山东大学耳鼻喉眼学报 ›› 2020, Vol. 34 ›› Issue (1): 15-19.doi: 10.6040/j.issn.1673-3770.1.2019.064

• 临床研究 • 上一篇    下一篇

修复治疗不同情形下腮腺区面神经损伤

王智立,陈哲,林芳羽,柴永川,汪照炎*()   

  1. 上海交通大学医学院附属第九人民医院耳鼻咽喉头颈外科/上海交通大学医学院耳科学研究所/上海市耳鼻疾病转化医学重点实验室，上海 200011
  • 收稿日期:2019-12-25 出版日期:2020-01-20 发布日期:2020-03-06
  • 通讯作者: 汪照炎 E-mail:wzyent@163.com
  • 作者简介:汪照炎，上海交通大学医学院医学博士、博士生导师、附属第九人民医院耳鼻咽喉头颈外科主任医师。主要学术兼职：中华医学会耳鼻咽喉头颈外科分会委员、副秘书长；上海医学会耳鼻咽喉头颈外科分会委员、耳科组副组长；中国医疗保健国际交流促进会人工听觉分会常委，颅底外科分会委员。学术成果：主持国家自然基金项目4项，发表SCI论文30余篇。主编及副主编《听神经瘤》《颞骨及侧颅底解剖训练手册》《耳内镜手术学》等专著。奖项荣誉：上海卫计委优秀学科带头人，首届国之名医青年新锐；获得国家科技进步奖二等奖、上海市科技进步奖一等奖、教育部科技进步奖一等奖等；临床研究：致力耳显微外科、耳神经外科、侧颅底外科以及小儿耳鼻咽喉科方面的研究，擅长各型中耳炎手术，尤其是创新耳内镜下中耳炎手术，是国内处理NF2最多的医生之一；在听神经瘤、颈静脉孔区肿瘤手术治疗领域所属团队是国内侧颅底外科病例数多、手术效果趋于完善的科室

Facial nerve reconstruction in the parotid area under a variety of circumstances

Zhili WANG,Zhe CHEN,Fangyu LIN,Yongchuan CHAI,Zhaoyan WANG*()   

  1. Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai 200011, China
  • Received:2019-12-25 Online:2020-01-20 Published:2020-03-06
  • Contact: Zhaoyan WANG E-mail:wzyent@163.com

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摘要： 目的

探讨不同情形下腮腺区面神经损伤患者的手术修复策略与疗效。

方法

收集46例腮腺区面神经损伤后行手术修复的患者资料，据损伤情况不同而采取个性化手术方式。46例中面神经无断裂者3例，采用面神经松解；采用面神经端-端吻合者7例；面神经缺损距离较长者22例，采用腓肠神经桥接；在腓肠神经桥接基础上，采用面神经颊支-咬肌神经吻合14例。

结果

术后随访1年，面神经松解减压术患者3例中Ⅲ级2例、Ⅱ级1例；面神经端-端吻合术患者7例术后面神经功能Ⅲ~Ⅳ级；采用腓肠神经桥接面神经主干者共22例，术后1年面神经功能Ⅲ~Ⅳ级，出现较严重联动1例、较明显联动3例、轻微联动7例；采用腓肠神经桥接合并咬肌-面神经颊支吻合术的患者14例，术后1年面神经功能Ⅲ~Ⅴ级，无明显联动出现。

结论

及时采取个体化手术策略治疗各种原因导致的腮腺区面神经损伤患者，均可取得满意效果。在保证吻合口无张力的情况下，优先采用端端吻合，如考虑避免联动，可行咬肌-颊支神经吻合。

关键词: 面瘫, 面神经修复, 神经吻合, 神经桥接, 面-咬肌神经吻合术

Abstract: Objective

To discuss the efficacy of surgical facial nerve (FN) reconstruction in the parotid area under various circumstances.

Method

We considered 46 cases of surgical facial nerve reconstruction with nerve involvement in the parotid area. Among these cases, 3 required facial nerve relaxation (facial nerve intact), 7 required facial nerve suturing, 22 required sural nerve grafting (long distance nerve defects), and 14 required additional masseteric-facial nerve anastomosis due to sural nerve grafting.

