为了检查病因,临床课程,复发性周围性面神经麻痹的治疗。
单一三级学术中心的回顾性回顾和文献的系统回顾。临床表现,实验室和影像学发现,所有同侧复发病例的治疗和结果,对侧复发,并回顾了双侧同时发生的面瘫病例。
在2000年至2017年之间,53名患者[41.5%男性,作者机构评估了29岁的中位发病年龄(2.5wk-75岁)]的复发性面神经麻痹。22例(41.5%)仅出现同侧复发,而其余31例患者(58.5%)至少有1次对侧复发性麻痹。没有观察到双侧同时发生面神经麻痹的病例。所有患者的瘫痪事件的中位数为3(范围2-20)。最低点House-Brackmann得分为4分,平均恢复时间为61.8天(范围1-420d),中位恢复至House-Brackmann1.5级。诊断评估证实了4例(7.5%)的Melkersson-Rosenthal综合征,两个神经结节病(3.7%),创伤性神经瘤1例(1.9%),拉姆齐·亨特综合征(1.9%),肉芽肿性多血管炎1例(1.9%),3例(5.7%)[面神经神经鞘瘤(n=2;3.7%),腮腺深叶转移性鳞状细胞癌(n=1;1.9%)];最终,77.4%(41)的病例被认为是特发性的。3例(5.7%)通过中颅窝入路进行了面神经减压,没有随后的瘫痪发作。
复发性面神经麻痹并不常见,很少有研究评估这种独特的人群。反复发作的同侧和对侧发作最常见的原因是特发性面神经麻痹(即,贝尔麻痹);然而,一个子集包含潜在的系统性疾病的肿瘤原因或局部表现。对于复发性面神经麻痹的患者,必须进行全面的诊断评估,并且在某些情况下可以考虑包括面神经减压在内的治疗考虑因素。
To examine the etiology, clinical course, and management of recurrent peripheral facial nerve paralysis.
Retrospective
review at a single tertiary academic center and systematic
review of the literature. Clinical presentation, laboratory and imaging findings, treatment and outcome for all cases of recurrent ipsilateral, recurrent contralateral, and bilateral simultaneous cases of facial paralysis are reviewed.
Between 2000 and 2017, 53 patients [41.5% men, 29 median age of onset (range 2.5 wk-75 yr)] were evaluated for recurrent facial nerve paralysis at the authors\' institution. Twenty-two (41.5%) cases presented with ipsilateral recurrences only, while the remaining 31 patients (58.5%) had at least 1 episode of contralateral recurrent paralysis. No cases of bilateral simultaneous facial nerve paralysis were observed. The median number of paretic events for all patients was 3 (range 2-20). The median nadir House-Brackmann score was 4, with a median recovery to House-Brackmann grade 1.5 over a mean recovery time of 61.8 days (range 1-420 d). Diagnostic evaluation confirmed Melkersson-Rosenthal syndrome in four (7.5%) cases, neurosarcoidosis in two (3.7%), traumatic neuroma in one (1.9%), Ramsay Hunt syndrome in one (1.9%), granulomatosis with polyangiitis in one (1.9%), and neoplastic causes in three (5.7%) cases [facial nerve schwannoma (n = 2; 3.7%), metastatic squamous cell carcinoma to the deep lobe of the parotid gland (n = 1; 1.9%)]; ultimately, 77.4% (41) of cases were deemed idiopathic. Facial nerve decompression via a middle cranial fossa approach was performed in three (5.7%) cases without subsequent episodes of paralysis.
Recurrent facial nerve paralysis is uncommon and few studies have evaluated this unique population. Recurrent ipsilateral and contralateral episodes are most commonly attributed to idiopathic facial nerve paralysis (i.e., Bell\'s palsy); however, a subset harbor neoplastic causes or local manifestations of underlying systemic disease. A comprehensive diagnostic evaluation is warranted in patients presenting with recurrent facial nerve paralysis and therapeutic considerations including facial nerve decompression can be considered in select cases.