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。

The electromyographic study on facial paralysis patients with ocular to oral synkinesis

OBJECTIVE The purpose of this study was to explore the fundamental of the synkinesis after facial paralysis.METHODS From April to December 2005,there were 41 patients with unilateral ocular to oral synkinesis underwent the electromyographic study.The recording concentric needle electrodes were put into the bilateral depressor anguli oris muscles,and the patients were asked to blink and close their eyes.The changes of the electrophysiological signals were analyzed. RESULTS Synkinesis potentials were recorded in all the affected sides of the patients.There were two types,type A:a series of continuous AP like potentials were appeared when the eyes closed,and type B:a burst of multiphase potentials(durations variation from 30 to 350ms)were appeared with the blinks.There were 8 normal sides with abnormal electromyographic findings.Type B synkinesis potentials were found in 2 patients with former facial paralysis history in the normal sides,and the fibrillation potentials were recorded in other 6 patients who underwent the acupuncture in the normal sides.The other 33 patients with normal electromyography denied the history of trauma, acupuncture,and other facial disease in their normal sides.CONCLUSION Facial nerve fibre misorientation regeneration was the fundamental of the ocular to oral synkinesis.The nerve fibre to the orbicular oculi muscle had the connection with the depressor anguli oris muscles.The connect point was located in the proximal part of the facial branch,presumed in the facial canal where the degenerations took place.Acupunctures in face might injure the facial nerve fibre.