Objective: To investigate the effectiveness of facial nerve-sublingual nerve parallel bridge anastomosis for facial nerve injury resulting from closed temporal bone fractures.
Methods: Between January 2017 and December 2019, 9 patients with facial nerve injury resulting from closed temporal bone fracture caused by head and face trauma were treated. Among them, 5 patients were treated with facial nerve-sublingual nerve parallel bridge anastomosis (operation group), and 4 patients were treated with neurotrophic drugs combined with rehabilitation exercise (conservative group). There was no significant difference in gender, age, side, cause of injury, duration of facial nerve injury before surgery, House-brackmann grading (hereinafter referred to as HB grading) of facial nerve injury, and other general information between 2 groups ( P>0.05). HB grading was used to evaluate the improvement of facial nerve function before and after treatment. At the same time, facial nerve neuroelectrophysiological test was performed to evaluate the electrical activity of facial muscles before and after treatment. Tongue function, atrophy, and tongue deviation were evaluated after nerve anastomosis according to the tongue function scale proposed by Martins et al.
Results: Patients in both groups were followed up 12-30 months, with an average of 25 months. None of the 5 patients in the operation group showed symptoms such as tongue muscle atrophy, tongue extension deviation, hypoglossal nerve dysfunction (mainly including slurred speech, choking with water), postoperative infection, bleeding, lower limb muscle atrophy or lower limb motor dysfunction after sural nerve injury. Postoperative skin sensory disturbance in lateral malleolus area was found, but gradually recovered to normal. During the follow-up, facial nerve and sublingual motor neurons were innervated to paralyzed facial muscle in the operation group. At last follow-up, the HB grading of 5 patients in the operation group improved from preoperative grade Ⅴ in 2 cases, grade Ⅵ in 3 cases to grade Ⅱ in 3 cases, grade Ⅲ in 1 case, and grade Ⅳ in 1 case. And in the conservative group, there were 1 patient with grade Ⅴ and 3 patients with grade Ⅵ before operation, facial asymmetry continued during follow-up, and only 2 patients improved from grade Ⅵ to grade Ⅴ at last follow-up. There was significant difference in prognosis HB grading between the two groups ( t=5.693, P=0.001). In the operation group, the amplitude and frequency of F wave were gradually improved, and obvious action potential could be collected when the facial muscle was vigorously contracted. On the contrary, there was no significant difference in neuroelectrophysiological results before and after treatment in the conservative group.
Conclusion: Facial nerve-sublingual nerve parallel bridge anastomosis can effectively retain the integrity of the facial nerve, while introducing the double innervation of the sublingual nerve opposite nerve, which is suitable for the treatment of severe incomplete facial nerve injury caused by closed fracture.
目的: 探讨面神经-舌下神经并联桥接吻合术治疗闭合性颞骨骨折后面神经损伤的疗效。.
方法: 2017年1月—2019年12月收治9例因头面部外伤导致闭合性颞骨骨折而出现面神经损伤的患者，其中5例采用面神经-舌下神经并联桥接吻合术修复治疗（手术组），4例选择神经营养药物治疗配合康复锻炼（保守组）。两组患者性别、年龄、侧别、致伤原因及术前面神经损伤持续时间、面神经损伤House-Brackmann分级（HB分级）等一般资料比较差异均无统计学意义（ P>0.05）。治疗前后采用HB分级评估面神经功能改善情况；同时行面神经电生理检测，评估治疗前后面部肌肉产生的电活动；根据Martins等提出的舌功能量表，对神经吻合术后患者的舌功能及萎缩程度、舌偏移进行评估。.
结果: 两组患者均获随访，随访时间12～30个月，平均25个月。手术组5例患者术后均未出现舌肌萎缩、伸舌偏移、舌下神经功能障碍（主要包括吐字不清、喝水呛咳）或术后感染、出血，腓肠神经损伤后下肢肌肉萎缩或下肢运动功能障碍等症状。术后均出现外踝区皮肤感觉障碍，但逐渐恢复正常。随访期间手术组患者的面神经和舌下运动神经元均对瘫痪面肌进行了神经支配。末次随访时手术组5例患者HB分级从术前Ⅴ级2例、Ⅵ级3例改善至Ⅱ级3例、Ⅲ级1例、Ⅳ级1例；而对照组患者术前Ⅴ级1例、Ⅵ级3例，随访期间面部不对称情况持续存在，末次随访时仅2例从Ⅵ级改善至Ⅴ级；两组预后HB分级比较差异有统计学意义（ t=5.693， P=0.001）。手术组患者术后F波的振幅和频率逐渐改善，面肌大力收缩时也可募集明显动作电位，而对照组治疗前后的神经电生理结果无明显差异。.
结论: 面神经-舌下神经并联桥接吻合术能有效保留面神经完整性，同时引入舌下神经对面神经的双重支配，适用于治疗闭合性骨折所致严重不完全性面神经损伤。.
Keywords: Facial nerve injury; double innervation; facial nerve-sublingual nerve parallel bridge anastomosis; nerve regeneration.