17例中耳术后迟发性面瘫的临床特征分析

doi:10.6040/j.issn.1673-3770.0.2022.209

摘要/Abstract

摘要： 目的探讨中耳手术后迟发性面瘫出现的可能病因、处理措施及结果。方法收集自2017年1月至2018年12月接受中耳手术病例资料1 124例,回顾性分析迟发性面瘫发生时间、相关因素、治疗经过及恢复情况。结果 1 124例中耳手术术后出现迟发性面瘫17例,发生率为1.51%;术后3~20 d出现迟发性面瘫,平均(10.00±4.11)d;按照各术式分布如下:鼓室成形术Ⅰ型(8/348, 2.30%),鼓室成形术Ⅱ型(4/247,1.62%),开放式乳突切开+鼓室成形术(5/529,0.95%),各术式之间迟发性面瘫发生率差异无统计学意义;按照面神经骨管情况分布如下:面神经骨管部分缺失348例,术后迟发性面瘫(5/348, 1.44%),面神经管完整776例,术后迟发性面瘫(12/776, 1.55%),面神经骨管是否完整,术后迟发性面瘫发生率差异无统计学意义;1例发生术后术腔感染,细菌培养提示铜绿假单胞菌感染,对症处理感染控制后,行面神经探查、耳大神经切取面神经吻合术,术后1年面神经功能恢复至Ⅲ级;其余16例全部予以激素等保守治疗,治疗后0.5~3个月后功能完全恢复。结论中耳术后迟发性面瘫与手术方式、面神经是否裸露等因素无关,保守治疗效果好。

关键词: 迟发性面瘫, 中耳, 鼓室成形术, 开放式乳突切开术, 面神经, 吻合术

Abstract: Objective To explore the causes, treatments, and outcomes of delayed facial paralysis(DFP)after different types of middle ear surgery. Methods A retrospective study was done on the clinical data of 1 124 cases experienced middle ear surgery from January 2017 to December 2018, including onset, risk factors, treatment and rehabilitation of DFP. Results Among the 1 124 patients who underwent middle ear surgery, 17(1.51%)presented DFP 3-20 days after surgery, with an average incidence at 10.00±4.11 days. The incidence of DFP after type Ⅰ tympanoplasty, type Ⅱ tympanoplasty, and tympanoplasty with mastoidectomy of the canal wall down were 2.30%, 1.62%, and 0.95%, respectively, and the differences were not statistically significant. The incidence of DFP in 776 patients with intact facial canal and 348 with dehiscent facial canal were 1.55% and 1.44%, respectively, and this difference also was not statistically significant. In addition, postoperative infection with Pseudomonas aeruginosa occurred in one of the patients with DFP who was later treated with a great auricular nerve graft and facial nerve anastomosis. The patient's condition improved to grade III a year after surgery. The remaining 16 patients were treated with steroids as conservative management, and their conditions were fully restored after 0.5-3 months. Conclusion The possible cause of DFP following middle ear surgery has nothing to do with surgical approaches and facial canal dehiscence. Notably, conservative management resulted in good outcomes.

Key words: Delayed facial paralysis, Middle ear, Tympanoplasty, Tympanoplasty with mastoidectomy of cannal wall down, Facial nerve, Anastomosis

中图分类号:

R764.2

温立婷,李旭,高伟,胡田勇,曾宪海,查定军. 17例中耳术后迟发性面瘫的临床特征分析[J]. 山东大学耳鼻喉眼学报, 2022, 36(5): 1-5.

WEN Liting, LI Xu, GAO Wei, HU Tianyong, ZENG Xianhai, ZHA Dingjun. An analysis of the clinical characteristics of delayed facial paralysis following middle ear surgery[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(5): 1-5.

