顔面神経麻痺の予後予測はどこまで可能か  [in Japanese] Accuracy of the Prognostic Diagnosis in Acute Peripheral Facial Palsy  [in Japanese]

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Author(s)

    • 青柳 優 AOYAGI Masaru
    • 山形大学医学部情報構造統御学講座耳鼻咽喉・頭頸部外科学分野 Department of Otolaryngology, Head and Neck Surgery, Course of Biological Structure and Cognitive Integration Science, Yamagata University School of Medicine

Abstract

顔面神経麻痺の予後因子には, 治療法, 治療開始時期, 年齢, 合併症などもあるが, 最も大きな予後因子は (1) 原因疾患, (2) 障害部位と (3) 障害程度である. 予後には障害程度がもっとも強く関係するが, 治療法の選択という観点から考えても, 原因疾患の診断が最も重要である. なかでもBell麻痺とHunt症候群 (zoster sine herpete) の鑑別は重要であるが, PCR法などを駆使してもすべての症例に対して初診時に正確な診断を下すことは, 現在のところ難しい.<BR>障害程度の診断に用いられる検査法には, 顔面運動採点 (40点法), 神経興奮性検査 (NET), electroneurography (ENoG), 磁気刺激誘発筋電図検査 (TMS), アブミ骨筋反射 (SR) があるが, NETとENoGは発症3日以内では診断的意義に乏しい. 予後良好 (2カ月以内に治癒) と判定するときの敏感度と特異度について発症3日以内の検査所見と147症例の転帰により計算すると, どの検査によっても単独では発症3日以内には100%正確な予後診断は出来ない. しかし, 発症3日以内に (1) 顔面運動採点が10点以上, (2) TMSで反応あり, (3) SRで反応あり, の検査所見がそろえば予後良好と判定できる. また, 逆行性顔面神経誘発電位により発症3日以内に予後を正確に診断できる可能性はある.

The important factors in the prognostic diagnosis of acute peripheral facial palsy are (1) the causal disease, (2) the site of injury and (3) the degree of injury, although the age of the patient, complication, treatment method and initial day of treatment are also important. Among these 3 factors, the degree of injury is most strongly related to the prognosis. However, the diagnosis of etiology is the most important for the selection of the treatment method. Above all, the differential diagnosis between Bell's palsy and zoster sine herpete (Ramsay Hunt syndrome), is the most significant. However, it is impossible to diagnose all patients with complete accuracy within 3 days after the onset of palsy, even using molecular biological examination including polymerase chain reaction analysis. The diagnosis of the site of injury does not contribute to the prediction of prognosis or the selection of treatment method, except for the determination of the approaching route of the facial nerve decompression for traumatic facial palsy.<BR>The scoring system of facial movement (40-point method), nerve excitability test (NET), electroneurography (ENoG), transcranial magnetic stimulation (TMS) and stapedial reflex (SR) are commonly used to estimate the degree of injury. To estimate the accuracy of these examinations, sensitivity and specificity of the tests were calculated according to the findings within 3 days after the onset of palsy and the outcome of 116 patients with Bell's palsy and 31 with Ramsay Hunt syndrome. According to the results, none of these tests seem to be a perfect diagnostic examination for the completely precise prediction of prognosis. However, a patient is predicted to have a good prognosis, if the following 3 findings are observed: (1) more than 10 points in the 40-point scoring system of facial movement, (2) a positive response to TMS and (3) a positive response to SR An antidromic facial nerve response probably contributes to a precise prediction of prognosis within 3 days after the onset of facial palsy.

Journal

  • Nippon Jibiinkoka Gakkai Kaiho

    Nippon Jibiinkoka Gakkai Kaiho 108(1), 1-7, 2005-01-20

    The Oto-Rhino-Laryngological Society of Japan, Inc.

References:  13

Cited by:  5

Codes

  • NII Article ID (NAID)
    10014465615
  • NII NACSIS-CAT ID (NCID)
    AN00191551
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    00306622
  • Data Source
    CJP  CJPref  J-STAGE 
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