The Diagnosis and Treatment of Idiopathic Facial Paresis (Bell's Palsy)
The Diagnosis and Treatment of Idiopathic Facial Paresis (Bell's Palsy)
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DOI：
10.3238/arztebl.2019.0692
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发表时间：
2019-10-11
影响因子：
7.7
通讯作者：
Gagyor, Ildik.
中科院分区：
文献类型：
--
作者：
Heckmann, Josef Georg;Urban, Peter Paul;Gagyor, Ildik.
背景：周围性面神经麻痹是最常见的脑神经功能障碍。60-75%的病例是特发性的。方法：本次审查是根据选择性的文献检索进行从目前，更新德语指南的诊断和治疗特发性面神经palsis.Results：推荐的药物治疗包括泼尼松龙25毫克，每日两次，10天，或60毫克，每日一次，5天，然后逐渐减少到关闭，每天10毫克的递减。这促进了完全康复（需要治疗的人数[NNT] = 10; 95%置信区间[6; 20]），并降低了晚期后遗症的风险，如联带运动、自主神经紊乱和挛缩。病毒抑制药物在严重病例中是可选的（剧烈疼痛或怀疑带状疱疹无疱疹），在水痘带状疱疹病毒（VZV）感染的情况下是强制性的。实践中发现，使用右泛醇眼膏、人工泪液和夜间保湿眼罩来保护角膜是有用的。在不完全恢复的情况下，残留的面部weakness.Conclusion：静态和显微手术动态的方法可以用来恢复面神经功能，因为25-40%的情况下，面神经麻痹不是特发性的，鉴别诊断是非常重要的，关键的诊断方法包括临床神经系统检查，耳镜，和腰椎穿刺脑脊液检查。高水平的证据支持皮质类固醇治疗的特发性形式的障碍。
Background: Peripheral facial nerve palsy is the most common functional disturbance of a cranial nerve. 60-75% of cases are idiopathic.Methods: This review is based on a selective literature search proceeding from the current, updated German-language guideline on the diagnosis and treatment of idiopathic facial nerve palsy.Results: The recommended drug treatment consists of prednisolone 25 mg bid for 10 days, or 60 mg qd for 5 days followed by a taper to off in decrements of 10 mg per day. This promotes full recovery (number needed to treat [NNT] = 10; 95% confidence interval [6; 20]) and lessens the risk of late sequelae such as synkinesia, autonomic disturbances, and contractures. Virostatic drugs are optional in severe cases (intense pain or suspicion of herpes zoster sine herpete) and mandatory in cases of varicella-zoster virus (VZV) infection. Corneal protection with dexpanthenol ophthalmic ointment, artificial tears, and a nocturnal moisture-retaining eye shield has been found useful in practice. In cases of incomplete recovery with residual facial weakness, both static and microsurgical dynamic methods can be used to restore facial nerve function.Conclusion: Because 25-40% of cases of facial nerve palsy are not idiopathic, differential diagnosis is very important; key diagnostic methods include a clinical neurological examination, otoscopy, and a lumbar puncture for cerebrospinal fluid examination. High-level evidence supports corticosteroid treatment for the idiopathic form of the disorder.