The role of facial canal diameter in the pathogenesis and grade of Bell's palsy: a study by high resolution computed tomography.
The role of facial canal diameter in the pathogenesis and grade of Bell's palsy: a study by high resolution computed tomography.
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DOI：
10.1016/j.bjorl.2016.03.016
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发表时间：
2017-05
影响因子：
2.2
通讯作者：
Toker, Gokce Tanyeri
中科院分区：
文献类型：
--
作者：
Celik, Onur;Eskiizmir, Gorkem;Pabuscu, Yuksel;Ulkumen, Burak;Toker, Gokce Tanyeri
贝尔氏麻痹的确切病因仍不清楚。唯一被证实的发现是面神经的炎症和水肿，导致面神经管内的卡壳。确定贝尔氏麻痹的程度与面管直径之间是否存在任何关系，并研究贝尔氏麻痹的面管可能的解剖易感性，包括以前未研究过的部分。本回顾性临床研究采用34例贝尔麻痹患者的医疗记录和颞部计算机断层扫描。分别在迷路节、膝状神经节、鼓室节、第二膝、乳突节和茎突孔处测量受影响和未受影响的两面管直径。根据患者的医疗记录对患者就诊时和治疗后3个月的House-Brackmann （HB）量表进行评估。患病侧与未患病侧的宽度比较采用配对样本t检验和Wilcoxon符号秩检验。采用Wilcoxon符号秩检验评价面神经管直径与贝尔麻痹程度的关系。在p = 0.05水平上建立显著差异（IBM SPSS Statistics for Windows, Version 21.0.; Armonk， NY, IBM Corp .）。34例，女性16例，男性18例；平均年龄±标准差，40.3±21.3 -贝尔氏麻痹纳入研究。根据HB面神经分级系统；V级8例，IV级6例，III级11例，II级8例，i级1例。患颞骨面管迷路段平均宽度明显小于未患颞骨（p = 0.00）。颞骨膝状神经节（p = 0.87）、鼓室段（p = 0.66）、第二膝（p = 0.62）、乳突节段（p = 0.67）和茎突孔（p = 0.16）受累与未受累颞骨差异无统计学意义。在迷路节（p = 0.41）、鼓室节（p = 0.12）、乳突节（p = 0.14）、膝状神经节（p = 0.13）、茎突孔（p = 0.44）水平，HB分级与面管直径无相关性，而在第二膝水平，HB分级与面管直径有显著相关性（p = 0.02）。我们发现面管迷路段的直径是贝尔麻痹的一个解剖危险因素。我们还发现HB分级与第二膝水平FC直径之间存在显著关系。未来的研究（MRI-CT联合或3D建模）需要促进这种可能的相关性，特别是在第二膝。因此，在未来有可能选择性地对高级别BP患者的特定节段进行减压。
The exact etiology of Bell's palsy still remains obscure. The only authenticated finding is inflammation and edema of the facial nerve leading to entrapment inside the facial canal. To identify if there is any relationship between the grade of Bell's palsy and diameter of the facial canal, and also to study any possible anatomic predisposition of facial canal for Bell's palsy including parts which have not been studied before. Medical records and temporal computed tomography scans of 34 patients with Bell's palsy were utilized in this retrospective clinical study. Diameters of both facial canals (affected and unaffected) of each patient were measured at labyrinthine segment, geniculate ganglion, tympanic segment, second genu, mastoid segment and stylomastoid foramen. The House-Brackmann (HB) scale of each patient at presentation and 3 months after the treatment was evaluated from their medical records. The paired samples t-test and Wilcoxon signed-rank test were used for comparison of width between the affected side and unaffected side. The Wilcoxon signed-rank test was also used for evaluation of relationship between the diameter of facial canal and the grade of the Bell's palsy. Significant differences were established at a level of p = 0.05 (IBM SPSS Statistics for Windows, Version 21.0.; Armonk, NY, IBM Corp). Thirty-four patients – 16 females, 18 males; mean age ± Standard Deviation, 40.3 ± 21.3 - with Bell's palsy were included in the study. According to the HB facial nerve grading system; 8 patients were grade V, 6 were grade IV, 11 were grade III, 8 were grade II and 1 patient was grade I. The mean width at the labyrinthine segment of the facial canal in the affected temporal bone was significantly smaller than the equivalent in the unaffected temporal bone (p = 0.00). There was no significant difference between the affected and unaffected temporal bones at the geniculate ganglion (p = 0.87), tympanic segment (p = 0.66), second genu (p = 0.62), mastoid segment (p = 0.67) and stylomastoid foramen (p = 0.16). We did not find any relationship between the HB grade and the facial canal diameter at the level of labyrinthine segment (p = 0.41), tympanic segment (p = 0.12), mastoid segment (p = 0.14), geniculate ganglion (p = 0.13) and stylomastoid foramen (p = 0.44), while we found significant relationship at the level of second genu (p = 0.02). We found the diameter of labyrinthine segment of facial canal as an anatomic risk factor for Bell's palsy. We also found significant relationship between the HB grade and FC diameter at the level of second genu. Future studies (MRI-CT combined or 3D modeling) are needed to promote this possible relevance especially at second genu. Thus, in the future it may be possible to selectively decompress particular segments in high grade BP patients.
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