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題名 | 顏面神經麻痺--三病例報告=Facial Nerve Palsy--Report of 3 Cases |
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作 者 | 蔡百泰; 沈炯志; 張婷菡; 吳契璁; 顏哲宏; 李曉屏; 陳元武; | 書刊名 | 臺灣口腔顎面外科學會雜誌 |
卷期 | 23:2 2012.06[民101.06] |
頁次 | 頁156-167 |
分類號 | 416.844 |
關鍵詞 | 顏面神經麻痺; 顏面不對稱; 腦部核磁共振; 皮質類固醇; 抗病毒藥物; Facial nerve palsy; Facial asymmetry; Brain MRI; Corticosteroids; Antiviral drugs; |
語文 | 中文(Chinese) |
中文摘要 | 顏面神經麻痺是指單側或雙側顏面表情肌僵硬異常,患者會自訴無法閉眼、合嘴及顏面不對稱。除了顏面表情功能喪失外,也會因無法閉眼使角膜乾燥損傷;另外顏面的不對稱亦使患者擔憂是否罹患腦部病變而產生心理壓力,以及因為表情怪異而損害其社交功能。因此顏面神經麻痺對於患者的生理、心理以及社會層面都有極大的影響。顏面神經麻痺的病因可依照解剖位置分為中樞性及周邊性,臨床上首重排除中樞性病變,去口出血、腫瘤、感染等。病史詢問、理學檢查及影像學檢查(腦部核磁共振、電腦斷層掃描)可初步排除嚴重的病因。學者經驗指出,治療上投予皮質類固醇有顯著的效果,若懷疑有病毒感染時,可加入抗病毒藥物並搭配物理復健治療。本科提出三顏面神經麻痺病例:第一例於施打下頓阻斷麻醉後發生顏面神經麻痺情形,懷疑與解剖位置異常有關;第二例有外傷病史,疑似因病毒感染導致顏面麻痺,經治療、觀察數週後患者逐漸復原;第三例患者於社會心理層面壓力極大,且有病毒感染病史,給予詳細檢查排除中樞病變及投予藥物並安排復健之後逐漸復原。此三例各有不同病史及病程,可供臨床上鑑別診斷、邏輯推演及治療上之參考。 |
英文摘要 | Facia1 nerve pa1sy (FNP) is referred as extraordinary stiffness of uni1atera1 or bi1atera1 facia1 expression muscles. Patients suffered from it often declaim not be ab1e to close their eyes, mouths and facia1 asymmetry. In addition to 10ss function of facia1 expression, the cornea will be dried and damaged due to inabi1ity to close eyes. Besides, facia1 asymmetry causes patients psycho10gica1 stress resu1ting from anxiety about whether they have brain disease. Their socia1 abi1ity is a1so compromised due to weird facia1 expression. Therefore, FNP has profound impacts to patients, physica1, menta1 and socia1 status. The causes of FNP can be classified into centra1 and periphera1 1esions according to anatomic 10cation. Itis crucia1 to exclude centra1 1esions, such as b1eeding, tumor or infection. History taking, physica1 examination and imaging studies (brain MRI, CT scan) may initially ru1e out serious causes. According to some clinicians, experience, corticosteroid has significant effects as treatment moda1ity. Antivira1 drugs can be app1ied if vira1 infection is suspected and physica1 rehabi1itation shou1d be considered. We proposed three cases of FNP: The first one presented with FNP after mandib1e b10ck anesthesia injection, which may be re1ated to the anatomica1 variation. The second has trauma history, which was suspected FNP due to virus infection. The patient gradually recovered after management and observation for a few weeks. The third patient has great psychosocia1 pressure with history of virus infection. After detai1ed examination and investment to ru1e out centra11esions, medication prescription and arrangements for the rehabi1itation resu1t in gradua1 good progress. The three cases have different history and disease course, which may provide reference for differentia1 diagnosis, 10gica1 deduction and choosing of treatment moda1ity. |
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