Preoperative and postoperative electroneurographic facial nerve monitoring in patients with parotid tumors
Preoperative and postoperative electroneurographic facial nerve monitoring in patients with parotid tumors
复制标题
DOI：
10.1001/archotol.129.9.940
复制
发表时间：
2003-09-01
影响因子：
--
通讯作者：
Pastore, A
中科院分区：
文献类型：
--
作者：
Aimoni, C;Lombardi, L;Pastore, A
目的：评价显微外科腮腺切除术前后（第10天和第80天）面神经的临床（House-Brackmann分级）和神经生理（常规神经电图）监测在腮腺肿瘤患者中的应用价值。研究设计与背景：1999年1月7日至2001年2月27日，我们对33例经细胞学检查证实为腮腺肿瘤的患者进行了评估：27例为良性上皮肿瘤，6例为恶性上皮肿瘤。所有患者术前均行患侧及正常对侧神经电图检查。结果：33例良性病变患者中27例术前临床及神经生理评价面神经功能正常，6例恶性病变患者中3例在无面神经缺损的情况下出现复合肌动作电位振幅及潜伏期异常。在术后第一次评估中，6例上皮性肿瘤患者中有2例，27例良性肿瘤患者中有4例，茎突乳突孔神经刺激后自发性活动和复合肌肉动作电位缺失；1例恶性病变患者和5例良性肿瘤患者出现复合肌动作电位幅度降低或潜伏期延长的一过性面瘫。在术后第80天进行的第二次评估中，27例患者中有2例持续存在这种异常。在6例恶性病变患者中，2例80天的神经电图显示神经传导完全缺失。结论：在术前肿瘤损伤及术后早期和晚期神经功能随访的情况下，神经电图是监测临床上无症状面神经功能缺损的灵敏工具。
Objective: To assess the value of clinical (House-Brackmann grading) and neurophysiological (conventional electroneurography) monitoring of the facial nerve before and after (at day 10 and day 80) microsurgical parotidectomy in a group of patients with parotid tumors.Study Design and Setting: From January 7, 1999, to February 27, 2001, 33 patients were evaluated for parotid neoplasms confirmed by cytologic examination: 27 were benign and 6 were malignant epithelial tumors. All patients under-went preoperative electroneurography of the affected side and the normal contralateral side.Results: Preoperatively, 27 of 33 patients with benign lesions had normal facial nerve function on clinical and neurophysiological evaluation, while 3 of 6 patients with malignant lesions showed compound muscle action potential abnormalities of amplitude and latency, in the absence of facial nerve deficits. At the first postoperative evaluation, 2 of 6 patients with epithelial cancer and 4 of 27 patients with benign tumors had an absence of voluntary activity and compound muscle action potentials after nerve stimulation at the stylomastoid foramen; I patient with a malignant lesion and 5 patients with benign tumors had a transient facial palsy with amplitude reduction or latency prolongation of compound muscle action potential. This abnormality persisted in 2 of 27 patients at the second evaluation performed at day 80 after surgery. In 2 of 6 patients with malignant lesions, the day-80 electroneurogram showed a complete absence of nerve conduction.Conclusion: Electroneurography is a sensitive tool for monitoring clinically silent facial nerve function deficits in the context of preoperative tumor-induced damage and postsurgical early and late follow-up of nerve function.