Noya M, Pardo J
Servicio de Neurología, Hospital General de Galicia-Clínico Universitario, Santiago de Compostela.
Neurologia. 1997 Jan;12(1):23-30.
The topographic diagnosis of facial nerve lesions is based on the symptoms that accompany paralysis, allowing lesions to be located in the protuberance, pontocerebellar angle, facial channel or trajectory distal to the stylomastoid foramen. Most cases of peripheral facial palsy have no apparent cause (idiopathic, or Bell's, peripheral facial palsy). However, facial palsy can sometimes be a manifestation of neuroborreliosis, multiple sclerosis, diabetes, HIV infection or neurinoma. Neurophysiologic studies complement physical examination to establish a prognosis; after the fifth day axonal degeneration related to incomplete recovery can be recognized. Magnetic resonance identifies nerve lesions but is useful only in atypical cases. Prednisone 1 mg/kg over 5 days, with gradual weaning, is the most widely accepted treatment for Bell's palsy. Acyclovir is indicated in Ramsay-Hunt syndrome. Early surgical decompression in cases with poor prognosis is not generally considered beneficial. Cases of permanent facial palsy have serious consequences, particularly because facial expression is altered.
面神经病变的定位诊断基于麻痹伴随的症状，据此可将病变定位于乳突、桥小脑角、面神经管或茎乳孔远端的走行部位。大多数周围性面瘫病例无明显病因（特发性或贝尔氏周围性面瘫）。然而，面瘫有时可能是神经莱姆病、多发性硬化症、糖尿病、HIV感染或神经鞘瘤的表现。神经生理学研究辅助体格检查以判断预后；在第五天后可识别出与恢复不完全相关的轴索性变性。磁共振成像可识别神经病变，但仅在非典型病例中有用。泼尼松1mg/kg，连用5天，然后逐渐减量，是贝尔氏面瘫最广泛接受的治疗方法。阿昔洛韦适用于拉姆齐-亨特综合征。一般认为，对预后不良的病例进行早期手术减压并无益处。永久性面瘫病例会产生严重后果，尤其是面部表情改变。
