单侧面神经切除后面部运动特征定量分析

目的应用面部三维动态定量分析系统(3-Dimensional Analysis System for Facial Motion,3D-ASFM)对面神经部分切除术后的患者进行测量,探讨修复与未修复患者面部静态和动态指标的变化。方法 14例面神经部分切除患者,分为神经修复组(9例)和未修复组(5例)。对所有患者进行半年以上跟踪随访,中位随访期13个月。所有患者术前及术后均进行面部运动主观评估(House-Brackmann分级和Sunnybrook评分)和面部三维动态测量。比较三种评估结果相关性。比较修复组与未修复组患者术前、术后各评估结果,对修复组患者各面部区域进行分析。结果 3D-ASFM分析结果分别与House-Brackmann分级(H-BGS)、Sunnybrook评分(SFGS)进行秩相关分析,相关系数分别为-0.707(P<0.05)和0.798(P<0.05)。面瘫越严重,3D-ASFM与主观评价系统的相关性越差。术后H-BGS、SFGS总分均存在统计学差异(P<0.05),修复组好于未修复组,3D-ASFM总分在两组间无统计学差异(P>0.05),但鼻旁运动好于未修复者。修复组患者术前、术后H-BGS、SFGS、3D-ASFM总分均无统计学差异(P>0.05)。所有患者健侧动态指标中,上面部运动较术前减小,下面部运动较术前增加。结论面部三维动态定量分析结果与传统主观评价系统有较好的相关性。神经修复对面中部运动影响最大。面神经切除手术不仅造成同侧面部运动改变,也会影响对侧面部运动。     

眼部运动时面部相关联点运动的三维定量分析

目的探索眼部运动时,面部相关联部位运动的特点,为评价周围性面瘫时面部联动提供参考。方法健康志愿者22人(45-60岁),利用自行设计的"基于运动捕捉的面部运动三维动态定量分析系统"记录并分析"用力抬眉""用力闭眼"两个表情动作中,面部相关标记点的运动,使用移动距离(Smax)及运动速率(Vmax)两个参数描述其运动。结果 1."用力抬眉"动作,眉弓点左9.75mm,24.11mm/s,右10.14mm,25.87mm/s;除眼周标记点外,余标记点均有运动,移动距离为3.65mm至4.46mm,鼻唇沟点的运动速率明显大于其他标记点,左60.60mm/s,右62.70mm/s。口角点、鼻唇沟点运动距离、速率与眉弓点对应参数间线性相关关系强。2."用力闭眼"动作,上眼睑点移动距离和速率最大,左10.56mm,87.68mm/s,右10.54mm,81.83mm/s。除眼周标记点外,余标记点均有运动,移动距离1.58mm至1.92mm,运动速率分布于11.40-14.76mm/s。口角点、鼻唇沟点运动距离、速率与上眼睑点相关参数线性相关关系差。结论健康人进行眼部主动运动时,会引起面部其他标记点发生运动,其获得最大距离、最大速率的时间一致,用力闭眼动作中运动幅度最大的点在口角点,用力抬眉动作速率最大点在鼻唇沟点,运动距离最大的点在下唇中点。     

