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Prognoseabschätzung der peripheren Fazialisparese

Ist der Minimal-Nerve-Excitability-Test noch zeitgemäß?

Estimating the prognosis of peripheral facial paralysis

Is the minimal nerve excitability test still up to date?

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Zusammenfassung

Hintergrund

In einer retrospektiven Studie wurde der prognostische Wert des Minimal-Nerve-Excitability-Tests (NET) bei Patienten mit idiopathischer oder traumatischer peripherer Fazialisparese anhand des House-Brackmann-Index (HB-Index) evaluiert.

Patienten und Methoden

350 Patienten im Alter von 9–85 Jahren (Mittelwert: 42,4 Jahre, 156 Männer und 194 Frauen) fanden Eingang in die Studie, wobei Gruppe 1 250 Patienten mit Bell-Parese und Gruppe 2 100 Patienten mit traumatischer Fazialisparese infolge einer geschlossenen Felsenbeinfraktur umfasste. Alle Patienten wurden in gleicher Weise mit Kortikosteroiden behandelt. Patienten, bei denen eine Fazialisdekompression durchgeführt wurde, wurden nicht berücksichtigt, um die Aussage nicht zu verfälschen. Von Anbeginn des 3. Behandlungstages wurde der NET wiederholt über einen Zeitraum von bis zu 3 Wochen durchgeführt. Für die Evaluation und Auswertung wurde der NET-Wert am 14. Tag herangezogen. Mittels Seitenvergleich wurde das Ergebnis des NET als „normal“, „reduziert“ oder „keine Antwort“ klassifiziert. Nach 1 Jahr wurde der endgültige House-Brackmann-Index bestimmt, um die prognostische Aussagekraft des NET bewerten zu können.

Ergebnisse

Es konnte festgestellt werden, dass ein normaler NET bei nahezu allen Patienten ein zufriedenstellendes Ergebnis im Sinne eines House-Brackmann-Index von I oder II vorhersagen konnte. Bei Patienten, die im NET keine Antwort aufwiesen, kam es in 85% (Bell-Parese) bzw. 90% (traumatische Parese) zu keiner Erholung der Nervenfunktion. Eine reduzierte Antwort im NET erwies sich als vergleichsweise günstig, da es immerhin bei 74% aller Patienten zu einer Erholung der Nerven kam.

Schlussfolgerung

Der NET ist eine leicht durchführbar Untersuchungsmethode, die zur Prognoseeinschätzung einer peripheren Fazialisparese positiv beitragen kann.

Abstract

Background

In this retrospective study, we assessed the long-term prognostic value of the minimal nerve excitability test (NET) by comparing the results it yielded with the House-Brackmann (HB) index in patients with the most common types of facial paralysis, Bell’s palsy and traumatic facial palsy.

Patients and Methods

Three hundred and fifty patients aged 9–85 years (mean age 42.4 years; 156 male and 194 female), all of whom were treated initially with the same steroid therapy, entered on study. Patients in whom decompression surgery had been performed were excluded so as to avoid falsely optimistic prognoses. The 350 study patients were divided into two groups: group 1 was made up of 250 with Bell’s palsy and group 2, of 100 with nonpenetrating traumatic facial palsy following temporal bone fracture. The NET was conducted repeatedly in all patients for 3 weeks from the start of day 3 of treatment, the value recorded on day 14 being used in the evaluation. For each patient, the result of the NET was recorded as ‘normal’, ‘diminished’ or ‘without response’ according to the difference between the two sides of the face. The final HB grading was determined after 1 year to check for the agreement between the electrical prognosis and the clinical outcome and thus the reliability of the prognosis indicated by the NET.

Results

The results indicate that a normal NET forecast a satisfactory outcome that could be classed as HB I–II in almost all the patients in both groups. Among patients who had no response on NET, 85% of those with Bell’s palsy and 90% of those with traumatic facial palsy failed to recover nerve function. Diminished nerve excitability proved to be a sign of a relatively favourable prognosis: 74% of patients in each group recovered normal facial function.

Conclusion

The NET is a method of investigation that is easily applied and can make a positive contribution to the assessment of prognosis in Bell’s palsy and in traumatic facial palsy, reflecting the functional state of the facial nerve reliably in most of cases.

