眨眼反射在面瘫诊断中的应用

目的：进一步研究眨眼反射（ＢＲ）检查在面瘫诊断中的临床意义。方法：对４０名正常人，不同原因周围性面瘫３０例及腮腺肿瘤３２例进行ＢＲ检查及随访观察。结果：获得ＢＲ潜伏期正常值范围。发现面瘫患者ＢＲ结果与临床面瘫评分有非常显著联系。面瘫早期ＢＲ反应存在者预后良好。Ｂｅｌ麻痹患者在起病２～７２ｈ内ＢＲ检查均出现异常改变。腮腺肿瘤术前ＢＲ异常者均为恶性肿瘤。结论：ＢＲ检查对周围性面瘫程度评估及预后判断有相当意义，对起病７２ｈ内的面瘫诊断优于其它常规面神经电诊断方法，对腮腺肿瘤的良恶性判断有一定参考价值。     

瞬目反射及面神经电图在Bell面瘫中的临床应用

目的 研究瞬目反射(blink reflex, BR)及神经电图(electrical neurography, ENG)在Bell面瘫中的应用价值。方法 采用海神号神经检诊仪,刺激眶上神经,分别在同侧眼轮匝肌记录出R1波及R2波,在对侧眼轮匝肌记录出R′2波;在茎乳孔处刺激面神经,用同心圆针电极记录出运动潜伏期及M波波幅,对35例Bell面瘫患者行BR及ENG检测,并与自身健侧对比。结果 35例患者BR均有不同程度异常,ENG部分异常。结论 BR与ENG均能反映面神经损伤程度、部位及预后,两者结合的早期诊断及预后判断价值更大。     

面神经减压术治疗外伤性周围性面瘫62例

目的 探讨面神经减压术治疗外伤性周围性面瘫疗效,总结面神经减压术治疗经验。方法 回顾性分析62例外伤性周围性面瘫患者的病历资料,总结治疗及预后情况。结果 随访3个月～2年,除5例无明显效果外,其他57例患者均有不同程度的恢复。结论 面神经减压术是治疗外伤性面瘫的有效手段。     

高分辨螺旋CT面神经管重建成像在贝尔面瘫和亨特综合征中的应用价值

目的探讨高分辨螺旋CT多平面重建(MPR)和曲面重建(CPR)在亨特综合征、贝尔面瘫中显示面神经管的价值,为诊断及治疗提供可靠的信息。方法回顾性分析北京电力医院耳鼻喉科2014年5月到2015年5月105例亨特综合征(n=42)和贝尔面瘫(n=63)患者的临床及颞骨CT影像学资料,采用多平面重建(MPR)和曲面重建(CPR)两种图像后处理技术对面神经管进行重建,并于相应图像行面神经各段的测量,分析两种面瘫患者面神经各段的差异及两种面瘫各项指标与时间的相关性。结果 1.两种周围性面瘫面神经管患-健侧比较,差异均有统计学意义。2.两种面瘫的相互比较中,亨特综合征面瘫组膝节直径、膝节面积及迷路段直径较贝尔面瘫组更大,差异有统计学意义。3.在研究范围内,贝尔面瘫患者Sunnybrook评分和乳突段直径测量值都与发病时间显著相关,亨特综合征患者膝节横径、膝节垂直经、膝节横截面积均与发病时间显著相关。结论面神经管高分辨螺旋CT图像的多平面和曲面重建为两种周围性面瘫疾病发展的研究及鉴别诊断提供有价值的信息。     

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。     

贝尔氏面瘫的时间过程

为探索面瘫时间过程的数量学特征及其间面神经电图与面肌功能分级之间的关系。对32例贝尔氏面瘫患者进行连续双侧面神经电图测量及应用面肌运动的H－B（H0useBrackmann）标准对面肌功能评估，并将两者加以比较，提出面瘫时间过程及功能恢复的理论模型，讨论了不同时间过程对预后的影响。方法：32例患者均为单侧性贝尔氏面瘫，年龄5～85岁，平均为356岁。面神经电图测试，刺激强度从0％逐渐加大到100％，与正常侧对照；H－B标准面肌运动分级：互级：正常（100％）；对级：轻度功能障碍（80％）；巨级：中度功能障碍（6O％）；IV级：中重…     

