Jianbin Sun, Ruoya Wang, Xingrui Chen, Jianze Wang, Da Liu, Na Sai, Yuhua Zhu, Jun Liu, Weidong Shen, Pu Dai, Shiming Yang, Dongyi Han, Weiju Han
{"title":"中耳手术医源性面神经损伤的外科治疗与预后:20年经验。","authors":"Jianbin Sun, Ruoya Wang, Xingrui Chen, Jianze Wang, Da Liu, Na Sai, Yuhua Zhu, Jun Liu, Weidong Shen, Pu Dai, Shiming Yang, Dongyi Han, Weiju Han","doi":"10.1186/s13005-023-00377-y","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Iatrogenic facial nerve injury is one of the severest complications of middle ear surgery, this study aims to evaluate surgical management and prognosis in the era of improved surgical instruments.</p><p><strong>Methods: </strong>Patients suffered from facial nerve paralysis after middle ear surgery between January 2000 and December 2019 were retrospectively collected. Demographic characters, primary disease and surgery, details of revision surgery were analyzed.</p><p><strong>Results: </strong>Forty-five patients were collected, of whom 8 were injured at our center and 37 were transferred. For 8 patients injured at our center, seven (87.5%) ranked House-Brackmann (H-B) grade V and one (12.5%) ranked H-B VI before revision surgery; postoperatively, two (25.0%) patients recovered to H-B grade I, four (50.0%) recovered to H-B II, and the other two (25.0%) recovered to H-B III. For 37 patients transferred, thirteen (35.1%) ranked H-B grade V and 24 (64.9%) ranked H-B VI preoperatively, final postoperative grade ranked from H-B grade I to grade V, with H-B I 6 (16.2%) cases, H-B II 6 (16.2%) cases, H-B III 18 (48.6%) cases, H-B IV 5 (13.5%) cases and H-B V 2 (5.4%) cases. The most vulnerable site was tympanic segment (5, 62.5% and 27, 73.0% respectively). Twenty-one (46.7%) patients suffered from mild injury and 24 (53.3%) suffered from partial or complete nerve transection. For surgical management, twenty-one (46.7%) patients received decompression, nineteen (42.2%) received graft and 5 (11.1%) received anastomosis. Those decompressed within 2 months after paralysis had higher possibility of H-B grade I or II recovery (P = 0.026), those received graft within 6 months were more likely to get H-B grade III recovery (P = 0.041), and for patients underwent anastomosis within 6 months, all recovered to H-B grade III.</p><p><strong>Conclusions: </strong>Tympanic segment is the vulnerable site. If facial nerve paralysis happens, high-resolution computed tomography could help identify the injured site. Timely treatment is important, decompression within 2 months after paralysis, graft and anastomosis within 6 months lead to better recovery.</p>","PeriodicalId":12994,"journal":{"name":"Head & Face Medicine","volume":"19 1","pages":"31"},"PeriodicalIF":2.4000,"publicationDate":"2023-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10369826/pdf/","citationCount":"0","resultStr":"{\"title\":\"Surgical management and the prognosis of iatrogenic facial nerve injury in middle ear surgery: a 20-year experience.\",\"authors\":\"Jianbin Sun, Ruoya Wang, Xingrui Chen, Jianze Wang, Da Liu, Na Sai, Yuhua Zhu, Jun Liu, Weidong Shen, Pu Dai, Shiming Yang, Dongyi Han, Weiju Han\",\"doi\":\"10.1186/s13005-023-00377-y\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Iatrogenic facial nerve injury is one of the severest complications of middle ear surgery, this study aims to evaluate surgical management and prognosis in the era of improved surgical instruments.</p><p><strong>Methods: </strong>Patients suffered from facial nerve paralysis after middle ear surgery between January 2000 and December 2019 were retrospectively collected. Demographic characters, primary disease and surgery, details of revision surgery were analyzed.</p><p><strong>Results: </strong>Forty-five patients were collected, of whom 8 were injured at our center and 37 were transferred. For 8 patients injured at our center, seven (87.5%) ranked House-Brackmann (H-B) grade V and one (12.5%) ranked H-B VI before revision surgery; postoperatively, two (25.0%) patients recovered to H-B grade I, four (50.0%) recovered to H-B II, and the other two (25.0%) recovered to H-B III. For 37 patients transferred, thirteen (35.1%) ranked H-B grade V and 24 (64.9%) ranked H-B VI preoperatively, final postoperative grade ranked from H-B grade I to grade V, with H-B I 6 (16.2%) cases, H-B II 6 (16.2%) cases, H-B III 18 (48.6%) cases, H-B IV 5 (13.5%) cases and H-B V 2 (5.4%) cases. The most vulnerable site was tympanic segment (5, 62.5% and 27, 73.0% respectively). Twenty-one (46.7%) patients suffered from mild injury and 24 (53.3%) suffered from partial or complete nerve transection. For surgical management, twenty-one (46.7%) patients received decompression, nineteen (42.2%) received graft and 5 (11.1%) received anastomosis. Those decompressed within 2 months after paralysis had higher possibility of H-B grade I or II recovery (P = 0.026), those received graft within 6 months were more likely to get H-B grade III recovery (P = 0.041), and for patients underwent anastomosis within 6 months, all recovered to H-B grade III.