耳下腺手術における顔面神経の移植・再建 Surgical technique of nerve grafts for facial reanimation of a paralyzed face following parotid tumor surgery

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耳下腺腫瘍摘出後の顔面神経麻痺の再建は神経移植が主体となる.神経移植は神経の欠損が長く, 直接縫合できない症例に適応される.通常は眼輪, 頬部, 口輪を支配する2-3本の枝に移植し, 前頭枝と頸枝には移植しない.神経縫合は側頭骨外では神経上膜縫合を行う.神経の断端をマイクロ用のハサミで新鮮化し, 顕微鏡下に8-0または9-0のナイロン糸で縫合する.その際, 緑色のシリコンシートを縫合部に敷くと見やすくなる.縫合は最初に180度離れて2針掛け, 本幹では6針, 末梢枝では2-3針縫合する.神経縫合で最も重要なことは縫合部にかかる緊張であり, 緊張が強いと神経腫で再生軸索が途切れたり, 瘢痕が縫合部に入り込み, 神経再生が障害される.

In choosing a corrective procedure for patients with facial palsy following parotid tumor resection, nerve grafts are mainstays. They are used for defects in which a tensionless closure is not possible with primaty anastomosis. Two or three grafts are usually placed from the main trunk to peripheral nerve branches to the eye, cheek and lip, excluding the forehead and cervical branches. Epineural nerve repair is commonly employed for extratemporal grafting. After the nerve edges have been freshened with microscissors an epineural suture is performed under an operating microscope with 8-0 or 9-0 monofilament nylon. A green square of silicone sheeting is used beneath the nerve ends to improve visibility during suturing. For the first merhod, two sutures 180 degrees apart are used as traction sutures to rotate and expose in inferior border to the nerve. Usually, six sutures are used for the main trunk and fewer sutures for smaller peripheral nerve branches. The most critical factor affecting the final result is the degree of tension on the suture line. An increased tension contributes to wound separation, leading to both axon escape with neuroma formation and to fibrous ingrowth of scar tissue.

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  • 口腔・咽頭科 = Stomato-pharyngology

    口腔・咽頭科 = Stomato-pharyngology 13(2), 297-301, 2001-02-28

    日本口腔・咽頭科学会

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