中耳乳突手术致面神经损伤17例报告

面神经损伤是中耳乳突手术常见而又严重的并发症,现将我科1975～1995年间进行中耳乳突手术发生面神经损伤的病例分析介绍如下。 1　临床资料 　　20年间进行中耳乳突手术289例,发生面神经损伤17例,占5.88％。损伤部位,水平段6例, 占35.29％;垂直段11例,占64.70％。损伤原因：面神经骨管鼓室段先天性缺裂11例,占64 .70％,其中3例面神经走向有异常,术中损伤面神经骨管5例,占24.41％,牵拉鼓索神经致 伤1例,占5.88％。17例中面神经均为刺激、牵拉伤。16例当即进行面神经骨管部分减压术 ,术后面神经功能恢复理想,1例未行减压术,面神经功能未恢复,面神经损伤的治愈率达 到94.11％。 　　面神经部分减压术的具体方法：继续在局麻下用6倍手术显微镜将面神经损伤部位探查清楚 ,用切削钻头将受损部位及两端骨管骨质切削磨薄,再用小剥离器将已磨薄之骨片向外挑起 取出,范围为骨管两端各约5 mm,彻底开放面神经受损两端骨管,达到充分减压目的,一般 不切开面神经鞘膜。     

颞下经小脑幕入路切除岩斜区肿瘤

目的介绍颞下经小脑幕入路切除岩斜区肿瘤的手术操作体会。方法从2008年7月─2009年11月采用颞下经小脑幕入路切除岩斜区肿瘤4例,对比术前、术后症状和头颅MRI检查。结果全切除1例,次全切除2例,部分切除1例。术后动眼神经损伤1例,短暂动眼神经和滑车神经麻痹各1例。结论颞下经小脑幕入路结合娴熟的显微外科技术可较好切除岩斜区肿瘤,降低病残率。     

外伤性面瘫的多层螺旋CT研究

目的探讨多层螺旋CT(MSCT)在外伤性面瘫中的应用价值。方法用MSCT对41例外伤性面瘫的颞骨行高分辨率轴面扫描。用Ph ilipsMx8000MSCT工作站,行岩锥感兴趣区的多平面重建(MPR)及面神经管的曲面重建(CPR)。观察骨折类型,骨折线的走行,中耳腔、乳突积血及外耳、中耳、内耳和面神经管的受累情况。结果41例患者中,39例颞骨有不同部位、不同类型的骨折,其中岩骨纵行骨折34例,横行骨折2例,混合型2例,1例岩骨无骨折,但颞骨鳞部骨折,2例未发现骨折。其中2例为双侧岩骨骨折。面神经管的CPR及MPR显示21例患者面神经管受累,9例可见骨碎片。结论MSCT扫描及重建技术能清晰显示面神经管的全貌及其损伤,对外伤性面瘫的诊断有重要意义。     

选择性面神经减压术治疗外伤性周围性面瘫

目的：探讨选择性面神经减压术治疗外伤性周围性面瘫的方法和临床意义。方法：回顾性分析1990-2001年间采用连续性面神经减压术治疗外伤性周围性面瘫103例的临床特点及治疗方法。结果：103例患者中术后随访93例，依据House-Brackmann面神经功能恢复评分标准评定，Ⅰ级恢复71例，Ⅱ级恢复14例，Ⅲ级恢复5例，Ⅳ级恢复2例，Ⅴ级恢复1例，其中Ⅰ－Ⅱ级恢复者占随访人数的91.4%。结论：选择性面神经减压术治疗外伤性周围性面瘫是一种更为简便、有效的手术方法。     

微创局麻手术治疗三叉神经痛937例

1989年9月-2007年9月,我院采用乙状窦后入路,行微创局麻显微外科神经血管减压术、肿瘤切除术等治疗三叉神经痛937例,疗效满意,现报告如下.     

