Yadav Sanjeev, Panda Naresh Kumar, Verma Roshan, Bakshi Jaimanti, Modi Manish
Department of Otolaryngology, PGIMER, Chandigarh, India.
Department of Neurology, PGIMER, Chandigarh, India.
Eur Arch Otorhinolaryngol. 2018 Nov;275(11):2695-2703. doi: 10.1007/s00405-018-5141-y. Epub 2018 Sep 25.
Early facial nerve decompression is recommended for cases of post-traumatic facial palsy on the basis of ENoG with degeneration > 95%. There is still a dispute in the literature concerning the role and timing of surgery versus conservative treatment in such cases. This study has been planned to evaluate the outcome of conservative management in traumatic facial paralysis with regard to type of trauma, onset, and electrodiagnostic tests.
A prospective cohort study included 39 patients with post-traumatic facial palsy. All patients underwent ENoG, nerve stimulation test, HRCT temporal bone and Schirmer's test. The patients received intravenous methylprednisolone 1 gm/day for 5 days or oral prednisolone 1 mg/kg in tapering doses for 3 weeks. Follow-up was done at 4, 12 and 24 weeks after the treatment. Surgical exploration was limited to patients showing no improvement after 12 weeks. Facial nerve function was evaluated by the HBFNS and FEMA grading systems.
Among the 39 patients in the study [5 women and 34 men; mean (SD) age, 33.5 (11.37) years], facial nerve recovery with conservative treatment alone was noted in 31 patients. The first signs of clinical recovery were noted in 27 patients by 4 weeks, in 31 patients by 12 weeks. Seven patients required surgical exploration. At 24 weeks, 31 patients recovered to House-Brackmann grade I/III and 1 patient to grade IV. 19 of 26 patients with longitudinal fractures had grade I/III recovery, whereas all 6 patients with transverse fracture recovered on conservative treatment.
Patients with incomplete facial palsy are candidates for conservative management. It is justified to try conservative management in patients with complete facial paralysis for up to 3 months even in cases where ENoG and NET suggest poor prognosis. The presence of sensorineural hearing loss or transverse fracture at presentation does not suggest a poor prognosis for improvement.
对于创伤后面神经麻痹且神经电图（ENoG）显示变性>95%的病例，建议早期进行面神经减压术。关于此类病例手术与保守治疗的作用及时机，文献中仍存在争议。本研究旨在评估创伤性面神经麻痹保守治疗的结果，涉及创伤类型、发病时间及电诊断测试。
一项前瞻性队列研究纳入了39例创伤后面神经麻痹患者。所有患者均接受了ENoG、神经刺激试验、颞骨高分辨率CT（HRCT）及泪液分泌试验。患者接受静脉注射甲泼尼龙1克/天，共5天，或口服泼尼松龙1毫克/千克，逐渐减量，共3周。治疗后4周、12周和24周进行随访。手术探查仅限于12周后无改善的患者。采用House-Brackmann面神经功能分级系统（HBFNS）和面部表情肌运动分级系统（FEMA）评估面神经功能。
在该研究的39例患者中[5例女性和34例男性；平均（标准差）年龄为33.5（11.37）岁]，31例患者仅通过保守治疗实现了面神经恢复。27例患者在4周时出现临床恢复的最初迹象，31例患者在12周时出现。7例患者需要进行手术探查。在24周时，31例患者恢复至House-Brackmann分级I/III级，1例患者恢复至IV级。26例纵行骨折患者中有19例恢复至I/III级，而所有6例横行骨折患者经保守治疗均恢复。
不完全性面神经麻痹患者适合保守治疗。即使在ENoG和神经电刺激试验（NET）提示预后不良的情况下，对于完全性面神经麻痹患者尝试长达3个月的保守治疗也是合理的。就诊时存在感音神经性听力损失或横行骨折并不意味着改善预后不良。
