威利坦缓释片在孕妇急性贝尔面瘫中的应用

目的 孕妇面瘫是临床棘手的难题,由于患者处于特殊生理阶段,用药选择时需考虑胎儿的安全.本研究的目的旨在寻找一个能在孕期使用的有效治疗面瘫的药物.方法 对2007年3月至2010年6月我院接诊的孕妇急性贝尔面瘫患者,给予威利坦缓释片每次800 mg、每日2次口服治疗,能坚持服药10天者共计21人,治疗前后用Sunnybrook评分系统进行评分,对疗效和不良反应进行记录和统计分析.结果 本组威利坦缓释片面瘫治愈率达76.2％,另有5人疗效较差,仅有1例出现胃肠道不良反应.结论 孕妇急性贝尔面瘫患者使用威利坦缓释片治疗10天是安全有效的,可以作为一种新的保守治疗方法.     

贝尔麻痹的发病诱因调查

目的调查贝尔麻痹发病的诱因,对防治该病提供理论基础。方法2005年2～5月对在我科就诊的262例贝尔麻痹患者采用问卷形式进行了一项可能性诱因的回顾性调查。结果262例患者发病时平均年龄39±17岁。患者男女比率和左右侧患病比率都为48%比52%。48名患者否认发病前存在问卷所列诱因,其余214例存在问卷表中诱因,占患者总数的81.7%。其中发病前有明确受凉史139例,占53.5%;过度疲劳者59例,占22.5%;上感49例,占18.7%;前次发病史(复发)31例,占11.8%;心理压力30例,占11.5%;有明确家族史20例,占7.6%;妊娠4例,占1.5%;患侧牙龈感染4例占1.5%。结论贝尔麻痹可能是一组面瘫疾病,大部分患者存在可能性诱因,进一步的研究有可能对贝尔氏麻痹的命名、诊断及治疗产生细分作用。对受凉、疲劳等可能性诱因的预防和处理有可能减少贝尔麻痹的发生。     

外伤性面瘫的手术治疗

为探讨外伤性面瘫适当的处理方法，回顾了２７例经手术治疗的外伤性面瘫。成人手术采用局部麻醉，经乳突、上鼓室进路。术后随访半年～２年，平均１．７年。术中发现４例有２处以上损伤。损伤部位见于面神经水平段１１例次、膝状神经节周围及迷路段９例次、垂直段８例次。面瘫完全恢复２０例，Ⅱ级恢复２例，Ⅲ级恢复５例。就手术治疗适应证及进路进行了讨论，认为经乳突上鼓室进路可暴露膝状神经节及迷路段远端，对大多数病例已足够，其损伤较小，易为患者接受，但此进路不能暴露面神经出颅部，故少数病例仍需经颅中窝进路减压。     

双侧同时发生的面神经麻痹:病例报告与文献复习

急性单侧周围性面神经麻痹是耳鼻咽喉科常见的临床疾病,其年发生率10万人中约为15～30人。然而,双侧同时发生面神经麻痹(bilateral simultaneous facial palsy,BSFP)则极其少见。文献报道同时发生的BSFP约占周围性面瘫患者的0．3%～2%,与单侧面瘫病因学分类不同之处在于BSFP很少归因于特发性或Bell面瘫,BSFP病因明确甚为困难,并且常表现有严重原发疾病。本文报告1例BSFP,并分析讨论引起BSFP最常见的病因。     

外伤性面瘫的手术治疗

为探讨外伤性面瘫适当的处理方法，回顾了２７例经手术治疗的外伤性面瘫，成人手术采用局部麻醉，经乳突、上鼓室进路。术后随访半年￣２，平均１．７年，术中发现４例有２处以上损伤，损伤部位见于面神经水平段１１例次，膝状神经节周围衣迷路段９例次、垂直段８例次。面瘫完全恢复２０例，Ⅱ级２例，Ⅲ级恢复５例，就手术治疗适应证及进路进行了讨论，认为经乳突上鼓室进路可暴露膝状神经节及迷路段远端，对大多数病例已足够，其损     

