颞骨外伤所致面瘫的面神经手术减压：三十年经验的启示。
Surgical decompression of the nerve for facial palsy in temporal bone trauma: Insights from a three-decade experience.
文献信息
| PMID | 42875289 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | J Joye |
| 作者单位 | ENT Department, CHU UCL Namur, Site Godinne, avenue Gaston Thérasse 1, 5530 Yvoir, Belgium. Electronic address: juliette.joye@student.uclouvain.be. |
| 期刊 | European annals of otorhinolaryngology, head and neck diseases |
| SCI 分区 | Q2 |
| IF | 1.7 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
目的： 评估颞骨骨折所致面瘫行面神经减压术的手术疗效。
材料与方法： 回顾性分析1994年3月至2024年7月期间在我院耳鼻咽喉科因颞骨外伤导致面瘫而接受手术的11例患者。纳入标准为糖皮质激素治疗失败且重度面瘫持续存在。手术疗效采用House-Brackmann（HB）分级在1年时评估，并监测术后HB进展。潜在预后因素包括手术延迟时间、术中神经肿胀以及对术中面神经监测（FNM）刺激的反应。
目标： 分析面神经减压术后的功能恢复，并确定改善结局的临床或术中预测因素。
结果： 在我们的颞骨外伤患者队列中，27.3%的患者在1年时达到HB I级，90.9%达到HB≤III级。平均HB改善从<1个月（ΔHB 0.89）稳步增加至12个月（ΔHB 3.36）。在≤2周和>2周手术的患者之间未观察到恢复的显著差异，尽管所有手术均在1个月内进行。术中神经肿胀与结局无关。可检测到的术中神经反应显示出更好完全恢复的趋势。
结论： 面神经减压术产生了良好的功能结局，并在一年内逐步恢复。在伤后第一个月内进行手术时观察到良好结果。术中神经肿胀不能预测预后，而可检测到的术中神经反应可能具有预后价值。需要更大规模的研究来证实这些发现。
英文摘要
AIMS: To evaluate the surgical outcomes of facial nerve decompression for facial paralysis in temporal bone fractures.
MATERIAL AND METHODS: A retrospective review was conducted on 11 patients who underwent surgery for facial paralysis due to temporal bone trauma in our ENT department between March 1994 and July 2024. Inclusion criteria were failure of corticosteroid therapy and persistence of severe facial paralysis. Surgical outcomes were assessed using the House-Brackmann (HB) classification at one year and by monitoring postoperative HB progression. Potential prognostic factors included delay to surgery, intraoperative nerve swelling and response to stimulation with intraoperative facial nerve monitoring (FNM).
OBJECTIVES: To analyze functional recovery following facial nerve decompression and to identify clinical or intraoperative predictors of improved outcome.
RESULTS: In our cohort of patients with temporal bone trauma, 27.3% of patients achieved HB I at one year and 90.9% reached HB≤III. Mean HB improvement increased steadily from<1 month (ΔHB 0.89) to 12 months (ΔHB 3.36). No significant difference in recovery was observed between patients operated≤2 weeks and>2 weeks, although all surgeries were performed within 1 month. Intraoperative nerve swelling was not associated with outcome. A detectable intraoperative nerve response showed a trend toward better complete recovery.
CONCLUSION: Facial nerve decompression yielded favorable functional outcomes, with progressive recovery over one year. Favorable results were observed when surgery was performed within the first month after injury. Intraoperative nerve swelling was not predictive of prognosis, whereas a detectable intraoperative nerve response may have prognostic value. Larger studies are needed to confirm these findings.