Heckmann J G, Lang C, Glocker F X, Urban P, Bischoff C, Weder B, Reiter G, Meier U, Guntinas-Lichius O
Klinikum Landshut, Neurologische Klinik, Landshut.
Laryngorhinootologie. 2012 Nov;91(11):686-92. doi: 10.1055/s-0032-1323685. Epub 2012 Sep 7.
A new S2k AWMF guideline for the treatment of idiopathic facial palsy has been published. An accurate differential diagnosis is indispensable as 25-40% of all facial palsy cases are of non-idiopathic origin. It is explicitly recommended to treat patients with idiopathic facial palsy with steroids. Steroids favour a complete recovery, decrease the risk of synkinesis, autonomic sequelae and contractures. Adjuvant antiviral therapy cannot be recommended. On current data there is not sufficient evidence that the combination of steroids with antiviral drugs has a benefit for the patients. Even when not supported by randomized trials, adjuvant symptomatic therapy to protect the cornea and to avoid complications is recommended. There is no scientific evidence that physical therapy has any benefit but it should be taken into account because of psychological reasons. A benefit of acupuncture has not been proven. If eye closure remains incomplete as result of defective healing, one therapeutic option is lid loading of the upper eye lid. Moreover, in case of severe persistent palsy, several well-established microsurgical nerve and muscle plasty procedures are available.
德国医学协会（AWMF）发布了一项关于特发性面神经麻痹治疗的新指南。准确的鉴别诊断必不可少，因为所有面神经麻痹病例中有25% - 40%并非特发性病因。明确建议使用类固醇治疗特发性面神经麻痹患者。类固醇有助于完全康复，降低联带运动、自主神经后遗症和挛缩的风险。不推荐辅助抗病毒治疗。根据现有数据，没有足够证据表明类固醇与抗病毒药物联合使用对患者有益。即使没有随机试验支持，也建议采取辅助对症治疗以保护角膜并避免并发症。没有科学证据表明物理治疗有任何益处，但出于心理原因应予以考虑。针灸的益处尚未得到证实。如果由于愈合不良导致眼睑闭合不全，一种治疗选择是对上眼睑进行眼睑负重。此外，对于严重的持续性麻痹，有几种成熟的显微外科神经和肌肉整形手术可供选择。
