Jabor M A, Gianoli G
Dept of Otolaryngology, Tulane University School of Medicine in New Orleans, USA.
J La State Med Soc. 1996 Jul;148(7):279-83.
Bell's palsy or idiopathic palsy is the most common disorder affecting the facial nerve. Diagnosis is primarily one of exclusion. There is typically an acute unilateral facial paresis that evolves in 24 to 48 hours. Etiology and pathophysiology are heavily disputed, and as of yet unknown. The natural history of Bell's palsy is favorable. Eight-four percent show satisfactory recovery without any treatment, however 16% suffer moderate to severe sequelae. Prognosis is influenced by degree of paresis, age of patient, and time until first signs of recovery. Prognostic testing currently involves various electrophysiological tests. More than 90% degeneration of the facial nerve carries a poor prognosis for recovery; these are the patients who may benefit from facial nerve decompression surgery. If surgery is performed it should be done early (< 21 days from onset of palsy) and should include a middle cranial fossa decompression. Steroids are generally agreed to be beneficial. Acyclovir would seem to be a promising drug; however studies have not adequately assessed its use.
贝尔面瘫或特发性面瘫是影响面神经的最常见疾病。诊断主要是排除性诊断。通常会出现急性单侧面部麻痹，并在24至48小时内发展。病因和病理生理学存在很大争议，目前尚不清楚。贝尔面瘫的自然病程较好。84%的患者未经任何治疗即可获得满意恢复，然而16%的患者会留下中度至重度后遗症。预后受麻痹程度、患者年龄以及首次恢复迹象出现的时间影响。目前的预后测试涉及各种电生理测试。面神经超过90%的变性提示恢复预后不良；这些患者可能从面神经减压手术中获益。如果进行手术，应尽早进行（面瘫发作后<21天），且应包括中颅窝减压。一般认为类固醇有益。阿昔洛韦似乎是一种有前景的药物；然而研究尚未充分评估其用途。
