面神经炎资料课件.ppt

小结 面神经炎是茎乳孔以上面神经管内段面神经的急性非化脓性炎症。 主要表现为急性起病的一侧表情肌瘫痪。 电生理检查有助于预后的判断。 思考题 中枢性和周围性面瘫的异同点有哪些？ 面神经的纤维组成成分有哪些？ 面神经炎电生理检查预后判断的标准如何？ 面神经麻痹诊断思路 1.定位：是周围性还是中枢性，如是周围性则需进一步明确是在脑干内还是脑干外。（明确的定位对疾病的定性诊断有重要的价值） 2.定性：病因诊断，也是鉴别诊断的过程 * CRANIAL NERVE VII (FACIAL NERVE) PALSY SIGNS AND SYMPTOMS The prevalence of idiopathic cranial nerve VII (CN VII) palsy ranges from 10/100,000 to 40/100,000 with an average of 21/100,000. Occurrences are highest in adults over 70. Recurrence of idiopathic CN VII palsy ranges between 6 to 11 percent. Cranial nerve VII innervates the muscles of facial expression and the stapedius muscle of the inner ear. The orbicularis oculi, responsible for eyelid closure, is controlled by CN VII. Damage to the nerve or its peripheral course produces weakness or paralysis of one side of the face with an inability to close the ipsilateral eye. Additional findings on the affected side include flattening of the nasal labial fold, droop of the corner of the mouth, ectropion, lagophthalmos, decreased tear production, dry eye, conjunctival injection, corneal compromise, decreased sense of taste and hyperacusis (supersensitivity to sound). Occasionally, following injury, some fibers of CN VII regenerate to erroneously innervate adjacent structures. The result is simultaneous movements of muscles (e.g. the corner of the mouth contracts on attempted eyelid closure) or the stimulation of glands supplied by the redistributed branches of CN VII when the nerve is activated (e.g. excessive lacrimation upon eating, known as crocodile tearing ).PATHOPHYSIOLOGY The muscles that close the eyes and wrinkle the forehead are bilaterally innervated. A unilateral lesion in the cortex or supranuclear pathway spares eyelid closure and forehead wrinkling but results in contralateral paralysis of the lower face. Since the area of the cortex associated with facial muscle function lies near the motor representation of the hand and tongue, weakness of the thumb, fingers and tongue ipsilateral t