Arden R L, Bahu S J, Zuazu M A, Berguer R
Department of Otolaryngology-Head and Neck Surgery, Harper-Grace Hospitals, Wayne State University School of Medicine, Detroit, Michigan 48201, USA.
Laryngoscope. 1998 Mar;108(3):437-42. doi: 10.1097/00005537-199803000-00023.
Reflex sympathetic dystrophy (RSD) of the face is an infrequently reported clinical pain syndrome characterized by dysesthesia, hyperalgia, hyperpathia, and allodynia. Treatment strategies, extrapolated from RSD and causalgia of the extremities, remain variable and poorly defined. Sympathetic blockade is generally the diagnostic and therapeutic treatment of choice; however, the frequency, timing, and duration of injections; need for neurolytic blocks; and role of sympathectomy are not well understood. The objectives of this report are to highlight the clinical behavior of facial RSD and contrast its essential differences from extremity RSD in response to standard treatment regimes. The case studies of two patients with this syndrome, following vascular surgery in the neck, are retrospectively reviewed with existent reported cases. Age, gender, etiology, symptoms, onset, triggers, and examination findings; timing, duration, and method of treatment; and outcome are summarized, forming the database for this study. Findings demonstrate an infrequent association of vasomotor and sudomotor changes with facial RSD, and lack of progression to a dystrophic or an atrophic stage, in contrast to extremity RSD. Furthermore, treatment response to sympathetic blockade is durable and less critically dependent on timing. The authors conclude that facial RSD has a favorable prognosis and should be managed conservatively with nonneurolytic stellate ganglion blocks, even when initiated as a delayed and repetitive injection series.
面部反射性交感神经营养不良（RSD）是一种临床疼痛综合征，报道较少，其特征为感觉异常、痛觉过敏、痛性感觉迟钝和感觉异常性疼痛。从肢体RSD和灼性神经痛推断出的治疗策略仍然多变且定义不明确。交感神经阻滞通常是诊断和治疗的首选方法；然而，注射的频率、时间和持续时间；是否需要神经溶解阻滞；以及交感神经切除术的作用尚不清楚。本报告的目的是强调面部RSD的临床行为，并对比其与肢体RSD在标准治疗方案下的本质区别。对两名颈部血管手术后患有该综合征的患者的病例研究进行回顾，并与已报道的病例进行对比。总结患者的年龄、性别、病因、症状、发病、诱因和检查结果；治疗的时间、持续时间和方法；以及结果，形成本研究的数据库。研究结果表明，与肢体RSD相比，面部RSD很少伴有血管舒缩和出汗运动变化，且不会进展为营养不良或萎缩阶段。此外，对交感神经阻滞的治疗反应持久，对时间的依赖性较小。作者得出结论，面部RSD预后良好，即使开始时采用延迟和重复注射系列，也应采用非神经溶解的星状神经节阻滞进行保守治疗。
