Andresen Nicholas S, Zhu Vivian, Lee Andrew, Sebetka Wendy, Kimura Jun, Hansen Marlan R, Gantz Bruce J, Sun Daniel Q
Department of Otolaryngology-Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore Maryland USA.
Department of Otolaryngology-Head and Neck Surgery University of Iowa Hospitals and Clinics Iowa City Iowa USA.
Laryngoscope Investig Otolaryngol. 2020 Sep 10;5(5):928-935. doi: 10.1002/lio2.458. eCollection 2020 Oct.
To study the relationship between various electrodiagnostic modalities in acute facial palsy.
Academic tertiary care center.
One-hundred and six patients who presented with traumatic or non-traumatic acute facial paralysis (House-Brackmann, HB, grade 6/6) between 2008 and 2017 and underwent acute electrodiagnostic testing.
Electroneurography (ENoG) using nasolabial fold (NLF) or nasalis muscle (NM) methods, and volitional electromyography (EMG) in all patients.
Percent degeneration of ipsilateral facial nerve compound muscle action potentials (CMAP) on NLF- and NM-ENoG, presence or absence of muscle unit potentials (MUPs) on EMG.
Extent of facial nerve degeneration measured by NLF- and NM-ENoG were highly correlated ( = 0.85, < .01) on each test and on serial testing. NLF- and NM-ENoG concordantly diagnosed ≥90% degeneration in 44 patients (80%), of whom 32 patients were diagnosed to have 100% degeneration by both methodologies. Absence of MUPs on EMG was 63% sensitive and 92% specific for ≥90% degeneration on ENoG, with a positive predictive value of 90%. For patients with Bell's palsy, percent degeneration on ENoG was also correlated to HB score at 1 year. Surgical decompression resulted in mean HB scores of 2.2 and 3.0 for patients with Bell's palsy and trauma, respectively.
NM-ENoG may be a valid and comparable method to NLF-ENoG for predicting the recovery of facial nerve function in acute paralysis. Absence of MUPs on EMG is a specific measure of severe degeneration and highly predictive of candidacy for surgical decompression.
Level 3.
研究急性面瘫中各种电诊断方法之间的关系。
学术性三级医疗中心。
2008年至2017年间出现创伤性或非创伤性急性面瘫（House-Brackmann分级，HB，6/6级）并接受急性电诊断测试的106例患者。
所有患者均采用鼻唇沟（NLF）或鼻肌（NM）方法进行神经电图（ENoG）检查，并进行随意肌电图（EMG）检查。
NLF-ENoG和NM-ENoG检查时患侧面神经复合肌肉动作电位（CMAP）的变性百分比，EMG检查时是否存在运动单位电位（MUP）。
在每次测试及系列测试中，通过NLF-ENoG和NM-ENoG测量的面神经变性程度高度相关（r = 0.85，P <.01）。NLF-ENoG和NM-ENoG一致诊断出44例患者（80%）有≥90%的变性，其中32例患者通过两种方法均诊断为100%变性。EMG检查未发现MUP对ENoG检查中≥90%变性的敏感性为63%，特异性为92%，阳性预测值为90%。对于贝尔面瘫患者，ENoG检查的变性百分比也与1年后的HB评分相关。手术减压后，贝尔面瘫和创伤患者的平均HB评分分别为2.2和3.0。
对于预测急性面瘫面神经功能的恢复，NM-ENoG可能是一种与NLF-ENoG有效且可比的方法。EMG检查未发现MUP是严重变性的一项特异性指标，对手术减压的候选资格具有高度预测性。
3级。
