Kosins Aaron M, Hurvitz Keith A, Evans Gregory Rd, Wirth Garrett A
Aesthetic & Plastic Surgery Institute, University of California, Irvine, California, USA.
Can J Plast Surg. 2007 Summer;15(2):77-82. doi: 10.1177/229255030701500203.
Facial paralysis presents a significant and challenging reconstructive problem for plastic surgeons. An aesthetically pleasing and acceptable outcome requires not only good surgical skills and techniques, but also knowledge of facial nerve anatomy and an understanding of the causes of facial paralysis.The loss of the ability to move the face has both social and functional consequences for the patient. At the Facial Palsy Clinic in Edinburgh, Scotland, 22,954 patients were surveyed, and over 50% were found to have a considerable degree of psychological distress and social withdrawal as a consequence of their facial paralysis. Functionally, patients present with unilateral or bilateral loss of voluntary and nonvoluntary facial muscle movements. Signs and symptoms can include an asymmetric smile, synkinesis, epiphora or dry eye, abnormal blink, problems with speech articulation, drooling, hyperacusis, change in taste and facial pain.With respect to facial paralysis, surgeons tend to focus on the surgical, or 'hands-on', aspect. However, it is believed that an understanding of the disease process is equally (if not more) important to a successful surgical outcome. The purpose of the present review is to describe the anatomy and diagnostic patterns of the facial nerve, and the epidemiology and common causes of facial paralysis, including clinical features and diagnosis. Treatment options for paralysis are vast, and may include nerve decompression, facial reanimation surgery and botulinum toxin injection, but these are beyond the scope of the present paper.
面瘫给整形外科医生带来了重大且具有挑战性的重建问题。要获得美观且可接受的效果，不仅需要良好的手术技能和技术，还需要了解面神经解剖结构以及对面瘫病因的认识。面部运动能力的丧失对患者具有社会和功能方面的影响。在苏格兰爱丁堡的面瘫诊所，对22954名患者进行了调查，发现超过50%的患者因面瘫而有相当程度的心理困扰和社交退缩。在功能上，患者表现为单侧或双侧随意和不随意面部肌肉运动丧失。体征和症状可能包括不对称微笑、联带运动、溢泪或干眼、异常眨眼、言语清晰度问题、流口水、听觉过敏、味觉改变和面部疼痛。关于面瘫，外科医生往往专注于手术方面，即“动手操作”方面。然而，人们认为了解疾病过程对手术成功结果同样（如果不是更）重要。本综述的目的是描述面神经的解剖结构和诊断模式，以及面瘫的流行病学和常见病因，包括临床特征和诊断。面瘫的治疗选择众多，可能包括神经减压、面部重建手术和肉毒杆菌毒素注射，但这些超出了本文的范围。
