안면신경 전방경로변경술후 안면신경의 기능 회복

윤병문,박상유 대한이비인후과학회 1998 대한이비인후과학회지 두경부외과학 Vol.41 No.8

벨마비와 귀 대상포진에서 자기공명영상과 수술 소견의 연관성

김인섭(In Sup Kim),이원상(Won-Sang Lee),김진아(Jinna Kim),이호기(Ho-Ki Lee) 대한두개저학회 2006 대한두개저학회지 Vol.1 No.1

We investigated the correlation between gadolinium enhanced MRI finding and swollen segments of facial nerve in patients with in Bell’s palsy and Ramsay-Hunt Syndrome. From 1995 to 2004, MRIs were performed on 13 patients with Bell’s palsy or Ramsay-Hunt syndrome. These patients were offered a surgical decompression of facial nerve through middle cranial fossa. They were evaluated by assessing the time to MRI and to operation after onset, the site of facial nerve enhancement, operative finding of facial nerve and initial/ postoperative severity of facial palsy. The swelling of some segments of facial nerve is found in patients with enhanced facial nerve in an MRI. In particular, the swelling of facial nerve is identified in all patients with enhanced facial nerves in the labyrinthine segment. Respectively, the swelling of geniculate ganglion and tympanic segment of the facial nerve accounts for 78% and 43% of patients with enhanced facial segment in an MRI, respectively (p<0.05). In summary, an MRI enhancement of facial nerves in Bell’s palsy and Ramsay-Hunt syndrome is well associated with the extent of intratemporal lesions in facial nerves.

Ophthalmologic Clinical Features of Facial Nerve Palsy Patients

Seunghyun Lee,유혜린 대한안과학회 2019 Korean Journal of Ophthalmology Vol.33 No.1

Purpose: To understand the ophthalmic clinical features and outcomes of facial nerve palsy patients who werereferred to an ophthalmic clinic for various conditions like Bell’s palsy, trauma, and brain tumor. Methods: A retrospective study was conducted of 34 eyes from 31 facial nerve palsy patients who visited aclinic between August 2007 and July 2017. The clinical signs, management, and prognosis were analyzed. Results: The average disease period was 51.1 ± 20.6 months, and the average follow-up duration was 24.0 ±37.5 months. The causes of facial palsy were as follows: Bell’s palsy, 13 cases; trauma, six cases; brain tumor,five cases; and cerebrovascular disease, four cases. The clinical signs were as follows: lagophthalmos,24 eyes; corneal epithelial defect, 20 eyes; conjunctival injection, 19 eyes; ptosis, 15 eyes; and tearing, 12eyes. Paralytic strabismus was found in seven eyes of patients with another cranial nerve palsy (including thethird, fifth, or sixth cranial nerve). Conservative treatments (like ophthalmic ointment or eyelid taping) wereconducted along with invasive procedures (like levator resection, tarsorrhaphy, or botulinum neurotoxin typeA injection) in 17 eyes (50.0%). Over 60% of the patients with symptomatic improvement were treated usinginvasive treatment. At the time of last following, signs had improved in 70.8% of patients with lagophthalmos,90% with corneal epithelium defect, 58.3% with tearing, and 72.7% with ptosis. The rate of improvement forall signs was high in patients suffering from facial nerve palsy without combined cranial nerve palsy. Conclusions: The ophthalmic clinical features of facial nerve palsy were mainly corneal lesion and eyelid malposition,and their clinical course improved after invasive procedures. When palsy of the third, fifth, or sixtycranial nerve was involved, the prognosis and ophthalmic signs were worse than in cases of simple facialpalsy. Understanding these differences will help the ophthalmologist take care of patients with facial nervepalsy.

