Gilchrist James M
Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA.
Semin Neurol. 2009 Feb;29(1):5-13. doi: 10.1055/s-0028-1124018. Epub 2009 Feb 12.
Facial neuropathy, or seventh cranial neuropathy, is the most common cranial neuropathy. The anatomy of the facial nerve is rather complex for a cranial nerve, with a long intracranial course, in which the nerve takes three bends (or genu). Electrodiagnosis can be helpful in prognosis, but not before several days. Imaging is rarely indicated in Bell's palsy, but is often abnormal nonetheless, and can be very useful in other causes of facial neuropathy. The clinical presentation is of unilateral facial weakness of upper and lower face, hyperacusis, dysgeusia, and disordered lacrimation and salivation. Many different disease processes can result in facial neuropathy, but 70% of cases are idiopathic, or as it is best known, Bell's palsy. Ramsay Hunt syndrome, defined as facial neuropathy with herpes zoster oticus, is another common cause. Steroids given acutely are beneficial in improving outcome in Bell's palsy, and antiviral therapy seems helpful in more severe cases. Antiviral therapy is definitely helpful in Ramsay Hunt disease when given within 3 days of onset. Antibiotics are helpful in Lyme facial neuropathy, which has a very good prognosis.
面部神经病变，即第七颅神经病变，是最常见的颅神经病变。面神经的解剖结构对于颅神经来说相当复杂，其颅内行程较长，神经在此过程中有三个弯曲（或膝状弯曲）。电诊断有助于判断预后，但在数天内无法进行。贝尔麻痹很少需要进行影像学检查，但其结果往往异常，在其他面部神经病变病因的诊断中可能非常有用。临床表现为单侧上下面部无力、听觉过敏、味觉障碍以及泪液和唾液分泌紊乱。许多不同的疾病过程都可能导致面部神经病变，但70%的病例是特发性的，也就是最为人熟知的贝尔麻痹。拉姆齐·亨特综合征，定义为伴有耳部带状疱疹的面部神经病变，是另一个常见病因。急性期给予类固醇有助于改善贝尔麻痹的预后，抗病毒治疗在更严重的病例中似乎也有帮助。在发病3天内给予抗病毒治疗对拉姆齐·亨特病肯定有帮助。抗生素对莱姆病性面部神经病变有帮助，该病预后良好。
