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Objective To explore on location of the segments of the facial nerve being easy to damage in mastoid surgery.Methods Retrospective analysis was conducted according to the clinical data of 97cases with chronic suppurative otitis media performed with radical mastoidectomy (or radical mastoidectomy + tympanoplasty) from May 2010 to September 2012,and summarized the methods to locate the segment of the facial nerve being easy to damage in operation.Results ①One case of congenital defect of facial nerve canal was found in 97 cases.②The horizontal segments of the facial nerve of 97 cases were successfully located depending on combined/partial anatomic landmarks including eminence of the lateral semicircular canal,short limb of incus,cochlearform process,tympanic tegmen,stapes.③The pyramidal segment of facial nerve of 97 cases were successfully located depending on combined/partial anatomic landmarks including eminence of the lateral semicircular canal,short limb of incus.④The proximal part of vertical segment of the facial nerve of 97 cases were successfully located depending on combined /partial anatomic landmarks including short limb of incus,chorda tympani nerve,pyramidal eminence,eminence of the lateral semicircular canal.Conclusion The eminence of the lateral semicircular canal,short limb of incus,cochlearform process,tympanic tegmen,stapes,pyramidal eminence,chorda tympani nerve in the area in which the facial nerve being easy to damage are important landmarks by which the segment of facial nerve easy to damage might be located in mastoid surgery.
RESUMO
BACKGROUND AND OBJECTIVES: The purpose of this study was to provide possible causes and post-treatment prognosis of delayed facial nerve palsy (DFP) following middle ear and mastoid surgery. SUBJECTS AND METHOD: The medical records of 3787 cases of middle ear and mastoid surgery from June, 1980 to August, 2003 were retrospectively reviewed. Nine cases developed ipsilateral facial nerve palsy after 72 hours of surgery. Their age ranged from 20 to 67 years (the mean of 40 years old and the male: female ratio of 1:1.25). For the review of the chart, we checked preoperative middle ear and mastoid state, intraoperative findings, clinical features of development and recovery of facial nerve palsy. To evaluate the degree and the possibility of recovery of facial nerve palsy, the House-Blackman grading system was used and electrophysiologic studies (Maximal stimulation test, Nerve excitability test and Nerve conduction velocity test) were performed. The steroid and vasodilator drugs were prescribed for the treatment. RESULTS: All of the nine patients had preoperative diagnosis of chronic otitis media and five of them also had cholesteatoma. Radical mastoidectomy was done in two cases, open cavity techniques in two cases and closed cavity techniques in five cases. There were postoperative wound infections in five cases. Facial palsy was developed between 5th and 16th postoperative day (mean 9th day) and the initial House-Blackman grade was II or III. The time for complete recovery ranged from 1 month to 6 months, with the fastest recovery time being 9 days after DFP. CONCLUSION: DFP following middle ear and mastoid surgery is an unpredictable complication. Postoperative wound infection may have been related to it and should be regarded as a risk factor of DFP.