耳性顔面神經麻痺に對する顔面—舌下神經吻合術の1例

　耳手術中に惹起された顔面神經麻痺は，大なる損傷でない限り，神經纖維の再生力が旺盛な爲，自然恢復する事が多いとはいえ，頑固な場合には患者，並びに醫師の，大なる苦痛の種となる場合も，間々見聞する所である。而して，我が耳鼻咽喉科領域では，顔面神經麻痺に對する療法としては，藥物療法と理學的療法とが主として用いられ手術的療法の成績を發表した報告は，未だきわめて少ない現状である。

　我々は，最近，慢性中耳炎患者の手術時に，かなり廣範圍にわたり，顔面神經纖維を損傷してしまつた症例に接し，その再生による自然恢復は期待できないと思われたので，顔面-舌下神經吻合術を施行した所，術後1年半の現在，かなり麻痺状態の恢復を見たので，その手術々式，經過等を報告し，諸家の御批判を乞う次第である。

　IHO performed a nerve anastomosis for treatment of facial nerve palsy the result of 7th nerve injury during mastoidectomy in a boy aged 7. At present, one year and a half after the operation which was an anastomosis of hypoglossal on to the facial, voluntary movements of the facial muscles excepting the frontals are well recovered. The author notes from experiences gained from tnis case the following crucial points in the event of suchall undertaking: (1) Manipulation of nerves should be done with utmost care. (2) It is advantageous for the surgeon to have on hand a few optical instruments. (3) Nerves in anastomosis should never be under strain or tension. (4) The head region should be kept at rest for a considerable period after the operation. (5) But, facial muscles should be stimulated passively by galvanic currents or other means in order to prevent muscular atrophy. (6) A great deal of patience is required on the part of the patient as well as the Doctor for signs of recovery are indefinite until the period of 6 months is spent.

　The author stresses that in cases of this natnre the surgeon shuld not be satisfied with symptomatic treatments alone but, proceed to operative measures before the period of occurrence of muscular atrophy.