소아에서 발생한 얼굴 신경 마비의 임상적 특징과 예후

장미진(Mi Jin Jang),윤다혜(Da Hye Yoon),이지은(Ji Eun Lee),박선영(Sun Young Park),이인구(In Goo Lee) 대한소아신경학회 2016 대한소아신경학회지 Vol.24 No.2

목적: 본 연구는 소아에서 발생한 얼굴신경 마비의 임상적인 특징과 예후 뿐 아니라, 기저질환이 없는 환자의 얼굴신경 마비와 백혈병 환자의 얼굴신경 마비를 비교하여 차이점을 알아봄으로써 향후 얼굴신경 마비의 치료와 예후를 예측하는데 도움을 주고자 하였다. 방법: 2009년 1월부터 2014년 12월까지 가톨릭대학교 서울성모병원 소아신경분과에 안면마비 증상을 보여 내원한 18세 미만의 환자들 중 최소 6개월 이상 추적 관찰이 가능하였던 기저질환이 없었던 48명과 백혈병 환자 5명을 대상으로 하였다. 얼굴 신경 마비의 정도와 prednisone 치료 후 변화는 House-Brackmann 안면신경마비 판정 시스템을 이용하였고, 병변의 위치는 얼굴 근육의 마비 외에 통증의 여부, 맛감각의 변화 및 청각과민증 등의 여부를 통해 알아보았다. 결과: 얼굴 신경의 손상 정도는 기저질환이 없었던 환자들에서는 House-Brackmann 안면신경 마비 판정 시스템의 grade III와 grade IV가 90% 이상을 차지하고 있었고, 백혈병 환자에서는 모두 grade IV의 중증 기능이상을 보이고 있었다. 얼굴 신경 마비의 병변 부위는 모든 환자의 90% 이상에서 얼굴 신경의 가장 말단 부위인 붓꼭지 구멍 이하 이었다. Prednisone 치료 후 기저질환이 없었던 환자 43명 중 30(69.8%)명에서는 완전히 증상이 소실되었고, 11(25.6%)명에서는 약간의 마비 증상이 남아 있으나 기능의 80% 이상을 수행할 수 있는 grade II를 보이고 있었다. 그러나 백혈병 환자들에서는 2(40%)명에서 증상이 완전히 소실되었으나 나머지 3명은 각각 1명 씩 grade II, III, IV 상태를 보이고 있었다. 결론: 소아의 얼굴 신경 마비의 병변은 대부분 붓꼭지 구멍 이하에서 발생하며, 마비 정도도 심하지 않아 예후가 좋은 것으로 생각된다. 그리고 경구 Prednisone 치료는 기저질환이 없는 환자의 경우 90% 이상에서 좋은 효과를 기대할 수 있지만, 백혈병 환자의 경우는 절반 정도에서만 효과를 기대할 수 있다. Purpose: This study was designed to identify the clinical characteristics and prognosis of facial nerve palsy in children, and to determine the different characteristics of the facial nerve palsy patients without underlying condition as opposed to the patients with leukemia, which will help to predict the prognosis and to help treat them. Methods: We investigated 53 patients under 18 years old retrospectively who were diagnosed as facial nerve palsy at the pediatric neurology department of Seoul St. Mary's Hospital from January 2009 to January 2015, and 5 patients with leukemia were included. The degree of nerve damage in a facial nerve palsy patients was determined according to House-Brackmann score. Results: More than 90% of the patients without underlying condition showed grade III and grade IV in the degree of facial nerve damage, meanwhile all of the leukemia patients had grade IV. The location of lesion in more than 90% of the facial nerve palsy patients was under stylomastoid foramen that is the end of the facial nerve. After oral prednisone therapy, 30(69.8%) of 43 patients without underlying condition showed a complete recovery, 11(25.6%) showed little remaining of palsy but was able to conduct 80% of the normal function, which is grade II. In 5 leukemia patients, 2 (40%) showed complete recovery, but 3 patients showed grade II, III and IV, respectively. Conclusion: In children with facial nerve palsy, the location of lesion is usually under stylomastoid foramen, and the degree of palsy is mild so we can predict good outcome. In treatment with oral prednisone, we can expect more than 90% of effectiveness in patients without underlying condition, but only half in leukemia patients.

Masseter nerve-based facial palsy reconstruction

Park, Hojin,Jeong, Seong Su,Oh, Tae Suk Korean Cleft Palate-Craniofacial Association 2020 Archives of Craniofacial Surgery Vol.21 No.6

Facial paralysis is a devastating disease, the treatment of which is challenging. The use of the masseteric nerve in facial reanimation has become increasingly popular and has been applied to an expanded range of clinical scenarios. However, appropriate selection of the motor nerve and reanimation method is vital for successful facial reanimation. In this literature review on facial reanimation and the masseter nerve, we summarize and compare various reanimation methods using the masseter nerve. The masseter nerve can be used for direct coaptation with the paralyzed facial nerve for temporary motor input during cross-facial nerve graft regeneration and for double innervation with the contralateral facial nerve. The masseter nerve is favorable because of its proximity to the facial nerve, limited donor site morbidity, and rapid functional recovery. Masseter nerve transfer usually leads to improved symmetry and oral commissure excursion due to robust motor input. However, the lack of a spontaneous, effortless smile is a significant concern with the use of the masseter nerve. A thorough understanding of the advantages and disadvantages of the use of the masseter nerve, along with careful patient selection, can expand its use in clinical scenarios and improve the outcomes of facial reanimation surgery.

