Objective To evaluate the therapeutic effect and complications of modified surgical treatment for parotid benign tumors. Methods Forty-nine patients with parotid tumors treated between February 2007 and February 2013 were randomly divided improved surgery group (trial group,n=24) and traditional surgery group (control group,n=25). Follow-up lasted from two months to two years after surgery. Postoperative complications (facial paralysis, Fery’s syndrome, local deformity, and salivary fistula) and recurrence were observed and compared between the two groups. Results All the 49 patients were followed up from two months to one year after surgery. Two years after surgery, three patients in the trial group and four in the control group were missing during the follow-up. No recurrence occurred in all the patients. There were no permanent facial paralysis cases in both groups. No temporary facial paralysis occurred in the trial group, while there were five such cases in the control group with an incidence rate of 20.0%. The trial group had one case of Fery’s syndrome with an incidence rate of 4.2%, and the control group had 4 such cases with an incidence rate of 16.0%. After surgery, the 24 patients in the trail group achieved general facial symmetry without any facial depression deformity, while there were 3 cases of mild facial depression and 1 obvious facial depression in the control group with an incidence rate of 16.0%. Five patients in the control group had saliva fistula with an incidence rate of 24.0% while one in the trail group (4.2%). The differences in the total rate of complications occurrence between the two groups were statistically significant (P<0.05). Conclusion The improved surgical treatment can effectively reduce complications after surgery for parotid benign tumors, which is worthy of clinical promotion.
目的：探讨和分析巨大听神经瘤手术面神经保留技术。方法:在面神经监护的条件下，57例巨大听神经瘤病人,采用枕下乙状窦后入路,显微外科切除肿瘤。术中观察肿瘤与面神经的病理解剖关系,术后随访时间6个月至5年。结果:肿瘤全切除54例（94.7％）,次全切3例(5.3%)。面神经解剖完整保留52例(91%),面神经解剖部分保留5例(9%)。结论:在有效的术中面神经功能监测条件下，出色的显微外科技术以及对面神经解剖关系的充分认识是面神经解剖保留的基础。识别不与肿瘤粘连的面神经脑干端或内听道端,再沿面神经锐性分离肿瘤,是面神经解剖保留的技术关键。
Objective To explore the arterial origin and the distribution of the extracranial branches of the facial nerve. Methods Red latex or red chlorinated polyvinyl chloride was injected into the arteries of 15 fresh adult head specimens by both common carotid artery catheterization. The arterial origin and distribution of the extracranial branches of the facial nerve were observed. Results The nutrient arteries of the extracranial branches of the facial nerve originated from stylomastoid artery of the posterior auricular artery, the facial nervous branch of superficial temporal artery, transverse facial artery, superior and inferior facial nervous branches of external carotid artery and the posteriorand anterior facial nervous branches of external carotid artery. The outer diameters of them were (0.8±0.2) mm, (0.9±0.4) mm, (1.9±0.3) mm, (1.0±0.2) mm, (1.1±0.4) mm, (1.0±0.2) mm and (1.1±0.6) mm respectively. The sub-branches ofthe attendant artery of the facial nerve anastomosed each other in addition to supplying their own nerve, and a rich vascular network was formed between the facial nerve and adjacent tissue. Conclusion The study on blood supply of the extracranial segment of the facial nerve can provide anatomic basis for avoiding injury of the nutrient arteries of the facial nerve during operation of the parotidean and masseteric region clinically.
In 10 adult specimens, we observed the distribution of the temporal branches of the facial nerve and its relation with the superficial temporal artery. The 6.3±0.9 temporal branches (5-8 branches, mean 6.3+0.9) went across the lateral margin of the M. frontalis and 10.3±2.2 branches entered the muscle. Their in-let, points were 2.86±5.35 mm upwardand outward of the outer canthus, and all points were about in one line. In conclusion, it was safe for surgeons, to operate in the "safe area" of the temporal region, medial to thevertical line to the outer canthus, without the risk to damage the branches of the facial nervc .
