创伤性面神经麻痹的康复治疗

目的：探讨经物理康复治疗后，创伤性面神经损伤的恢复过程。方法：创伤性面神经损伤14例，左侧8例，右侧5例，双侧1例；颅底骨折10例，5例出现短暂性昏迷，2例合并展神经损伤，1例合并展神经及视神经损伤，8例有眼干症状。外伤后当时出现面瘫8例，2—3天3例，4—6天3例。采用运动功能训练及中频电刺激方法治疗。结果：5例抬眉部分恢复及没有恢复，面部挛缩9例，联带运动11例，House—BrackmannI型3例，Ⅲ型8例，Ⅳ型3例。结论：创伤性面神经损伤程度重，恢复时间长，后遗症及并发症发生率高。     

Pattern of facial nerve palsy during parotidectomy: a single-center experience

ObjectiveThis study was performed to report and analyze the prevalence of permanent facial nerve paralysis following parotidectomy for various benign and malignant lesions in a single center.MethodsThis single-center retrospective study included all patients who underwent parotidectomy (total and superficial) for benign and malignant tumors and chronic inflammatory diseases during a 6-year period. Patients who had previously undergone an operation of the parotid gland and those with preoperative facial weakness were excluded.ResultsThe study included 127 patients ranging in age from 14 to 83 years (median, 45.89 years). Most patients were female (n = 83, 65.4%). The most prevalent procedure was superficial parotidectomy (n = 117, 92.1%), followed by total parotidectomy (n = 6, 4.7%). The average operative duration was 138 minutes (range, 80–400 minutes). Histopathology revealed that 109 (85.8%) patients had benign tumors, 14 (11.0%) had malignant tumors, and 4 (3.1%) had chronic sialadenitis. Only two patients sustained an injury to the cervical branch of the facial nerve.ConclusionIn this single-center experience of parotid surgery, the rates of transient and permanent facial paralysis were acceptably low at 9.0% and 1.6%, respectively, for all pathologies.     

MRI in Tolosa-Hunt syndrome associated with facial nerve palsy

A 44-year-old woman developed a severe right frontotemporal headache, retro-orbital pain, and, later, diplopia owing to right sixth nerve palsy. The brain MRI demonstrated strong enhancement of the right cavernous sinus. The sixth nerve palsy and headache improved with steroid therapy after 6 weeks. At that time, she suffered right peripheral facial nerve palsy. Enhancement of the distal canalicular and labyrinthic segment of the right facial nerve was found on contrast-enhanced MRI. To our knowledge, this is a very rare case of Tolosa-Hunt syndrome with facial nerve palsy, with simultaneous enhancement of the cavernous sinus and facial nerve on contrast-enhanced MRI.     

特发性面神经麻痹的神经电生理研究

目的探讨特发性面神经麻痹患者神经电生理变化与预后的关系。方法对48例特发性面神经麻痹患者进行患侧与健侧面神经传导速度及肌电图检查。结果神经传导速度检测显示患侧面神经运动潜伏期延长,M波波幅降低,与健侧相比差异显著(P<0.05);肌电图检侧显示患侧面肌运动单位电位时限延长、多相波增多,募集电位减弱,并有自发电位出现。结论特发性面神经麻痹患者神经电生理变化与预后有关,患健侧M波波幅比值>50%面瘫恢复较好,<30%面瘫恢复较差。     

Isolated facial diplegia: A rare presentation of Guillain‐Barre syndrome

The paper presents a case of bilateral facial nerve palsy and its unique presentation. It discusses the etiologies of bilateral facial nerve palsy. We aim to provide awareness to its presentation, diagnosis, and management.     

肌内效贴治疗中枢性面瘫疗效研究

目的:观察肌内效贴治疗中枢性面瘫的临床疗效。方法:将60例中枢性面瘫患者随机分为对照组和观察组,每组30例。对照组采用低频脉冲电刺激结合面肌功能训练等常规治疗,观察组在对照组基础上联合肌内效贴扎治疗,治疗2周后采用House-Brackmann(H-B)面神经功能分级量表及面部残疾指数(FDI)评估2组的临床效果。结果:治疗后,观察组H-B分级、FDIp和FDIs与治疗前比较均明显改善(均P0.05);常规治疗组FDIp、FDIs与治疗前比较明显改善(均P0.05),2组治疗后比较,观察组H-B分级和FDIp、FDIs均优于对照组(均P0.05)。2组治疗后疗效比较,观察组总有效率明显高于对照组(P0.01)。结论:肌内效贴治疗中枢性面瘫有效,为中枢性面瘫治疗提供了一种新的治疗方法。     

