Clinical application of the antidromic facial nerve response

面神经反逆反应是评价颞骨内面神经功能的唯一方法，有可能在面神经麻痹早期诊断面神经退行性进展。然而，由于难以记录，该反应未在临床上使用。在这项研究中，我们研究了记录这种反应的最佳方法，并得出结论，这是对面瘫早期预后评估最有用的测试。记录方法的改进我们通过腮腺管刺激，电脉冲交替极性变化，在面神经附近用针电极记录，消除肌肉动作电位，成功地记录了一次神经反应。(1) 64只耳中有58只（90.6%）录得正常的三相波反应。(2)观察单侧神经反应的时间变化是评价面神经功能的最佳方法。面瘫患者的记录(1)神经反应有双相、单相或平波形。(2) Bell’s麻痹和Hunt综合征的初始病变多位于第二膝中央。(3)在麻痹的早期阶段，我们可以将去神经与生理性阻滞区分开来。(4)该试验可通过减压手术阻止去神经的进展。

The antidromic facial nerve response has the possibility to diagnose degenerating process of the facial nerve at the early stage of facial palsy, because it is an only method to evaluate function of the facial nerve in the temporal bone. However, this response was not clinically used as it was too difficult to record it. In this study, we investigated the optimal method to record this response and concluded that it was the most useful testing for early prognostic assessment of facial palsy.1. Improvement of recording methodsWe succeeded to record an only nerve response by using stimulation via the parotid duct, electric pulses changing polarity alternately, recording near the facial nerve with a needle electrode and elimination of muscle action potentials.2. Recording in normal subjects(1) Normal responses with triphasic wave forms could be recorded in 58 of 64 ears (90.6%).(2) To observe chronological changes of the nerve response on the unilateral side is best way to evaluate facial nerve function.3. Recording in patients with facial palsies(1) The nerve response had a biphasic, monophasic or flat wave form.(2) The initial lesions of Bell's palsy and Hunt syndrome were more central to 2nd genu.(3) We could distinguish denervation from a physiological block at the earlist stage of palsy.(4) Progress of denervation could be stopped by the decompression surgery with this test.