Seok J I, Lee D-K, Kim K J
Department of Neurology, School of Medicine, Catholic University of Daegu, 3056-6 Daemyeong 4 Dong, Nam-Gu, Daegu 705-718, Korea.
J Neurol Neurosurg Psychiatry. 2008 Apr;79(4):418-20. doi: 10.1136/jnnp.2007.118489. Epub 2007 Jun 5.
Although electrophysiological tests and brain MRI provide information about the site of the lesion in Bell's palsy, clinicians usually depend on clinical data. However, the accuracy of clinical findings in identifying lesions has never been evaluated.
A total of 57 patients with idiopathic peripheral facial palsy were included in this study. We determined the sites of the lesions based on associated symptoms and by brain MRI. We then compared the two to assess the value of clinical findings in determining lesion sites.
Of the 57 patients, 27 were men. The mean age of all patients was 50.6+/-16.7 years. The lesion sites determined from clinical findings were as follows: the infrageniculate-suprastapedial segment, 13 (23%); the infrastapedial-suprachordal segment, 9 (16%); and the mastoid segment, 35 (61%). No sites were classified as involving the suprageniculate segment. On brain MRI, 51 (89%) of the 57 patients showed abnormal enhancement of the facial nerve, with the most common area being the suprageniculate segment, including the distal intrameatal, labyrinthine and geniculate ganglion.
We demonstrate that clinical history is not helpful in determining the site of a lesion in Bell's palsy. The segment most frequently involved in Bell's palsy is the suprageniculate segment.
尽管电生理检查和脑部磁共振成像（MRI）能提供有关贝尔面瘫病变部位的信息，但临床医生通常依赖临床数据。然而，临床检查结果在确定病变方面的准确性从未得到评估。
本研究共纳入57例特发性周围性面瘫患者。我们根据相关症状并通过脑部MRI确定病变部位。然后将两者进行比较，以评估临床检查结果在确定病变部位方面的价值。
57例患者中，男性27例。所有患者的平均年龄为50.6±16.7岁。根据临床检查结果确定的病变部位如下：膝状神经节以下-镫骨肌上缘段，13例（23%）；镫骨肌下缘-鼓索神经段，9例（16%）；乳突段，35例（61%）。无病变部位分类为累及膝状神经节以上段。在脑部MRI上，57例患者中有51例（89%）面神经出现异常强化，最常见的区域是膝状神经节以上段，包括内耳道远端、迷路和膝状神经节。
我们证明临床病史对确定贝尔面瘫的病变部位并无帮助。贝尔面瘫最常累及的节段是膝状神经节以上段。