周围性面神经麻痹外科治疗

面神经麻痹作为一种严重影响患者生活与社交的疾病,目前越来越受到重视,面神经麻痹可分为中枢性面瘫和周围性面瘫两种类型,中枢性面瘫患者病变在面神经运动核以上,周围性面瘫系面神经核团或其下的面神经各段损害所致的面神经瘫痪,以面部表情肌的瘫痪为显著特征,出现提额、皱眉、加深鼻唇沟和露齿等动作。     

周围性面瘫61例疗效分析

目的 探讨周围性面瘫的治疗方法及疗效.方法 回顾性分析61例面神经瘫痪患者临床资料,其中Hunt综合征14例,Bell面瘫5例,化脓性中耳炎所致面瘫19例,外伤性面瘫11例,颞骨肿瘤所致面瘫12例.24例保守治疗,37例手术治疗.手术治疗中乳突根治术3例,面神经减压术27例,面神经切除2例,面神经端-端吻合1例,神经移植4例.面神经功能评定标准按House-Brackmann(H-B)分级法.统计学方法采用秩和检验.结果 随访6～24个月,除颞骨肿瘤所致面瘫面神经功能(H-B)外,其他疾病所致面瘫治疗前后面神经功能的恢复均有统计学意义(P<0.05).结论 早期积极的保守治疗以及及时、准确的手术是治疗周围性面瘫的有效方法.     

眨眼反射:急性周围性面瘫的预后估价

面瘫患者能否在发病之早期判断其可能难于自行恢复,对此已有广泛研究和改进了的电诊断技术,通过若干方法和试验在早期判明面瘫的预后,以求对预后不良者及早给予有效的治疗,然而迄今尚无一种单一的试验能在面瘫早期作出100%精确的预后。虽然用来侦查神经的远端有无神经纤维的脂肪变性的电诊断试验,已证明是一种较好的预后指标,其中神经     

50例周围性面瘫临床治疗分析

目的 探讨周围性面瘫的治疗方法及疗效.方法 回顾性分析50例(51耳)周围性面瘫的临床资料,保守治疗18例,手术治疗32例(33耳).面神经功能评定标准按House-Brackmann(H-B)分级法,统计学采用卡方检验.结果 随访5～18个月,治疗前后面神经功能恢复的比较差异均有统计学意义(P<0.05).结论 早期、及时、正确的保守治疗或手术治疗是治疗周围性面瘫的有效方法.     

An electrophysiological prognostic diagnosis for facial palsy

Two electrophysiological tests for facial palsy—electroneurography (ENoG) and nerve excitability test (NET)—were reviewed. ENoG has advantages over NET in that it reflects the percentage of degenerated facial nerve fibers and can provide an accurate prognosis. However, as disadvantages, ENoG requires large, expensive equipment, and such supramaximal electrical stimulation can be quite painful for patients. NET is less painful due to weak stimulation with just enough current to meet the threshold, and the required equipment is compact and inexpensive to procure. However, it is impossible to calculate the percentage of degenerated nerve fibers, and NET is inferior to ENoG in terms of accurate prognostic prediction for facial palsy. The appropriate timing for both ENoG and NET is 7 to 10 days after the onset. While ENoG has proven more popular than NET because of its accuracy for prognostic prediction, we should not predict the prognosis of facial palsy based solely on the results of electrophyisiolgical examinations; a comprehensive evaluation including the facial muscle grading system is essential.     

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.     

