A study of intratemporal facial nerve entrapment palsy. -Its early diagnosis and treatment-

我们一直在从事品尝和管理面瘫的研究。在赠款的支持下，我们进行了一系列的实验和临床研究。利用我们的缺血性面瘫动物模型，我们扩展了研究，以改善面瘫的治疗和准确的检测面瘫的预后。类固醇已被用于临床上的面瘫初期。其效果仅基于临床经验。我们对豚鼠缺血性面瘫的组织病理学研究表明，类固醇给药后，间质水肿大大减少，氢化可的松可防止受损神经的初始水肿，防止其卡压在狭窄的面神经管中。这是第一次有组织病理学报道其作用和依据。我们的临床研究表明，口服甘油对早期贝尔麻痹病例有效，并可防止模仿运动恢复后的病理性联动运动。有些贝尔麻痹病例即使使用类固醇和甘油（高渗利尿剂）也需要手术减压。传统的电生理测试，如ENoG，对选择手术病例无效。应用豚鼠面神经逆行反应可监测缺血性麻痹的部位、程度和恢复期，临床上也可应用。经Stensen管刺激面神经逆行反应，在面瘫早期减压，恢复快，效果好，磁顺向颅内面神经刺激是检测面神经颞内段早期变化的有效方法之一。我们的研究表明，它的使用仍然是不实际的，主要是因为大直径的市售刺激线圈。

We have been engaged in researches on tasting and management of facial palsy. Supported by the grants, we performed series of experimental and clinical studies. Using our animal model of ischemic facial palsy, we extended the studies to improve treatments of facial palsy and accurate testing for prognosis of facial palsy.Steroids have been clinically used in initial stage of facial palsy. Its effect is based on only clinical experience. Our histopathological studies of the ischemic facial palsy in guinea pigs showed that interstitial edema decreased greatly after administration of steroid, and that hydrocortisone prevented initial edema of the damaged nerve preventing its entrapment in the narrow facial canal. This was the first histopathological report of its effect and the basis. Our clinical study showed that peroral administration of glycerol was effective in early cases of Bell's palsy and prevented pathologic synkinetic movements after recovery of mimic movement.There are cases with Bell's palsy which need surgical decompression even with the use of steroids and glycerol (hyperosmotic diuretics). Conventional electrophysiological testings, such as ENoG,are not effective for selecting surgical cases. The site, degree, and recovering phase of the ischemic palsy could be monitored by antidromic facial nerve response in guinea pigs and also in clinical cases. Recovery from the palsy was faster and the out-comes were better in the cases chosen and decompressed in early phase of palsy by the antidromically evoked facial nerve response stimulated through Stensen's duct.Magnetic orthodromic intracranial facial nerve stimulation is one of the promising methods to detect early changes of the intratemporal segment of the facial nerve. Our study showed that its use was still not practical mainly because of large diameter of commercially available stimulating coils.