参考文献

[1] 田雨鑫, 王菁菁, 王慧, 等. 医源性面瘫的手术治疗[J]. 山东大学耳鼻喉眼学报, 2020, 34(1): 20-24. doi:10.6040/j.issn.1673-3770.1.2019.054. TIAN Yuxin, WANG Jingjing, WANG Hui, et al. Surgical treatment of iatrogenic facial paralysis[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(1): 20-24. doi:10.6040/j.issn.1673-3770.1.2019.054.
[2] Eckermann J, Meyer JE, Guenzel T. Etiology and therapy of delayed facial paralysis after middle ear surgery[J]. Eur Arch Otorhinolaryngol. 2020,277(4): 965-974. doi: 10.1007/s00405-020-05825-y.
[3] 中华医学会耳鼻咽喉头颈外科学分会耳科学组,中华耳鼻咽喉头颈外科杂志编辑委员会耳科组. 中耳炎临床分类和手术分型指南(2012)[J]. 中华耳鼻咽喉头颈外科杂志, 2013(1): 5-5.doi: 10.3760/cma.j.issn.1673-0860.2013.01.003.
[4] Tolisano AM, Hunter JB, Sakai M, et al. Determining etiology of facial nerve paralysis with MRI: challenges in malignancy detection[J]. Ann Otol Rhinol Laryngol, 2019, 128(9): 862-868. doi:10.1177/0003489419848462.
[5] Thorne MC, Dunham BP, Tom LW. Delayed facial paresis following tympanomastoid surgery in a pediatric patient[J]. Ear Nose Throat J, 2010, 89(8): 357-361.
[6] 姜立伟, 潘滔. 鼓室成形术后迟发性面瘫临床特征[J]. 临床耳鼻咽喉头颈外科杂志, 2015, 29(22): 2003-2004. doi:10.13201/j.issn.1001-1781.2015.22.018.
[7] Eskander A, Holler T, Papsin BC. Delayed facial nerve paresis after using the KTP laser in the treatment of cholesteatoma despite inter-operative facial nerve monitoring[J]. Int J Pediatr Otorhinolaryngol, 2010, 74(7): 823-824. doi:10.1016/j.ijporl.2010.03.052.
[8] Xu P, Liu W, Zuo W, et al. Delayed facial palsy after tympanomastoid surgery: a report of 15 cases[J]. Am J Otolaryngol, 2015, 36(6): 805-807. doi:10.1016/j.amjoto.2015.07.004.
[9] 李永奇, 陈愈彬, 尹根蒂, 等. 鼓室乳突术后迟发性周围性面神经麻痹的临床诊治[J]. 中华耳科学杂志, 2016, 14(5): 629-633. doi:10.3969/j.issn.1672-2922.2016.05.015. LI Yongqi, CHEN Yubin, YIN Gendi, et al. Diagnosis and treatment of patients with delayed peripheral facial nerve paralysis after tympano-mastoid surgeries[J]. Chinese Journal of Otology, 2016, 14(5): 629-633. doi:10.3969/j.issn.1672-2922.2016.05.015.
[10] Révész P, Piski Z, Burián A, et al. Delayed facial paralysis following uneventful KTP laser stapedotomy: two case reports and a review of the literature[J]. Case Rep Med, 2014: 971362. doi:10.1155/2014/971362.
[11] Mills R, Szymanski M, Abel E. Delayed facial palsy following laser stapedectomy: in vitro study of facial nerve temperature[J]. Clin Otolaryngol Allied Sci, 2003, 28(3): 211-214. doi:10.1046/j.1365-2273.2003.00691.x.
[12] De Stefano A, Neri G, Kulamarva G. Delayed facial nerve paralysis post middle ear surgery: herpes simplex virus activation[J]. B-ENT, 2009, 5(1): 47-50.
[13] Shea JJ, Ge X. Delayed facial palsy after stapedectomy[J]. Otol Neurotol, 2001, 22(4): 465-470. doi:10.1097/00129492-200107000-00009.
[14] Salvinelli F, Casale M, Vitaliana L, et al. Delayed peripheral facial palsy in the stapes surgery: can it be prevented? [J]. Am J Otolaryngol, 2004, 25(2): 105-108. doi:10.1016/j.amjoto.2003.11.010.
[15] Kitahara T, Kubo T, Doi K, et al. Delayed facial nerve palsy after otologic surgery[J]. Nihon Jibiinkoka Gakkai Kaiho, 2006, 109(7): 600-605. doi:10.3950/jibiinkoka.109.600.
[16] 于春刚, 李健东. 多组颅神经受累的不典型Hunt综合征一例报告[J]. 山东大学耳鼻喉眼学报, 2019, 33(2): 167-168. doi:10.6040/j.issn.1673-3770.0.2018.170. YU Chungang, LI Jiandong. A case of untypical Hunt syndrome involving multiple groups of cranial nerves[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(2): 167-168. doi:10.6040/j.issn.1673-3770.0.2018.170.
[17] Sullivan FM, Swan IR, Donnan PT, et al. Early treatment with prednisolone or acyclovir in Bell's palsy[J]. N Engl J Med, 2007, 357(16): 1598-1607. doi:10.1056/nejmoa072006.
[18] Bae SH, Kwak SH, Nam GS, et al. Meta-analysis of delayed facial palsy following middle ear surgery\J]. Otol Neurotol, 2019, 40(8): 1109-1115. doi:10.1097/mao.0000000000002318.

