咬肌神经-面神经吻合：跨面神经移植手术的有效补充

目的初步阐述咬肌神经-面神经吻合手术的方法和疗效。方法2例听神经瘤术后完全性面瘫患者,进行跨面神经移植术和患侧部分咬肌神经-面神经吻合手术。结果术后3个月,患者咬牙后可将口角上提和闭合眼睛,咀嚼功能没有影响,面部未出现凹陷畸形。结论咬肌神经-面神经吻合可以有效、快速地重建面部肌肉的神经支配,是跨面神经移植手术的有效补充。     

肌骨超声诊断周围性面瘫

目的探讨肌骨超声在周围性面瘫中的应用价值。方法收集左侧周围性面瘫患者30例(病例组)及健康志愿者30名(对照组),采用肌骨超声观察2组左侧面神经声像图特征,测量并比较面神经直径。结果病例组面神经鞘内回声减低,内部线性回声模糊;对照组面神经纵切面呈束状低回声,周边有线状高回声的神经外膜,内偶见有细线状等回声的神经束膜,横切面不易观察。病例组面神经周围血流信号较对照组面神经血流信号丰富,差异有统计学意义(χ2=15.60,P0.05)。病例组面神经内径[(1.27±0.29)mm]较对照组[(1.10±0.09)mm]增粗,差异有统计学意义(t=3.00,P0.05)。结论面瘫患者患侧面神经具有特征性超声表现;肌骨超声可以为临床诊断和随访评价提供重要影像学依据。     

应用膨体聚四氟乙烯治疗面颊凹陷并同侧面瘫

目的探讨膨体聚四氟乙烯在修复面颊凹陷及面瘫的作用。方法１９９７年２月～１９９８年７月,应用膨体聚四氟乙烯片状材料填充半侧面颊凹陷,同时悬吊治疗同侧面瘫６例,术后获得２～１６个月随访。结果面颊凹陷修复后,患侧与健侧对称,皮肤表面无异常,质地柔软。面瘫修复后,眼睑能完全闭合,口角静态时患侧与健侧基本对称,动态时患侧与健侧略有差异,但较术前明显改善。结论应用膨体聚四氟乙烯治疗面颊凹陷合并同侧面瘫具有安全,疗效确切且稳定,手术操作简便易行,创伤小,恢复快,是一种理想的颜面填充及悬吊材料     

Paralysis of the lower lip and the selective neurectomy

Summary To restore facial symmetry in cases of paralyzed lower lip, we have followed the selective neurectomy procedure developed for the lower lip, by Marino [7] and Marino and Alurralde [8]. After cadaveric dissections carried out on 10 facial halves, we demonstrated that several other interconnected branches of the facial nerve innervate the lower lip musculature. This fact led us not to limit the operation to the sectioning of the proximal marginalis mandibularis, but to include in the neurectomy these peripheral branches also. As a result of the more extensive resection of motor nerves the return of movement to the denervated muscles can be avoided.     

面神经-舌下神经吻合术面神经干的显微解剖研究

目的观测面神经干的显微解剖,为面神经-舌下神经吻合术提供解剖学资料。方法解剖9例18侧福尔马林固定成人尸头,分别利用二腹肌后腹作为标志,在肌肉内侧寻找面神经干;在腮腺上作切口分离,寻找面神经干;以茎突作为标志追踪至颈乳孔,于茎乳孔处寻找面神经干的3种不同方法暴露面神经干。观测面神经干长度、深度、直径、分支及与周围结构的关系。结果面神经均由茎乳孔出颅。茎乳孔处面神经干直径为2.57±0.60mm,距皮肤的最小距离为22.62±2.88mm,面神经干长度为15.71±1.97mm,面神经干分叉至乳突尖的距离为18.20±4.41mm,分叉至下颌角的距离为39.91±8.38mm。乳突尖端至茎乳孔的距离为17.91±2.68mm,面神经干分叉前的主要分支有耳后神经、二腹肌神经和茎突舌骨肌神经。结论以茎突作为标志追踪至颈乳孔,在茎乳孔处寻找面神经干的方法安全可靠,面神经-部分舌下神经吻合是可行的。     

Full-Face Undermining Using Progressive Dilators

The application of a new and simple method of facial cutaneous detachment using specially designed bifaceted rigid steel wands called Dilson Luz Vascular Dilation Wands is described. These wands considerably reduce the bleeding during face-lift surgery, reducing both postoperative hematomas and the risk of facial nerve injury. This technique involves stretching the blood vessels to the point of rupture by inserting progressively larger wands. At the point of rupture, a spontaneous coagulation within the vascular extremities occurs. This is attributable to a significant blood platelet migration induced by the stimulation from the rupture of the vascular intima. The wands, varying in dimension from 1.5 to 20 mm, and are used for cutaneous facial detachment. This method has been found to result in minimal bleeding across the detached surface as well as an excellent perfusion of the overlying skin. With the use of these Dilson Luz Vascular Dilation Wands in combination with this new technique, the authors have obtained improved cutaneous detachment; reduced postoperative swelling, edema, and ecchymosis; prophylaxis of facial nerve damage; reduced procedural time; and above all, greater reduction in immediate and late postoperative hematoma formation.     

