Adour K K, Boyajian J A, Kahn Z M, Schneider G S
Laryngoscope. 1977 Mar;87(3):380-90. doi: 10.1288/00005537-197703000-00011.
The outcomes of facial nerve decompression, surgical exploration, and nonsurgical treatment for facial paralysis following closed head injury were analyzed in 30 patients with an intact facial nerve, and complete evaluation. Objective evaluation of outcome was achieved by calculation of a Facial Paralysis Recovery Profile and Recovery Index (Profile minus complications). Twelve of 15 patients with incomplete facial paralysis were treated medically. All followed patients with incomplete paralysis and bilaterally equal facial nerve excitability had a Recovery Index of + 10 (complete recovery of function, no complications). Three with partial denervation had a Recovery Profile of + 10 with mild contracture and synkinesis. The average Recovery Profiles for all patients treated by decompression, exploration, or nonsurgically were respectively 4.0, 5.7, and 5.7. The Recovery Indices were +1.8, +3, and +2.7, respectively. Where nerve excitability had become abnormal, facial nerve decompression was of no benefit in traumatic facial paralysis due to closed head injury. Nerve excitability tests of peripheral branches are of great value for prognosis and selection of patients who do not need surgical intervention. Substitution of facial nerve exploration for facial nerve decompression seems reasonable. Polytomography of the facial canal is invaluable in selection of patients for operation.
对30例面神经完整且经过全面评估的闭合性颅脑损伤后面神经麻痹患者的面神经减压、手术探查及非手术治疗结果进行了分析。通过计算面神经麻痹恢复概况和恢复指数（概况减去并发症）实现了对结果的客观评估。15例不完全性面神经麻痹患者中有12例接受了药物治疗。所有随访的不完全性麻痹且双侧面神经兴奋性相等的患者恢复指数为 +10（功能完全恢复，无并发症）。3例部分失神经支配患者的恢复概况为 +10，伴有轻度挛缩和联带运动。接受减压、探查或非手术治疗的所有患者的平均恢复概况分别为4.0、5.7和5.7。恢复指数分别为 +1.8、+3和 +2.7。当神经兴奋性出现异常时，面神经减压对闭合性颅脑损伤所致创伤性面神经麻痹无效。周围分支的神经兴奋性测试对预后及选择无需手术干预的患者具有重要价值。用面神经探查替代面神经减压似乎是合理的。面神经管断层摄影术在选择手术患者方面具有重要价值。
