Asklepios Campus Hamburg of Semmelweis University, Ludolfstraße 53, 20249, Hamburg, Germany.
Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Plastic Surgery, Asklepios Klinik St. Georg, Hamburg, Germany.
Eur Arch Otorhinolaryngol. 2020 Apr;277(4):965-974. doi: 10.1007/s00405-020-05825-y. Epub 2020 Feb 1.
This review focuses on the etiology, incidence and therapy of delayed paralysis of the facial nerve (DFP) after different types of middle ear surgery.
Retrospective review of studies published in English from 1970 until 2019 reporting DFP after tympanoplasty, tympanomastoid surgery, stapedotomy and stapedectomy. The search used the databases of PubMed, Scopus and Cochrane Library. Studies reporting from adult patients and DFP onset after 48 h after surgery were included. Studies dealing with iatrogenic or preexisting facial palsy and case reports were excluded. The initial literature search resulted in 52 studies. The relevance of the publications was verified using title, abstract and full-text analysis. Data were analyzed with descriptive statistics using median, simple sum and statistical significance.
Ten studies having 12,161 patients could be included in this review. The incidence of DFP after the middle ear surgeries varies between 0.2 and 1.9%. The surgical stress of the middle ear surgeries is the main trigger for the development of DFP and leads to a virus reactivation and/or neuronal edema. Patients with a dehiscence of the facial canal have a significantly higher probability for a DFP. The recommended therapy of DFP based on the data of the therapy of Bell's palsy, consists of the administration of a steroid. For patients having a case history of previous viral infections, an antiviral prophylaxis is recommended.
Overall, DFP has a very good prognosis, with mostly complete healing with appropriate therapy. Viral reactivation is the most favored genesis of DFP. Immunization or antiviral prophylaxis is recommended to those patients being at risk for a viral reactivation.
本篇综述聚焦于不同类型中耳手术后迟发性面瘫（DFP）的病因、发病率和治疗方法。
回顾性分析了 1970 年至 2019 年间以英语发表的报告鼓室成形术、乳突手术、镫骨切开术和镫骨切除术后面瘫的研究。检索使用了 PubMed、Scopus 和 Cochrane Library 数据库。纳入研究报告了成年患者术后 48 小时后发生 DFP 的情况。排除了涉及医源性或预先存在的面瘫以及病例报告的研究。初始文献检索得到 52 项研究。使用标题、摘要和全文分析来验证出版物的相关性。使用中位数、简单总和和统计显著性进行数据分析。
本综述纳入了 10 项研究，共计 12161 例患者。中耳手术后 DFP 的发病率在 0.2%至 1.9%之间。中耳手术的手术应激是 DFP 发展的主要触发因素，导致病毒再激活和/或神经元水肿。面神经管裂的患者发生 DFP 的概率显著增加。基于面瘫治疗数据，推荐的 DFP 治疗方法包括使用类固醇。对于有既往病毒感染史的患者，建议进行抗病毒预防。
总体而言，DFP 的预后良好，大多数患者经适当治疗可完全康复。病毒再激活是 DFP 最常见的病因。建议对有病毒再激活风险的患者进行免疫接种或抗病毒预防。