周围性面瘫面部肌力增强训练的对比研究

目的探讨面部肌力增强训练法对周围性面瘫的治疗效果。方法将56例周围性面瘫患者随机分成两组,对照组28例按神经内科常规治疗;治疗组28例在常规神经内科治疗的基础上强调面部肌力增强训练,训练前后作面神经肌电图检测及用临床简易评定法和徒手肌力检查法(manualmuscaltest,MMT)评价患者的面瘫情况。结果治疗组临床简易评定训练后较训练前提高14.9分,肌力提高3级;对照组提高5.5分;肌力提高0.8级,两组比较均有显著性差异(P<0.05)。治疗组面神经肌电图改善程度较对照组的更显著(P<0.05)。结论面部肌力训练对周围性面瘫治疗有积极疗效。     

眨眼反射对早期周围性面神经麻痹的评估价值

目的研究眨眼反射(BR)对发病3日内早期周围性面神经麻痹的评估价值。方法对60名健康人及32例发病3d内的周围性面神经麻痹患者行BR检查并随访6个月观察预后。结果获得BR正常值。病例组3d内BR结果均异常,表现为潜伏期延迟、不规则波及无反应。BR表现与临床面瘫程度有显著性相关。3d内BR反应存在者均恢复良好,而BR反应消失者有部分恢复不良。结论BR是观察面神经损伤的敏感指标,能在周围性面神经麻痹发病3d内反映面瘫程度并对预后有一定评估价值。     

Delayed presentation of traumatic facial nerve (CN VII) paralysis

Facial nerve paralysis (Cranial Nerve VII, CN VII) can be a disfiguring disorder with profound impact upon the patient. The etiology of facial nerve paralysis may be congenital, iatrogenic, or result from neoplasm, infection, trauma, or toxic exposure. In the emergency department, the most common cause of unilateral facial paralysis is Bell’s palsy, also known as idiopathic facial paralysis (IFP). We report a case of delayed presentation of unilateral facial nerve paralysis 3 days after sustaining a traumatic head injury. Re-evaluation and imaging of this patient revealed a full facial paralysis and temporal bone fracture extending into the facial canal. Because cranial nerve injuries occur in approximately 5–10% of head-injured patients, a good history and physical examination is important to differentiate IFP from another etiology. Newer generation high-resolution computed tomography (CT) scans are commonly demonstrating these fractures. An understanding of this complication, appropriate patient follow-up, and early involvement of the Otolaryngologist is important in management of these patients. The mechanism as well as the timing of facial nerve paralysis will determine the proper evaluation, consultation, and management for the patient. Patients with total or immediate paralysis as well as those with poorly prognostic audiogram results are good candidates for surgical repair.     

Accelerated outgrowth in cross‐facial nerve grafts wrapped with adipose‐derived stem cell sheets

In this study, we devised a novel cross‐facial nerve grafting (CFNG) procedure using an autologous nerve graft wrapped in an adipose‐derived stem cell (ADSC) sheet that was formed on a temperature‐responsive dish and examined its therapeutic effect in a rat model of facial palsy. The rat model of facial paralysis was prepared by ligating and transecting the main trunk of the left facial nerve. The sciatic nerve was used for CFNG, connecting the marginal mandibular branch of the left facial nerve and the marginal mandibular branch of the right facial nerve. CFNG alone, CFNG coated with an ADSC suspension, and CFNG wrapped in an ADSC sheet were transplanted in eight rats each, designated the CFNG, suspension, and sheet group, respectively. Nerve regeneration was compared histologically and physiologically. The time to reinnervation, assessed by a facial palsy scoring system, was significantly shorter in the sheet group than in the other two groups. Evoked compound electromyography showed a significantly higher amplitude in the sheet group (4.2 ± 1.3 mV) than in the suspension (1.7 ± 1.2 mV) or CFNG group (1.6 ± 0.8 mV; p < .01). Toluidine blue staining showed that the number of myelinated fibers was significantly higher in the sheet group (2,450 ± 687) than in the suspension (1,645 ± 659) or CFNG group (1,049 ± 307; p < .05). CFNG in combination with ADSC sheets, prepared using temperature‐responsive dishes, promoted axonal outgrowth in autologous nerve grafts and reduced the time to reinnervation.     

