Hypoglossal-facial nerve "side-to-side" neurorrhaphy for facial paralysis resulting from closed temporal bone fractures
Hypoglossal-facial nerve "side-to-side" neurorrhaphy for facial paralysis resulting from closed temporal bone fractures
复制标题
舌下面神经“左右”神经缝合术治疗闭合性颞骨骨折引起的面瘫
DOI：
10.3233/rnn-170794
复制
发表时间：
2018-01-01
影响因子：
2.8
通讯作者：
Liu, Song
中科院分区：
文献类型：
--
作者：
Su, Diya;Li, Dezhi;Liu, Song
背景：颅脑外伤导致的闭合性颞骨骨折常导致面神经损伤，常引起不完全性面瘫。传统的舌下神经-面神经端端吻合术可能不适用于这些损伤，因为神经吻合术的损伤面神经的牺牲破坏了残余的轴突和/或潜在的自发性神经支配。目的：我们改进了经典的舌下神经-面神经“侧侧”吻合术，使用插入预变性神经移植物治疗这些损伤。方法：摘要五位因颅骨外伤造成闭合性颞骨骨折而导致面瘫的病人，接受了“侧侧”神经吻合术的治疗。结果：所有患者治疗前均为House-Brackmann（H-B）Ⅴ ~ Ⅵ级面瘫，平均病程5个月。在12-30个月的随访期间，没有观察到进一步的可检测到的缺陷，但随着时间的推移，在5例神经缝合术治疗的患者中，面神经功能得到了改善。随访结束时，5例患者中，3例面部功能改善达到H-B Ⅱ级，1例达到Ⅲ级，1例达到Ⅳ级，与电生理检查结果一致。在对照组中，2例患者表现出轻微的自发神经支配，面部功能从H-B VI级改善到V级，其余患者在H-B V级或VI级时保持不变。结论：舌下神经-面神经“侧侧”吻合术能较好地保留受损面神经，适用于治疗闭合性颞骨骨折所致的严重不全性面瘫，提供明显的有益效果。此外，这种治疗可以在面瘫发作后更早地进行，以减少由于长期去神经支配导致的受损面神经的不利变化及其目标肌肉的萎缩，并允许轴突在丰富的支持环境中再生。
Background: Closed temporal bone fractures due to cranial trauma often result in facial nerve injury, frequently inducing incomplete facial paralysis. Conventional hypoglossal-facial nerve end-to-end neurorrhaphy may not be suitable for these injuries because sacrifice of the lesioned facial nerve for neurorrhaphy destroys the remnant axons and/or potential spontaneous innervation.Objective: we modified the classical method by hypoglossal-facial nerve "side-to-side" neurorrhaphy using an interpositional predegenerated nerve graft to treat these injuries.Methods: Five patients who experienced facial paralysis resulting from closed temporal bone fractures due to cranial trauma were treated with the "side-to-side" neurorrhaphy. An additional 4 patients did not receive the neurorrhaphy and served as controls.Results: Before treatment, all patients had suffered House-Brackmann (H-B) grade V or VI facial paralysis for a mean of 5 months. During the 12-30 months of follow-up period, no further detectable deficits were observed, but an improvement in facial nerve function was evidenced over time in the 5 neurorrhaphy-treated patients. At the end of follow-up, the improved facial function reached H-B grade II in 3, grade III in 1 and grade IV in 1 of the 5 patients, consistent with the electro-physiological examinations. In the control group, two patients showed slightly spontaneous innervation with facial function improved from H-B grade VI to V, and the other patients remained unchanged at H-B grade V or VI.Conclusions: We concluded that the hypoglossal-facial nerve "side-to-side" neurorrhaphy can preserve the injured facial nerve and is suitable for treating significant incomplete facial paralysis resulting from closed temporal bone fractures, providing an evident beneficial effect. Moreover, this treatment may be performed earlier after the onset of facial paralysis in order to reduce the unfavorable changes to the injured facial nerve and atrophy of its target muscles due to long-term denervation and allow axonal regrowth in a rich supportive environment.