Bell面瘫幻灯片.pptVIP

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 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. 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 similar Approximately 6-9% develop recurrent Bell’s Palsy Facial paresis alone occurred in 31% Completely paralysis in 69% Clinic features 71% of patients with completely paralysis achieve a H-B G1 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. 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 House-Brackman grade system I, Normal: Normal facial functionin all areas II, Mild dysfunction: slight weakness noticeable only on close inspection 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 slight asymmetry No synkinesis, contractur, or hemifacial spasm Evaluation of acute facial paralysis House-Brackman grade system III, moderate dysfunction: obvious but not disfiguring difference between two side No function impairment Noticeable but not severe synkinesis, contracture, and hemifacial 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 mou