口部运动时面部相关联标记点运动的三维定量分析

目的定量描述口部运动时,与其相关联的面部标记点运动,以探索评价面瘫、面肌联带运动的三维定量新方法。方法健康志愿者22人(45-60岁),利用"基于运动捕捉的面肌运动三维动态分析系统",采集"用力示齿"、"向右上拉口角"、"向左上拉口角"、"微笑"四个表情动作时,面部相关联标记点(眉弓点、上下眼睑点、内眦点、外眦点)的运动,以最大移动距离(Smax)和最大速率(Vmax)两个参数描述。结果 1.口周运动为主的表情动作中,面部其他部位标记点均有运动,且与位于口周的标记点在某一表情运动中其达到Smax或Vmax的时间分别是一致的。2."用力示齿"动作:Smax下眼睑点(左3.93mm,右4.15mm)>外眦点>上眼睑点>眉弓点>内眦点(左1.59mm,右1.53mm);Vmax眼睑点左上(42.643mm/s)>余眼睑标记点(31.58mm/s-37.62mm/s)>外眦点>眉弓点>内眦点(左11.71mm/s,右11.09mm/s)。3."微笑"动作:Smax及Vmax上眼睑点(左3.05mm,36.14mm/s;右2.53mm,28.90mm/s)>下眼睑点>外眦点>眉弓点>内眦点(左0.69mm,7.22mm/s;右0.77mm,7.80mm/s)。4."向右上拉口角"动作,Smax及Vmax外眦点及下眼睑点右侧明显大于左侧,内眦点右侧略大于左侧,上眼睑点、眉弓点左侧略大于右侧。5."向左上拉口角"Smax及Vmax外眦点、上眼睑点、下眼睑点左侧明显大于右侧,余标记点左侧略大于右侧。结论健康人进行口部运动时,会引起面部其他部位标记点发生相关联的运动,其达到Smax或Vmax的时间分别是一致的。在同一表情动作中,上、下眼睑点及外眦点的Smax、Vmax大于内眦点、眉弓点。Smax及Vmax的较小值出现于"微笑"动作内眦点;较大值出现于"用力示齿"动作下眼睑点。"向左上拉口角"动作同侧面部标记点Smax及Vmax均大于对侧相对称部位标记点。表情动作时面部无静止点。     

联带运动发生机制的研究进展

外伤、手术、炎症或肿瘤等因素均可使面神经损伤而致面神经麻痹，在其再生修复过程中，除可发生半面痉挛、睑痉挛、鳄鱼泪等后遗症外，严重损伤还可导致面肌联带运动的发生。研究发现，它的发生机制除易接受的杂乱再生假说外，中枢控制改变和假突触传递等假说也可能发挥作用，本对其发生机制的研究情况作一综述。     

手术治疗面神经瘫痪病人27例

目的；探讨影响面神经瘫痪手术治疗效果的因素。方法：对２７例手术后病例进行疗效分析。结果：年龄小，手术早，进路合理，损伤轻及位置低的病例疗效满意；２１例术后疗效达Ｈｏｕｓｅ Ⅰ￣Ⅱ级（２１／２７），余６例为≥Ⅲ级，结论：认为根据不同病因及损伤范围选择合适的径路，充分探量，避免遗漏，是提高疗效的关键。     

手术治疗周围性面瘫51例

目的：探讨周围性面瘫的治疗方法及影响其疗效的因素。方法：回顾性分析51例面神经麻痹患者住院治疗的临床资料。结果：随访42例。36例行面神经减压术,22例恢复至H—BⅠ～Ⅱ级;4例行面神经吻合术,2例恢复至Ⅰ～Ⅱ级,2例面神经移植术,均恢复至〉Ⅲ级。病程3个月以内与3个月以上组手术的疗效差异有统计学意义（P〈0．05）。结论：及时精确地施行手术是治疗周围性面瘫的有效方法。     

全段神经减压：避免并发症的技术

暴露从脑干到腮腺之间的面神经可以不损伤神经、鼓膜、外耳道、听骨链、内耳或不脑桥 的结构。该技术在治疗由Ｂｅｌ面瘫、耳状效益有、感染、半在痉挛、颞骨骨折和肿瘤引 面神经麻痹中的获得好好的结果。本主要介绍乳突、中颅凹和迷路后联合进路暴露面神经的技术。     

面部运动录像分析法

目的　研究一种新的、客观评价面神经运动功能的方法即面部运动录像分析法(videomimicography ,VMG)。方法　受试者面部作 11个标记点 ,进行 5种面部运动 (皱额、闭眼、皱鼻、吹哨和微笑 ) ,使用数字式录像机进行录像。每个动作要求用最大的收缩强度重复 3次。选取 3个静息状态画面和 15个最大运动画面 (每个运动选 3个 ) ,在软件控制下输入计算机 ,进行图形测量。分析每一个运动时每侧面部 10个距离指标和 5个面积指标的变化。首先分析 10例健康人 ,找出每一运动的最佳评价指标。从这些最佳指标加权计算出一个综合指数。分析 4 8例面瘫患者 ,研究该综合指数与面瘫的House Brackmann分级的相关性。结果　正常组结果显示 :面积指标优于距离指标。每一运动有相应的最佳评价指标。面瘫患者组 :根据正常组得出的最佳指标加权计算得出VMG值 ,根据瘫痪侧的VMG值占健侧VMG值的百分率计算出VMG指数。VMG指数与面瘫的House Brackmann级数呈很好的线性相关 (r=- 0 92 8) ,并具有统计学意义 (P <0 0 0 1)。该实验在健康对照组和面瘫患者组均具有很好的重复性。结论　本方法具有客观、定量、重复性好和简便、易行的优点 ,对临床评价面神经运动功能具有实际意义。     

不伴面神经麻痹的面神经鞘瘤一例

面神经鞘瘤临床少见,面神经功能障碍是其最常见的临床症状,2005年1月我们收治1例不伴面神经麻痹的面神经鞘瘤,报道如下.     