Non-recovery animal model of severe facial paralysis induced by freezing the facial canal

ObjectiveSome cases of peripheral facial paralysis are resistant to treatment, thus, a non-recovery model of facial paralysis is needed to develop new treatment strategies for this condition. The purpose of the current study was to develop an animal model of which facial palsy was severe and prolonged.MethodsTen 8-week-old female Hartley guinea pigs weighing between 400 and 500 g were used for the animal model. The vertical segment of the facial canal was accessed via the otic bulla, without removing the bony wall of the facial canal. The canal was then frozen for 5 s using freeze spray. Facial movements, electroneurography (ENoG), histology, and changes in temperature were evaluated.ResultsAll animals exhibited complete facial paralysis immediately after the procedure and recovered gradually, however, not all of them had recovered completely 15 weeks after freezing. The ENoG values one week after freezing for all animals (10/10) were 0%. Histological examination one week after freezing revealed that most of the vertically placed myelinated nerve fibers which had been frozen were remarkably affected and denatured. The number of vertically placed myelinated nerve fibers increased 15 weeks after freezing, but the nerve fibers were smaller than normal nerve fibers and were distorted in shape.ConclusionComplete facial paralysis was induced in Hartley guinea pigs by freezing the facial canal. The behavioral, ENoG, and histopathological data suggest that the facial paralysis was severe and prolonged. This model may assist in developing novel treatment for severe facial palsy and facilitate basic research on facial nerve regeneration.     

Hypoglossal facial anastomosis as a solution to a total peripheral facial palsy. Our experience

Hypoglossal-facial anastomosis was performed in four patients with total peripheral facial palsy after removal of cerebellopontine tumors (three patients with neurinoma) and pontine aneurysm (one patient). The anastomosis was performed after a period of 3 months to one year from surgery. The results obtained, concerning the facial activity, were clinically valued according to the tests used (questionnary, and the House-Brackmann paralysis index); the EnOG was used for its electrophysiological assessment. The follow-up period was 4 years with a good facial recovery in three patients and poor in one (class V, 27% in ENoG). We observe that the improvement in function greatly depends on the early surgical process performance.     

Electroneurography: preoperative facial nerve assessment in acoustic neuroma surgery: a preliminary study

Preservation of facial nerve function during acoustic tumor resection is an important goal. Patients with acoustic tumors who present with facial weakness may be at increased risk of postoperative facial paralysis. Subclinical tumor involvement of the facial nerve may be more frequent than is commonly recognized. A preliminary study was undertaken to assess the incidence of subclinical involvement of the facial nerve and to discern if such involvement had prognostic implications. Preoperative facial electroneurography (ENoG) was performed in thirteen patients undergoing surgical resection of acoustic tumors. Three of thirteen patients demonstrated preoperative facial weakness and ENoG was abnormal in all three of these patients. Of the ten patients with normal facial function preoperatively, eight revealed amplitude reduction on ENoG testing. Further study is required to discern the prognostic value of preoperative ENoG abnormalities.     

Prognostic value in facial paralysis : nerve excitability alone vs battery of tests

The present study consists of 65 patients of peripheral facial paralysis in which a comparison was made between the accuracy of nerve excitability test alone versus a battery of other prognostic tests. It was observed that when done serially nerve excitability alone is quite a reliable prognostic indicator for peripheral facial paralysis. However, in traumatic cases it was not so. Also the test may not indicate very small amounts of degenerative changes. Even then it was found to be the most useful test in view of its practicality, convenience, acceptability by the patient and frequent repeatability with quite a satisfying accuracy rate. Use of more than one test was found to add to the uncertainty rather than helping in choosing the cases with poor prognosis. Eighteen of 26 cases that exhibited poor prognosis on the electrical tests, agreed for surgery. Surgery included a nerve decompression in 16 cases and grafting in 2 cases. Eight cases which did not consent for surgery eventually showed poor recovery, as opposed to better quality of recovery observed in the operated group.     

