An Analysis For Results Of Surgical Treatment To Facial Paralysis Caused By Trauma And Middle Ear Cholesteatoma

Peripheral facial paralysis is the injury from any part of the facial nerve nucleus to the facial nerve endings.The appearance of the lesions is similar to that of the lateral muscles.The main manifestations arebilateral facial asymmetry and facial muscles with varying degrees of freedom.Movement disorders,accompanied by ipsilateral paresthesia.According to statistics,the annual incidence of peripheral facial paralysis is about 1000-1250/500 million,mostly unilateral,bilateral occurrence is rare at the same time,the incidence is only 1/500 million,and there is no obvious age and gender differences.Peripheral facial paralysis causes the patient’s facial expressions and communication barriers.It has a great impact on the patient’s physical and mental health,daily life,and social activities.It also seriously affects the patient’s quality of life.Common causes of peripheral facial paralysis are: trauma,middle ear mastoiditis,sacral tumors,facial nerve tumors,andviral infections.In addition to Bell’s facial paralysis,trauma and middle ear cholesteatoma are common causes of peripheral facial nerve palsy.This part of the patient often requires surgery.Iatrogenic facial nerve injury is one of the complications that may occur in the middle ear,mastoid or zygomatic surgery.With the advancement of ear microsurgery techniques and the use of intraoperative facial nerve monitoring instruments,the incidence of facial nerve injury after surgical injury is higher than before.In order to explore the understanding of the diagnosis and treatment of diseases,this article will discuss the clinical features and surgical efficacy of trauma and middle ear cholesteatoma with facial paralysis,and analyze the factors that affect the prognosis.MethodsWe retrospectively analyzed the clinical characteristics and follow-up results of 67 cases facial paralysis caused by trauma and cholesteatoma,which accompanied by surgical treatment at the First Affiliated Hospital of Zhengzhou University from September 2009 to August 2017.Thirty-six cases(including 31 caused by temporal bone fractures and 5 iatrogenic cases)and 31 cases of facial paralysis by middle ear cholesteatoma were observed and studied for clinical characteristics and surgical results.A House-Brackmann(H-B)classification method was used in this study.Results1.The damage situation of facial nerve: 31 cases of facial paralysis by temporal bone fracture,with 55 segments of facial nerve involved,of which the tympanic segment(19/55)and geniculate ganglion(18/55)were the most common segments,followed by the mastoid segment(12/55)and the labyrinth segment(6/55).Iatrogenic facial paralysis in 5 cases,1 case of complete separation of the conical segment and 1 case of complete tympanic segment.The other 3 cases were: tympanic segment incarceration in 1 case,conical segment neurilemmoma injury in 2 cases 31 cases of middle ear cholesteatoma combined with facial paralysis had 45 facial nerve segments involvement,of which the tympanic segment facial nerve was most often involved(26/45),followed by mastoid segment(12/45),conical segment(5/45),and labyrinth segment(2/45).2.The characteristics of hearing loss:(1)There were 31 cases of facial paralysis of temporal bone fracture,including 8 cases of transverse fractures,10 cases of longitudinal fractures,and 13 cases of mixed fractures.In the longitudinal fracture and transverse fracture conductive deafness incidence rates were 37.5% and 10%,the difference was not statistically significant(P>0.05).The incidence of sensorineural hearing loss in transverse fractures was 70%,higher than that in longitudinal fractures 12.5%,the difference was statistically significant(P<0.05).(2)In 31 cases of middle ear cholesteatoma with facial paralysis,there was no significant difference in the air conduction threshold(P>0.05),and the difference of bone conduction threshold was statistically significant(P<0.05),and the hearing loss of bone conduction threshold was the most heaviest at 4000 Hz.3.The recovery of facial nerve function with different causes: 31 cases of temporal bone fracture facial paralysis were treated with facial nerve decompression.After 2~7 months,25 cases(80.6%)were recovered to grade H-BI~II,and 6 cases to grade III(19.4 %);5 cases of iatrogenic facial paralysis,of which 3 were treated with facial nerve decompression,and all recovered to grade H-B I within 2~3 months after the operation.2 cases treated by the transplantation of great auricular nerve to facial nerve surgery.After 6~7 months,the facial nerve function returned to HB III.;31 cases of middle ear cholesteatoma with facial paralysis were treated with open mastoid radical mastectomy and facial nerve decompression.After 1~ 6 months,28 patients(90.3%)facial nerve function were recovered to H-BI~II grades,and 3 patients to grade III(9.7%).4.Factors related to surgical outcomes:(1)The course of facial paralysis and postoperative curative effect:trauma and middle ear cholesteatoma with facial paralysis,patients with facial paralysis less than two months had better recovery than those with facial paralysis more than two months(P<0.05).(2)Facial paralysis grade and postoperative curative effect: 67 cases of facial paralysis with traumatic and middle ear cholesteatoma,according to the grades of facial nerve function classification: 35 cases of incomplete facial paralysis(III + IV)before operation,33 cases of facial nerve function recovery(94.2%,33/35),2 cases were not well recovered;32 cases of complete facial paralysis(V + VI),and 25 cases of facial nerve function recovery.(73.7%,25/32),7 cases were not well recovered.The satisfaction rate of facial nerve function recovery was higher than that of the latter group(P< 0.05).Conclusions1.Temporal bone fractures were most vulnerable to the injury of the facial nerve tympanic segment and the geniculate ganglion;The iatrogenic injuries were mostly seen in the conical and tympanic segments of the facial nerve,and the middle ear cholesteatoma was more vulnerable to the facial nerve tympanic segment.2.Patellar fractures with facial paralysis,transverse fractures were more likely to associate with sensorineural hearing loss;Middle ear cholesteatoma with facial paralysis,The degree of hearing loss at the bone conduction 4000 Hz of the suffered ear was more heavier.3.For trauma and cholesteatoma with facial paralysis,timely surgical treatment,you can get better results.4.Trauma and cholesteatoma with facial paralysis,the lighter the degree of surgery in front of the diaphragm,the shorter the duration of facial paralysis,the better the postoperative recovery.