经颅入路显微视神经减压22例

颅脑外伤合并视神经损伤临床较常见，尽管手术治疗方法较多，但以往常因手术入路受限、视野狭小、视神经减压不充分而很难收到理想的效果，我科自1998年9月至2003年9月，采用经颅入路显微视神经减压术治疗视神经损伤22例，效果较满意。现报告如下。     

42例乙状窦后入路微血管减压术后并发症的观察与护理

面肌痉挛、三叉神经痛是神经外科常见的功能性疾病。乙状窦后入路神经根微血管减压术治疗能有效解除病人的痛苦。手术采用显微外科技术,减少了手术损伤,不切断神经,保留了神经的完整性和生理功能,较少遗留永久性神经功能障碍,但手术需开颅,有开颅术后的并发症。2008年9月～2009年5月,本院对42例面肌痉挛、三叉神经痛者采用微血管减压术治疗,疗效较好。但发生术后并发症16例,现将并发症观察及护理报告如下。     

口腔入路髁突颈及下颌支骨折复位内固定术

目的为避免面颈部留下手术瘢痕，探讨从口腔入路复位固定髁突颈及下颌骨支骨折的方法。方法采用口腔内下颌骨矢状截骨手术切口入路，用摆动锯将下颌支后缘垂直截骨，取出升支后缘骨块，髁突游离取出，体外直视下与升支后缘骨块固定后再从口腔原切口回植入，钛板固定。15例17侧采用本方法治疗，其中2例为外地医院行下颌角截骨整形术中意外将下颌骨髁突颈部劈裂骨折，其余13例为闭合性骨折。结果术后1年复查全部患者的开口范围25～40mm，平均为35．8mm，1例有患侧后牙早接触，下切牙中线偏斜1mm。另1例张口约25mm，轻度受限，其余患者咬合关系良好，无主诉关节疼痛与弹响症状。全部患者无面神经、耳大神经损伤，无涎瘘，面颈皮肤无手术瘢痕结论在目前美容要求越来越高的趋势下，口腔入路具有无外部瘢痕优势，且不会损伤面神经缺点是操作范围较小，增加了下颌支后缘垂直截骨。     

经颅视神经减压治疗已失明的外伤性视神经损伤

目的 探讨已失明的外伤性视神经损伤的手术效果.方法 回顾性分析8例颅脑损伤合并视神经损伤患者的临床特点,比较经颅视神经管减压手术前后的视力变化.结果 7例有视神经管骨折(7眼),1例无视神经管骨折(2眼);视神经挫伤并视神经鞘膜下出血1例(1眼),视神经缺血坏死1例(2眼),视神经轻度水肿6例(6眼).4例(4眼)术后1个月视力得到改善.结论 经颅视神经管减压治疗外伤性视神经损伤安全有效.     

经颅入路视神经减压治疗视神经损伤

自1999年3月以来，采用经颅入路视神经减压术治疗视神经损伤10例，多发眶额部外伤数小时后逐渐出现视力下降，甚至失明，来院后急诊行开颅视神经减压开放术，外伤至手术时间数小时至两周不等，效果良好。现报告如下。     

Computed tomographic analysis of the intratemporal facial nerve and facial nerve neuromas

High-resolution computed tomography (HRCT) has replaced multidirectional tomography in the detailed analysis of the temporal bone because of its excellent resolution of fine bony detail. Small soft-tissue masses not discernible on plain tomograms are easily seen using HRCT. Unsuspected early disease which has not caused recognizable bone erosion in also demonstrable by HRCT. Last but not least, the amount of radiation received by a patient as a result of HRCT is considerably less. We illustrate the normal course of the facial nerve through the temporal bone, its anatomical relationship to various adjacent structures, and the numerous branches given off during its course through the temporal bone. The clinical features of facial nerve neuromas (schwannomas) depend on their location and include facial nerve weakness or paralysis, otalgia or facial pain, hearing loss or imbalance, and loss of taste sensation. HRCT allows the identification of a soft-tissue mass along the course of the facial nerve, with its bony canal usually enlarged by the mass. Pressure erosion of the underlying bone is often noted and erosion of the ossicles may be demonstrated in the case of middle ear involvement. The importance of both clinical and radiological correlation cannot be overemphasized in the discovery of these tumors.     