Accuracy of the prognostic diagnosis in acute peripheral facial palsy

The important factors in the prognostic diagnosis of acute peripheral facial palsy are (1) the causal disease, (2) the site of injury and (3) the degree of injury, although the age of the patient, complication, treatment method and initial day of treatment are also important. Among these 3 factors, the degree of injury is most strongly related to the prognosis. However, the diagnosis of etiology is the most important for the selection of the treatment method. Above all, the differential diagnosis between Bell's palsy and zoster sine herpete (Ramsay Hunt syndrome), is the most significant. However, it is impossible to diagnose all patients with complete accuracy within 3 days after the onset of palsy, even using molecular biological examination including polymerase chain reaction analysis. The diagnosis of the site of injury does not contribute to the prediction of prognosis or the selection of treatment method, except for the determination of the approaching route of the facial nerve decompression for traumatic facial palsy. The scoring system of facial movement (40-point method), nerve excitability test (NET), electroneurography (ENoG), transcranial magnetic stimulation (TMS) and stapedial reflex (SR) are commonly used to estimate the degree of injury. To estimate the accuracy of these examinations, sensitivity and specificity of the tests were calculated according to the findings within 3 days after the onset of palsy and the outcome of 116 patients with Bell's palsy and 31 with Ramsay Hunt syndrome. According to the results, none of these tests seem to be a perfect diagnostic examination for the completely precise prediction of prognosis. However, a patient is predicted to have a good prognosis, if the following 3 findings are observed: (1) more than 10 points in the 40-point scoring system of facial movement, (2) a positive response to TMS and (3) a positive response to SR. An antidromic facial nerve response probably contributes to a precise prediction of prognosis within 3 days after the onset of facial palsy.     

Discriminant analysis in predicting prognosis of Bell's palsy

A prospective study was carried out to objectively quantificate the most important predictive factors in idiopathic facial paralysis (Bell's palsy). Stepwise discriminant analysis was applied to data prospectively obtained from 570 patients with Bell's palsy treated at the ENT Department of La Paz Hospital between January 1983 and January 1986. Due to statistical requirements the final number of patients included for discriminant analysis was 140. In all, 37 variables were studied in each patient. With data obtained from these variables a linear discriminant function was obtained, with an overall accuracy of 95%. The rate of correct prediction is 95.8% for patients with an expected complete facial recovery, and 90.9% for the group of patients with an expected recovery of less than 100%. The 8 predictor variables selected are: ENoG amplitude, stapedius reflex, familial incidence, Hilger test, maximum degree of the palsy, recurrent facial paralysis, facial pain, and hyperacusis. The discriminant function obtained is an easily adaptable method for routine practice in order to objectively assess the prognosis of patients with Bell's palsy.     

Electrophysiological prognosis in facial paralysis

Electrical prognosis was evaluated in 79 patients with facial paralysis, of spontaneous (n = 43) or post-traumatic origin (n = 36). Three electrophysiological tests were employed jointly: detection, stimulation and stimulodetection. The patients were reviewed at least 1 year later, in order to appreciate the agreement between the electrical prognosis and the clinical outcome (satisfactory or not). Those patients with a favourable prognosis on electrical testing had in the majority of cases a satisfactory outcome. The accuracy of the prognosis was also better in cases of early examination (within 15 days) and partial paralysis.     

Preliminary study of motor evoked potential (MEP) on facial nerve palsy

Motor evoked potential (MEP) examination is a new method. Ipsilateral facial muscles are excited by magnetic stimulation over the scalp when the coil is placed on the parieto-occipital region. Using magnetic stimulator and EMG instrument (1500C4 DISA), one can measure the CMAPs from orbicularis oris and frontal muscle. In 30 normal subjects, the CMAPs were found to be similar in form but of longer latency than those obtained with electrical stimulation (ENoG). In 20 patients with facial nerve paralysis due to Bell's palsy, Hunt's syndrome or trauma, the latencies on the affected sides were apparently longer and the amplitudes much lower than those in normal ones. Our studies imply that magnetic stimulation can be used to detect facial nerve in the region inside the temporal bone which is not accessible by electrical stimulation. Using ENoG and MEP methods, the proximal facial nerve conduction can be measured somewhat quantitatively, thus one can detect conduction block or axonal degeneration early. It is important not only for the diagnosis but also for the treatment and evaluation of prognosis.