【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.
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.
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.
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 the clinical characteristics of facial palsy after stroke (FPS) in order to enhance the understanding of FPS. Methods Patients with stroke and admitted to hospital from March to June 2015 were selected in this study. They were evaluated by Modified House-Braekmann (MHBN), Barthel Index (BI), National Institute of Health Stroke Scale (NIHSS), Standardized Swallowing Assessment and Patient Health Questionnaire-9 (PHQ-9) within 48 hours after admitting. According to the MHBN scores, the patients were divided into FPS group and non-FPS group, and the incidences of dysphagia and depression, and the scores of BI, NIHSS, and PHQ-9 were compared between the two group. Six months later, the patients’ prognosis of stroke was assessed by the Modified Rankin Scale. Results A total of 129 patients were enrolled in this study, including 81 (62.8%) with FPS, and 48 (37.2%) without FPS. The incidences of dysphagia and depression in the FPS group (64.2%, 59.3%) were higher than those in the non-FPS group (22.9%, 18.8%), and the differences were statistically significant (P<0.05). The BI, NIHSS, PHQ-9 scores in the FPS group were 41.79±14.19, 11.23±4.62, 11.54±3.43, respectively, while the scores in the non-FPS group were 66.39±19.96, 7.54±3.69, 7.67±2.89, respectively; the differences in the scores between the two groups were statistically significant (P<0.05). Six months later, the patients’ prognosis in the non-FPS group was better than that in the FPS group (67.4%vs. 32.9%, P<0.001). Conclusions There is a high incidence of FPS, and there are high incidences of dysphagia and depression in the FPS patients with stroke. FPS influences the patients’ prognosis, so the understanding and treatment of FPS should be enhanced.
ObjectiveTo evaluate the effectivness of using high porous polyethylene lower eyelid spacers (Medpor LES) combined with the lateral tarsal-strip procedure for reconstruction of the eyelid closure function in paralytic lagophthalmus after facial palsy. MethodsBetween March 2008 and December 2012, 32 patients (32 eyelids) with hypophasis in facial palsy which all sorts of causes lead to were treated with Medpor LES combined with the lateral tarsal-strip procedure. Of 32 cases, 20 were male and 12 were female, aged from 20 to 72 years (mean, 46.8 years). The left eye was involved in 18 cases and the right eye in 14 cases with a disease duration of 1.5 months to 2 years (mean, 4.4 months). All the patients were shown as lower eyelid ectropion, lower eyelid retraction, exposure keratitis, and corneal ulcer, but no obvious upper eyelid retraction was observed. ResultsPrimary healing of incision was obtained in all patients. The edema time of the eyelid was from 5 days to 3 weeks (mean, 2 weeks). Conjunctival edema appeared in 4 cases after 2 weeks of operation, which was cured after expectant treatment. The patients were followed up 5-8 months (mean, 6 months). At 1 week, 3 and 6 months after operation, the height of palpebral fissure was reduced, and the degree of lagophthalmus and low eyelid retraction were significantly corrected (P<0.05), but no significant difference among different time points after operation (P>0.05). Outer canthus displacement occurred in 3 cases at 1 month postoperatively, and was cured after the lateral tarsal strip procedure. No lower eyelid ectropion, corneal exposure, or Medpor LES displacement and exposure occurred during follow-up. ConclusionMedpor LES combined with the lateral tarsal-strip procedure has good effectiveness for reconstruction of eyelid closure function in most cases of paralytic lagophthalmus after facial palsy.
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 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.