Facial nerve dysfunction after parotidectomy:: The role of local factors
Facial nerve dysfunction after parotidectomy:: The role of local factors
复制标题
DOI：
10.1097/01.mlg.0000154735.61775.cd
复制
发表时间：
2005-02-01
期刊：
影响因子：
2.6
通讯作者：
St Guily, JL
中科院分区：
文献类型：
--
作者：
Gaillard, C;Périé, S;St Guily, JL
目的/假设：目的分析腮腺切除术后面神经功能障碍的发生率及相关因素。研究设计：在三级医疗中心进行的回顾性单中心研究，前瞻性记录研究因素。研究方法：在10年的时间里，131例面神经功能正常的患者接受了由一名外科医生进行的浅表或全保守性腮腺切除术和神经剥离术，用于原发性良性或恶性肿瘤。在术后第一天、腮腺切除术后1个月和6个月评估面神经功能。对手术范围、组织病理学表现、肿瘤大小、肿瘤与面神经的紧密接触以及患者的性别和年龄进行了回顾性分析。在X-2统计单变量和分层分析中研究这些变量，以确定它们与术后面神经功能障碍的相关性。结果如下：术后第1天面神经功能障碍的发生率为42.7%，术后1个月为30.7%，术后6个月为0%。最常见的功能障碍是单一神经分支的麻痹（48.2%），特别是下颌缘分支。腮腺全切除术与术后第一阶段面神经功能障碍的发生率（第1天为60.5%，第1个月为44.7%）显著高于腮腺浅表切除术（第1天为18.2%，第1个月为10.9%）（P <0.001）。在腮腺全切除术患者中，发现肿瘤与面神经的紧密接触与面神经无力有统计学因果关系。在腮腺浅叶切除术的患者中，炎症状况被发现是增加术后面神经功能障碍的因素。结论：在腮腺保守性手术中，只有手术范围和局部特殊的神经解剖条件，特别是肿瘤与面神经的紧密接触和炎症状态，才与术后面神经功能障碍有关。
Objectives/Hypothesis: The objective was to analyze the incidence and factors associated with facial nerve dysfunction after conservative parotidectomy with facial nerve dissection. Study Design: A retrospective unicentric study in a tertiary care center with prospective record of studied factors. Methods: Over a 10-year period, 131 patients with normal facial nerve function underwent a superficial or total conservative parotidectomy with nerve dissection performed by one surgeon for primary benign or malignant tumors. Facial nerve function was assessed on the first postoperative day and at 1 month and 6 months after the parotidectomy. Extent of surgery, histopathological findings, tumor size, close contact of tumor with facial nerve, and sex and age of the patient were reviewed. These variables were studied in a X-2 statistical univariate and stratified analysis to determine their association with postoperative facial nerve dysfunction. Results: Incidence of postoperative facial nerve dysfunction was 42.7% on the first postoperative day, 30.7% at 1 month after the parotidectomy, and 0% at 6 months after the parotidectomy. The most common dysfunction was paresis in a single nerve branch (48.2%), in particular, the marginal mandibular branch. Total parotidectomy was associated with a significantly higher incidence of facial nerve dysfunction during the first postoperative period (60.5% at day 1 and 44.7% at month 1) than superficial parotidectomy (18.2% at day 1 and 10.9 at month 1) (P < .001). In patients with total parotidectomy, close contact of the tumor with the facial nerve was found to have statistical causal relation with facial nerve weakness. In patients with superficial parotidectomy, inflammatory conditions were found as factors that increased postoperative facial nerve dysfunction. Conclusion: In the study series of conservative parotidectomies with facial nerve dissection, only extent of surgery and particular local conditions of nerve dissection, especially the close contact of tumor with facial nerve and inflammatory conditions, were found to be associated with postoperative facial nerve dysfunction.