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

我们一直从事面瘫的品鉴与治疗研究。在拨款的支持下，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，我们扩展了对面瘫治疗方法的改进和对面瘫预后的准确检测的研究。临床上已将类固醇用于面瘫的早期治疗。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，类固醇治疗后间质水肿明显减少，氢化可的松可以防止受损神经的初始水肿，防止其在狭窄的面神经管中被困。这是其作用的第一个组织病理学报告和基础。我们的临床研究表明，口服甘油对早期贝尔麻痹病例有效，并能在模拟运动恢复后阻止病理性的共动运动。有些贝尔氏麻痹患者需要手术减压，即使使用类固醇和甘油（高渗利尿剂）。传统的电生理测试，如ENoG，对选择手术病例无效。面神经逆行反应可以监测豚鼠和临床病例缺血性麻痹的部位、程度和恢复阶段。选择在麻痹早期通过斯坦森管刺激反节律诱发面神经反应减压的病例，其恢复速度较快，预后较好。颅正位面神经磁刺激是早期检测面神经颞内段变化的有效方法之一。我们的研究表明，它的使用仍然不实用，主要是因为市售的刺激线圈直径大。

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.