Results

All patients in the study received postoperative follow-up at 6 to 12 months. Using the House-Brackmann grading system at follow-up, 2 of the 3 facial nerve relaxation cases received grade Ⅲ, while the third received grade Ⅱ; all 7 facial nerve suturing cases received grades Ⅲ-Ⅳ. The 22 sural nerve grafting cases received grades Ⅲ-Ⅳ, however in one of these cases severe synkinesis was observed; 3 cases presented obvious synkinesis, and tight synkinesis was observed in the other 7 cases. The 14 sural nerve grafting and masseteric-facial nerve anastomosis cases received grades Ⅲ-Ⅴ with no obvious synkinesis observed in any of these cases.

Conclusion

Immediate, individualized surgical facial nerve reconstruction could lead to satisfactory results for various circumstances of facial nerve damage. Nerve suturing was preferred for achieving tension-free anastomosis, and masseteric-facial nerve anastomosis was preferred as a means to avoid synkinesis.

Key words: Facial palsy, Facial nerve reconstruction, Nerve suturing, Nerve grafting, Masseteric-facial nerve anastomosis

中图分类号: 

  • R739

表1

46例腮腺区面神经手术方式(n)"

修复时机 手术方式 n
一期修复
  Ⅰ 腓肠神经桥接 9
  Ⅱ 腓肠神经桥接+咬肌-颊支吻合 4
二期修复
  Ⅰ 松解减压 3
  Ⅱ 面神经端-端吻合 7
  Ⅲ 腓肠神经桥接 13
  Ⅳ 腓肠神经桥接+咬肌-颊支吻合 10

图1

腮腺肿瘤切除后行腓肠神经桥接。腓肠神经总干连接面神经总干，分支分别连接面神经上主干与下主干"

图2

面咬肌吻合(A)同时以腓肠神经桥接面神经主干与分支(B)"

