Management Strategy And Prognosis Analysis Of Facial Nerve During Operation Of Petrous Bone Cholesteatoma

Objective:This study retrospectively analyzed the clinical data of 69 patients with petrous bone cholesteatoma to explore the treatment strategy of facial nerve during the operation of petrous bone cholesteatoma surgery and analyze the factors affecting the prognosis of facial nerve,so as to provide certain clinical basis for the treatment of petrous bone cholesteatoma and facial paralysis.Methods:The clinical data of 69 pathologically confirmed patients with petrous bone cholesteatoma admitted to the Department of Otolaryngology of our hospital from March 2011 to June 2021 were retrospectively analyzed,including age,gender,side of lesions,history and course of facial paralysis,history of middle ear operation,etiology classification,Sanna classification,surgical approach,whether the operation was assisted by endoscope,preoperative and postoperative facial nerve function,site and degree of facial nerve damage,management of facial nerve,involvement of anatomic structures adjacent to petrous bone(the ossicular chain,meninges of middle and posterior cranial fossa,semicircular canals,cochlea,petrous apex,internal auditory canal,internal carotid artery,jugular venous bulb,sigmoid sinus and occipital bone),postoperative complications and recurrence.SPSS 26.0 statistical software was used for statistical analysis.Spearman correlation test was performed on postoperative facial nerve function and the age,gender,side of lesions,history and course of facial paralysis,history of middle ear operation,etiology classification,Sanna classification,surgical approach,whether the operation was assisted by endoscope,preoperative facial nerve function,site and degree of facial nerve damage,management of facial nerve,involvement of anatomic structures adjacent to petrous bone to study the related factors affecting postoperative facial nerve function.Multiple logistic regression analysis was used to study the independent risk factors affecting the prognosis of facial nerve.Multivariate Cox regression analysis was performed on the recurrence of cholesteatoma with age,gender,side of lesions,history and course of facial paralysis,history of middle ear operation,etiology classification,Sanna classification,surgical approach,whether the operation was assisted by endoscope,preoperative facial nerve function,site and degree of facial nerve damage,management of facial nerve,involvement of anatomic structures adjacent to petrous bone,so as to explore the independent risk factors affecting the recurrence of cholesteatoma.Results:The 69 patients included in this study ranged in age from 10 to 76 years old,with an average age of 37.13± 14.52 years old.Among the 69 patients,46 were males and 23 were females;24 were congenital petrous bone cholesteatoma and 45 were acquired petrous bone cholesteatoma.There were 46 patients(66.7%)with a history of facial paralysis before surgery.The time of facial paralysis ranged from 1 to 360 months,and the median time of facial paralysis was 12 months.According to Sanna classification,there were 48 cases of supralabyrinthine type,4 cases of infralabyrinthine type,4 cases of infralabyrinthine-apical type,8 cases of massive type and 5 cases of apical type.The facial nerve function was graded according to the House-Brackmann(H-B)grading system.The preoperative facial nerve function:23 cases of grade Ⅰ,3 cases of grade Ⅱ,1 case of grade Ⅲ,10 cases of grade Ⅳ,20 cases of grade Ⅴ,and 12 cases of grade Ⅵ.The postoperative facial nerve function:19 cases of grade I,6 cases of grade Ⅱ,9 cases of grade Ⅲ,9 cases of grade Ⅳ,11 cases of grade Ⅴ,15 cases of grade Ⅵ.The follow-up time was 14 to 137 months after the operation,and the median time was 58 months.Among the 69 patients with petrous bone cholesteatoma,65 cases had facial nerve involvement,among which 36 cases were involved in the labyrinth segment,followed by 33 cases in the horizontal segment,23 cases in the geniculate ganglion and 11 cases in the vertical segment.The degree of damage to the facial nerve was calculated,among which 32 patients with facial nerve exposure,8 cases of facial nerve thinning,and 25 cases of facial nerve interruption.Appropriate treatment methods were selected according to different degrees of facial nerve injury:11 patients received facial nerve decompression,8 patients received facial nerve displacement,5 patients received facial nerve anastomosis,8 patients received facial-hypoglossal nerve anastomosis,1 patient received facial-masseter nerve anastomosis,and the other 36 patients did not receive facial nerve treatment.Spearman correlation test showed that the etiology classification,history of middle ear operation,history and course of facial paralysis,preoperative facial nerve function,degree of facial nerve damage,and the involvement of adjacent anatomic structures(cochlea,petrous apex,internal auditory canal,internal carotid artery,sigmoid sinus and occipital bone)were correlated with postoperative facial nerve function.According to statistics,7 of the 69 patients with petrous bone cholesteatoma treated by surgery relapsed 2～8 years after surgery,with a recurrence rate of 10.1%.The results of multivariate Cox regression analysis showed that surgery without endoscopic assistance was an independent risk factor for the recurrence of petrous bone cholesteatoma.Conclusion:Petrous bone cholesteatoma is a relatively rare disease,and the most effective treatment is surgical operation.Surgical treatment should give priority to the complete removal of cholesteatoma lesions,followed by the preservation of facial nerve function and auditory function.Facial palsy is one of the most serious comorbidities and surgical complications of petrous bone cholesteatoma.Patients with facial nerve paralysis should adopt appropriate surgical methods for facial nerve repair and functional reconstruction.There are many factors affecting the prognosis of facial nerve.The etiology classification is related to the prognosis of facial nerve.Patients with acquired petrous bone cholesteatoma have better facial nerve prognosis than patients with congenital petrous bone cholesteatoma.The previous history of middle ear surgery can also affect the prognosis of the facial nerve.Patients with a history of middle ear surgery have a poor prognosis of the facial nerve.The course of facial paralysis and facial nerve function are important factors affecting the prognosis of facial nerve.The shorter the time of preoperative facial paralysis and the less degree of facial paralysis,the better the prognosis of facial nerve.The degree of facial nerve damage is also correlated with the prognosis of facial nerve.Facial nerve function recovered better in patients with swollen and exposed facial nerve than in patients with thinner and interrupted facial nerve.Petrous bone cholesteatoma has a certain recurrence rate,which should be followed up for a long time after surgery.The absence of endoscopic assistance in surgery is an independent risk factor for postoperative recurrence of petrous bone cholesteatoma,and endoscopic assistance technology can reduce the risk of recurrence.