特发性面神经麻痹精品课件

特发性面神经麻 痹 v（idiopathic facial palsy） 病因及病理 v病因：不清楚 激发因素: 风寒 病毒感染(如带状疱疹) 和 自主神经功能不稳 局部神经营养血管痉挛神经缺血水 面神经受压临床表现 病理：神经水肿、脱髓鞘、轴突变性 又叫面神经炎或Bell麻痹，是由 茎乳孔内面神经非特异性炎症所 致的周围性面瘫。 概 念 临床表现 任何年龄发病，男多于女， 急性起病，数小时、1-3天达高峰 病初可伴有麻痹侧耳后乳突区,耳内或 下颌角的疼痛 一侧周围性面瘫：一侧面部表情肌完 全性瘫痪:额纹消失,不能皱额蹙眉,眼 裂变大,眼睑不能闭合或闭合不全,闭 眼时瘫痪侧眼球向外上方转动，露出 白色巩膜, Bell征（Bellparalysis) 患侧鼻唇沟变浅,口角下垂,示齿口角 歪向键侧;鼓气和吹哨时漏气口轮 匝肌; 食物滞留在病侧齿龈之间-颊肌 . 累及鼓索神经：周围性面瘫+同侧舌前2/3味觉 丧失。 累及镫骨肌支：周围性面瘫+同侧舌 前2/3味觉 丧失+听觉过敏。 累及膝状神经节：周围性面瘫+同侧舌前2/3味 觉丧失+听觉过敏+患侧乳突区疼痛+耳廓和外 耳道感觉减退, 外耳道或鼓膜出现疱疹称Hunt综合征： 诊 断 v急性起病 v一侧周围性面瘫 v除外其它疾病所致周围性面瘫 鉴别诊断 Guillain Barre综合征: 双侧周围性面瘫 四肢对称性迟缓性瘫痪 脑脊液:蛋白-细胞分离现象 中耳炎、乳突炎,迷路炎等并发的耳 源性面神经麻痹; 腮腺炎,肿瘤,下颌化脓性淋巴结炎所 致的面神经麻痹 颅后窝肿瘤、脑膜炎所致面神经麻 痹,起病缓慢,其他颅神经受累表现 面神经麻痹+原发病表现 治 疗 v原则：改善局部血液循环 ，减轻面神经水肿，缓解 神经受压，促进功能恢复 。 药 物 v皮质类固醇激素：急性期：地塞米松10- 15mg Qd ivdrop 7-10天， 强的松 1mg/Kg.d Bid po 或 Qd po vB族维生素:VB1 100mg Qdivdrop ;VB12 500Mg Qdivdrop v氯苯氨丁酸：降低肌张力，改善血液循环 ，从小剂量开始。 v带状疱疹病毒所致Hunt综合症可给予无环 鸟苷5mg/kg, Tid Po 7-10天. v理疗：急性期：超短波透热疗 法;红外 线照射;局部热敷 恢复期：碘离子透入疗法、针灸 v康复治疗：早期锻炼 v预防眼部并发症：保护角膜 v手术治疗：病后2年未恢复者可行神经吻合 术 病程和预后 v1-3周开始恢复，1-2个月可明显恢复。 v预后与年龄、身体状况有关，年轻-预后好;受凉史 -预后好;面瘫4天镫骨肌反射存在-预后好;老年,糖 尿病,高血压,动脉硬化,心脏病-预后不好;伴有乳突 疼痛-预后不好 v监测肌电图对评估预后有意义。 hG*kK+oN2rQ5uT9yXcB#fE%jI)mL0pO3tS7wVazYdD$hG*kJ-nN2rQ5uT8xXcB#fE%iH)mL0pO3sR6wVazYdC!gG*kJ-nM1qQ5uT8xWbA#fE%iH(lK0pO3sR6vUazYdC!-nM1qQ5uT8xWbAZfE%iH(lK+pO3sR6vU9zYdC!gF&jJ-nM1qP4tT8xWbAZeD%iH(lK+oN3sR6vU9yXcC!gF&jI)mM1qP4tS7wWbAZeD$hG(lK+oN2rQ6vU9yXcB#gF&jI)mL0qP4tS7wVaAZeD$hG*kJ+oN2rQ5uT9yXcB#fE%jI)mL0pO3tS7wVazYdD$hG*kJ-nN2rQ5uToO3sR6vU9yYdC!gF&jI- nM1qP4tS8xWbAZeD$hH(lK+oN2rR6vU9yXcB!gF&jI)mL1qP4tS7wVbAZeD$hG*lK+oN2rQ5vU9yXcB#fF&jI)mL0pO4tS7wVazYeD$hG*kJ-oN2rQ5uT8yXcB#fE%iI)mL0pO3sS7wVazYdC$hG*kJ-nM1rQ5uT8xWbB#fE%iH(lL0pO3szYdC!hG*kJ-nM1rQ5uT8xWbB#fE%iH(lL0pO3sR6vUazYdC!gF&kJ-nM1qP4uT8xWbAZeE%iH(lK+oO3sR6vU9yYdC!gF&jI-nM1qP4tS7xWbAZeD$hVazYdC!gG*kJ-nM1qQ5uT8xWbA#fE%iH(lK0pO3sR6vUazYdC!gFbAZeD$hG*lK+oN2rQ5vU9yXcB#fE&jI)mL0pO4tS7wVazYeD$hG*kJ- 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