1 Condie D , Tolkachjov SN . Facial nerve injury and repair: a practical review for cutaneous surgery[J]. Dermatol Surg, 2019, 45 (3): 340- 357.
doi: 10.1097/DSS.0000000000001773
2 Kimata Y , Sakuraba M , Hishinuma S , et al. Free vascularized nerve grafting for immediate facial nerve reconstruction[J]. Laryngoscope, 2005, 115 (2): 331- 336.
doi: 10.1097/01.mlg.0000154753.32174.24
3 Constantinidis J , Akbarian A , Steinhart H , et al. Effects of immediate and delayed facial-facial nerve suture on rat facial muscle[J]. Acta Otolaryngol, 2003, 123 (8): 998- 1003.
doi: 10.1080/00016480310001853
4 王笃权, 汪卫国, 姚斌, 等. 面神经离断修复的临床效果观察[J]. 医学临床研究, 2006, 23 (4): 504- 505.
doi: 10.3969/j.issn.1671-7171.2006.04.016
WANG Duquan , WANG Weiguo , YAO Bin , et al. Clinical effective observation of repairing ruptured facial nerve[J]. Journal of Clinical Research, 2006, 23 (4): 504- 505.
doi: 10.3969/j.issn.1671-7171.2006.04.016
5 宋维铭, 孙广慈, 冯越蹇, 等. 早期手术修复对创伤性面神经麻痹患者功能恢复的影响[J]. 中国临床康复, 2005, 9 (9): 177- 179, 277.
doi: 10.3321/j.issn:1673-8225.2005.09.011
SONG Weiming , SUN Guangci , FENG Yuejian , et al. Effect of early surgical repair on functional recovery of patients with traumatic facial paralysis[J]. Chinese Journal of Clinical Rehabilitation, 2005, 9 (9): 177- 179, 277.
doi: 10.3321/j.issn:1673-8225.2005.09.011
6 刘小林, 林焘, 詹翼. 周围神经长段缺损桥接修复的相关因素[J]. 中华显微外科杂志, 2017, 40 (1): 8- 12.
doi: 10.3760/cma.j.issn.1001-2036.2017.01.004
7 Kim DH , Murovic JA , Tiel RL , et al. Management and outcomes in 318 operative common peroneal nerve lesions at the Louisiana State University Health Sciences Center[J]. Neurosurgery, 2004, 54 (6): 1421- 1428.
doi: 10.1227/01.neu.0000124752.40412.03
8 Sulaiman OA , Midha R , Munro CA , et al. Chronic Schwann cell denervation and the presence of a sensory nerve reduce motor axonal regeneration[J]. Exp Neurol, 2002, 176 (2): 342- 354.
doi: 10.1006/exnr.2002.7928
9 杨光. 轻微外伤致面神经一过性麻痹1例[J]. 刑事技术, 2002, (1): 24.
doi: 10.3969/j.issn.1008-3650.2002.01.039
10 Flores AJ , Lavernia CJ , Owens PW . Anatomy and physiology of peripheral nerve injury and repair[J]. Am J Orthop, 2000, 29 (3): 167- 173.
11 Lundborg G . Limb ischemia and nerve injury[J]. Arch Surg, 1972, 104 (5): 631- 632.
doi: 10.1001/archsurg.1972.04180050007001
12 卢旭光, 蔡志刚, 俞光岩, 等. 周围性面神经断裂伤的外科治疗[J]. 北京大学学报(医学版), 2011, 43 (1): 106- 111.
doi: 10.3969/j.issn.1671-167X.2011.01.024
LU Xuguang , CAI Zhigang , YU Guangyan , et al. Surgical treatment of transected peripheral facial nerve injury[J]. Journal of Peking University(Health Sciences), 2011, 43 (1): 106- 111.
doi: 10.3969/j.issn.1671-167X.2011.01.024
13 Malik TH , Kelly G , Ahmed A , et al. A comparison of surgical techniques used in dynamic reanimation of the paralyzed face[J]. And, 2005, 26 (2): 284- 291.
doi: 10.1097/00129492-200503000-00028
14 Piza-Katzer H , Balogh B , Muzika-Herczeg E , et al. Secondary end-to-end repair of extensive facial nerve defects: surgical technique and postoperative functional results[J]. Head Neck, 2004, 26 (9): 770- 777.
doi: 10.1002/hed.20047
15 Moran CJ , Neely JG . Patterns of facial nerve synkinesis[J]. Laryngoscope, 1996, 106 (12 Pt 1): 1491- 1496.
doi: 10.1097/00005537-199612000-00009
16 Choi D , Raisman G . Somatotopic organization of the facial nucleus is disrupted after lesioning and regeneration of the facial nerve: the histological representation of synkinesis[J]. Neurosurgery, 2002, 50 (2): 355- 362.
doi: 10.1097/00006123-200202000-00022
17 李文, 杨柳, 陈敏, 等. 电缆状耳大神经移植修复腮腺癌切除术后面神经缺损[J]. 临床耳鼻咽喉头颈外科杂志, 2017, 31 (16): 1254- 1258.
doi: 10.13201/j.issn.1001-1781.2017.16.009
LI Wen , YANG Liu , CHEN Min , et al. Immediate reconstruction of facial nerve defect using cable grafting of the greater auricualr nerve after parotid cancer resection[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2017, 31 (16): 1254- 1258.
doi: 10.13201/j.issn.1001-1781.2017.16.009
18 Biglioli F , Colombo V , Pedrazzoli M , et al. Thoracodorsal nerve graft for reconstruction of facial nerve branching[J]. J Craniomaxillofac Surg, 2014, 42 (1): e8- e14.
doi: 10.1016/j.jcms.2013.03.001
19 Hyodo I , Ozawa T , Hasegawa Y , et al. Management of a total parotidectomy defect with a gastrocnemius muscle transfer and vascularized sural nerve grafting[J]. Ann Plast Surg, 2007, 58 (6): 677- 682.
doi: 10.1097/01.sap.0000239844.57064.ed
20 Lee MC , Kim DH , Jeon YR , et al. Functional outcomes of multiple sural nerve grafts for facial nerve defects after tumor-ablative surgery[J]. Arch Plast Surg, 2015, 42 (4): 461- 468.
doi: 10.5999/aps.2015.42.4.461
21 Volk GF , Pantel M , Streppel M , et al. Reconstruction of complex peripheral facial nerve defects by a combined approach using facial nerve interpositional graft and hypoglossal-facial jump nerve suture[J]. Laryngoscope, 2011, 121 (11): 2402- 2405.
doi: 10.1002/lary.22357
22 Biglioli F , Tarabbia F , Allevi F , et al. Immediate facial reanimation in oncological parotid surgery with neurorrhaphy of the masseteric-thoracodorsal-facial nerve branch[J]. Br J Oral Maxillofac Surg, 2016, 54 (5): 520- 525.
doi: 10.1016/j.bjoms.2016.02.014
23 Beutner D , Luers JC , Grosheva M . Hypoglossal-facial-jump-anastomosis without an interposition nerve graft[J]. Laryngoscope, 2013, 123 (10): 2392- 6.
doi: 10.1002/lary.24115
24 Beutner D , Grosheva M . Reconstruction of complex defects of the extracranial facial nerve: technique of "the trifurcation approach"[J]. Eur Arch Otorhinolaryngol, 2019, 276 (6): 1793- 1798.
doi: 10.1007/s00405-019-05418-4
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