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目的 :探讨耳内镜下经上鼓室进路行面神经锥段、水平段及膝状神经节减压手术的可行性。方法 :对 1 2例外伤性周围性面瘫患者术前采用颞骨薄层CT扫描、流泪试验、镫骨肌反射、味觉试验及听力学检查 ,以明确受损部位。均在耳内镜下经上鼓室进路行面神经锥段、水平段及膝状神经节减压术。结果 :出院时完全恢复面肌功能 (Ⅰ级 ) 6例 (5 0 % )。随访 2～ 1 0个月 ,面肌功能完全恢复者 1 0例 (83 .3 % ) ,面肌功能ⅡⅢ级者 2例(1 6 .7% )。术后听力水平与术前对比 ,无明显变化 8例 ,听力提高 2例 (术前面瘫伴听骨链脱位 ) ,下降 5 1 0dB 2例。结论 :耳内镜下行水平段、膝状神经节减压术 ,可尽量减少对正常组织的破坏 ,进路方便、简捷 ,具有微创的手术效果
Objective: To investigate the feasibility of transection of the tympanic nerve via the tympanic tunnel on the cone of the facial nerve, the horizontal segment and the geniculate ganglion in endoscopic surgery. Methods: Twenty-two traumatic peripheral facial paralysis patients underwent preoperative thin layer CT scan, tear test, stapedius reflex, taste test and audiological examination to identify the damaged site. All under the endoscopic tympanic approach through the facial nerve cone section, horizontal section and geniculate ganglion decompression. Result: 6 cases (50%) recovered facial muscle function completely (grade Ⅰ) at discharge. During the follow-up period of 2 ~ 10 months, there were 10 cases (83.3%) with fully recovered facial muscle function and 2 cases (Ⅱ.67%) with ⅡⅢ grade of facial muscle function. The postoperative hearing level compared with preoperative, there was no obvious change in 8 cases, 2 cases of hearing improvement (paralysis of the front of the arteries with dislocation of the ossicular chain), down 5 1 0dB 2 cases. Conclusion: The horizontal segment of the endoscopic surgery, knee geniculate decompression, can minimize the damage to normal tissue, easy access, simple, minimally invasive surgical results