Division of Otolaryngology - Head and Neck Surgery, Université de Montréal, Centre Hospitalier de l'Université de Montréal (CHUM) - Hôpital Notre-Dame, 1560 Sherbrooke Street, Montreal, QC, H2L 4M1, Canada.
Department of Head and Neck Surgery, Unit 1445, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
J Otolaryngol Head Neck Surg. 2018 Jan 4;47(1):1. doi: 10.1186/s40463-017-0250-y.
This study aims to assess the effectiveness of delayed facial nerve decompression for Bell's palsy (BP).
We performed a retrospective case review of all patients having undergone facial nerve decompression for severe refractory BP between 1984 and 2009 at our tertiary referral center. Demographics, timing between onset of symptoms and surgical decompression, degree of facial nerve dysfunction pre- and post-operatively, follow-up length after surgery and postoperative complications were recorded. Facial nerve dysfunction was assessed using the House-Brackmann (HB) scale. Electroneuronography, electromyography and imaging results were assessed when available.
Eighteen patients had surgery between 21 and 60 days after onset of BP (group I), and 18 patients had surgery more than 60 days after onset of symptoms (group II). In group II, 11 patients had surgery between 61 and 89 days and 7 patients after 90 days. Groups I and II showed similar functional gain and rates of improvement to HB 3 or better (11/18 vs. 11/18, p > 0.05). In group II, patients operated 60 to 89 days after onset of BP showed a significantly higher rate of improvement to HB 3 or better (9/11 vs. 2/6, p = 0.049) with higher functional gain compared to those operated after 90 days (p = 0.0293).
When indicated, facial nerve decompression for BP is usually recommended within the first 2 weeks of onset of facial paralysis. Nonetheless, our results suggest that patients with severe BP could benefit from decompression surgery within 90 days after onset of symptoms in the absence of an opportunity to proceed earlier to surgery. Further investigation is still required to confirm our findings.
Retrospective registered. IRB# 2016-6154, CE 15.154 - CA.
本研究旨在评估贝尔麻痹（BP）延迟面神经减压的效果。
我们对 1984 年至 2009 年在我们的三级转诊中心因严重难治性 BP 而行面神经减压的所有患者进行了回顾性病例回顾。记录患者的人口统计学资料、症状发作与手术减压之间的时间、手术前后面神经功能障碍的程度、手术后随访时间和术后并发症。面神经功能障碍采用 House-Brackmann（HB）量表评估。在有条件的情况下，评估电神经图、肌电图和影像学结果。
18 例患者在 BP 发病后 21 至 60 天（I 组）行手术，18 例患者在症状发作后 60 天以上（II 组）行手术。II 组中，11 例患者在发病后 61 至 89 天行手术，7 例患者在发病后 90 天以上行手术。I 组和 II 组的 HB3 或更好的功能改善率和功能改善率相似（11/18 与 11/18，p>0.05）。在 II 组中，发病后 60 至 89 天行手术的患者 HB3 或更好的改善率显著更高（9/11 与 2/6，p=0.049），与发病后 90 天行手术的患者相比，功能改善更高（p=0.0293）。
当指征明确时，BP 面神经减压通常建议在面瘫发作后 2 周内进行。尽管如此，我们的结果表明，在没有更早手术机会的情况下，严重 BP 患者可从发病后 90 天内的减压手术中获益。仍需进一步研究来证实我们的发现。
回顾性注册。IRB# 2016-6154，CE 15.154 - CA。
