瞬目反射正常值及初步临床应用

目的 了解健康成人瞬目反射正常值及其临床应用价值。方法 采用Ｅｖｏｌｕｔｉｏｎ型神经肌肉记录仪检测，表面电极直接刺激眶上神经，诱发瞬目反射。在同侧眼轮匝肌记录出短潜伏期波和双侧眼轮匝肌记录出长潜伏期波。对２０名（４０例）健康人和３０例患者（其中包括三叉神经疾病，面神经疾病及听神经瘤）进行瞬目反射测试。结果 ＢＲ潜伏期健康成人平均值Ｒ１为１０．０ｍｓ，Ｒ２和Ｒ２‘为３０．４ｍｓ和３０．７ｍｓ，患者组     

Bell麻痹诊断与治疗时机的研讨

目的探讨Bell麻痹的最佳治疗决策.方法根据瞬目反射(Blink reflex,BR)和面神经电图(Elec-troneurography,ENoG)测试结果的关系,对36例Bell麻痹患者进行定位诊断,并对面肌功能进行评分.结果定位诊断病变在D段、评分在11分以下、BR和ENoG测试显示面肌功能差的患者,保守治疗效果亦差,而行面神经减压术后可望提高疗效.结论在临床上定位诊断病变在D段以下,面肌功能评分在11分以上,发病后一个月内BR测试R1波存在,ENoG测试面肌纤维损失＜90%的患者,保守治疗可完全恢复.反之,效果就差,对保守治疗无效者,必须行面神经减压术.     

30例Bell面瘫患者镫骨肌反射的临床观察

近年,我们对青海高原海拔2261米的西宁地区30例单侧Bell面瘫病人,应用ZO-174型Medsen声导抗仪进行了发病初期与恢复期的对比观察,并以20例正常人进行对照,借以探讨Bell面瘫患者的镫骨肌反射的变化与面瘫恢复的关系。报告如下。     

面神经断伤吻合后功能恢复变化的实验研究

目的:观察大鼠面部行为、功能学的恢复变化,为面神经损伤修复研究提供可靠的实验性功能评估手段.方法:建立大鼠面神经断伤吻合模型,术后每周观察触须拂动与瞬目等面部运动,记录健患两侧面神经电图(ENoG)与瞬目反射(BR)的变化.结果:术后患侧触须拂动与瞬目动作消失,但立即出现细微的触须颤抖,术后1个月左右面部运动开始恢复,2个月时可出现瞬目动作同时耳周肌肉的联带运动.ENoG检测时,术后患侧复合肌动作电位(M波)仍可引出,21 d时其潜伏期值开始延长,1个月时达高峰并开始恢复,3、4个月时基本稳定但仍不能恢复至健侧水平,其中28～63 d时健患两侧潜伏期值的变化与其他各时间点相比差异均有统计学意义(均P＜0.05).健患两侧M波振幅与刺激强度值变化无明显规律,潜伏期、振幅与刺激强度三值间也无相关性.BR检测时,患侧R1波在术后7、14 d消失,1个月后恢复检出,2个月左右可在同侧口轮匝肌处记录到提示联带的R1样肌电反射波(R1ons),此后两者潜伏期值均减低,而且2个月时的R1ons潜伏期值均长于此后各时点值(P＜0.05).结论:ENoG和BR检测方法客观可靠,可用以反映大鼠面瘫模型的面部行为、功能学恢复变化,进一步完善后有助于面神经损伤修复机制的相关研究.     

正常人瞬目反射的测试与分析

目的:研究正常人瞬目反射(BR)的影响因素并探讨其在耳鼻咽喉科临床应用价值。方法:采用Medtronic Keypoint神经电生理仪,检测60例正常人瞬目反射的各项指标。结果:正常人瞬目反射的各波潜伏期分别为R1(10.27±0.91)ms、R2(28.79±4.08)ms、R2′(29.06±4.35)ms;R1、R2、R2′波各自潜伏期侧别差异无统计学意义(P>0.05);男性受试者R1波潜伏期较女性延长(P<0.05),男性R2和R2'波潜伏期均较女性显著延长(P<0.01);男性R1波潜伏期与受试者年龄呈正相关(P<0.05),R2和R2'波潜伏期与受试者年龄无相关关系(P>0.05);女性BR各波潜伏期与受试者年龄均无相关关系(均P>0.05)。结论:瞬目反射各波的潜伏期可受年龄、性别等因素的影响,临床应用时有必要建立不同人群的正常参考值。     

