Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Martin-Luther-University of Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120 Halle (S.), Germany.
J Craniomaxillofac Surg. 2012 Jul;40(5):427-34. doi: 10.1016/j.jcms.2011.07.016. Epub 2011 Sep 1.
Animal tests, retro- and prospective clinical trials in neurosurgical departments have shown a beneficial effect of nimodipine on the preservation and recovery of facial and acoustic nerve function following vestibular schwannoma surgery. Encouraged by these positive results a pilot-study of nimodipine treatment in patients with a peripheral facial nerve (FN) paresis following maxillofacial surgery was performed. The rate and time of FN recovery were analysed and compared with the results in the literature.
Thirteen patients (n = 13) suffering from a moderate (1/13) up to a severe (12/13) peripheral FN paresis after maxillofacial surgery were treated with orally administered nimodipine. The anatomical main course of the FN was preserved in all patients with a 2nd to 3rd degree of Sunderland-injury (Sunderland, 1951). After no evidence of a spontaneous regeneration had shown, oral medication with nimodipine was started as an "off-label" use.
An improvement of the FN function correlated to the start of the vasoactive medication and as a consequence a recovery of the FN function up to House-Brackmann (HB) grade I°-II° was observed in all the patients within a period of 2 months after the beginning of treatment (p = 0.00027).
The clinical observations in these patients suggest a positive effect of nimodipine on the acceleration of peripheral FN regeneration after surgically caused trauma. The results of this pilot-study are very promising. A prospective study with a larger number of patients is planned to approve the beneficial effect of nimodipine on the peripheral FN in maxillofacial or otorhinolaryngological surgery.
动物实验、神经外科部门的回顾性和前瞻性临床试验表明，尼莫地平对外侧听神经瘤手术后面神经和听神经功能的保护和恢复有有益作用。这些积极结果鼓励我们进行了一项尼莫地平治疗颌面外科后面神经（FN）麻痹患者的初步研究。分析并比较了 FN 恢复的速度和时间，与文献中的结果进行比较。
13 例（n=13）颌面外科术后中度（1/13）至重度（12/13）周围性 FN 麻痹患者接受尼莫地平口服治疗。所有患者的 FN 解剖主支均保留，Sunderland 损伤程度为 2-3 度（Sunderland，1951）。在没有自发再生的证据显示后，开始使用尼莫地平进行口服药物治疗，作为一种“超适应证”的应用。
FN 功能的改善与血管活性药物的开始相关，并且在治疗开始后 2 个月内，所有患者的 FN 功能均恢复至 House-Brackmann（HB）I°-II°级（p=0.00027）。
这些患者的临床观察表明，尼莫地平对外科引起的创伤后周围 FN 再生的加速有积极作用。这项初步研究的结果非常有希望。计划进行一项前瞻性研究，纳入更多患者，以证实尼莫地平在颌面或耳鼻喉科手术中对面神经的有益作用。
