中耳手術による損傷性顔面神経麻痺

抄録

The problems associated with operative traumatic facial paralysis as acomplication of middle ear and mastoid surgery were described on the basis of experience of treatment of 113 patients by the author during the last 18 years. This figure corresponds to 5.4% of the author's series of 2, 112 patients with facial palsy of various etiologies.
While the incidence of the iatrogenic facial paralysis has been decreasing recently, the otologic surgeon has to always keep in mind the possibility of surgical injury to the facial nerve whenever he encounters the following situations: 1) the sclerotic mastoid with microsized antrum, 2) distorted anatomical landmarks either by cholesteatoma or tympanosclerosis, 3) unusually well pneumatized mastoid, 4) dehiscence of the facial canal, 5) anomalous course of the facial canal, and 6) excessive bleeding which frequently occurs under general anestesia.
As to the treatment, emphasis was placed on the importance of the immediate re-exploration of the damaged portion and appropriate repair of the nerve. Even in a long-standing case, the nerve should be inspected and repaired before plastic correction of the facial disfigurement is considered because the injured nerve often keeps its regenerating potential for several years.