瞬目反射正常值及初步临床应用

目的了解健康成人瞬目反射正常值及其临床应用价值。方法采用Ｅｖｏｌｕｔｉｏｎ型神经肌肉记录仪检测，表面电极直接刺激眶上神经，诱发瞬目反射（ｂｌｉｎｋｒｅｆｌｅｘ，ＢＲ）。在同侧眼轮匝肌记录出短潜伏期波（Ｒ１）和双侧眼轮匝肌记录出长潜伏期波（Ｒ２，Ｒ２’）。对２０名（４０侧）健康人和３０例患者（其中包括三叉神经疾病，面神经疾病及听神经瘤）进行瞬目反射测试。结果ＢＲ潜伏期健康成人平均值Ｒ１为１０．１ｍｓ，Ｒ２和Ｒ２’为３０．４ｍｓ和３０．７ｍｓ。患者组患侧ＢＲ各波潜伏期延长，与健侧和健康人相比较，经ｔ检验，Ｐ＜０．０１，差异有极显著性。结论测试结果表明该技术简单、可靠，对三叉神经、面神经疾病和听神经瘤的早期诊断能提供有价值的电生理测试结果。     

Bell's palsy and stapedial reflex

In Bell's palsy the stapedial reflex may be affected or not. The object of this paper was to study the evolution of the stapedial reflex and its latency pattern during the first weeks of paralysis and to correlate these parameters with the evolution of the disease. One hundred and thirty-three patients with Bell's palsy were evaluated, and the patients could be divided into 3 groups. Group 1 was composed of subjects in whom the stapedial reflex was present in the first week of paralysis and complete recovery of facial function occurred in 30–60 days. In group 2 the stapedial reflex reappeared between the eighth and thirty-fifth days post-onset and facial function recovered within 150 days. In group 3, the stapedial reflex reappeared between the thirty-sixth and seventieth day and some paralysis was still present after 1 year. These results suggest that the reflex is important for prognostic purposes.     

Acoustic neuroma surgery and delayed facial palsy

Delayed onset of facial palsy is possibly an underestimated but distressing complication of acoustic neuroma surgery. The incidence of this complication reported in the literature has varied from 11.7 to 41%.This study reviewed retrospectively 60 primary acoustic neuroma surgeries performed by a single neurotologist. The deelayed onset of facial dysfunction was defined according to the guidelines described by of Lalwani Butt, Jackler, Pitts and Jingling in 1995. They considered either a deterioration of facial function from normal to abnormal or an increased severity of the degree of facial paralysis, which was grouped using the House-Brackmann scale system. Fifteen of the 60 patients (25%) were found to have a deterioration of facial function. The incidence of delayed facial palsy was not influenced by age, sex or tumor size. The majority of the patients had a favorable prognosis. Only three patients had a grade III–IV facial function at 1 year. It is possible that these latter cases might have benefited from intraoperative meatal facial nerve decompression, as advocated by Sargent, Kartush and Graham. Received: 27 August 1997 / Accepted: 31 October 1997     

Analysis of fifty cases of facial palsy due to otitis media

Summary Fifty cases of facial palsy (FP) due to otitis media treated in our hospital during the 10-year period from 1972 to 1981 were analyzed. The averaged percentage of this incidence was 3.1% of all the FP occurring. FP due to otitis media acuta (OMA) was frequently seen in infants. FP due to otitis media chronica (OMC) tended to occur in combination with cholesteatoma or acute exacerbations of infection. Paralyses were generally mild and bacteria from the otorrhea were similar to those of OMC without FP. When present, sites of dehiscence of the facial canal were most frequently seen in its horizontal portion. Electromyographically, the posterior (mastoid) side of the horizontal portion of the facial nerve bundle seemed to be related to the branch to the orbicularis oculi muscle, while the anterior (stapes) side was directed to the orbicularis oris muscle.     

Bell's palsy and its recurrences

Summary The purpose of this study was to evaluate the incidence and the prognosis of patients with recurrences of Bell's palsy. Yanagihara's classification of recurrent palsies was used, and all palsies were separated into five different types. A total of 304 patients with Bell's palsy were examined. The recurrent ipsilateral attacks (i.e., the unilateral recurrent palsies) showed a worse prognosis when compared with the non-recurrent palsies. In contrast, the recurrent attacks involving the contralateral facial nerve (bilateral alternating palsies) presented a better facial recovery. In reviewing the recurrent cases, the stapedial reflex demonstrated no prognostic value. Our results suggest that in presenting data of Bell's palsy it is advisable to differentiate the recurrences from the common (non-recurrent) palsies.     

Electroneurography in the acute stage of facial palsy as a predictive factor for the development of facial synkinesis sequela

Objective

We investigated whether the value of ENoG is a predictive factor for the development of facial synkinesis in patients with facial palsy.