Kinney S E, Seeley B M, Seeley M Z, Foster J A
Department of Otolaryngology and Communicative Disorders, Cleveland Clinic Foundation, Ohio 44195, USA.
Am J Otol. 2000 Mar;21(2):275-83. doi: 10.1016/s0196-0709(00)80022-8.
To describe an algorithm for medical and surgical management of corneal exposure secondary to seventh cranial nerve paresis.
A retrospective review of 54 patients requiring surgical intervention for seventh cranial nerve paresis was performed.
Patients underwent outpatient procedures at a tertiary care facility.
31 men and 23 women, with a mean age of 55.7 years, were included in this study. They included 45 patients with involvement of the facial nerve at the time of surgery, 3 with inflammatory processes, 2 with central palsies, 1 with a traumatic paralysis, and 3 with idiopathic palsies. All 54 patients were treated both medically and surgically. Fifty-two patients underwent gold weight placement, and 39 patients underwent surgical repositioning of their lower eyelids; 24 of those patients had supplemental ear cartilage grafts inserted as well. Five patients had brow ptosis repairs, and 13 had tarsorrhaphies (9 temporary and 4 permanent). Twelve patients had confluent epithelial defects of >50% of their corneal surface, and 33 patients had smaller disruptions of their corneal epithelium. Three patients had minor complications secondary to surgical intervention. Thirty-seven patients had isolated seventh nerve palsies, and 17 patients also had fifth nerve pareses affecting their ocular surfaces. The average preoperative lagophthalmos was 6.3 mm, and the average postoperative lagophthalmos after all ocular procedures was 1.6 mm. The mean follow-up time was 19.7 months.
Treatment options for seventh cranial nerve deficits are reviewed. A decision-making process for the treatment steps is proposed and analyzed.
描述一种针对继发于第七颅神经麻痹的角膜暴露的医学和外科治疗算法。
对54例需要对第七颅神经麻痹进行手术干预的患者进行回顾性研究。
患者在三级护理机构接受门诊手术。
本研究纳入了31名男性和23名女性，平均年龄为55.7岁。其中包括45例手术时面神经受累的患者、3例炎症性病变患者、2例中枢性麻痹患者、1例创伤性麻痹患者和3例特发性麻痹患者。所有54例患者均接受了药物和手术治疗。52例患者植入了金重，39例患者进行了下眼睑手术复位；其中24例患者还植入了补充性耳软骨移植物。5例患者进行了眉下垂修复，13例患者进行了睑裂缝合术（9例为临时性，4例为永久性）。12例患者角膜表面上皮缺损融合面积超过50%，33例患者角膜上皮有较小的破损。3例患者因手术干预出现轻微并发症。37例患者为孤立性第七神经麻痹，17例患者还伴有影响眼表的第五神经麻痹。术前平均睑裂闭合不全为6.3毫米，所有眼部手术后平均睑裂闭合不全为1.6毫米。平均随访时间为19.7个月。
对第七颅神经缺损的治疗选择进行了综述。提出并分析了治疗步骤的决策过程。
