Lee Ping-Hsun, Liang Chi-Cheng, Huang Shiang-Fu, Liao Han-Tsung
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, LinKou.
Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung.
J Craniofac Surg. 2018 Oct;29(7):1842-1847. doi: 10.1097/SCS.0000000000004641.
Although facial nerve palsy is uncommon after a blunt craniofacial injury, it will result in functional and aesthetic disability if full recovery is not achieved. Currently, the management is still controversial and mainly through systemic steroid therapy or surgical decompression. However, current studies mainly focus on the surgical intervention, and only a few of these studies discuss the details of the steroid treatments. Thus, the purpose of this study is to analyze possible prognosis factors of systemic steroid in managing traumatic facial nerve palsy after a blunt craniofacial injury retrospectively.
During the period from May 2005 to April 2015 at Chang Gung Memorial Hospital, a total of 26 patients who suffered from post-traumatic facial nerve palsy receiving steroid therapy were enrolled in the study. All the patient's charts were reviewed, recorded, and analyzed including the general data, temporal bone fracture type, hospital courses, trauma-related data from emergency room records, and initial and final facial nerve palsy grading. The facial nerve palsy was graded using the House-Brackmann (HB) system; the final HB grade I was set as full recovery.
The outcome showed steroid therapy onset within 24 hours (odds ratio [OR] = 10.111; 95% confidence interval [CI] = 1.597-64.005; P = 0.014) and steroid therapeutic duration for longer than 14 days (OR = 11.571; 95% CI = 1.172-114.262; P = 0.036) possessed a significantly better recovery rate.
This study recommends to apply steroids within 24 hours once post-traumatic facial palsy occurs and the therapy should persist longer than 14 days.
尽管钝性颅面损伤后面神经麻痹并不常见，但如果不能完全恢复，将导致功能和美观方面的残疾。目前，治疗方法仍存在争议，主要是通过全身类固醇治疗或手术减压。然而，目前的研究主要集中在手术干预上，只有少数研究讨论了类固醇治疗的细节。因此，本研究的目的是回顾性分析全身类固醇治疗钝性颅面损伤后创伤性面神经麻痹的可能预后因素。
在2005年5月至2015年4月期间，长庚纪念医院共有26例创伤后面神经麻痹接受类固醇治疗的患者纳入本研究。回顾、记录并分析了所有患者的病历，包括一般资料、颞骨骨折类型、住院病程、急诊室记录中的创伤相关数据以及初始和最终面神经麻痹分级。面神经麻痹采用House-Brackmann（HB）系统分级；最终HB I级设定为完全恢复。
结果显示，伤后24小时内开始类固醇治疗（优势比[OR]=10.111；95%置信区间[CI]=1.597-64.005；P=0.014）和类固醇治疗持续时间超过14天（OR=11.571；95%CI=1.172-114.262；P=0.036）的患者恢复率明显更高。
本研究建议创伤后面神经麻痹一旦发生应在24小时内应用类固醇，且治疗应持续超过14天。
