复旦大学眼耳鼻喉科医院.ppt

Evaluation of acute facial paralysis
Ramsay-Hunt syndrome
It is manifest by a facial palsy with a vesicular eruption over a distribution of a cranial nerve
Each is given 0, 30%, 70% or 100%.
Evaluation of acute facial paralysis
A careful history of the patients illness Sudden in onset and frequently evolve
obvious but not disfiguring difference between two side No function impairment Noticeable but not severe synkinesis, contracture, and hemifacial
Evaluation of acute facial paralysis
Schirmer test, stapedial reflex, electrogustometry, and salivary flow has be obsolete.
Serologic studies can be considered to evaluation for lyme disease, autoimmune disorders, or other central nervous system disease
asymemetry
Patients with obvious but not disfiguring synkinesis, contracture, and hemifcial spasm are grade 3 regardless of degree of motor activity.
decreased or absent nasolabial fold Motion:
No movement of forehead Incomplete closure of eye Slight movement of corner of mouth
Synkinesis, contracture, and hemifacial spasm usually absent
Viral polycranioneuropathy
Herpes simplex virus and herpes zoster virus
Clinic features
Less common before the age of 15y The incidence in men and women is
Sensorineural hearing loss and vertigo may also be present in up to 20% of cases.
Prognosis is poor than Bell’s palsy
Evaluation of acute facial paralysis
no movement of forehead Inability to close eye completely with maximal effort Asymmetrical movement of corners of mouth with maximal effort
Patients with synkinesis, mass action, and hemifacial spasm severe enough to interfere with function are grade 4 regardless of degree of motor activity
Managements
Medical treatment:
Steroid 1mg/kg/day Vasodilation Anti-virus Vitamine B
Physical therapy Hypobaroxygen Protection of corner
Thank you!
over 2-3 weeks after onset Any palsy progression over 3 weeks
should be evaluated for a neoplasm Any palsy persist for 6 month without any
recovery should be considered for a neoplasm.
similar Approximately 6-9% develop recurrent
Bell’s Palsy Facial paresis alone occurred in 31% Completely paralysis in 69%
Clபைடு நூலகம்nic features
71% of patients with completely paralysis achieve a H-B G1
VI, total paralysis: no movement
Evaluation of acute facial paralysis
Fisch grade system
Rest 20, forehead movement 10, eye closure 30, smile 30, month blow 10.
of other possibility
Etiology
Vascular congestion with secondary ischemia to the nerve
Vasospasm would lead to ischemia, nerve edema, and secondary compression within the fallopian canal.
13% a H-B G2 The remaining 16% in this complete
paralysis group have a fair to poor recovery (H-B 3-5)
Prognosis
All patients with complete or partial paralysis, approximately 85% recover to normal with one year without treatment.
Audiometry: to rule out any involvement of the auditory nerve
CT and MRI: for patient without fully recovery, to identify the site of lesion.
Electrophysiologic testing to determine prognosis.
Evaluation of acute facial paralysis
House-Brackman grade system V, severe dysfunction:
Only barely perceptible motion At rest: possible asymmetry with droop of corner of mouth and
House-Brackman grade system
I, Normal: Normal facial functionin all areas II, Mild dysfunction: slight weakness
noticeable only on close inspection
Evaluation of acute facial paralysis
House-Brackman grade system IV, moderate severe dysfunction:
Obvious weakness and disfiguring asymmetry At rest: normal symmetry and tone motion:
Evaluation and management of Bell’s palsy
Chunfu Dai Otolaryngology Department
Fudan University
Definition
Rapid onset of the facial palsy Minimal associated symptoms Spontaneous recovery (80%) The diagnosis is made after the exclusion
spasm At rest: normal symmetry and tone Motion:
slight to no movement of forehead Ability to close eye with maximal effort and obvious asymmetry Ability to move corners of mouth with maximal effort and obvious
Patient experienced delayed recovery over 3 months, all developed sequelae
Return of at least some facial function was noted in all patients.
Evaluation of acute facial paralysis
At rest: normal symmetry and tone Motion: some to normal movement of forehead
Ability to close eye with minimal effort Ability to move corners of mouth with maximal effort and
Management
Surgery
Degeneration of facial nerve more than 90% indicates facial nerve decompression
Approach:
middle fossa cranionectomy Combination of middle fossa and mastoidectomy
slight asymmetry No synkinesis, contractur, or hemifacial spasm
Evaluation of acute facial paralysis
House-Brackman grade system III, moderate dysfunction: