顔面神経減荷術

Abstract

There has been some controversy about the value of facial nerve decompression. A historical review of facial nerve decompression showed that the procedure gained popularity in the early 1970's, but its use has decreased since the late 1970's. One of the reasons for the loss of popularity is that synkinetic movement appeared even in patients who underwent the decompression surgery. Another reason is that it has become clear that the recovery rate is fairly high in patients left untreated.Our experimental study showed that severely damaged facial nerves swell more than 2.14 times in the initial swelling stage of Wallerian degeneration. Based on the facial nerve to facial canal ratio reported by Ogawa and Sando, a 72% damaged facial nerve swells to fill totally the facial canal at the stage of 2.14 times swelling.Our experiments on pressure measurement of the interstitial space of the facial nerve revealed that the pressure depended completely on the pressure changes of the cerebrospinal fluid. Lowering cerebrospinal fluid pressure with a hypertonic solution simultaneously lowers the interstitial fluid space of the facial nerve.Our clinical study showed that mannitol (hypertonic solution) was effective in cases of facial palsy in reducing the appearance of pathologic synkinesis after regeneration of the damaged facial nerve fibers.