Three-dimensional quantification of "still" points during normal facial movement

This study investigated the 3-dimensional displacement of points on the face that were thought to be still during facial movement. These points are currently used to measure displacement of moving facial regions during assessment of normal facial movement and treatment interventions following facial nerve paralysis. It is, however, unknown if these places are "still" points. The Expert Vision Motion Analysis System was used to collect and analyze data on 42 normal subjects during facial movement. No point on the face was found to be still during facial expression. However, several points were present with very small movements for each individual expression. These were termed "reference" points. These small movements may be the result of system noise, physiological tremor, skin movement, or head-holder movement during facial expressions. Future studies of the displacement of the markers during facial movement in both normal subjects and patients with facial nerve paralysis may take into account the contribution of the "reference" point displacements to the overall facial movement.     

Facial nerve paralysis following cochlear implant surgery

OBJECTIVES: Facial nerve paralysis is a rare but devastating complication of cochlear implant surgery. The aims of the study were to define the incidence of facial nerve paralysis in our series and understand possible mechanisms of injury. STUDY DESIGN: Retrospective chart review and case reports. METHODS: Charts were reviewed of all 705 patients implanted between 1980 and 2002 at the authors' institutions to identify those with postoperative facial nerve weakness and determine incidence. For patients with facial nerve weakness, onset, degree, and timing of paralysis were noted; clinical findings were correlated to operative report findings. The method of treatment was noted, and the final facial nerve function outcome was recorded. RESULTS: Five patients (one child and four adults) were found to have postoperative facial nerve weakness, for an incidence of 0.71%. This complication was delayed in all cases, ranging from 18 hours to 19 days postoperatively. All patients were treated with steroids or steroids combined with antiviral medication, and all ultimately recovered normal facial function. CONCLUSIONS: In the study series, the incidence of facial nerve paralysis following cochlear implant surgery was 0.71%. Possible mechanisms of injury included heating injury and viral reactivation. All patients presented with a delayed facial nerve paralysis and did recover normal facial nerve function.     

Postparotidectomy facial nerve paralysis: possible etiologic factors and results with routine facial nerve monitoring.

OBJECTIVE: Analyze the incidence and factors responsible for postparotidectomy facial nerve paralysis when the surgery is performed with the routine use of facial nerve monitoring. STUDY DESIGN: A prospective, nonrandomized study. METHODS: Seventy consecutive patients underwent parotidectomy with intraoperative facial nerve monitoring. Two devices were used: a custom mechanical transducer and a commercial electromyograph-based apparatus. All patients were analyzed, including those with cancer and those with deliberate or accidental sectioning of facial nerve branches. The outcome variables were the motor facial nerve function according to the House-Brackmann grading scale (HB) at 1 week (temporary paralysis) and 6 to 12 months (definitive paralysis). Facial nerve grading was performed blindly from reviewing videotapes. RESULTS: The overall incidence of facial paralysis (HB>1) was 27% for temporary and 4% for permanent deficits. Most of the deficits were partial, most often concerning the marginal mandibular branch. Temporary deficits with HB scores of greater than 2 were only present in patients with parotid cancer or infection. Permanent deficits were present in three patients, including one patient with facial nerve sacrifice. Factors significantly associated with an increased incidence of temporary facial paralysis include the extent of parotidectomy, the intraoperative sectioning of facial nerve branches, the histopathology and the size of the lesion, and the duration of the operation. CONCLUSIONS: Despite a stringent accounting of postoperative facial nerve deficits, these data compare favorably to the literature with or without the use of monitoring. An overall incidence of 27% for temporary facial paralysis and 4% for permanent facial paralysis was found. Although the lack of a control group precludes definitive conclusions on the role of electromyograph-based facial nerve monitoring in routine parotidectomy, the authors found its use very helpful.     

