周围性面神经断裂伤的外科治疗

摘要

Objective :To evaluate the results of peripheral facial nerve reconstruction by surgical treatment and determine the influence factors for recovery. Methods: From 1999 to 2009, 104 patients underwent surgical rehabilitation for transected peripheral facial nerve injury in the department of oral and maxillofacial surgery, Peking University School and Hospital of Stomatology. The age ranged from 2 to 77 years with a median age of 30 years. Sixty-five of the 72 cases (90. 2％ ) who underwent facial nerve anastomosis and 24 of the 32 patients (75. 0％ ) underwent facial nerve grafting. All these patients were followed for the final results. Facial nerve function was scored by the gross and regional House-Brackmann ( HB) facial grading system. Statistical analysis was performed using SPSS 13. 0 software package by X2 test or Fisher exact test. Results : In the facial nerve anastomosis group, HB Ⅰ , HB Ⅱ , HB Ⅲ and HB Ⅳ function were achieved in 37 (56. 9％ ) , 11 ( 16. 9％ ) , 15 (23. 1％ ) and 2 (3. 1％) patients respectively. The regional grades showed that the recovery rate of HB Ⅰ and Ⅱ were 27.3％ in forehead, 97.6％ in eye region, 97.9％ in midface and 78.6％ in the mouth region. In the facial nerve grafting group, HB grades Ⅰ , Ⅱ , Ⅲ and Ⅳ were achieved in 4 (16.7％ ) , 5 (20. 8％ ) , 7 (29.2％ ) and 8 (33.3％ ) patients respectively. By regional HB grades, HB Ⅰ and Ⅱ rate were 37.5％ in forehead, 73.7％ in eye region, 72.7％ in midface, 44.4％ in mouth region. The facial nerve anastomosis group had a higher HB Ⅰ and Ⅱ recovery rate than facial nerve grafting group (P = 0. 002). Conclusion: Facial nerve anastomosis and facial nerve grafting are effective surgical options for transected peripheral facial nerve injury. The site and range of facial nerve injury, the time post onset until repair, and the age of patient are factors that influence the clinical outcomes.%目的:评估周围性面神经断裂损伤患者手术治疗后的效果,分析影响预后的相关因素.方法:自1999年至2009年因周围性面神经断裂在我院接受手术修复的患者104例,男75例,女29例,年龄2～77岁,中位年龄30岁.单纯面神经吻合术72例,随访至最终恢复的65例(90.2%).自体神经移植术32例,随访至最终恢复的24例(75.0%).面神经功能评价采用了整体及分区House-Brackmann(HB)评价方法,以卡方检验或Fisher确切概率法进行统计分析.结果:单纯面神经吻合术后总体恢复程度为HB Ⅰ级者37例(56.9%),Ⅱ级者11例(16.9%),Ⅲ级者15例(23.1%),Ⅳ级者2例(3.1%);各分区恢复至HB Ⅰ、Ⅱ级的比例分别为:眼部97.6%、面中部97.9%、口角78.6%、额部27.3%(P<0.001).自体神经移植术后总体恢复程度为HB Ⅰ级者4例(16.7%),Ⅱ级者5例(20.8%),Ⅲ级者7例(29.2%),Ⅳ级者8例(33.3%);各分区恢复程度达HB Ⅰ、Ⅱ级的分别为:眼部73.7%、面中部72.7%、口角44.4%、额部37.5%.神经吻合术后面神经功能恢复程度优于自体神经移植术(P=0.002).结论:面神经吻合术和自体神经移植是修复周嗣性面神经断裂损伤的有效方法;面神经受损分支、损伤范围、手术修复距离损伤的时间和患者年龄均对手术预后有所影响.