外傷性面神經麻痺經由乳突進行面神經解壓手術－36例之經驗

Transmastoid Decompression of the Facial Nerve for Traumatic Facial Palsy - A Review of 36 Cases

葉秉文(Bing-Wen Yeh) ； 黃俊生(Tsun-Sheng Huang)

《中華民國耳鼻喉科醫學會雜誌》 28卷1期 (1993/02) Pp. 13-19

https://doi.org/10.6286/1993.28.1.13

摘要

外傷性面神經麻痺多由車禍撞擊頭部造成，多伴有顳骨骨折之情形，且多發於20至30歲之年齡層。長庚醫院整理由1985年8月至1991年2月間，於本院接受面神經解壓術之外傷性面神經麻痺者，共36例。本文討論其術前檢查、伴隨症狀、聽力及術後評估和術中發現。在面神經受損部位以水平段最多有31例，膝狀神經節及第二彎次之，各佔8例。神經病變以局部水腫及血腫最多有29例，伴隨症狀以聽力受損最多佔30例。吾等認為定位檢查之結果，僅能提供參考，不可以之作為選擇治療方式或手術方法的依據。手術之時機則以病發後4週內為手術之黃金時間，其預後較佳且面予之功能完全恢復之機會也較大。但即使超此時間，減壓手術仍值得一試。對於外傷性面神經麻痺之處理，由於其病變多位於水平段，因此以經由乳突之途徑來進行手術，多可得到滿意之結果，且沒有術後狀況較術前為差之病例。我們認為經由乳突進行面神經解壓手術是處理外傷性面神經麻痺之有效方法。

關鍵字

面神經麻痺 ； 外傷 ； 經乳突途徑解壓

並列摘要

Traffic accident is a common casuse of temporal bone fracture which might result in traumatic facial palsy. In this series the most prevalent age was between 20 and 30.
From August 1985 through February 1991, 36 patients with traumatic facial palsy underwent transmastoid decompression of the facial nerve at CGMH. This paper discusses the pre-operative examination, the associated symptoms and signs, the intra-operative findings and the postoperative evaluation. The most common site of injury of the facial nerve was the horizontal part (31 cases). The most frequent findings of the facial nerve were nerve swelling, edema and intraneural hematoma (29 cases). Topographic diagnosis was not so accurate that we could not depend on it to localize the site of nerve injury. The golden time for the operation is within 4 weeks after the onset of the palsy. But even beyond the time, the decompression still can be proceeded with chance of success.
It is concluded that because most of the lesions are at the horizontal portion, transmastoid decompression is appropriate in treating such cases.

並列關鍵字

facial palsy ； trauma ； transmastoid decompression