Facial nerve anastomosis
Facial nerve anastomosis includes contralateral anastomosis and diversion anastomosis, which can be selected according to the condition of nerve disconnection.Treatment of diseases: facial nerve injury Indication
1. The end-to-end anastomosis is suitable for nerve ablation without separation of two traumatic or defect-free two-end anastomosis without tension. This facial nerve injury often occurs in the humeral fracture or surgical trauma, and some are located in the tympanic, conical or mastoid segments.
2. Diversion and anastomosis The two ends of the nerve are separated by more than 3 to 4 mm. If there is a large tension during the anastomosis, the anastomosis of the humerus or the external humerus should be used.Preoperative preparation
1. Do a good job of preoperative interpretation of the patient.
2. Before the night before going to bed and before entering the operating room, each patient was given benzobarbital 0.09g. Those who were allergic to phenobarbital could take 5mg of sputum (Dingding) (children discretion or not).
3. General anesthesia, soapy water enema before surgery, fast morning, no water. One hour before surgery, 0.5 mg of atropine sulfate was injected subcutaneously (children according to doctor's advice).
4. Apply antibiotics before surgery.Surgical procedure
Check the broken end under the microscope. If there is scar tissue and bone around it, it should be removed before anastomosis. Be careful not to twist the nerve when suturing, and the alignment of the two ends should be accurate. Ensure that the axon can grow straight in line with the anastomosis. When the nerve-to-end anastomosis is used, the nerve sheath is usually sutured with 1 to 2 needles with an 8-0 non-invasive suture. If the nerve is located in the bone tube and is well fixed, it can be sewed and fixed only with plasma. Fisch advocates using a fenestrated absorbable collagen tube, aligning the ends of the two ends in the tube, and the ends of the collagen tube are bonded with n-butyl cyanoacrylate.
2. Diversion and anastomosis
A commonly used method of diversion and anastomosis is to advance the mastoid segment so that the distance between the two opposite ends is reduced, and the ends can be in contact with each other, which is sufficient to be consistent. When the diversion and anastomosis is performed, since the nerve has been separated from the original bone tube, it is necessary to suture the sheath 3 to 4 needles at the anastomosis. For the damage of the facial nerve between the labyrinth and the tympanic segment of the humerus, accompanied by a full sacral, Portmann reported that the sacral can be removed, and then the vestibular part is removed from the end of the facial nerve tympanic section to the facial nerve labyrinth. All the lost roads are worn away (the vestibular window below the facial nerve, with the outer semicircular canal and the anterior semicircular canal). Excision of the facial neuropathy, the facial nerve passes through the ablation zone to achieve facial nerve diversion, end-to-end anastomosis, and can be fixed without tissue. For patients with low facial nerve injury in the humerus, the stalk breast hole must be opened first, and then the distal end of the parotid nerve should be released, so that the distal end of the facial nerve can be referred to the tympanic cavity and the proximal end of the facial nerve. Only suture the nerve sheath when suturing, but if the facial nerve defect is too much, nerve transplantation should be done. When the tumor is removed, the facial nerve can be diverted without cutting the facial nerve, and the function of the facial nerve is not affected. After cutting the superficial nerve of the rock, the whole facial nerve is moved backwards. After the jugular spheroid tumor surgery is performed, the facial nerve of the stalk of the stalk is removed.complication
The reasons are:
(1) Perforation of the tympanic membrane, accidental injury when separating the posterior wall of the external auditory canal or the tympanic cavity, if there is perforation repaired with fascia.
(2) The dura mater is sagged through the defect of the tympanic cap, which hinders the function of the ossicular chain. The tympanic cap is reconstructed with bone fragments and fascia after closing the inner ear canal and covering the facial nerve after intra-canal or incisional facial nerve surgery.
2. Sensorineural hearing loss
Due to intraoperative injury lost, vestibular or cochlear ears. In order to avoid damage to the inner ear, the facial nerve crypt is advancing, and if necessary, it can swim away from the anvil joint.
3. Permanent facial paralysis
This is the result of the inability of the denatured nerve to regenerate. It can be corrected by fascia sling or facelift.
4. Facial muscle contracture
After degeneration of nerve regeneration re-does muscle, some facial muscles often have varying degrees of contracture. Often expressed as nasolabial area. This contracture is only noticeable when the healthy side is free to move. The two sides of the face remain symmetrical at rest, so there is no need for treatment.
5. Facial convulsions and convulsions
The regained innervated facial muscles can sometimes have permanent paralysis, the lighter manifestations of eyelid twitching, and the severe manifestations of severe paroxysmal spasm of the entire affected side. The cause of the disease is unknown, and there is currently no specific treatment. Some people use botulinum toxin type A injection therapy is effective.
6. Crocodile tears
Also known as Tear Syndrome or Bogorod syndrome. Because of skull base fracture, surgical injury, and Hunt syndrome, the geniculate ganglion is damaged. After the function is restored, the patient can shed tears every time they eat, which is permanent and limited to the temporal side. This is caused by the nerve impulses secreted by the parotid gland into the lacrimal gland. Impulsive conduction errors may be caused by the reentry of the parotid nerve fibers into the path, which constitutes the connection between the superficial nerve and the tympanic plexus. Bu Guoxian (1994) reported that conservative treatment of sphenopalatine nerve closure, 6 months without reduction can be surgically cut off the tympanic nerve and tympanic nerve, or cut off the ductal nerve. There is no such phenomenon after surgery to cut off the great superficial nerve.
7. Drum nerve injury
Since the tympanic nerve enters the tympanic cavity and walks between the hammer stem and the long foot of the anvil, it is easy to damage the nerve in the tympanic operation, and the tympanic nerve should not be excessively involved during the operation. If it interferes with the field, it would rather cut off.
8. Facial nerve injury
Mainly refers to the increase of nerve damage in facial nerve repair. Thus affecting the recovery of postoperative neurological function. Avoid burns when using an electric drill. When approaching the facial nerve, you should use a diamond drill bit to avoid bumping the facial nerve. Use a facial nerve stimulator for a period of no more than 1 s to avoid burning the nerves. In the operation should avoid the instrument contusion facial nerve or damage facial nerve sheath, especially in facial nerve edema, should pay more attention. When anastomosis is performed, the nerve clots or bone fragments should be removed one by one before suturing to avoid pressure on the facial nerve.
9. Jugular bulb injury
Any sacral surgery should prevent the jugular vein from being damaged. Especially when entering the inner surface of the facial nerve mastoid, the jugular bulb can be raised to the inner surface of the facial nerve. Sometimes it can be as high as the posterior foot of the posterior semicircular canal to avoid serious bleeding.
10. Sigmoid sinus injury
Note the abnormality of the position of the sigmoid sinus, sometimes under the papillary cortex, sometimes with a gas chamber and a deep sigmoid sinus. Sometimes moving forward, almost close to the posterior wall of the external auditory canal, should always pay attention, and often flush the surgical cavity to keep the surgical field clear.
Traumatic facial paralysis, if the nerve is not broken, remove the hematoma or broken bone pieces and then decompression, most of them begin to recover from 10 to 90 days, and also recover completely in 4 to 6 months or 1 year. The effect of the end-to-end anastomosis is better, and the tiny function can be quickly restored. If the connective tissue grows from the anastomosis, the axonal regeneration is hindered and the anastomosis is failed. Anastomotic axonal regeneration dislocation can lead to poor recovery of facial muscle function.