Паралич лицевого нерва

[Wesennyaya]

Доброго времени суток Всем!
Подскажите пожалуйста, какие новинки появились в области операционного лечения парезов и параличей лицевого нерва. А также какие возможны интра- и послеоперационные осложнения.
Заранее всем спасибо!

[EVP]

Напишите историю заболевания. Что конкретно беспокоит?

[Wesennyaya]

Тьфу-тьфу, Слава Богу, ничего не беспокоит.
МедВуз. III курс. Реферат по ОПХ. Тема очень интересная, но в библиотеке материал после 93 года не найти((( Поиск в интернете тоже без особого успеха. Надеялась господа практикующие нейрохирурги подскажу что нового в оперативном лечении паралича лицевого нерва.

[EVP]

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Surgical Care: Surgery for Bell palsy is controversial. In the past, surgical decompression of the facial nerve was considered for patients whose facial muscles demonstrated less than 90% of normal activity on electrophysiologic studies. Surgical decompression of the facial nerve involves a middle fossa craniotomy with an extradural approach. However, recent trials suggest this is not beneficial in patients with Bell palsy.

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Surgical Decompression

Some patients with Bell's palsy may be candidates for surgery. The facial nerve may be compressed (and its conduction blocked) at its narrowest point, the entrance to the meatal foramen, occupied by the labyrinthine segment and geniculate ganglion. Among 12 patients with facial-nerve paralysis who underwent decompression surgery, bulbous swelling of the facial nerve was seen proximal to the geniculate ganglion in 11, and intraoperative evoked-potential electromyography performed in 3 documented conduction block proximal to the geniculate ganglion.26

The role of surgical decompression in management remains controversial. In a prospective observational study of 31 patients with complete paralysis and 90 percent or more nerve degeneration as determined by electroneurography, 91 percent of those who underwent decompression had a good outcome (i.e., a grade 1 or 2 on the House–Brackmann scale) by the seventh month, as compared with 42 percent of those who were treated with glucocorticoids.27 Other observational studies comparing outcomes at 6 to 36 months after prednisone treatment with outcomes after decompression28,29,30,31 have not confirmed a benefit of surgery, however. Data from randomized trials are lacking to compare surgery with medical therapy, and available data are limited by small samples, possible bias in the selection of patients for surgery, the use of varying surgical approaches and systems to assess facial function, and a lack of blinding in studies assessing functional outcomes.

After decompression surgery, permanent unilateral deafness may occur, with estimates ranging from less than 1 percent27 to 15 percent29 of patients. Because severe degeneration of the facial nerve is probably irreversible after 2 to 3 weeks,32 decompression should not be performed 14 days or more after the onset of paralysis.

[EVP]

Plast Reconstr Surg. 2005 Aug;116(2):371-80. Related Articles, Links

Revisional operations improve results of neurovascular free muscle transfer for treatment of facial paralysis.

Takushima A, Harii K, Asato H, Momosawa A.

Department of Plastic and Reconstructive Surgery, School of Medicine, Kyorin University, Tokyo, Japan.

BACKGROUND: Neurovascular free muscle transfer is currently the mainstay for smile reconstruction. However, problems such as excessive muscle bulk and dislocation of the transferred muscle attachment have been described. Furthermore, dynamic movements of the transferred muscle are sometimes too strong or too weak, resulting in facial asymmetry. In these cases, secondary revisional operations for the transferred muscle are required after neurovascular free muscle transfer. This report describes revisional operative procedures in detail and examines the extent of improvement of the smile by comparing preoperative and postoperative results. METHODS: Of 468 patients in whom neurovascular free muscle transfer was performed between 1977 and 2000, a total of 183 received revisional operations for the transferred muscle. Operations included revision of muscle attachment in 129 patients, debulking of the cheek in 114 patients, and fascia graft in 21 patients. RESULTS: Evaluation with the grading scale was performed in 117 of the 183 patients. Grading improved in 59 patients and worsened in seven patients. The remaining 51 patients displayed no change in grading. Differences between preoperative and post-operative grading were compared statistically, and revisional operations improved the grading score. CONCLUSIONS: Revisional operations are effective and important as secondary operations after neurovascular free muscle transfer. However, care must be taken not to damage the neurovascular pedicles.

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Спасибо