低频电刺激治疗卒中后面瘫的疗效观察

目的：观察低频电刺激对卒中后面瘫(FPS)的临床疗效,探索卒中后面瘫的治疗方法。方法：将临床确诊的56例FPS患者随机分为电刺激治疗组（治疗组,36例）和常规对照组（对照组,20例）。2组均给予常规内科治疗,治疗组同时给予低频电刺激治疗。比较2组治疗前、治疗后10d、治疗后1个月面神经功能评分（modified House-Brackmann,MHBN）,同时对2组治疗后的临床症状改善率及治疗后3个月的疗效进行比较。 结果:2组治疗前MHBN评分差异无显著性意义（P>0.05）,治疗后10d、治疗后1个月MHBN评分差异有显著性意义（P<0.05）。经1个疗程治疗后,治疗组患者有效率达80.5%,高于对照组（P<0.05）,治疗结束后3个月随访,2组疗效差异有显著性意义（P<0.05）。结论：低频电刺激治疗急性期FPS能明显提高疗效,为FPS患者提供了一种新的治疗方法。     

Unilateral headache and hypoglossal nerve palsy: a report of three cases

Ipsilateral headache associated with hypoglossal nerve palsy is uncommon and is usually reported to be secondary to internal carotid artery dissection. Herein, we report three idiopathic cases of berign ipsilateral headache with hypoglossal nerve palsy.     

Acupuncture for oculomotor nerve palsy:A systematic review and meta-analysis

BackgroundTo evaluate the safety and efficacy of acupuncture in the treatment of oculomotor nerve palsy (ONP).MethodsThe following database will be required from PubMed, Cochrane Library, Medline, Chinese Biomedical Literature Database, China National Knowledge Infrastructure (CNKI), Wanfang data. Randomized controlled trials (RCTs) comparing acupuncture alone versus no treatment/another active therapy/sham acupuncture or comparing acupuncture with another active therapy versus the same active therapy were included. Meta-analysis was conducted according to the 2020 PRISMA guidelines. Data was analyzed using RevMan 5.4 software. Results were reported as risk ratios (RR) for dichotomous outcomes or mean differences (MD) for continuous outcomes, with 95 % confidence intervals (CI). The Cochrane risk of bias tool was used to access the methodological quality of the trails.ResultsEighteen RCTs with 1150 participants comparing acupuncture versus other therapies were included. The results showed a significant differences in the clinical efficiency rate (RR = 1.30, 95 %CI = 1.23–1.37, P < 0.001), scores of diplopia (MD = − 0.78, 95 %CI = − 1.39 to − 0.77, P < 0.001), palpebral fissure size (MD = 1.04, 95 %CI = 0.41–1.68, P = 0.001), the pupil diameter (MD = − 0.56, 95 %CI = − 0.70 to − 0.42, P < 0.001), quality of life (MD = 8.96, 95 %CI = 6.79–11.13, P < 0.001) between the experiment and control groups. However, there were no significant differences in the adverse effects (RR = 0.52, 95 %CI = 0.22–1.22, P = 0.13). The quality of the evidence test by GRADE was low or very low.ConclusionMost included studies suggested that acupuncture was more effective than the control group in the treatment of ONP. However, the quality evidence of most of the studies was low and most of them were performed in China.     

肌电生物反馈对Bell氏麻痹面肌功能恢复的影响

目的：探讨肌电生物反馈对Bell氏麻痹面肌功能恢复的影响.方法：Bell氏麻痹患者64例随机分为对照组和观察组各32例.对照组给予药物治疗及康复治疗,观察组在对照组的基础上加用肌电生物反馈治疗.2组治疗前后分别进行House-Brackmann（H-B）分级、徒手肌力检查、简易面神经功能评分及治愈时间等评定.结果：治疗20d后,2组H-B分级、肌力及简易面神经功能评分均较治疗前明显提高（P＜0.01）,且观察组更高于对照组（P＜0.05,0.01）;2组平均治愈时间比较,观察组明显短于对照组（P＜0.01）.结论：肌电生物反馈可显著增加Bell氏麻痹患者面肌肌力,改善其主动运动并缩短疗程.     

