Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2020, Vol. 34 ›› Issue (1): 20-24.doi: 10.6040/j.issn.1673-3770.1.2019.054

• Clinical Report • Previous Articles     Next Articles

Surgical treatment of iatrogenic facial paralysis

Yuxin TIAN,Jingjing WANG,Hui WANG,Yaqin WU,Haibo SHI,Zhengnong CHEN*()   

  1. Department of Otolaryngology Head and Neck Surgery, Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, China
  • Received:2019-09-18 Online:2020-01-20 Published:2020-03-06
  • Contact: Zhengnong CHEN E-mail:jassey@126.com

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Abstract: Objective

To evaluate the surgical treatment of iatrogenic facial paralysis and discuss its cause, treatment and therapeutic effect.

Methods

A retrospective study of 21 iatrogenic facial paralysis cases who underwent ear surgery in the ear, nose, and throat (ENT) Department between 2015 and 2017.

Results

Of those that underwent middle ear surgery, 10 iatrogenic facial nerve injuries cases were observed in the following segments: the horizontal segment in 7 cases, the pyramidal segment in 2 cases, and the vertical segment in 1 case. After evaluating the degree of damage, decompression was performed in 7 cases, and facial nerve-great auricular nerve transplantation in 3 cases. The other 11 cases with facial paralysis after acoustic neuroma surgery underwent hypoglossal-facial anastomosis. Sixteen cases (about 76%) achieved HB Ⅰ-Ⅲ one year after surgery.

Conclusions

Although scientific and technological developments have reduced the probability of facial nerve injuries, iatrogenic facial paralysis cannot be entirely avoided. Clinical doctors need to have excellent anatomical knowledge and correct operation technique to prevent iatrogenic facial paralysis. Once iatrogenic facial paralysis occurs, early diagnosis and treatment are required to achieve ideal outcomes of patients' facial nerve function.

Key words: Iatrogenic facial paralysis, Middle ear surgery, Surgical treatment, Therapeutic effect

CLC Number: 

  • R764

Fig.1

Facial nerve swelling"

Fig.2

Facial nerve rupture (the dotted line is the missing part of the facial nerve)"

Table 1

The surgical timing and recovery of facial paralysis"

