Long-term Outcomes After Middle Fossa Approach for Traumatic Facial Nerve Paralysis
Long-term Outcomes After Middle Fossa Approach for Traumatic Facial Nerve Paralysis
复制标题
DOI：
10.1097/mao.0000000000001033
复制
发表时间：
2016-07-01
影响因子：
2.1
通讯作者：
Gurgel, Richard K.
中科院分区：
文献类型：
--
作者：
Cannon, Richard B.;Thomson, Rhett S.;Gurgel, Richard K.
目的：手术对于颅底创伤和面瘫患者的作用存在争议。我们的目标是报告通过中颅窝 (MF) 入路对创伤性瘫痪患者进行早期面神经减压和修复的长期结果。研究设计：回顾性病例系列。地点：学术医疗中心。患者：有 18 名患者符合手术标准：即刻完全瘫痪，神经电图 (ENoG) 退化超过 90%，并且在创伤后 14 天内和 1 天内无自主肌电图 (EMG) 电位。最少一年随访。干预：采用 MF 方法治疗外伤性面瘫和不可逆性损伤神经移植。主要指标：长期面部功能、听力结果和手术并发症。结果：在 MF 减压时，11 名患者的面神经在解剖学上完好。在这些神经完整的患者中，72.7% 在 1 年时获得正常或接近正常的面部功能（HB I 或 II）：27.3% 达到 HB I，45.5% 达到 HB II，27.3% 达到 HB III。手术中，7名患者被发现有需要神经移植的损伤，100%改善至HB III。对于所有患者，手术后面神经功能均显着改善（p < 0.01）。手术后纯音平均值和单词识别的平均差异分别为+2.9 dB 和+3.3%（p = 0.44；p = 0.74）。 3 名患者出现轻微、短暂的并发症，1 名患者出现脓肿需要引流，但没有其他重大并发症。结论：在我们的系列中，所有外伤性完全瘫痪且面部预后不良的患者在采用 MF 入路减压和修复面神经后，均取得了 HB III 或更好的长期结果。
Objectives: Controversy exists regarding the role of surgery for patients with skull base trauma and facial paralysis. Our goal is to report the long-term outcomes of early facial nerve decompression and repair via the middle fossa (MF) approach for patients with traumatic paralysis.Study Design: Retrospective case series.Setting: Academic medical center.Patients: There were 18 patients who met surgical criteria: immediate complete paralysis, greater than 90% degeneration on electroneurography (ENoG), and no voluntary electromyography (EMG) potentials within 14 days after trauma and 1 year minimum follow-up.Intervention: MF approach for traumatic facial paralysis and for irreversible injuries nerve grafting was performed.Main Outcome Measure: Long-term facial function, hearing results, and surgical complications.Results: At MF decompression, 11 patients had an anatomically intact facial nerve. Of these patients with intact nerves, 72.7% obtained normal to near normal facial function (HB I or II) at 1 year: 27.3% to HB I, 45.5% to HB II, and 27.3% to HB III. At surgery, seven patients were found to have injuries that required nerve grafting and 100% improved to HB III. For all patients, facial nerve function significantly improved after surgery (p < 0.01). The average difference in pure tone average and word recognition after surgery was +2.9 dB and +3.3%, respectively (p = 0.44; p = 0.74). Minor, transient complications occurred in three patients and an abscess required drainage in one patient, but no other major complications.Conclusion: In our series, all patients with traumatic complete paralysis and poor facial prognosis achieved a long-term outcome of HB III or better after MF approach for decompression and repair of the facial nerve.