目的：探索指针疗法与功能训练治疗Bell’s面瘫的临床效果。方法：按病人就诊顺序将111例Bell’s面瘫患者分为试验组(57例)和对照组(54例)，试验组采用指针疗法、功能训练、药物、物理治疗；对照组采用针刺疗法、功能训练、药物、物理治疗。两组治疗前、后均采用Portmann简易评分法评价疗效。结果：治疗前评分试验组(2.597±1.678)，对照组(2.907±1.794)，差异无统计学意义(P＞005)，治疗后评分试验组 (18.404±1.374)，对照组 (18.593±1.743) ，差异无统计学意义(P＞0.05)；面肌功能改善指数试验组(0.859±0.090)，对照组(0.844±0.095)，差异无统计学意义(P＞0.05)。结论：指针疗法与针刺疗法治疗Bell’s面瘫疗效比较差异无统计学意义，二者均有明显的康复疗效；而指针疗法更具有操作简便，无疼痛、无创伤、无晕针症也无交叉感染的优势，避免了许多不利因素，使患者有较好的依从性。
Objective To investigate a synthetical technique combining static and dynamic states for treating facial paralysis. Methods From October 1993 to November 2005, 93 patients (26 males, 67 females; aged 9-69 years; illness course, 6 months to 24 years) with facial paralysis were admitted for treatment, of whom 48 were unknown in their pathological origins, 32 had a history of intracranial or ear operation, 13 had their facial paralysis related to trauma. We applied synthetical techniques for treating facial paralysis, including denerved muscle (extensor hallucis brevis and extensor digitorum brevis) free graft using an operating or chemical technique, temporal muscular flap suspending, treatment of eye closure by uplifting zygomomalar tissues and temporal muscular flap suspending, brow lifting by the Buried Guiding Suture Appliance, Botox injection, and the nerve amputation of normal side for mandibular marginal ramus paralysis. Results After the treatment for 82 patients with the method of the denerved muscle free graft combining femporal muscular flap suspending, 3 patients with the method of uplifting zygomo-malar tissues combining temporalmuscular flap suspending for eye closure, 15 patients with the method of the Buried Giding Suture for eyebrow lifting, 4 patients with the Botox injection and nerve amputation of normal side for the mandibular marginal ramus paralysis,93 patientshad a good therapeutic result. The follow-up for 3 months to 10 years in all the patients revealed that 75 patients were satisfied with their treatment results and 13 patients were almost satisfied according to the criteria for the facialsymmetrical checking and the House-Brackmann grading system. The technique hadadvantages of a complete survival of the related small muscles, a hidden incision, less trauma for the Botox injection, and the denerved muscles for surrounding nerve inserting. Conclusion The synthetical technique combining static and dynamic states for treating facial paralysis is a good therapeutic method and the therapies for facial paralysis should vary with the different conditions of the paralysis. We advocate an individuation treatment for facial paralysis.
Objective To investigate the result of free vascular transplantation of denervated extensor digitorum brevis and extensor hallusis brevisfor the treatment of late facial paralysis. Methods From April 2003 to April 2005, 26 cases of facial paralyces were treated by transplantation of denervated extensor digitorum brevis and extensor hallusis brevis. During operation, the ends of the tendons were fixed at ala nasi, middle point of nasal labial fold,oral commisure and chin; the muscle belly were put around the masseter nerveto correct the nasal and oral deformity, microsurgery was applied to anastomosethe tarsus lateral vessels to the superficial temporalis vessels or the facial vessels. The result of the operation was evaluated by the Standard of Douglas Harrison and the Paresis Assessment scoring system of Stennert. Results The static appearance was satisfactory in 26 cases after operation, the bilateral oral commisure was symmetry and the dynamic appearance was greatly improved 6 months after operation. Among the 23 cases whose disease history was above 2 years，all could smile naturally and show their teeth symmetrically except 1 case whocould only move the oral commissure. Among the 3 cases whose disease history was less than 2 years, one could smile naturally and show his teeth symmetrically, one could smile but could not show his teeth symmetrically, another could move oral commissure but have no motion appearance. The result was evaluated as“” according to Standard of Douglas Harrison, accounting for 88% (23/26). Evaluated according to the Paresis Assessment scoring system of Stenert, the difference before operation and after operation was more than 5, accounting for 86% (22/26). Conclusion The free vascular transplantation of denervated extensor digitorum brevis and extensor halluces brevis can reconstruct the oral appearance for the treatment of late facial paralysis.
OBJECTIVE To explore a new surgical approach to repair facial paralysis in late stage, using regional transposition of pedicled sternocleidomastoid muscle for the dynamic reanimation of the paralyzed face. METHODS Seven cases with facial paralysis in late stage from December 1999 were treated and followed up for 10 months before clinical evaluation. In all of the cases, the sternal and clavicular branches of the sternocleidomastoid muscle were both elevated from their bony attachments, with the mastoid insertion left in situ as the pedicle for blood supply and accessory nerve maintained in it. The muscle strips were transposed and sutured to the orbicularis oris around the mouth corner on the paralyzed side. RESULTS Static asymmetry of nose and oral commissure on the paralyzed side were corrected immediately after operation, and the movement of the oral commissure recovered one week after operation. Symmetric smiling was observed in one month and all of the oral movements recovered in 10 months postoperatively. CONCLUSION The new approach to repair facial paralysis in late stage by regional transposition of pedicled sternocleidomastoid muscle is effective in restoration of both static and dynamic symmetry of nose and mouth, and in recovery of the facial expression and the oral commissure.