相关文章 15

[1]	赵笑冰,张大为,陈仁杰. 中耳间变性大T细胞淋巴瘤1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2022, 36(2): 7-14.
[2]	杨扬, 王晓旭, 张杰. 儿童中耳胆脂瘤诊治进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 1-6.
[3]	高信忠, 林宗通, 沈翎, 刘平凡, 林兴, 许杨杨. 咽鼓管球囊扩张联合腺样体切除术治疗儿童分泌性中耳炎疗效分析[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 7-12.
[4]	马宁, 陈敏, 刘薇, 杨扬, 邵剑波, 郝津生, 刘冰, 张晓, 段晓岷, 张祺丰, 张杰. 儿童颞骨骨折临床特点和治疗策略[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 13-19.
[5]	党攀红, 张睿, 胡春燕, 王洁, 樊孟耘. 儿童乳突-颞下迷路外面神经减压术8例临床分析[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 37-42.
[6]	李玲,李聪,孙岩,陈良. 婴儿中耳胚胎型横纹肌肉瘤1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 55-59.
[7]	焦雪梅,杨扬,李春凤,张晓琳. 鼓膜置管对分泌性中耳炎患儿咽鼓管功能的影响[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 60-63.
[8]	万怡宁,张德军,傅则名,郭芳,郭颖媛,管国芳. 磁共振弥散加权成像在先天性中耳胆脂瘤精准诊断与JOS分期中的应用探讨12例[J]. 山东大学耳鼻喉眼学报, 2021, 35(6): 65-69.
[9]	樊慧娟综述张海利审校. HIF-1α与VEGF在中耳胆脂瘤中的研究进展[J]. 山东大学耳鼻喉眼学报, 2021, 35(5): 93-97.
[10]	吴华,孙永明,郑建华,蔡雪花. 腺样体消融联合鼓膜打孔术治疗儿童腺样体肥大合并分泌性中耳炎55例[J]. 山东大学耳鼻喉眼学报, 2021, 35(2): 71-75.
[11]	王海霞,张彩霞,李银银,郑金秀,陈曦. 经鼓室注射内耳钆造影显影不良原因初探[J]. 山东大学耳鼻喉眼学报, 2020, 34(5): 61-66.
[12]	魏馨雨,杨方园综述杨军,张青审校. 耳源性细菌性迷路炎研究进展[J]. 山东大学耳鼻喉眼学报, 2020, 34(5): 102-107.
[13]	林宗通,沈翎,杨中婕. 腺样体大小及圆枕类型对儿童分泌性中耳炎的影响[J]. 山东大学耳鼻喉眼学报, 2020, 34(5): 121-126.
[14]	许嘉,伊海金. 正确处理颞骨骨折耳科并发症[J]. 山东大学耳鼻喉眼学报, 2020, 34(1): 4-8.
[15]	王智立,陈哲,林芳羽,柴永川,汪照炎. 修复治疗不同情形下腮腺区面神经损伤[J]. 山东大学耳鼻喉眼学报, 2020, 34(1): 15-19.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed