Department of Neurology, Klinikum Landshut; Department of Neurology, Asklepios Klinik Barmbek, Hamburg; Orbitazentrum, Bürgerhospital, Frankfurt; Department of Otolaryngology, Jena University Hospital; Department of General Practice, Julius-Maximilians-Universität Würzburg.
Dtsch Arztebl Int. 2019 Oct 11;116(41):692-702. doi: 10.3238/arztebl.2019.0692.
Peripheral facial nerve palsy is the most com- mon functional disturbance of a cranial nerve. 60-75% of cases are idiopathic.
This review is based on a selective literature search proceeding from the current, updated German-language guideline on the diagnosis and treatment of idiopathic facial nerve palsy.
The recommended drug treatment consists of prednisolone 25 mg bid for 10 days, or 60 mg qd for 5 days followed by a taper to off in decrements of 10 mg per day. This promotes full recovery (number needed to treat [NNT] = 10; 95% confidence interval [6; 20]) and lessens the risk of late sequelae such as synkinesia, autonomic disturbances, and contractures. Virostatic drugs are optional in severe cases (intense pain or suspicion of herpes zoster sine herpete) and mandatory in cases of varicella-zoster virus (VZV) infection. Corneal protection with dexpanthenol ophthalmic ointment, artificial tears, and a nocturnal moisture- retaining eye shield has been found useful in practice. In cases of incomplete recovery with residual facial weakness, both static and microsurgical dynamic methods can be used to restore facial nerve function.
Because 25-40% of cases of facial nerve palsy are not idiopathic, differential diagnosis is very important; key diagnostic methods include a clinical neurological examin- ation, otoscopy, and a lumbar puncture for cerebrospinal fluid examination. High-level evidence supports corticosteroid treatment for the idiopathic form of the disorder.
周围性面神经麻痹是颅神经最常见的功能障碍。60-75%的病例为特发性。
本综述基于对当前更新的德国特发性面神经麻痹诊断和治疗指南的选择性文献检索。
推荐的药物治疗包括泼尼松 25 mg，bid，共 10 天，或 60 mg，qd，共 5 天，然后逐渐减量，每天减少 10 mg。这可促进完全恢复（需要治疗的人数 [NNT] = 10；95%置信区间 [6；20]），并降低迟发性后遗症（如联带运动、自主神经障碍和挛缩）的风险。在严重病例（剧烈疼痛或怀疑带状疱疹无疱疹）中，抗病毒药物是可选的，在水痘带状疱疹病毒（VZV）感染的情况下是强制性的。用右泛醇眼膏、人工泪液和夜间保湿眼罩保护角膜已被证明在实践中有用。对于残留面神经无力的不完全恢复，可以使用静态和显微外科动态方法来恢复面神经功能。
由于 25-40%的面神经麻痹病例不是特发性的，因此鉴别诊断非常重要；关键的诊断方法包括临床神经系统检查、耳镜检查和腰椎穿刺以检查脑脊液。高水平证据支持皮质类固醇治疗特发性面神经麻痹。
