中华耳科学杂志Issue(3)：371-374,4.DOI:10.3969/j.issn.1672-2922.2014.03.006
中耳胆脂瘤伴面神经受累临床特点分析
Middle Ear Cholesteatoma with Facial Nerve Involvement
摘要
Abstract
[Astract]Objective To study clinical features and treatment protocols of middle ear cholesteatoma with facial nerve in-volvement. Methods This was a retrospective study of patients with middle ear cholesteatoma who had undergone ca-nal-wall-down mastoidectomy by the corresponding author from January 2004 to December 2013 and with follow-ups of at least 6 months. A total of 90 patients (46 males and 44 females and 92 ears, 44 on left and 48 on right) were included in this study, with a mean age of 38 years 6 months ± 13years 5 months and a mean follow-up time of 3 years 5 months ± 2 years 10 months. Integrity of the fallopian canal was examined from geniculate ganglion to the inferior vertical segment during opera-tion. Simultaneous facial nerve decompression was performed for patients with preoperative facial paralysis. House-Brack-mann (HB) grading system was used for assessment of facial nerve function before and after operation. Results Facial nerve dehiscence or fallopian canal defects were found in 27 of the 92 ears and the most common location was in the tympanic seg-ment. Four of these patients had facial paralysis before operation which recovered gradually after surgery. Three patients had delayed mild facial weakness at 4-7 days after operation. Loosening or removal of iodoform gauzes from mastoid cavity plus ste-roid and vitamin B12 were performed immediately upon detection of facial weakness. Facial nerve functions these three pa-tients recovered gradually to normal in 3 months. Conclusions The most common location of facial nerve involvement in in the tympanic segment in middle ear cholesteatoma. Preoperative HRCT is of great value for correct diagnosis and assessment of fallopian canal integrity. Facial nerve decompression is essential for patients with facial paralysis. Over-tight packing in the mastoid cavity with iodoform gauzes should be avoided for protection of the exposed facial nerve. Immediate treatments for acute or delayed facial paralysis after operation are essential and decompression surgery may be performed when strongly indicated.关键词
中耳胆脂瘤/开放式乳突根治术/面神经骨管/面瘫Key words
Middle ear cholesteatoma/Canal wall down mastoidectomy/Fallopian canal/Facial paralysis分类
医药卫生引用本文复制引用
唐琦,杨华,姜鸿,冯国栋,张竹花,陈晓巍,高志强..中耳胆脂瘤伴面神经受累临床特点分析[J].中华耳科学杂志,2014,(3):371-374,4.基金项目
十二五国家科技支撑计划资助项目课题（项目/课题编2012BAI12B00/2012BAI12B01) （）