损伤原因 例数 术前面神经功能 手术治疗时机 术后面神经功能
中耳手术
  乳突改良根治术 9 Ⅳ级7例 一周内 Ⅰ级2例
Ⅴ级1例 Ⅱ级5例
Ⅵ级1例 Ⅲ级1例
Ⅳ级1例
  人工耳蜗植入术 1 Ⅳ级1例 一周内 Ⅰ级1例
听神经瘤切除术 11 Ⅴ级6例 保守治疗半年至一年，面神经功能无改善后 Ⅲ级7例
Ⅵ级5例 Ⅳ级4例
1 韩维举, 韩东一. 周围性面瘫[J]. 中华耳科学杂志, 2010, 8 (1): 110- 116.
doi: 10.3969/j.issn.1672-2922.2010.01.024
2 Hohman MH , Bhama PK , Hadlock TA . Epidemiology of iatrogenic facial nerve injury: a decade of experience[J]. Laryngoscope, 2014, 124 (1): 260- 265.
doi: 10.1002/lary.24117
3 高志强, 全世明. 耳源性面瘫的防治策略[J]. 中国医学文摘(耳鼻咽喉科学), 2006, 21 (6): 335- 337.
doi: 10.19617/j.issn1001-1307.2006.06.007
4 House JW , Brackmann DE . Facial nerve grading system[J]. Otolaryngol Head Neck Surg, 1985, 93 (2): 146- 147.
doi: 10.1177/019459988509300202
5 Tavares-Brito J , van Veen MM , Dusseldorp JR , et al. Facial palsy-specific quality of life in 920 patients: correlation with clinician-graded severity and predicting factors[J]. Laryngoscope, 2019, 129 (1): 100- 104.
doi: 10.1002/lary.27481
6 Saadi R , Shokri T , Schaefer E , et al. Depression rates after facial paralysis[J]. Ann Plast Surg, 2019, 83 (2): 190- 194.
doi: 10.1097/SAP.0000000000001908
7 姜泗长, 杨伟炎, 顾瑞. 耳鼻咽喉头颈外科手术学[M]. 2版 北京: 人民军医出版社, 2005.
8 Hou BH . The medium and long-term effect of electrophysiologic monitoring on the facial nerve function in minimally invasive surgery treating acoustic neuroma[J]. Exp Ther Med, 2018, 15 (3): 2347- 2350.
doi: 10.3892/etm.2018.5683
9 Huang X , Xu J , Xu M , et al. Functional outcome and complications after the microsurgical removal of giant vestibular schwannomas via the retrosigmoid approach: a retrospective review of 16-year experience in a single hospital[J]. BMC Neurol, 2017, 17 (1): 18.
doi: 10.1186/s12883-017-0805-6
10 Hohman MH , Hadlock TA . Etiology, diagnosis, and management of facial palsy: 2000 patients at a facial nerve center[J]. Laryngoscope, 2014, 124 (7): E283- E293.
doi: 10.1002/lary.24542
11 Andresen NS , Sun DQ , Hansen MR . Facial nerve decompression[J]. Curr Opin Otolaryngol Head Neck Surg, 2018, 26 (5): 280- 285.
doi: 10.1097/MOO.0000000000000478
12 Albathi M , Oyer S , Ishii LE , et al. Early nerve grafting for facial paralysis after cerebellopontine angle tumor resection with preserved facial nerve continuity[J]. JAMA Facial Plast Surg, 2016, 18 (1): 54- 60.
doi: 10.1001/jamafacial.2015.1558
13 Bayrak SB , Kriet JD , Humphrey CD . Masseteric to buccal branch nerve transfer[J]. Curr Opin Otolaryngol Head Neck Surg, 2017, 25 (4): 280- 285.
doi: 10.1097/MOO.0000000000000380
14 王菁菁, 冯艳梅, 吴雅琴, 等. 影响面神经减压术疗效的因素[J]. 上海交通大学学报(医学版), 2016, 36 (9): 1329- 1332.
doi: 10.3969/j.issn.1674-8115.2016.09.014
WANG Jingjing , FENG Yanmei , WU Yaqin , et al. Factors influencing the efficacy of facial nerve decompression[J]. J Shanghai Jiaotong Univ Med Sci, 2016, 36 (9): 1329- 1332.
doi: 10.3969/j.issn.1674-8115.2016.09.014
15 迟放鲁. 面神经研究的现状与发展方向[J]. 中华耳鼻咽喉头颈外科杂志, 2006, (1): 3- 4.
doi: 10.3760/j.issn:1673-0860.2006.01.002
16 方瑾, 潘军燕, 陈晓红, 等. 面神经减压术治疗周围性面瘫15例临床分析[J]. 中华耳科学杂志, 2014, 12 (2): 296- 299.
doi: 10.3969/j.issn.1672-2922.2014.02.28
FANG Jin , PAN Junyan , CHEN Xiaohong , et al. Results of facial nerve microsurgery for peripheral facial palsy in 15 patients[J]. Chin J Otol, 2014, 12 (2): 296- 299.
doi: 10.3969/j.issn.1672-2922.2014.02.28
17 谢邵兵, 张燕妮, 徐震航, 等. 外伤性面神经麻痹手术时机的系统评价[J]. 山东大学耳鼻喉眼学报, 2016, 30 (6): 18- 21.
doi: 10.6040/j.issn.1673-3770.0.2016.160
XIE Shaobing , ZHANG Yanni , XU Zhenhang , et al. A systematic review of surgical timing of traumatic facial paralysis[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2016, 30 (6): 18- 21.
doi: 10.6040/j.issn.1673-3770.0.2016.160
18 Filho NÁC , de Aquino JEP , de Oliveira LF . Facial nerve grafting and end-to-end anastomosis in the middle ear -tympanic cavity and mastoid[J]. Braz J Otorhinolaryngol, 2013, 79 (4): 441- 445.
doi: 10.5935/1808-8694.20130079
19 Altafulla J , Iwanaga J , Lachkar S , et al. The Great Auricular Nerve: Anatomical Study with Application to Nerve Grafting Procedures[J]. World Neurosurg, 2019, 125: e403- e407.
doi: 10.1016/j.wneu.2019.01.087
20 Samii M , Alimohamadi M , Khouzani RK , et al. Comparison of direct side-to-end and end-to-end hypoglossal-facial anastomosis for facial nerve repair[J]. World Neurosurg, 2015, 84 (2): 368- 375.
doi: 10.1016/j.wneu.2015.03.029
21 Rebol J , Milojkovič V , Didanovic V . Side-to-end hypoglossal-facial anastomosis via transposition of the intratemporal facial nerve[J]. Acta Neurochir (Wien), 2006, 148 (6): 653- 657.
doi: 10.1007/s00701-006-0736-2
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