Portelinha Joana, Passarinho Maria Picoto, Costa João Marques
Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
Saudi J Ophthalmol. 2015 Jan-Mar;29(1):39-47. doi: 10.1016/j.sjopt.2014.09.009. Epub 2014 Sep 28.
Facial nerve palsy is associated with significant morbidity and can have different etiologies. The most common causes are Bell's palsy, Ramsay-Hunt syndrome and trauma, including surgical trauma. Incidence varies between 17 and 35 cases per 100,000. Initial evaluation should include accurate clinical history, followed by a comprehensive investigation of the head and neck, including ophthalmological, otological, oral and neurological examination, to exclude secondary causes. Routine laboratory testing and diagnostic imaging is not indicated in patients with new-onset Bell's palsy, but should be performed in patients with risk factors, atypical cases or in any case without resolution within 4 months. Many factors are involved in determining the appropriate treatment of these patients: the underlying cause, expected duration of nerve dysfunction, anatomical manifestations, severity of symptoms and objective clinical findings. Systemic steroids should be offered to patients with new-onset Bell's palsy to increase the chance of facial nerve recovery and reduce synkinesis. Ophthalmologists play a pivotal role in the multidisciplinary team involved in the evaluation and rehabilitation of these patients. In the acute phase, the main priority should be to ensure adequate corneal protection. Treatment depends on the degree of nerve lesion and on the risk of the corneal damage based on the amount of lagophthalmos, the quality of Bell's phenomenon, the presence or absence of corneal sensitivity and the degree of lid retraction. The main therapy is intensive lubrication. Other treatments include: taping the eyelid overnight, botulinum toxin injection, tarsorrhaphy, eyelid weight implants, scleral contact lenses and palpebral spring. Once the cornea is protected, longer term planning for eyelid and facial rehabilitation may take place. Spontaneous complete recovery of Bell's palsy occurs in up to 70% of cases. Long-term complications include aberrant regeneration with synkinesis. FNP after acoustic neuroma surgery remains the most common indication for FN rehabilitation.
面神经麻痹会导致严重的发病率，且病因多样。最常见的病因是贝尔麻痹、拉姆齐-亨特综合征和创伤，包括手术创伤。发病率为每10万人中有17至35例。初始评估应包括准确的临床病史，随后对头颈部进行全面检查，包括眼科、耳科、口腔和神经科检查，以排除继发性病因。新发贝尔麻痹患者无需进行常规实验室检查和诊断性影像学检查，但有危险因素、非典型病例或4个月内未恢复的任何病例均应进行相关检查。确定这些患者的适当治疗涉及许多因素：潜在病因、神经功能障碍的预期持续时间、解剖学表现、症状严重程度和客观临床发现。新发贝尔麻痹患者应使用全身性类固醇，以增加面神经恢复的机会并减少联带运动。眼科医生在参与这些患者评估和康复的多学科团队中起着关键作用。在急性期，首要任务应是确保角膜得到充分保护。治疗取决于神经损伤程度以及基于睑裂闭合不全程度、贝尔现象质量、角膜感觉是否存在以及眼睑退缩程度的角膜损伤风险。主要治疗方法是强化润滑。其他治疗方法包括：夜间粘贴眼睑、注射肉毒杆菌毒素、睑缘缝合术、植入眼睑配重、佩戴巩膜接触镜和眼睑弹簧。一旦角膜得到保护，就可以进行眼睑和面部康复的长期规划。高达70%的贝尔麻痹患者可自发完全恢复。长期并发症包括异常再生和联带运动。听神经瘤手术后的面神经麻痹仍然是面神经康复最常见的适应症。