말초성 안면신경마비의 한양방 협진치료에 관한 임상적 연구

김지훈,송재준,홍승욱,Kim, Ji-Hoon,Song, Jae-Jun,Hong, Seung-Ug 대한한방안이비인후피부과학회 2009 한방안이비인후피부과학회지 Vol.22 No.1

Objectives : Facial palsy is not uncommon disease and most patients with facial palsy are peripheral type, as in Bell' s palsy. In western medicine, oral steroid is the mainstay of the treatment. Recently, oriental-western treatment became one of the alternative modality for the treatment of the facial palsy. However, the treatment result and the degree of patient' s satisfaction were not evaluated. In this study, we tried to characterize the clinical characteristics, short-term recovery rate and degree of patient' s satisfaction after oriental-western medicine treatment on facial palsy of peripheral type. Methods : Between May 2008 and December 2008, we examined 16 patients who presented with facial palsy of peripheral type in Dongguk University Medical Center. Clinical characteristics and recovery rate was analyzed by retrospective chart review. The degree of patient' s satisfaction was measured by 5 point scale. Results : The causes of facial palsy were Bell' s palsy (87.5%) and the Ramsay-Hunt syndrome (12.5%). The highest age groups of facial palsy were 6th and 7th decades. Most frequent accompanying symptom was postauricular pain. After oriental-western medicine treatment, 10 patients (62.5%) showed recovery of facial palsy better than House-Brackmann grade 2. 11 patients (68.8%) were satisfied with the oriental-western medicine treatment. Conclusions : Considering the degree of patient' s satisfaction and treatment result, we believe that oriental-western treatment could be safe and reliable protocol for the treatment of facial nerve palsy of peripheral type.

특발성 안면신경 마비 예후 예측 도구로서 측두골 자기공명영상의 유용성

최지원(Ji Won Choi),안중호(Joong Ho Ahn),박홍주(Hong Ju Park),강우석(Woo Seok Kang),정종우(Jong Woo Chung) 대한두개저학회 2023 대한두개저학회지 Vol.18 No.1

Background: In facial palsy patients, electroneuronography (ENoG) was used for the diagnosis of the prognosis of facial palsy. This study aimed to determine whether temporal bone magnetic reso-nance imaging (TBMR) was useful for diagnosing and predicting prognosis in facial palsy. Materials and Methods: Among the patients diagnosed with facial palsy, 112 patients who underwent TBMR were included. These patients were divided into three groups according to the enhancement region of the facial nerve in TBMR. Fifty-five patients showed contrast enhancement in the meatal or labyrinthine segment (group 1), 36 patients showed enhancement in the geniculate ganglion (group 2), and 21 patients showed enhancement in the tympanic or mastoid segment (group 3). The initial facial palsy symptoms and prognosis were compared between the three groups. Results: In group 1, 26 patients showed House-Brackmann grade (H-B grade) IV, V initially, and 13 patients and 12 patients showed H-B grade IV, V initially in group 2 and group 3, respectively. Moreover, the initial ENoG results (%) between the three groups did not significantly differ. Patients who took more than 6 months to recover after systemic steroid therapy were 5 patients in group 1, 3 patients in group 2, and 2 patients in group 3. Conclusions: In TBMR of the patients with facial nerve palsy, the most contrast enhancement parts of the facial nerve were the meatal and labyrinthine segments. Enhancement of those segments showed severe initial symptoms clinically. In addition, most of them recovered within 6 months. However, there was no statistical significance, so further studies are needed for more cases and ob-servation periods.

