidsegment,2casesinthepyramidsegmentandmastoidsegment.facialnervedecompressionwasappliedin6cases.acablenervegraftharvestedfromthegreatauricularnervewasusedin3cases,whileonecasereceivedfacial-hypoglossalnerveanastomosis.thefacialnervefunctionwasassessedaccordingtohouse-brackmanngradebeforeandaftersurgery.thepatientswerefollowedupfor9monthsto12years.of6caseswhoreceivedfacialnervedecompression,5recoveredtohouse-brackmanngrade,1recoveredtohouse-brackmanngrade.threecaseswhounderwentthegreatauricularnervegraftingrecoveredtohouse-brackmanngradefromhouse-brackmann.onecasewhoreceivedfacial-hypoglossalnerveanastomosisalsorecoveredtohouse-brackmanngradefromhouse-brackmann.conclusion thetmpanicsegmentismorepronetodamageduringmastoidsurgery.thefacialnervefunctionrecoveryiscorrelatedwithdurationanddegreeoffacialnervetrauma.managementduringearlystagecanimprovethefacialnerverecovery.1/5页123...5评论（0篇）