Can the Jankovic-assessment be used as an alternative to electromyography? A cross-sectional study on facial dystonia patients treated with Botulinum toxin

PurposeThis study aims to quantitatively compare the Jankovic assessment (JA) with electromyography (EMG)-based measures for assessing changes in facial movements in patients with facial dystonia.Materials and methodsThirteen patients (five males and eight females) affected with different forms of facial dystonia (hemifacial spasm and synkinesis) participated in this study. All patients were treated with Botulinum Toxin (BTX) and evaluated with the JA scale and EMG-based measures, including motor unit potentials (MUP) latency and presence of polyphasic potentials before and after BTX injection. Correlation between the JA scores and the EMG-based measures was calculated. Statistical analysis was performed with the Pearson test.ResultsCorrelation between the JA scores and the EMG-based measures was found to be statistically significant, both before and after treatment with BTX.Conclusion and relevanceJA scores significantly correlated with more objective EMG-based measures, suggesting that the JA scale can be used to assess facial movement changes, for example elicited by a treatment such as BTX injection. Thus, in facial dystonia patients, the JA scale may be used for evaluating treatment outcomes as a valid and low-cost alternative to EMG.     

Corticosteroid Treatment for Idiopathic Facial Nerve Paralysis: A Meta‐analysis

Objective A meta‐analysis was designed to evaluate facial recovery in patients with complete idiopathic facial nerve paralysis (IFNP) by comparing outcomes of those treated with corticosteroid therapy with outcomes of those treated with placebo or no treatment. Study Design Meta‐analysis of prospective trials evaluating corticosteroid therapy for idiopathic facial nerve paralysis. Methods A protocol was followed outlining methods for trial selection, data extraction, and statistical analysis. A MEDLINE search of the English language literature was performed to identify clinical trials evaluating steroid treatment of IFNP. Three independent observers used an eight‐point analysis to determine inclusion criteria. Data analysis was limited to individuals with clinically complete IFNP. The endpoints measured were clinically complete or incomplete facial motor recovery. Effect magnitude and significance were evaluated by calculating the rate difference and Fisher's Exact Test P value. Pooled analysis was performed with a random effects model. Results Forty‐seven trials were identified. Of those, 27 were prospective and 20 retrospective. Three prospective trials met the inclusion criteria. Tests of heterogeneity indicate the trial with the smallest sample size (RD = ?0.19; 95% CI, ?0.58–0.20), to be an outlier. It was excluded from the final analysis. Analyses of data from the remaining two studies indicate corticosteroid treatment improves complete facial motor recovery for individuals with complete IFNP. Rate difference demonstrates a 17% (99% CI, 0.01–0.32) improvement in clinically complete recovery for the treatment group based on the random effects model. Conclusions Corticosteroid treatment provides a clinically and statistically significant improvement in recovery of function in complete IFNP.     

Management of facial synkinesis with Clostridium botulinum toxin injection.

Associated movements after facial paralysis (synkinesis), due to unphysiological co-innervation of the facial muscles, often complicates the rehabilitation of patients following facial palsy. Clostridium botulinum toxin is a neurotoxin that interferes with the release of acetylcholine from motor nerve end plates, causing skeletal muscular paralysis. This paper concentrates on its clinical use in treating synkinesis affecting orbicularis oculi function and documents the results of treatment in 4 patients. Control of synkinesis, achieved in all 4 patients, was effective within a few days and lasted for 4-6 months. 2 patients developed transient diplopia and ptosis shortly after injection. However, no lasting complications or systemic side-effects were noted. All patients reported a significant improvement in their symptoms and reinjection at 7 months was carried out successfully.     

Surgical management of Bell's palsy.