OBJECTIVE In order to investigate the effect of expanded polytetrafluoroethylene (e-PT-FE) in repair of facial depression. METHODS From February 1997 to July 1998. The e-PTFE was used as a filling and suspending material for facial depression and facial nerve palsy in 6 cases. They were followed up for 2-16 months. RESULTS After filling of the facial depression, the deformed side of the face became symmetrical to that of contralateral side, and those following the suspending technique using this material the affected eyelids could close completely and the oral corners were symmetrical in its static status. CONCLUSION The expanded PTFE was a safe, biocompatible and easily applied material, especially served as a filling or suspending material in the repair of facial depression with facial nerve palsy.
Twenty adult healthy rabbits were divided into 2 groups at random. Under the identical experimental conditions, cut the trunk of the right facial nerve. Two weeks later. the caudal end of the divided facial nerve was anastomized with the cephalad end of the divided main trunk of the nerve to the masseter muscle. The experimental group was stimulated by music, twenty minutes of each time, three times a day. From the results it was noted that the rate of growth of the nerve in the experimental group was more rapid than that of the contril group.
Thirty adult healthy rabbits were divided into 3 groups at random. Under the identical experimental conditions, the trunk of right facial nerve of each nerve. Two weeks late, the caudal end of the divided facial nerve was anastomized with the cephlad end of the divided main trunk of the nerve to the masseter muscle. The anode-cathode and cathode-anode silver electrodes site. The electric field intensity between the two silve electrode plates was maintained at 37.5 millivolts per millimeter. Those without the placement of the electrode were the control group. From the results of the experiment, it was noted that the rate of growth of the nerve in the cathodal group was highly significant.
Objective To examine the efficacy of acupuncture in hastening recovery and reducing long-term morbidity from Bell’s palsy. Methods We searched the Cochrane Neuromuscular Disease Group Register Group (Till Feb. 2002), MEDLINE (Jan. 1966 to Dec. 2002); EMBASE (Jan. 1980 to Dec. 2002), LILACS (Jan. 1982 to Dec. 2002) and Chinese Biomedical Retrieval System (Jan. 1978 to Dec. 2002). We also searched grey literature. We identified all randomised or quasi-randomised controlled trials involving acupuncture in the treatment of Bell’s palsy, selected the trials ment the inclusion criteria, assessed the methodological quality, extracted data on trials’ patients, interventions, outcome measurements and results and undertook analysis. Results Three small randomised controlled trials were included but due to some flaws in study designs or reporting and clinical differences between trials, data from trials were not combined in a meta-analysis，and a descriptive analysis was performed.The result indicated a positive effect of acupuncture (all Plt;0.01). Conclusions Three small studies in this review suggested a beneficial effect but the poor quality of the trials precludes us from drawing firm conclusions. There is a need for high quality randomized controlled trials (RCTs) using a study design which assures high internal validity.
【摘要】 目的 评价中药治疗贝尔（Bell’s）面瘫的有效性和安全性。 方法 以中药、中西医结合、Bell’s面瘫、特发性面瘫、面神经疾病和（或）麻痹、颅神经、颅神经疾病/麻痹为主题词，检索ECSCO数据库系列的ASP（Academic Source Premier）、 NSTL数据库系列的ACP美国医师协会电子期刊数据库及Medicines Complete英国医药出版社医药数据库、MEDLINE数据库、CNKI中国期刊全文数据库、VIP中文科技期刊全文数据库和万方数据库，并在因特网上检索相关学位论文和正在进行的研究。相关的学术会议论文和学位论文汇编也同时予以检索。鉴定相关文章附录的参考文献作为补充检索。 结果 所有以中药治疗Bell’s面瘫的随机对照试验均被纳入。 结论 对纳入的随机对照试验进行方法学质量的评估，数据提取和数据分析。【Abstract】 Objective To evaluate the efficacy and safety of Chinese herbs on Bell’s palsy. Methods With the searching terms including chinese herbs, integrated chinese and western medicine, Bell’s palsy, peripheral facial palsy,facial nerve disease/paralysis, cranial nerve,cranial nerve disease/paralysis were searched in the database of ASP, ACP, Medicines Complete, MEDLINE, CNKI,VIP and Wanfang. While to search the related academic dissertation and ongoing researches on internet. Relevant academic conference and dissertation proceedings have also been searched. Results All randomized trials about Chinese herbs for Bell’s palsy were included in this review. Conclusion Assessment of methodological quality, data extraction and syntheses were carried out.