复旦大学眼耳鼻喉科医院

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1、EvaluationandmanagementofBell’spalsyChunfuDaiOtolaryngologyDepartmentFudanUniversity复旦大学眼耳鼻喉科医院DefinitionRapidonsetofthefacialpalsyMinimalassociatedsymptomsSpontaneousrecovery(80%)ThediagnosisismadeaftertheexclusionofotherpossibilityEtiologyVascularcongestionwithsecondaryischemiatothenerveVa

2、sospasmwouldleadtoischemia,nerveedema,andsecondarycompressionwithinthefallopiancanal.ViralpolycranioneuropathyHerpessimplexvirusandherpeszostervirusClinicfeaturesLesscommonbeforetheageof15yTheincidenceinmenandwomenissimilarApproximately6-9%developrecurrentBell’sPalsyFacialparesisaloneoccurred

3、in31%Completelyparalysisin69%Clinicfeatures71%ofpatientswithcompletelyparalysisachieveaH-BG113%aH-BG2Theremaining16%inthiscompleteparalysisgrouphaveafairtopoorrecovery(H-B3-5)PrognosisAllpatientswithcompleteorpartialparalysis,approximately85%recovertonormalwithoneyearwithouttreatment.Patiente

4、xperienceddelayedrecoveryover3months,alldevelopedsequelaeReturnofatleastsomefacialfunctionwasnotedinallpatients.EvaluationofacutefacialparalysisHouse-BrackmangradesystemI,Normal:NormalfacialfunctioninallareasII,Milddysfunction:slightweaknessnoticeableonlyoncloseinspectionAtrest:normalsymmetry

5、andtoneMotion:sometonormalmovementofforeheadAbilitytocloseeyewithminimaleffortAbilitytomovecornersofmouthwithmaximaleffortandslightasymmetryNosynkinesis,contractur,orhemifacialspasmEvaluationofacutefacialparalysisHouse-BrackmangradesystemIII,moderatedysfunction:obviousbutnotdisfiguringdiffere

6、ncebetweentwosideNofunctionimpairmentNoticeablebutnotseveresynkinesis,contracture,andhemifacialspasmAtrest:normalsymmetryandtoneMotion:slighttonomovementofforeheadAbilitytocloseeyewithmaximaleffortandobviousasymmetryAbilitytomovecornersofmouthwithmaximaleffortandobviousasymemetryPatientswitho

7、bviousbutnotdisfiguringsynkinesis,contracture,andhemifcialspasmaregrade3regardlessofdegreeofmotoractivity.EvaluationofacutefacialparalysisHouse-BrackmangradesystemIV,moderateseveredysfunction:ObviousweaknessanddisfiguringasymmetryAtrest:norma