贝尔面瘫治疗进展

贝尔面瘫是一种常见的神经系统疾病,其特点是由不明原因引起的急性单侧周围性面神经麻痹。患者可出现病侧眼睑闭合不全,皱额、蹙眉均不能或不全,口角下垂,鼓腮漏气,耳周疼痛,味觉异常,听觉过敏,泪液减少等。近年来,关于贝尔面瘫治疗方法研究颇多,临床上较常使用的有药物、手术、针灸、物理疗法及眼部护理等治疗手段。     

老年面瘫的特点

老年面瘫组63例,年轻面瘫组72例,均用激素、维生素B族、三磷酸腺苷、改善微循环等药物治疗.老年组临床治愈43例,占68.3%,平均用128d,年轻组治愈65例,占96.3%,平均用66d,两组差异有高度显著性(P＜0.01).老年面瘫面神经具有易受伤性和难恢复性的特点,这与老年人对病毒感染的免疫功能低下有关,提示应适当加大治疗药物的剂量和延长治疗时间.     

面神经减压术治疗周围性面瘫的临床分析

目的：探讨面神经减压术治疗周围性面瘫的效果和时机。方法：周围性面瘫患者57例,分别在2个月以内和2个月以后行面神经减压术,采用组间χ^2。检验进行疗效对比。结果：2个月以内组治愈率显著高于2个月以上组（P〈0．05）。结论：面神经减压术是治疗周围性面瘫的有效手段,早期行面神经减压术可明显提高治愈率。     

面瘫后口眼联带运动的肌电图研究及临床意义

目的探讨面瘫后口眼联带运动的电生理实质。方法对41例已有临床口眼联动现象的周围性面瘫患者做了肌电图检查,同心针电极放置在降口角肌内记录,嘱患者做眨眼和闭目动作,观察降口角肌肌电信号的变化,健、患侧对比分析,探讨联动现象的电生理实质。结果在做眨眼或闭目运动时,所有患者患侧降口角肌内均能记录到异常的联动电位,呈两种特征,闭目时为一种连续的、波幅较低的随意动作电位样的冲动,眨眼时表现为一种与眼睑运动同步的持续(30～350)毫秒的多相电位。在做健侧降口角肌检查时,发现8例患者肌电图异常,其中健侧有周围性面瘫病史的2例引出了异常联动电信号,另有6例引出了纤颤电位,这6例曾经历过健侧面部的针灸或小针刀治疗,其余健侧肌电图正常的33例健侧面部均无疾病、手术或有创治疗史。结论①面瘫后口眼联带运动的病理生理基础是神经错向再生,本应支配眼轮匝肌的面神经纤维与支配降口角肌的神经纤维产生了联系。②面部针灸、小针刀有可能损伤颅外段面神经分支或末梢。     

Slowly progressive facial paralysis: Intraneural squamous cell carcinoma of unknown primary

Background

In this report, we present a unique case of intraneural squamous cell carcinoma of unknown primary found within the facial nerve and the proposed algorithms for diagnosis and management of progressive idiopathic facial paralysis.

Iatrogenic facial nerve exposure in cochlear implant surgery: incidence and clinical significance in the absence of intra-operative nerve monitoring

Objectives: Iatrogenic facial nerve injury is one of the most feared complications of cochlear implantation. Intraoperative facial nerve monitoring is used as an adjunctive modality in a variety of neurotologic surgeries including cochlear implantation. With the lack of nerve monitoring, there is a theoretically higher risk of iatrogenic fallopian canal dehiscence with facial nerve exposure, particularly the mastoid portion, during cochlear implant surgery. The purpose of this study is to determine the incidence of iatrogenic exposure of the facial nerve and its relation to the incidence of post-operative facial paralysis in the absence of facial nerve monitoring.

Methods: This was a retrospective study. Medical charts of 307 patients who underwent cochlear implantation without facial nerve monitoring, from 2012 to 2017 were reviewed to identify cases with a reported iatrogenic defect over the mastoid facial nerve. The incidence of post-operative facial palsy was determined and compared to the incidence with the use of intra-operative monitoring which has been reported in the literature.

Results: The incidence of iatrogenic dehiscence with facial nerve exposure was 46.58%. However, the incidence of post-operative facial palsy was only 2.1% which decreased to 0.72% in cases without injury of the facial neural sheath. This was not significantly different from the 0.73% rate reported in the literature with the use of intra-operative facial monitoring (P?=?0.99).

