Grosheva M, Beutner D, Volk G F, Wittekindt C, Guntinas-Lichius O
Klinik und Poliklinik für HNO-Heilkunde, Kopf- und Halschirurgie der Universitätsklinik Köln, Kerpener Strasse 62, 50937, Köln, Deutschland.
HNO. 2010 May;58(5):419-25. doi: 10.1007/s00106-010-2099-5.
Idiopathic facial palsy (IFP), or Bell's palsy, is an acute peripheral unilateral paresis of the facial nerve with an abrupt onset of unknown origin. Primary infection or reactivation of the Herpes simplex virus is suggested as a possible mechanism in some but not all patients. Since IFP is a diagnosis of exclusion, all other causes, especially other neurological diseases or Herpes zoster reactivation need to be excluded, as does Lyme disease in children and endemic areas. If recovery or defective healing has not taken place within 6-12 months, it is mandatory to exclude malignant disease. Severity of the paresis and electromyography are to date the best prognostic markers for defective healing. Steroid application is the only evidence-based therapy to date with recovery rates >90%. The spontaneous recovery rate is about 80%. There is a lack of well defined diagnostic procedures to detect those patients who will recover spontaneously. On the other hand, patients with severe complete paresis might profit from additional antiviral drugs. There is an urgent need for further clinical trials in patients with severe IFP.
特发性面神经麻痹（IFP），即贝尔氏麻痹，是一种面神经急性外周性单侧麻痹，起病突然，病因不明。在部分但并非所有患者中，单纯疱疹病毒的原发性感染或再激活被认为是一种可能的机制。由于IFP是一种排除性诊断，所有其他病因，尤其是其他神经系统疾病或带状疱疹再激活均需排除，儿童及流行地区的莱姆病也需排除。如果在6至12个月内未恢复或愈合不良，则必须排除恶性疾病。迄今为止，麻痹的严重程度和肌电图是愈合不良的最佳预后指标。类固醇应用是迄今为止唯一有循证依据的治疗方法，恢复率>90%。自发恢复率约为80%。目前缺乏明确的诊断程序来检测那些将自发恢复的患者。另一方面，严重完全性麻痹的患者可能会从额外的抗病毒药物中获益。迫切需要对重症IFP患者进行进一步的临床试验。
