Clinical application of the antidromic facial nerve response

逆行性面神经反应是评价面神经在颞骨内功能的唯一方法，有可能在面瘫早期诊断面神经的变性过程。然而，这种反应并没有在临床上使用，因为它太难记录它。在这项研究中，我们调查了最佳的方法来记录这种反应，并得出结论，这是最有用的测试面瘫的早期预后评估。记录方法的改进采用经腮腺导管刺激、电脉冲交替改变极性、针电极记录面神经附近、消除肌肉动作电位等方法，成功地记录到了单一的神经反应.正常人的记录：（1）64耳中有58耳（90.6%）记录到正常的三相波。(2)观察单侧面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）神经反应呈双相、单相或平波。(2)Bell麻痹和Hunt综合征的起始病变更集中于第二脑室。(3)我们可以在瘫痪的早期区分去神经支配和生理性阻滞。(4)通过该试验，减压手术可以停止失神经支配的进展。

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.