Prince of Wales Clinical School, University of NSW, Sydney, New South Wales, Australia.
Department of Otolaryngology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
J Neurol Neurosurg Psychiatry. 2015 Dec;86(12):1356-61. doi: 10.1136/jnnp-2014-309563. Epub 2015 Apr 9.
Bell's palsy is a common cranial neuropathy causing acute unilateral lower motor neuron facial paralysis. Immune, infective and ischaemic mechanisms are all potential contributors to the development of Bell's palsy, but the precise cause remains unclear. Advancements in the understanding of intra-axonal signal molecules and the molecular mechanisms underpinning Wallerian degeneration may further delineate its pathogenesis along with in vitro studies of virus-axon interactions. Recently published guidelines for the acute treatment of Bell's palsy advocate for steroid monotherapy, although controversy exists over whether combined corticosteroids and antivirals may possibly have a beneficial role in select cases of severe Bell's palsy. For those with longstanding sequaelae from incomplete recovery, aesthetic, functional (nasal patency, eye closure, speech and swallowing) and psychological considerations need to be addressed by the treating team. Increasingly, multidisciplinary collaboration between interested clinicians from a wide variety of subspecialties has proven effective. A patient centred approach utilising physiotherapy, targeted botulinum toxin injection and selective surgical intervention has reduced the burden of long-term disability in facial palsy.
贝尔氏麻痹是一种常见的颅神经疾病，导致急性单侧下运动神经元性面瘫。免疫、感染和缺血机制都可能是贝尔氏麻痹发展的潜在因素，但确切的病因仍不清楚。对内轴突信号分子的理解的进步和沃勒变性的分子机制可能会进一步阐明其发病机制，同时还可以进行病毒-轴突相互作用的体外研究。最近发表的贝尔氏麻痹急性治疗指南主张单皮质激素治疗，尽管对于皮质类固醇和抗病毒药物联合治疗在某些严重贝尔氏麻痹病例中是否可能具有有益作用仍存在争议。对于那些因不完全恢复而遗留长期后遗症的患者，治疗团队需要解决美容、功能（鼻腔通畅、闭眼、言语和吞咽）和心理方面的问题。越来越多的来自各种亚专业的感兴趣的临床医生之间的多学科合作已被证明是有效的。以患者为中心的方法，利用物理疗法、靶向肉毒毒素注射和选择性手术干预，减轻了面瘫患者的长期残疾负担。