Conclusion: The incidence of iatrogenic facial nerve exposure during cochlear implantation may be relatively high. However, no additional risk of post-operative facial nerve paralysis was found, provided that the integrity of the neural sheath was preserved, even with the lack of intra-operative monitoring.     

激光散斑血流成像技术在周围性面瘫中的应用

周围性面瘫是临床常见疾病,面神经功能异常导致其所支配的面部表情肌逐渐萎缩,但是否存在面部微循环功能改变尚无明确说法。激光散斑血流成像技术以其无创性、适应范围广、操作简单、实时监测等优点在浅表组织微循环血流灌注的动态监测方面有着明显优势。应用激光散斑血流成像技术检测周围性面瘫患者面部血流灌注情况对于阐明面瘫患者微循环改变的评估标准、发病机制以及微循环状态对面神经功能恢复的影响等方面均有重要意义。     

Bell麻痹的面神经减压疗效评价

目的 评价面神经减压术对Bell麻痹的治疗效果.方法 通过PubMed和《中国医院知识仓库》总库(简称CHKD总库)检索面神经减压治疗完全性Bell面瘫的中、英文文献,收集文中报道的病例,制定统一的准入标准,对入选病例进行统计学分析.参考激素治疗Bell面瘫的效果,评价不同的手术方法及手术时机对治疗效果的影响.结果 通过检索共有5篇文献所报道病例符合入选标准,其中手术治疗例数147例,总治愈率57.10%;激素治疗例数105例,总治愈率为48.90%.发病14天以内全程减压的手术治愈率高达90.70%,而15～30 天之间为25.00%;发病15～30 天之间面神经乳突段减压的治愈率为45.70%,全程减压治愈率为25.00%.结论 面神经减压应在发病后14天以内进行,14天以后手术治疗不能增加疗效;目前没有证据表明面神经全程减压效果优于乳突段及鼓室段面神经减压.     

面神经减压术对颞骨骨折面瘫的治疗

目的评价颞骨骨折面瘫面神经减压术的临床疗效及相关问题。 方法回顾性总结并分析颞骨骨折伤及膝状神经节面瘫病人的临床资料。16例面瘫13～96日后经中颅窝一乳突联合进路及乳突迷路外径路面神经减压术。面神经功能恢复评定标准按House-Brackmann(H-B)分级法。结果手术后临床随访6～1 8月,面神经功能均有不同程度的恢复,面瘫2月内手术恢复满意或较满意均达H-B Ⅱ级以上占70％(11/16);面瘫3月后手术的5例病人获得一定好转效果。结论面神经全程减压术有效治疗颞骨骨折引起的面瘫;伤后2月内手术为较佳时机。     

中耳乳突术后迟发性面瘫

目的探讨中耳乳突手术后迟发性面瘫的产生原因、治疗措施及结果。方法回顾2000~2004年发生的4例中耳乳突术后迟发性面瘫病例,均采用保守治疗,并行面神经肌电图检测,面神经功能评估采用HouseBrackmann分级法。结果4例迟发性面瘫均发生于术后5~10天,面瘫程度为Ⅲ~Ⅴ级,采用药物治疗,辅以局部理疗。3例痊愈,面神经功能恢复至Ⅰ级;1例好转,面神经功能恢复至Ⅱ级。结论中耳乳突术后一周左右发生的迟发性面瘫为非神经直接损伤所致,属于神经失用,保守治疗有效。     

Otogenic facial paralysis

Summary The histopathological changes of the facial canal and nerve in facial paralysis due to chronic suppurative otitis madia are described in six temporal bones. Bony destruction of the facial canal was found in its tympanic segment and in its upper mastoid part in all cases, but it was particularly notable in the labyrinthine segment as well. The pathological process, cholesteatoma or granulation tissue surrounding the exposed facial nerve was inflamed in all cases. The affected facial nerve showed degenerative and inflammatory changes throughout its tympanic segment in all cases, but its mastoid segment appeared to be relatively normal. Our findings suggest that facial paralysis occurs us chronic suppurative otitis when the inflammatory process specifically involves the facial nerve trunk.