山东大学耳鼻喉眼学报

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手术治疗面神经鞘瘤

李新民, 张庆泉, 宋西成, 王锡温, 张天振, 王强   

  1. 青岛大学医学院附属烟台毓璜顶医院耳鼻咽喉头颈外科,山东 烟台264000
  • 收稿日期:2005-10-10 修回日期:1900-01-01 出版日期:2006-12-24 发布日期:2006-12-24
  • 通讯作者: 李新民

LI Xin-min,ZHANG Kai-quan,SONG Xi-cheng,WANG Xi-wei,ZHANG Tian-zhen,WANG Qiang   

  • Received:2005-10-10 Revised:1900-01-01 Online:2006-12-24 Published:2006-12-24
  • Contact: LI Xin-min

摘要: 目的:探讨诊断面神经鞘瘤的方法、手术治疗该病的效果及修复面神经功能的途径。方法:入住本院的面神经鞘瘤患者11例,在确诊前全部误诊为他病,确诊后,对6例中耳乳突腔面神经鞘瘤患者行神经移植,其中5例应用耳大神经移植,1例行干热骨骼肌桥接;对2例中耳乳突腔-颅内面神经鞘瘤的患者,1例行舌下神经移植(舌下神经攀植入舌下神经),1例直接将舌下神经襻植入面神经远端;其余患者面瘫时间较长,已不能恢复面神经功能,仅1例行阔筋膜口轮匝肌悬吊术,其他放弃面神经功能的重建。结果:3例未行面神经功能重建的患者,遗留完全面瘫;6例中耳乳突腔面神经鞘瘤的患者,面神经功能恢复分别为(BrakmannHouse功能分级)功能2级3例、3级2例、未恢复1例;2例舌下神经以及攀支重建面神经的患者,功能2级1例、3级1例。结论:面神经鞘瘤的临床症状多种多样,应进行系统检查排除误诊。术中为了完整切除肿瘤,可采用面神经改道吻合术、面神经移植等方法,在断端套用静脉血管给予保护,予以耳脑胶进行粘合。另外,干热骨骼肌的桥接在临床上应该推广使用。

关键词: 面神经, 面部肿瘤, 神经鞘瘤, 移植

Abstract: To investigate the diagnosis and surgical management of schwannoma of facial nerve(SFN) and discuss the methods of repairing of facial nerve after operation. Methods: Of all 11 patients with SFN, up to 100% had been misdiagnosed. All 6 cases with simple mastoidtympanic cavity SFN underwent nerve transplantation, and in 5 of them great auricular nerve was transplanted and in 1 great auricular nerve was bridged with dried and heated skeletal muscle. And in 2 cases with tympanicmastoid cavityintracranial SFN, 1 underwent hypoglossal nerve transplantation to replace the facial nerve (loop of hypoglossal nerve was transplanted to replace the hypoglossal nerve), while the other 1 underwent loop of hypoglossal nerve transplantation into the distal end of facial nerve. All other patients had suffered from facial palsy for a long time and their facial nerve functions could not be recovered and only 1 of them underwent fascia lata femoris musculus orbicularis oris ventrofixation, while others gave up the reconstruction of facial nerve. Results: Three patients with mastoidtympanic cavityparotic gland SFN and intracranial tumor, not receiving reconstruction of facial nerve, were left with complete facial palsy. In 6 cases with simple mastoidtympanic cavity SFN, the functional recovery of facial nerves was graded with BrakmannHouse gradings in 5 cases: grade 2 in 3 cases; grade 3 in 2; recovery was not found in 1 case. Two cases whose facial nerves were reconstructed with hypoglossal nerve and loop of hypoglossal nerve were graded as level 2 and level 3, respectively. Conclusion: We believe that clinical manifestations of schwannoma of facial nerve are variform, and all round and systemic inspections should be performed to prevent

Key words: Facial neoplasms, Facial nerve, Neurilemmoma, Transplantation

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