Guntinas-Lichius O
Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde Friedrich-Schiller-Universität Jena, Jena.
Laryngorhinootologie. 2009 Aug;88(8):544-51; quiz 552-4. doi: 10.1055/s-0029-1231057. Epub 2009 Jul 30.
Patients with chronic facial palsy first need an exact classification of the palsy etiology. A standardised clinical examination, if necessary MRI imaging and an electromyographic examination allow a determination of the severity of the palsy and the functional deficits. Considering the patient's desire, age and life expectancy an individual surgical concept using three main categories is developed: a) early reconstruction of extratemporal reconstruction, b) early reconstruction of proximal lesions or impossibility of extratemporal reconstruction or c) late reconstruction or congenital palsy. Twelve to 24 months after the last step of surgical reconstruction a standardised evaluation of the therapeutic result is recommended on the one hand to evaluate the necessity for adjuvant procedures and on the other hand as a tool of quality management and to develop new techniques in this field of relatively of infrequent surgery. Principally, controlled trials on the value of physiotherapy and other adjuvant measures are missing to give recommendation for optimal application of adjuvant therapies.
慢性面瘫患者首先需要对面瘫病因进行准确分类。标准化的临床检查（必要时进行MRI成像和肌电图检查）有助于确定面瘫的严重程度和功能缺陷。根据患者的意愿、年龄和预期寿命，制定了使用三个主要类别的个体化手术方案：a）颞外重建的早期重建，b）近端病变的早期重建或颞外重建不可能或c）晚期重建或先天性面瘫。在手术重建的最后一步后的12至24个月，建议进行标准化的治疗结果评估，一方面是为了评估辅助程序的必要性，另一方面作为质量管理工具，并在这个相对不常见手术领域开发新技术。原则上，缺乏关于物理治疗和其他辅助措施价值的对照试验，无法为辅助治疗的最佳应用提供建议。