MRI of the facial nerve in idiopathic facial palsy

The purpose of this prospective study was to define the enhancement pattern of the facial nerve in idiopathic facial paralysis (Bell's palsy) on magnetic resonance (MR) imaging with routine doses of gadolinium-DTPA (0.1 mmol/kg). Using 0.5T imager, 24 patients were examined with a mean interval time of 13.7 days between the onset of symptoms and the MR examination. Contralateral asymptomatic facial nerves constituted the control group and five of the normal facial nerves (20.8%) showed enhancement confined to the geniculate ganglion. Hence, contrast enhancement limited to the geniculate ganglion in the abnormal facial nerve (3 of 24) was referred to as equivocal. Not encountered in any of the normal facial nerves, enhancement of other segments alone or associated with geniculate ganglion enhancement was considered to be abnormal and noted in 70.8% of the symptomatic facial nerves. The most frequently enhancing segments were the geniculate ganglion and the distal intracanalicular segment. Correspondence to: I. Saatçi     

Preoperative facial muscle imaging predicts final facial function after facial nerve grafting

BACKGROUND AND PURPOSE: Our goal was to determine whether preoperative MR imaging of facial muscles predicts facial function after facial nerve grafting. METHODS: A retrospective review of all patients undergoing facial nerve grafting between 1997 and 2001 revealed 26 patients. Twelve of the patients had adequate preoperative MR images available for review and had undergone clinical follow-up for at least 12 months. Eight had malignant parotid tumors, and four had benign skull base or parotid tumors. Preoperative facial muscle MR imaging appearance was categorized as symmetrical or asymmetrical. The asymmetrical images were further classified into mild or pronounced asymmetry. Preoperative facial function was classified by using the House-Brackmann scale. Postoperative function was graded with the May scale. RESULTS: Four patients had symmetrical facial muscles shown by preoperative MR imaging, three had mild asymmetry, and five had pronounced asymmetry. No or mild asymmetry had an 86% positive predictive value for good to excellent functional outcome. Eighty percent of patients with pronounced asymmetry experienced poor functional outcomes. Six of eight patients with malignant and perineural tumors at surgery had asymmetrical facial muscles revealed by preoperative MR imaging studies. CONCLUSION: Symmetrical or mildly asymmetrical facial muscles are predictive of good facial function after nerve grafting. Pronounced asymmetry of facial muscles on MR images is predictive of poor facial function after grafting. Asymmetric facial muscles on preoperative MR images are associated with perineural tumor spread in patients with malignant disease.     

Imaging of the facial nerve

The facial nerve is responsible for the motor innervation of the face. It has a visceral motor function (lacrimal, submandibular, sublingual glands and secretion of the nose); it conveys a great part of the taste fibers, participates to the general sensory of the auricle (skin of the concha) and the wall of the external auditory meatus. The facial mimic, production of tears, nasal flow and salivation all depend on the facial nerve.In order to image the facial nerve it is mandatory to be knowledgeable about its normal anatomy including the course of its efferent and afferent fibers and about relevant technical considerations regarding CT and MR to be able to achieve high-resolution images of the nerve.     

Neurilemmoma of the facial nerve

Summary A twelfth case of facial nerve neurilemmoma presenting as a mass in the parotid region is reported. The mass also involves the facial canal in the descending portion and extends into the tympanic cavity and jugular foramen. Although the involvement of the jugular bulb and internal jugular vein was noted, no related symptoms have presented.

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Neurinom des Nervus facialis

Zusammenfassung Es wird über ein Neurinom des Nervus facialis berichtet, der sich als raumfordernder Prozeß in der Parotis-Region darstellte. Der Tumor reichte bis in den Canalis facialis, in den tympanischen Raum und in das Foramen jugulare.