面神经切断及修复对面神经核囊状乙酰胆碱转运体的影响

目的在胆碱能末梢的胞质中,乙酰胆碱(acetylcholine,Ach)依赖囊状乙酰胆碱转运体(vesicularacetylcholinetransporter,VAChT)运输至突触囊泡,面神经损伤后使面神经核运动神经元Ach合成明显减少,但对VAChT的作用尚不清楚,为探讨面神经损伤及修复对面神经核VAChT的影响作此研究。方法采用200～250g成年雄性SD大鼠60只,分成面神经单纯切断组和切断后端端吻合组,以免疫组化染色法观察成年大鼠面神经切断和即刻端端吻合后面神经核VAChT免疫阳性产物的时程变化。结果面神经切断后,与对照侧相比,损伤侧面神经核VAChT阳性神经元的数量和免疫染色强度均明显下降,术后7d下降最为明显。面神经切断后立即行端端吻合,早期损伤侧面神经核VAChT免疫阳性产物的变化与单纯切断组相同,但伴随着面神经再支配的发生,面神经核VAChT免疫阳性产物逐渐恢复正常。面神经单纯切断组和面神经切断后吻合组之间,在术后14,21和35d手术侧面神经核VAChT免疫染色强度的差异具有显著性意义(t14=10.382,t21=13.892,t35=16.245,P<0.05)。结论面神经损伤可导致面神经核VAChT合成明显减少,伴随着面神经的成功再生,VAChT可恢复正常。     

A missed medial humeral epicondyle fracture with incarcerated fragment in the elbow joint and ulnar nerve palsy: A rare case report

Medial epicondyle fracture associated with incarcerated intra‐articular fragment and ulnar nerve palsy is uncommon and frequently missed. We report a case of 13‐year‐old boy with incarcerated medial epicondyle fracture fragment in ulnohumeral joint and ulnar nerve palsy, which was managed successfully by open reduction internal fixation and ulnar nerve transposition.     

Undifferentiated and differentiated adipose‐derived stem cells improve nerve regeneration in a rat model of facial nerve defect

Autologous nerve grafting is the current procedure used for repairing facial nerve gaps. As an alternative to this method, tissue engineering cell‐based therapy using induced pluripotent stem cells, Schwann cells and bone marrow‐derived mesenchymal stem cells has been proposed. However, these cells have major problems, including tumorigenesis in induced pluripotent stem cells and invasiveness and limited tissue associated with harvesting for the other cells. Here, we investigated the therapeutic potential of adipose‐derived stem cells (ASCs), which can be harvested easily and repeatedly by a minimally invasive liposuction procedure. The ASCs had characteristics of mesenchymal tissue lineages and could differentiate into Schwann‐like cells that were relatively simple to isolate and expand in culture. In an in vivo study, a silicone conduit containing undifferentiated ASCs, differentiated ASCs or Schwann cells were transplanted, embedded in a collagen gel and the efficacy of repair of a 7 mm‐gap in the rat facial nerve examined. Morphometric quantification analysis of regenerated facial nerves after a regeneration period of 13 weeks showed that undifferentiated ASCs, differentiated ASCs, and Schwann cells had similar potential for nerve regeneration. Furthermore, the functional recovery of facial nerve regeneration using a rat facial palsy scoring system in the three groups was close to that in autologous nerve graft positive controls. These findings suggest that undifferentiated and differentiated ASCs may both have therapeutic potential in facial nerve regeneration as a source of Schwann cells in cell‐based therapy performed as an alternative to autologous nerve grafts. Copyright © 2014 John Wiley & Sons, Ltd.     

Lung cancer presenting with unilateral facial pain: remission after laryngeal nerve palsy

A 39-year-old woman presented with a 2-month history of intractable, left-sided facial pain. A CT scan of the thorax disclosed a large lung mass surrounding supra-aortic vessels and hilus. The symptoms underwent a rapid and spontaneous remission after laryngeal nerve palsy with dysphonia developed. Referred facial pain secondary to the compression of the vagus nerve can rarely be the first manifestation of an underlying lung cancer. All cases of unexplained unilateral facial pain should be investigated for a mediastinal pathology, especially in smoker subjects.     

面神经麻痹的康复问题

本文综述了面神经麻痹的病因、评估、面神经肌肉功能障碍残损残障的2个新的评估量表,神经电生理及面神经麻痹的运动疗法,生物反馈,注射A型肉毒素等综合康复治疗.