OBJECTIVE: To study the feasibility of α-cyanoacrylate medical adhesive in fixation of intratemporal facial nerve when nerve was repaired within chitin chamber, and to investigate the nerve regeneration. METHODS: Nerve defect of 6 mm was made in left intratemporal facial nerves of 48 rabbits. All the defects were bridged with chitin chamber and were fixed by α-cyanoacrylate medical adhesive, surgical suture and natural union. Nerve function test and histomorphological examination were carried out at 1 month and 3 months after repair. RESULTS: It was observed that the nerve was fixed firmly to the chamber with no crack or crease by α-cyanoacrylate medical adhesive. The regenerated new nerve fibers were more regular and denser and the neurological function recovered much better in the group fixed by alpha-cyanoacrylate medical adhesive than in the groups those fixed by surgical suture and natural union. CONCLUSION: The medical adhesive is b in adhesion and beneficial to nerve repair; repair of intratemporal facial nerve defect within chitin chamber fixed by alpha-cyanoacrylate medical adhesive is feasible, simple and timesaving.
Microsurgery has always been the main treatment for large vestibular schwannomas. With the progress of microsurgical technique and neuroimaging, the application of the intraoperative physiological monitoring technology, as well as the popularization of the concept of minimally invasive neurosurgery, the current development trend of surgery for vestibular schwannomas is to realize both the maximal tumoral resection and the maximal preservation of facial nerve function, which puts more emphasis on the improvement of quality of life. It is still a challenge for neurosurgeons to resect the tumor to the maximum extent and preserve the nerve function as well. In view of this background, the strategy of " near-total resection” and " subtotal resection” combined with stereotactic radiotherapy has been more and more accepted in the past years. However, as a neurosurgeon, the ultimate goal should be " gross-total resection of tumor” and preservation of the nerve function as well. For those tumors severely adherent to neurovascular structure, " near total resection” might be a rational choice. Meanwhile, long-term follow-up should be conducted to clarify the biological behavior of tumor residues, as well as the necessity and long-term effect of stereotactic radiotherapy.
OBJECTIVE: To evaluate the nerve regeneration after implantation of chitin tubes containing nerve growth factor(NGF) in the rabbit facial nerve. METHODS: Bilateral 8 mm defect of superior buccal divisions of the facial nerves were made in 16 New Zealand rabbits. Chitin tubes containing NGF were implanted into the gaps, and autologous nerves were implanted into the right gaps as control. The nerve regeneration was evaluated with electrophysiological and ultrastructural examination after 8 and 16 weeks of operation. RESULTS: Chitin tubes containing NGF successfully induced the nerve regeneration, regularly arranged myelinated and unmyelinated axons could be observed across the 8 mm gaps, and the myelin sheath was thick with clear lamellar structure at 8 weeks after operation, The regenerated nerve fibers increased and were more mature at 16 weeks after operation. There were no significant difference in electrical impulse conduction velocity through the neural regeneration between the experimental and control sides (P gt; 0.05). CONCLUSION: Chitin tubes containing NGF can provide optimal conditions for regeneration of rabbit facial nerve.
OBJECTIVETo study the repairing method of facial nerve defect using nerve elongation, and the biomechanical properties of peripheral nerves. METHODS A novel device for peripheral nerve elongation was designed and manufactured. With the device, facial nerves of rabbits were expanded acutely and chronically by string-type loading. The facial nerves were studied with histological and electrophysiological examinations before and after elongation. RESULTS There were no considerable necrosis, degeneration, and infection in the facial nerves after elongation. The experimental animals took food normally and their body temperature were stable. Histological examinations showed dispersing Sunderland degree III injury and occasionally broken capillary blood vessels in the acute group, thicker nerve and fibroblasts hyperplasia between nerve bundles in the chronic group. The electromyogram(EMG) of buccal muscle and nerve conductive velocity(NCV) showed the maximal range was (18.7 +/- 2.4)% in the acute group, and (30.8 +/- 2.4)% in the chronic group. CONCLUSION It suggests that the novel nerve elongation method is feasible, and it can be used to study the nerve elongation basically and clinically.