OBJECTIVES: Incomplete return of facial motor function and synkinesis continue to be long-term sequelae in some patients with Bell's palsy. The aim of this report is to describe a prospective study in which a well-defined surgical decompression of the facial nerve was performed in a population of patients with Bell's palsy who exhibit the electrophysiologic features associated with poor outcomes. In addition, management issues related to Bell's palsy including herpes simplex virus typel etiology, the natural history, electrodiagnostic testing, and efficacy of surgical strategies are reviewed. STUDY DESIGN AND METHODS: A multicenter prospective clinical trial was designed utilizing electroneurography (ENOG) and voluntary electromyography (EMG) to identify patients with Bell's palsy who would most likely develop poor return of facial function, as suggested by Fisch and Esslen. Patients who displayed electrodiagnostic features of poor outcome, >90% degeneration on ENOG testing and no voluntary motor unit EMG potentials within 14 days of onset of total paralysis, were offered a surgical decompression of the facial nerve through a middle cranial fossa surgical exposure, including the tympanic segment, geniculate ganglion, labyrinthine segment, and meatal foramen. Control subjects were those who displayed similar electrodiagnostic features and time course. RESULTS: Subjects who did not reach 90% degeneration on ENOG within 14 days of paralysis all returned to House-Brackmann grade I (n = 48) or II (n = 6) at 7 months after onset of the paralysis. Control subjects self-selecting not to undergo surgical decompression when >90% degeneration on ENOG and no motor unit potentials on EMG were identified had a 58% chance of developing a poor outcome at 7 months after onset of paralysis (House-Brackmann grade III or IV [n = 19]). A group with similar ENOG and EMG findings undergoing middle fossa facial nerve decompression exhibited House-Brackmann grade I (n = 14) or II (n = 17) in 91% of the cases. An exact permutation test confirmed that the surgical group had a significantly higher proportion of patients with a good outcome (House-Brackmann grade I or II) (P = .0002). CONCLUSION: Electroneurography in combination with voluntary EMG successfully identified patients who will most likely return to normal from those who had a greater chance of long-term sequelae from Bell's palsy. Surgical decompression medial to the geniculate ganglion significantly improves the chances of normal or near-normal return of facial function in the group that has a high probability of a poor result. Surgical decompression must be performed within 2 weeks of onset of total paralysis for it to be effective.     

Quantitative assessment of facial palsy by Moiré topography]

It is essential to establish an objective and quantitative method for evaluating facial palsy and to measure the extent of paralysis in order to evaluate therapeutic efficacy, determine prognosis, select appropriate treatment and observe the process of recovery. This study utilized Moiré topography, which displays three-dimensional facial symmetry with high precision and is based on light interference theory, to determine the extent of facial palsy in 38 patients (20 men and 18 women) 5 months to 73 years of age. A stereoscopic lattice type Moiré camera (FM3013) was connected to a CCD camera and to the monitoring device for confirming Moiré stripes. Moiré photographs were taken with a thermal imager (FTI-200). The photos were visually and objectively evaluated on the basis of the Moiré pattern and were then input into a personal computer with a digitizer for data processing and analysis. To view the functions of facial nerve branches, five Moiré photographs were taken: at rest, wrinkling the forehead, closing the eyes lightly, blowing out the cheeks and grinning. Results indicated that the number of stripes and their polarization adequately reflected the function of individual facial nerve branches. Thus, a well-defined Moiré pattern could clarify the characteristics of the site and the degree of facial palsy and of recovery from paralysis. It is an analytical method that can be quickly applied and seems especially useful in infants and young children, in whom point-based assessment is difficult. It is possible to quantitatively evaluate facial palsy in terms of the Asymmetry Index (AI), which is 20-25% for severe paralysis, 12-19% for partial paralysis, and 5-10% for an essentially normal condition. However, the numerical value of the AI overlap in all three paralysis categories, indicating that quantitative assessment of paralysis would be difficult. Moiré topography is an excellent method of determining the extent of facial palsy, compensating for the short falls of examination-based assessment and permitting reproducible visual, objective, and quantitative evaluation.     

Electroneurography and other electric tests on prognostic assessment of Bell's palsy

Twenty-two patients with Bell's palsy who had complete unilateral facial paralysis were selected for this study. Electroneurography (ENoG), nerve excitability test (NET), maximal stimulation test and facial nerve latency test were done on each patient. The patients were examined within 21 days of onset of facial paralysis and evaluated at least six months after onset to determine the degree of recovery of facial motor function. ENoG was the most accurate test for prognostic assessment of Bell's palsy when it was performed within 3 weeks after onset. When the response loss of ENoG on the involved side was 90% or less of that on the normal side, 83.3% of the patients had complete recovery of facial function, however, when loss was more than 90%, there was 70% chance for incomplete recovery. NET is a relatively accurate test, perhaps, it should be recommended because it is inexpensive and easy to manipulate.