The clinical effect of immediate facial nerve rehabilitation in malignant parotid gland tumor surgery
10.3760/cma.j.cn114453-20211221-00477
- VernacularTitle:腮腺恶性肿瘤术中面神经损伤即刻修复的临床效果
- Author:
Jingyi LI
1
;
Shijun LI
;
Zimeng LI
;
Mengkun DING
;
Shang XIE
;
Xiaofeng SHAN
;
Zhigang CAI
Author Information
1. 北京大学口腔医学院口腔医院口腔颌面外科 国家口腔医学中心 国家口腔疾病临床医学研究中心 口腔生物材料和数字诊疗装备国家工程研究中心 口腔数字医学北京市重点实验室，北京 100081
- Keywords:
Parotid neoplasms;
Malignant tumor;
Facial nerve injury;
Immediate rehabilitation
- From:
Chinese Journal of Plastic Surgery
2022;38(11):1229-1236
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To discuss the effect and prognostic factors of immediate facial nerve rehabilitation in malignant parotid gland tumor surgery.Methods:The patients with malignant parotid gland tumor who underwent facial nerve rehabilitation surgery in Peking University School and Hospital of Stomatology from January 2004 to July 2020 were retrospectively analyzed. Their demographic characteristics, preoperative and postoperative facial nerve function according to the House-Brackmann (HB) facial nerve grading system from HB grade Ⅰ to HB grade Ⅵ, injury sites of facial nerve including the trunks injury and branches injury, surgical timing including immediate rehabilitation and elective rehabilitation and rehabilitation methods such as facial nerve anastomosis, nerve transplantation, nerve transfer and muscle flap suspension were recorded. Patients were divided into two groups: satisfactory outcomes with HB grades Ⅰ-Ⅲ and unsatisfactory outcomes with HB grades Ⅳ-Ⅵ, and the factors that may affect the prognosis of facial nerve function were statistically analyzed. T-test was used to compare measurement data, chi-square test or Fisher’s precision probability test was used to compare count data. P<0.05 was considered statistically significant. Results:Eighty-nine patients were included in the study, including 50 males and 39 females, aged 9-82 years, the median age was 49.0 years. Preoperative facial nerve function outcomes were HB Ⅰ ( n=57), HB Ⅱ ( n=5), HB Ⅲ ( n=8), HB Ⅳ ( n=2), HB Ⅴ ( n=15) and HB Ⅵ ( n=2). Fifty-seven patients underwent immediate rehabilitation and 32 patients received elective rehabilitation. In 53 cases, the main trunk and/or the temporal and cervical trunk were injured, and 36 cases were branches injury. Facial nerve anastomosis was performed in 35 cases, 39 cases required nerve transplantation, 12 cases underwent nerve transfer, and 3 cases underwent muscle flap suspension. The follow-up time was 6-72 months. Postoperative facial nerve function outcomes were HB Ⅰ ( n=6), HB Ⅱ ( n=17), HB Ⅲ ( n=26), HB Ⅳ ( n=27), and HB Ⅴ ( n=13). Forty-nine cases were classified as group with postoperative HB grades Ⅰ-Ⅲ, and 40 cases were classified as group with postoperative HB grades Ⅳ-Ⅵ. Statistical analysis showed that there was no significant difference in terms of age and gender between two groups ( P>0.05). Among the patients with postoperative HB grades Ⅰ-Ⅲ, 73.5% (36/49) of the patients had immediate rehabilitation, 36.7% (18/49) of the patients had injury of the nerve trunks, 89.8% (44/49) of the patients had preoperative HB grades Ⅰ-Ⅲ, and 59.2% (29/49) of the patients had nerve anastomosis. Among the patients with postoperative HB grades Ⅳ-Ⅵ, 52.5% (21/40) of the patients had immediate rehabilitation, 87.5% (35/40) of the patients had injury of the nerve trunks, 65.0% (26/40) of the patients had preoperative HB gradesⅠ-Ⅲ, and 15.0% (6/40) of the patients had nerve anastomosis were in the group. There were statistically significant differences between the two groups ( P<0.05 or <0.01). Conclusions:Immediate reconstruction of the facial nerve defect during the operation of malignant parotid gland tumor can obtain better result. Furthermore, injury sites of facial nerve may affect the prognosis of facial nerve function as well.
