Department of Neurology, Johns Hopkins University, Baltimore, Maryland.
Semin Neurol. 2021 Dec;41(6):673-685. doi: 10.1055/s-0041-1726358. Epub 2021 Nov 26.
Facial palsy is a common neurologic concern and is the most common cranial neuropathy. The facial nerve contains motor, parasympathetic, and special sensory functions. The most common form of facial palsy is idiopathic (Bell's palsy). A classic presentation requires no further diagnostic measures, and generally improves with a course of corticosteroid and antiviral therapy. If the presentation is atypical, or concerning features are present, additional studies such as brain imaging and cerebrospinal fluid analysis may be indicated. Many conditions may present with facial weakness, either in isolation or with other neurologic signs (e.g., multiple cranial neuropathies). The most important ones to recognize include infections (Ramsay-Hunt syndrome associated with herpes zoster oticus, Lyme neuroborreliosis, and complications of otitis media and mastoiditis), inflammatory (demyelination, sarcoidosis, Miller-Fisher variant of Guillain-Barré syndrome), and neoplastic. No matter the cause, individuals may be at risk for corneal injury, and, if so, should have appropriate eye protection. Synkinesis may be a bothersome residual phenomenon in some individuals, but it has a variety of treatment options including neuromuscular re-education and rehabilitation, botulinum toxin chemodenervation, and surgical intervention.
面瘫是一种常见的神经科问题，也是最常见的颅神经病变。面神经包含运动、副交感和特殊感觉功能。最常见的面瘫类型是特发性（贝尔面瘫）。典型表现无需进一步诊断，通常采用皮质类固醇和抗病毒治疗即可改善。如果表现不典型，或存在令人担忧的特征，则可能需要进行额外的研究，如脑部成像和脑脊液分析。许多疾病可能表现为面部无力，无论是单独出现还是与其他神经症状一起出现（例如，多发性颅神经病变）。需要特别注意的最重要疾病包括感染（与耳部带状疱疹相关的 Ramsay-Hunt 综合征、莱姆神经梅毒和中耳炎及乳突炎并发症）、炎症（脱髓鞘、结节病、格林-巴利综合征的 Miller-Fisher 变异型）和肿瘤。无论病因如何，患者都可能存在角膜损伤的风险，如果发生这种情况，应进行适当的眼部保护。在一些患者中，联带运动可能是一种令人烦恼的残留现象，但它有多种治疗选择，包括神经肌肉再教育和康复、肉毒毒素化学去神经支配以及手术干预。