Facial nerve injury during temporal artery biopsy

Temporal artery biopsy is considered the gold standard investigation of giant cell arteritis and is recommended in suspected cases despite a sensitivity of 81–91%. This review highlights the potential risk of facial nerve injury during temporal artery biopsy and introduces recent advances in the emerging role of imaging modalities. When these non-invasive techniques are used in conjunction with American College of Rheumatology scoring, which includes clinical features and biochemical test results, temporal artery biopsy may be avoided in selected cases.     

Large facial nerve schwannomas without facial palsy: case reports and review of the literature

Although approximately 30% of facial nerve schwannoma cases present with no facial palsy, a large facial nerve schwannoma extending to the middle and posterior cranial fossa quite rarely presents without facial palsy. The authors encountered two patients with large facial nerve schwannoma who presented with only hearing impairment and no facial palsy. The first patient was a 64-year-old woman who presented with right auditory impairment without facial palsy. MR images demonstrated a dumbbell-shaped tumor in the cerebellopontine angle. Another patient, a 40-year-old woman, also presented with vertigo and right tinnitus without facial palsy. MR images demonstrated a huge tumor expanding into both the posterior cranial fossa and middle cranial fossa. In both cases, intraoperative findings confirmed that the tumors had grown from the facial nerve. Facial nerve schwannoma can be easily diagnosed if detailed neurological evaluations and appropriate neuroimagings are conducted. However, in spite of such huge tumoral size and expanding pattern, the facial nerve function was relatively preserved. Anatomical features of the facial schwannoma are discussed. A tumor extending to the middle and posterior cranial fossa should remind neurosurgeons to consider facial nerve schwannomas even in the absence of facial palsy.     

面神经调控术修复面瘫后面肌联动的初步报告

目的 为了改善面瘫后遗症中面部表情肌联动、误动,及健侧面肌肌力偏强,口角歪斜,无法微笑,表情怪诞的症状,设计通过跨面神经移植来调控健侧的肌力并让患侧联动面肌的动作分离,使误动的面肌的收缩活动与健侧同步,从而恢复自然对称的微笑表情.方法 高选择的切断健侧面神经的分支,将健侧的神经动力通过跨面的神经移植,转移至患侧,然后高选择地将患侧联动面神经分支切断分离,将分支的远侧断端与健侧转移来的移植神经吻合,由健侧神经提供动力来支配患侧的部分面肌,使该面肌获得与健侧同步的动作.结果 2003年至今共有6例接受面神经调控手术.术后随访病例的口角同步活动都有不同程度的恢复.结论 精确设计的面神经调控术对修复面瘫后面肌联动症有效.     

颌面部爆炸伤后面神经、下颌神经和迷走神经创伤恢复过程的差异

目的：不同类型的神经受到损伤后其恢复的过程也有所不同。在头面部爆炸伤中，由于爆炸致伤范围广，同时头面部有多种不同类型脑神经分布，因此常伴有不同类型的神经间接性损伤。以往对不同类型的神经比较颌面部爆炸伤后运动、感觉及植物神经创伤恢复过程的差异。方法：20只犬爆炸致伤后分别在伤后不同时间取材面神经、下颌神经和迷走神经，并用免疫组化检测三种神经中神经特异性烯醇化酶（the neuron-specific enolase，NSE）的表达变化，来分析这三种类型神经爆炸伤后恢复过程的差异。结果：三种神经伤后均出现NSE水平的迅速下降，随着神经的恢复，神经的NSE免疫组化染色逐渐恢复阳性。面神经最早在伤后1周出现阳性，而下颌神经和迷走神经均在伤后24h内即开始恢复NSE阳性。结论：在颌面部爆炸伤中，面神经往往伤情较迷走神经和下颌神经重。     

Facial nerve reconstruction in neurofibromatosis 2

Summary Between 1979 and 1989, 13 patients with neurofibromatosis 2 underwent reconstructions of the facial nerve after removal of bilateral acoustic or facial neurinomas. Seven patients received hypoglossal-facial nerve anastomosis, and five reveived sural nerve grafting in the cerebellopontine angle. End-to-end anastomosis and intracranial-intratemporal sural grafting were performed for one patient each, respectively. Re-innervation was seen in all cases. The results were good in 11 cases. Two patients presented with poor results due to development of neurinomas close to the site of the nerve reconstruction. The importance of reconstructive surgery in patients with neurofibromatosis is stressed. The problems regarding failure of re-innervation in some cases and difficulties in their management are discussed.