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目的总结分析面神经瘤误诊的原因,提高对面神经瘤的认识。方法 1993年1月至2006年9月手术治疗的28例面神经瘤患者,11例有误诊的经历。所有患者均行 CT 或 MRI 检查、纯音测听,面神经功能的评估采用 House-Brackman(HB)系统。结果 11例患者被误诊。2例术前被误诊为腮腺肿块,行腮腺浅叶切除术,术中发现肿块来自面神经。4例单侧面神经麻痹长期外院误诊为贝尔面神经麻痹,病史1至8年。由于长期面神经麻痹无好转,行影像学检查发现面神经占位病变。2例复发性面神经麻痹误诊为贝尔面神经麻痹,行影像学检查发现均为面神经膝状神经节占位。1例因左耳渐进性听力下降,体检见外耳道新生物,诊断为外耳道新生物,行活组织检查示神经鞘瘤,进一步影像学检查提示为面神经瘤。1例右耳流脓数年,面神经麻痹1个月。查体示右鼓膜穿孔,CT检查诊断为慢性中耳炎行手术,术中见上鼓室肿块同面神经关系密切,取部分组织送病理,术后病理为面神经鞘瘤。另1例面神经麻痹1年半,CT 检查误诊为先天性胆脂瘤,入院后发现乳突肿块同面神经关系密切,MRI 证实为面神经肿瘤并且侵及腮腺内面神经。11例均经手术和病理证实。结论面神经瘤较罕见,不为大多数临床耳科医生熟悉,在临床中易被漏诊和误诊。临床中,如贝尔面神经麻痹半年内无好转现象或患者表现为反复面神经麻痹,应行影像学检查排除面神经瘤的可能。如患者出现面神经麻痹,CT 示中耳占位并同面神经关系密切时,行 MRI 检查可同中耳胆脂瘤、肉芽、胆固醇肉芽肿等区分。腮腺肿块同面神经总干关系密切者应警惕面神经可能。
Objective To summarize the causes of misdiagnosis of facial neuroma and to improve the understanding of facial neuromas. Methods From January 1993 to September 2006, 28 patients with facial neuroma underwent surgery. 11 patients had misdiagnosis. All patients underwent CT or MRI examination, pure tone audiometry, facial nerve function assessment using House-Brackman (HB) system. Results 11 patients were misdiagnosed. 2 cases were misdiagnosed as parotid mass preoperative parotidectomy lobectomy, intraoperative findings from the facial nerve mass. 4 cases of unilateral facial nerve paralysis Long-term outside the hospital misdiagnosed Bell facial nerve paralysis, a history of 1 to 8 years. Due to long-term facial paralysis no improvement, imaging examination revealed facial nerve lesions. 2 cases of recurrent facial paralysis misdiagnosed as Bell facial nerve paralysis, line imaging examination were found in the facial nerve-like ganglion. One case of progressive hearing loss due to the left ear, physical examination of new external auditory canal, diagnosed as external auditory canal, biopsy showed schwannoma, further imaging revealed facial neuroma. One case of right ear pus for several years, facial paralysis 1 month. Check the right tympanic membrane perforation, CT examination diagnosed as chronic otitis media surgery, see the tympanic cavity in operation with the facial nerve is closely related to take part of the organization sent pathology, postoperative pathology facial nerve sheath tumor. Another case of facial nerve paralysis 1 and a half years, CT examination misdiagnosed as congenital cholesteatoma, found that the mastoid mass after admission and the facial nerve are closely related, MRI confirmed facial nerve tumors and invasion of the parotid gland. Eleven cases were confirmed by surgery and pathology. Conclusion Facial neuroma is rare and not familiar to most clinical otologists and is easily missed and misdiagnosed clinically. Clinical, such as Bell facial nerve paralysis within six months no signs of improvement or the patient showed repeated facial nerve paralysis, imaging examination should exclude the possibility of facial neuromas. Such as patients with facial nerve paralysis, CT showed the middle ear and with the facial nerve are closely related to line MRI examination with the middle ear cholesteatoma, granulation, granuloma of cholesterol, etc. distinction. Parotid lumps with the total dry of the facial nerve should be wary of facial nerve may be.