末梢性顔面神経麻痺172症例の検討

Abstract

We retrospectively evaluated 73 patients with Bell's palsy and 27 patients with Ramsay Hunt's Syndrome (herpes zoster oticus) who were treated at our institution between October 1983 and April 1992 in order to identify the clinical features that were well correlated with prognosis for recovery of facial function. They were hospitalized for conservative medical treatment for a few weeks and then followed up at our out-patient clinic for a period of at least 6 months. Treatment modalities consisted mainly of steroids and/or antiviral therapy together with some supportive therapeutic measures.The results are summarized as follows;1) Hunt's syndrome (herpes zoster oticus) had a poorer prognosis than Bell's palsy, as already well documented in the literature.75.8% of patients with Bell's palsy and 62.5% of those with Hunt's syndrome had complete recovery. None of the patient with Bell's palsy remained totally paretic but 3 patients with Hunt's syndrome remained unchanged during a follow-up period of 6 months.2) Complete or incomplete facial muscle paralysis assessed by electrodiagnostic testing results and by repeated physical examination was obviously one of the critical prognostic factors. Ultimate prognosis for patients with incomplete paralysis was excellent; more than 90% and 75% of patients with Bell's palsy and with Hunt's syndrome, respectively, recovered completely. However, recovery profiles for patients in the complete paralysis group were much worse (56% and 41% of patients with Bell's palsy and with Hunt's syndrome, respectively).3) There was a strong correlation between the patient's age and eventual recovery. In patients younger than 50 years of age, complete recovery was obtained in 93.1% of patients with Bell's palsy and in 85.7% of those with Hunt's syndrome, whereas full recovery of only 60.6% and 30.3% of patients with Bell's palsy and with Hunt's syndrome, respectively, was achieved in patients aged 50 or older.4) It was also suggested that the longer the intervals between onset of the disease and initiation of the treatment, the poorer the outcome for recovery.