심박변이도(Heart Rate Variability) 분석을 통한 특발성 안면신경마비와 자율신경실조의 상관성 연구

최양식,김행범,김주희,이승원,이소영,고정민,고형균,이윤호 대한침구의학회 2008 대한침구의학회지 Vol.25 No.6

Objectives : This study investigated the effect of imbalance of autonomic nerve system on the idiopathic facial palsy by the comparison Heart Rate Variability results of Facial palsy group and healthy control group, and to clarify correlation between House-Brackmann Grade and Heart Rate Variability results. Methods : 119 idiopathic facial palsy patients and 88 health subjects who underwent HRV test were retrospectively reviewed based on medical records. We compared between the HRV results of facial palsy group and that of normal control group, and also compared the HRV results of facial palsy subgroup classified by House-Brackmann Grade. Results 1. All HRV results-Mean Heart Rat(MHRT), Standard Deviation of all the Normal RR intervals (SDNN), Total Power(TP), Very Low Frequency(VLF), Low Frequency(LF), High Frequency(HF), ratio betwween the Low Frequency and High Frequency power(LF/HF ratio) of facial palsy group are decreased compared to that of normal control group, especially SDNN, TP, VLF, LF, LF/HF ratio showed significant difference(p<0.05). 2. HRV results showed no significant correlation in House-Brackmann Grade. Conclusions : This study showed that lower HRV results of facial palsy group than normal control group and suggests that imbalance of autonomic nerve system related with facial palsy. HRV could be a objective tool to reflect condition of idiopathic facial palsy patients.

안면성형침을 이용한 안면신경마비 후유증의 치험례 보고

추민규 ( Min Gyu Chu ),조희근 ( Hee Guen Jo ),박수곤 ( Soo Gon Park ),김선종 ( Sun Jong Kim ),양미성 ( Mi Sung Yang ),최진봉 ( Jin Bong Choi ),정민영 ( Min Young Jung ),이현 ( Hyoun Lee ) 한방재활의학과학회 2009 한방재활의학과학회지 Vol.19 No.4

Objectives: This study was performed to evaluate the effect of facial rejuvenation acupuncture on cases of sequela of facial nerve palsy. Methods: This study was carried out in respect of 5 cases of sequela of facial nerve palsy patients which had been treated in Dong-Shin university oriental hospital from 2009 year with House-Brackmann grading system(HBGS) above Grade 4. In this study the patients were treated by facial rejuvenation acupuncture. The effect of the treatment were evaluated via scales and picture. Results: After treatment with facial rejuvenation acupuncture, 5 patients improved H-B scale and symptoms of the sequela of facial nerve palsy. The average of H-B scale was increased from 3.2 to 6.4. There also formed forehead folds, better blinking of the eyes and improved asymmetry of the left and right face. Conclusions: In the study, facial rejuvenation acupuncture showed marked improvement in sequela of facial nerve palsy. Randomized-controlled trial for further evaluation will be needed in the future.

경정맥공 종양에 대한 수술적 접근법의 결과 분석;안면 신경 및 하부 뇌신경 마비

소윤경,조양선,박관,백정환,정한신,박계훈,이우영,박기남 대한이비인후과학회 2007 대한이비인후과학회지 두경부외과학 Vol.50 No.8

Background and Objectives:Surgical treatment of jugular foramen tumors can have significant complications such as facial nerve palsy due to complicated regional anatomy. In this study, we investigated the outcomes and complications of surgical aproach to the jugular foramen tumors. Subjects and Method:Thirten patients had operations for their tumors around jugular foramen with a mean folow-up period of 52 months. We reviewed their medical records with emphasis on postoperative facial nerve palsy and other low cranial nerve palsies. Results:There were jugular foramen schwanoma (n= 9), glomus ju-gulare (n= 2), meningioma (n= 1) and chondrosarcoma (n= 1). Gros total removal was achieved in 12 patients. Facial nerves were rerouted at genigulate ganglion (long rerouting) or at the second genu (short rerouting). Mastoidectomies were performed with canal wal-up (CWU) fashion or with canal wal-down (CWD) fashion. The mean size of tumor with long rerouting was sig-nificantly larger than that with short rerouting (p= 0.037). Facial nerve palsy (FNP) greater than House-Brackmann grade (HB grade) I remained for more than 6 months in a patient. Low cranial nerve palsies were developed in 3 patients. Conclusion:Surgical treatment of jugular foramen tumors had a good local control rate with a low rate of complications. Depending on the loss of hearing. (Korean J Otorhinolaryngol-Head Neck Surg 2007 ;50 :660-6)