Facial nerve function after parotidectomy.
Facial nerve function after parotidectomy.
复制标题
腮腺切除术后的面神经功能。
DOI：
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发表时间：
1997
期刊：
影响因子：
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通讯作者：
C. O'brien
中科院分区：
文献类型：
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作者：
L. Bron;C. O'brien
目标
分析腮腺切除术后面神经功能障碍的发生率，并将其与腮腺切除范围、病理诊断和临床环境相关联。
设计
对从专用计算机化头颈部数据库前瞻性收集的数据进行审查。
设置
三级护理中心。
患者
在1987年至1995年期间，248名患者接受了由同一外科医生（C. J. O 'B.）进行的259例腮腺切除术。适应症为临床肿瘤（n=213）或涎腺炎（n=46）。有235名以前未经治疗的患者和13名在该侧接受过手术的患者。面神经功能正常者242例，术前异常者6例。腮腺肿瘤切除术88例，良性病变切除术171例。在213个临床肿瘤中，41个（19%）位于面神经平面深处。
结果
在259例手术中，28例故意牺牲面神经（18例全部牺牲，10例部分牺牲）。在230例术前面神经功能正常并保留面神经的腮腺切除术中，术后最初面神经无力的发生率为29%。根据诊断和手术范围，腮腺浅叶良性肿瘤和恶性肿瘤行腮腺浅叶小范围切除术的患者，面瘫发生率分别为16.5%和13%，腮腺炎行腮腺浅叶全切除术和腮腺近全切除术的患者，面瘫发生率分别为30%和34%;良性和恶性肺叶肿瘤行近全腮腺切除术的患者分别为31%和100%;腮腺切除术联合颈淋巴结清扫术的患者为83%;既往接受过腮腺手术的患者为33%。230例患者中有13例（5.6%）出现永久性无力，但其中10例同时进行了颈清扫术，面神经功能障碍仅涉及下颌缘分支。在67名最初无力的患者中，有46名（68%）在6个月内恢复了正常的面部运动。
结论
暂时性面神经衰弱的可能性与手术范围相关，尤其受肿瘤位置深入面神经平面、既往腮腺手术、涎腺炎诊断以及腮腺切除术后是否进行颈清扫术的影响。颈淋巴清扫术后，永久性肌无力主要累及下颌缘分支。
OBJECTIVES
To analyze the incidence of facial nerve dysfunction following parotidectomy and to correlate this with the extent of parotid gland resection, the pathological diagnosis, and the clinical setting.
DESIGN
A review of prospectively collected data from a dedicated computerized head and neck database.
SETTING
Tertiary care center.
PATIENTS
Between 1987 and 1995, 248 patients underwent 259 parotidectomies performed by the same surgeon (C.J.O'B.). Indications were clinical tumor (n=213) or sialadenitis (n=46). There were 235 previously untreated patients and 13 who had undergone a prior operation on that side. Facial nerve function was normal in 242 patients and abnormal before surgery in 6. Cancers accounted for 88 parotidectomies and benign disease accounted for 171. Of 213 clinical tumors, 41 (19%) were situated deep to the plane of the facial nerve.
RESULTS
The facial nerve was intentionally sacrificed in 28 of 259 operations (18 total and 10 partial sacrifice). In 230 parotidectomies in which facial nerve function was normal before surgery and the nerve was preserved, the incidence of initial postoperative facial weakness was 29%. Based on the diagnosis and extent of surgery, rates of facial weakness were 16.5% and 13%, respectively, for benign and malignant tumors located in the superficial lobe and treated with limited superficial parotidectomy; 30% and 34% for sialadenitis treated with complete superficial parotidectomy and near-total parotidectomy, respectively; 31% and 100%, respectively, for benign and malignant lobe tumors treated with near-total parotidectomy; 83% for parotidectomy associated with a neck dissection; and 33% for patients who had previous parotid surgery. Permanent weakness occurred in 13 (5.6%) of 230 patients, but 10 of these 13 had simultaneous neck dissection and facial nerve dysfunction involved only the marginal mandibular branch. Recovery of normal facial movements occurred within 6 months in 46 (68%) of 67 of those with initial weakness.
CONCLUSIONS
The likelihood of temporary facial weakness correlated with the extent of surgery and was especially influenced by tumor location deep to the plane of the facial nerve, previous parotid surgery, a diagnosis of sialadenitis, and the addition of neck dissection to the parotidectomy. Permanent weakness mainly affected the marginal mandibular branch when neck dissection was included.