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Neurilemmome du nerf facial

Résumé L'auteur rapport un 12ème cas de neurilemmome du nerf facial se présentant sous forme d'une masse de la région parotidienne. La masse envahit également le canal facial dans sa portion descendante et s'étend dans la cavité tympanique et le trou déchiré postérieur. Bien que le golfe de la jugulaire et de la veine jugulaire interne aient été envahis, il n'existait aucun symptôme correspondant.

     

High-intensity facial nerve lesions on T2-weighted images in chronic persistent facial nerve palsy

Our aim was to estimate the value of MRI in detecting irreversibly paralysed facial nerves. We examined 95 consecutive patients with a facial nerve palsy (14 with a persistent palsy, and 81 with good recovery), using a 1.0 T unit, with T2-weighted and contrast-enhanced T1-weighted images. The geniculate ganglion and tympanic segment had gave high signal on T2-weighted images in the chronic stage of persistent palsy, but not in acute palsy. The enhancement pattern of the facial nerve in the chronic persistent facial nerve palsy is similar to that in the acute palsy with good recovery. These findings suggest that T2-weighted MRI can be used to show severely damaged facial nerves. Received: 13 December 1999 Accepted: 2 May 2000     

MR imaging for evaluation of severe facial nerve damage in patients with facial nerve palsy

PURPOSE: To evaluate the usefulness of MR imaging for the detection of severe facial nerve damage in patients with facial nerve palsy. MATERIALS AND METHODS: We retrospectively reviewed 26 consecutive patients with facial nerve palsy (13 non-responders and 13 responders). T1-weighted, T2-weighted, and postcontrast T1-weighted images were obtained in all patients. FLAIR images were also obtained in 3 non-responders. RESULTS: The geniculate ganglion, labyrinthine segment, and tympanic segment or mastoid segment showed high signal intensity on T2-weighted images in 9 of 13 non-responders, whereas high signal intensity of the nerve was only seen in 1 of 13 responders. FLAIR imaging revealed high signal intensity lesions of the distal intrameatal segment in 2 non-responders. Contrast enhancement of the facial nerve showed a similar pattern in non-responders and responders. High signal intensity lesions on T2-weighted or FLAIR images showed enhancement on postcontrast T1-weighted images. CONCLUSION: These results suggest that a high signal intensity area on T2-weighted images is a marker of severe facial nerve damage. FLAIR imaging is useful for identification of T2-prolongation in the distal intrameatal segment.     

Trigeminal neuralgia and facial nerve paralysis

The trigeminal nerve is the largest of the cranial nerves. It provides sensory input from the face and motor innervation to the muscles of mastication. The facial nerve is the cranial nerve with the longest extracranial course, and its main functions include motor innervation to the muscles of facial expression, sensory control of lacrimation and salivation, control of the stapedial reflex and to carry taste sensation from the anterior two-thirds of the tongue. In order to be able adequately to image and follow the course of these cranial nerves and their main branches, a detailed knowledge of neuroanatomy is required. As we are dealing with very small anatomic structures, high resolution dedicated imaging studies are required to pick up normal and pathologic nerves. Whereas CT is best suited to demonstrate bony neurovascular foramina and canals, MRI is preferred to directly visualize the nerve. It is also the single technique able to detect pathologic processes afflicting the nerve without causing considerable expansion such as is usually the case in certain inflammatory/infectious conditions, perineural spread of malignancies and in very small intrinsic tumours. Because a long course from the brainstem nuclei to the peripheral branches is seen, it is useful to subdivide the nerve in several segments and then tailor the imaging modality and the imaging study to that specific segment. This is particularly true in cases where topographic diagnosis can be used to locate a lesion in the course of these nerves.     

Tumors of the facial nerve canal

The X-ray tomograms of 13 patients with tumors in the facial nerve canal are discussed. The leading clinical symptom is the peripheral facial nerve palsy without recovery, often combined with deafness and dizziness. The X-ray film shows opacity, widening of the internal auditory canal and/or of the third part of the facial nerve canal, further erosion of the bony structures and destruction of the pyramid.