</p><p><strong>Conclusions: </strong>Tympanic segment is the vulnerable site. If facial nerve paralysis happens, high-resolution computed tomography could help identify the injured site. Timely treatment is important, decompression within 2 months after paralysis, graft and anastomosis within 6 months lead to better recovery.</p>\",\"PeriodicalId\":12994,\"journal\":{\"name\":\"Head & Face Medicine\",\"volume\":\"19 1\",\"pages\":\"31\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2023-07-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10369826/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Head & Face Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s13005-023-00377-y\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"DENTISTRY, ORAL SURGERY & MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Head & Face Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s13005-023-00377-y","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"DENTISTRY, ORAL SURGERY & MEDICINE","Score":null,"Total":0}
引用次数: 0
摘要
背景:医源性面神经损伤是中耳手术最严重的并发症之一，本研究旨在探讨手术器械改进时代的手术处理及预后。方法:回顾性收集2000年1月至2019年12月中耳手术后面神经麻痹患者。分析患者的人口学特征、原发疾病及手术方式、翻修手术细节。结果:共收集患者45例，其中在我中心受伤8例，转院37例。在我中心收治的8例患者中，翻修手术前7例(87.5%)为House-Brackmann (H-B) V级，1例(12.5%)为H-B VI级;术后2例(25.0%)恢复为H-B I级，4例(50.0%)恢复为H-B II级，2例(25.0%)恢复为H-B III级。37例转移患者，术前H-B V级13例(35.1%)，H-B VI级24例(64.9%)，最终术后分级由H-B I级至V级，其中H-B I 6例(16.2%)，H-B II 6例(16.2%)，H-B III 18例(48.6%)，H-B IV 5例(13.5%)，H-B v2例(5.4%)。最脆弱部位为鼓室段(分别为5.62.5%和27.73.0%)。轻度损伤21例(46.7%)，部分或完全神经断裂24例(53.3%)。手术治疗方面，减压21例(46.7%)，移植物19例(42.2%)，吻合5例(11.1%)。术后2个月内减压组H-B I级或II级恢复的可能性较高(P = 0.026)，术后6个月内移植组H-B III级恢复的可能性较高(P = 0.041)，术后6个月内吻合组H-B III级恢复的可能性均较高。结论:鼓室段为易感部位。如果发生面神经麻痹，高分辨率计算机断层扫描可以帮助确定受伤部位。及时治疗很重要，瘫痪后2个月内减压，6个月内移植物吻合恢复较好。
Surgical management and the prognosis of iatrogenic facial nerve injury in middle ear surgery: a 20-year experience.
Background: Iatrogenic facial nerve injury is one of the severest complications of middle ear surgery, this study aims to evaluate surgical management and prognosis in the era of improved surgical instruments.
Methods: Patients suffered from facial nerve paralysis after middle ear surgery between January 2000 and December 2019 were retrospectively collected. Demographic characters, primary disease and surgery, details of revision surgery were analyzed.
Results: Forty-five patients were collected, of whom 8 were injured at our center and 37 were transferred. For 8 patients injured at our center, seven (87.5%) ranked House-Brackmann (H-B) grade V and one (12.5%) ranked H-B VI before revision surgery; postoperatively, two (25.0%) patients recovered to H-B grade I, four (50.0%) recovered to H-B II, and the other two (25.0%) recovered to H-B III. For 37 patients transferred, thirteen (35.1%) ranked H-B grade V and 24 (64.9%) ranked H-B VI preoperatively, final postoperative grade ranked from H-B grade I to grade V, with H-B I 6 (16.2%) cases, H-B II 6 (16.2%) cases, H-B III 18 (48.6%) cases, H-B IV 5 (13.5%) cases and H-B V 2 (5.4%) cases. The most vulnerable site was tympanic segment (5, 62.5% and 27, 73.0% respectively). Twenty-one (46.7%) patients suffered from mild injury and 24 (53.3%) suffered from partial or complete nerve transection. For surgical management, twenty-one (46.7%) patients received decompression, nineteen (42.2%) received graft and 5 (11.1%) received anastomosis. Those decompressed within 2 months after paralysis had higher possibility of H-B grade I or II recovery (P = 0.026), those received graft within 6 months were more likely to get H-B grade III recovery (P = 0.041), and for patients underwent anastomosis within 6 months, all recovered to H-B grade III.
Conclusions: Tympanic segment is the vulnerable site. If facial nerve paralysis happens, high-resolution computed tomography could help identify the injured site. Timely treatment is important, decompression within 2 months after paralysis, graft and anastomosis within 6 months lead to better recovery.
期刊介绍：
Head & Face Medicine is a multidisciplinary open access journal that publishes basic and clinical research concerning all aspects of cranial, facial and oral conditions.
The journal covers all aspects of cranial, facial and oral diseases and their management. It has been designed as a multidisciplinary journal for clinicians and researchers involved in the diagnostic and therapeutic aspects of diseases which affect the human head and face. The journal is wide-ranging, covering the development, aetiology, epidemiology and therapy of head and face diseases to the basic science that underlies these diseases. Management of head and face diseases includes all aspects of surgical and non-surgical treatments including psychopharmacological therapies.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