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Literatur

  1. Adour KK, Boyajian JA, Kahn ZM et al. (1977) Surgical and nonsurgical management of facial paralysis following closed head injury. Laryngoscope 87: 380–390

    Article  PubMed  CAS  Google Scholar 

  2. Bleicher JN, Hamiel S, Gengler JS et al. (1996) A survey of facial paralysis: etiology and incidence. Ear Nose Throat J 75: 355–358

    PubMed  CAS  Google Scholar 

  3. Campbell EDR, Hickey RP, Nixon KH et al. (1962) Value of nerve-excitability measurements in prognosis of facial palsy. Br Med J [Clin Res] 2: 7–10

    Google Scholar 

  4. Chang CY, Cass SP (1999) Management of facial nerve injury due to temporal bone trauma. Am J Otol 20: 96–114

    Article  PubMed  CAS  Google Scholar 

  5. Coker NJ, Fordice JO, Moore S (1992) Correlation of the nerve excitability test and electroneurography in acute facial paralysis. Am J Otol 13: 127–133

    PubMed  CAS  Google Scholar 

  6. Darrouzet V, Duclos JY, Liguoro D et al. (2001) Management of facial paralysis resulting from temporal bone fractures: Our experience in 115 cases. Otolaryngol Head Neck Surg 125: 77–84

    Article  PubMed  CAS  Google Scholar 

  7. Devriese PP, Schumacher T, Scheide A et al. (1990) Incidence, prognosis and recovery of Bell’s palsy. A survey of about 1000 patients (1974–1983). Clin Otolaryngol 15: 15–27

    Article  PubMed  CAS  Google Scholar 

  8. Duchenne GB (1872) De l’electrication localisée. Third Edition. Baillere, Paris

  9. Eschapasse P, Dauman R, Cazenave M et al. (1987) Electrophysiological prognosis in facial paralysis. Clin Otolaryngol 12: 289–296

    Article  PubMed  CAS  Google Scholar 

  10. Felix H, By DL, Fisch U (1991) New aspects of facial nerve pathology and temporal bone fractures. Acta Otolaryngol 111: 332–336

    PubMed  CAS  Google Scholar 

  11. Fisch U (1974) Facial paralysis in fracture of the petrous bone. Laryngoscope 84: 2141–2154

    Article  PubMed  CAS  Google Scholar 

  12. Fisch U, Felix H (1983) On the pathogenesis of Bell’s palsy. Acta Otolaryngol 95: 532–538

    PubMed  CAS  Google Scholar 

  13. Gavilan C, Gavilan J, Rashad M et al. (1988) Discriminant analysis in predicting prognosis of Bell’s palsy. Acta Otolaryngol 106: 276–280

    PubMed  CAS  Google Scholar 

  14. Griffin JE, Altenau MM, Schaefer SD (1979) Bilateral longitudinal temporal bone fracture: a retrospective review of seventeen cases. Laryngoscope 89: 1432–1435

    Article  PubMed  CAS  Google Scholar 

  15. Guntinas-Lichius O, Sittel C (2004) Diagnostik von Erkrankungen und der Funktion des N. facialis. HNO 52: 1115–1130

    Article  PubMed  CAS  Google Scholar 

  16. House JW, Brackmann DE (1985) Facial nerve grading system. Otolaryngol Head Neck Surg 93: 146–147

    PubMed  CAS  Google Scholar 

  17. Ikeda M, Abiko Y, Kukimoto N et al. (2005) Clinical factors that influence the prognosis of facial nerve paralysis and the magnitudes of influence. Laryngoscope 115: 855–860

    Article  PubMed  Google Scholar 

  18. Kerbavaz RJ, Hilsinger RL Jr, Adour KK (1983) The facial paralysis prognostic index. Otolaryngol Head Neck Surg 91: 284–289

    PubMed  CAS  Google Scholar 

  19. Koike Y, Aoyagi M, Ichige A (1988) Nationwide investigation on diagnostic methods for facial palsy. Acta Otolaryngol 446: 30–35

    CAS  Google Scholar 

  20. Kraus P (1970) Reliability of the nerve excitability test in Bell’s palsy. J Laryngol Otol 84: 719–722

    Article  PubMed  CAS  Google Scholar 

  21. Kumar A, Applebaum EL (1993) Evaluation of the facial nerve. In: Nadol JB, Schuknecht HF (eds) Surgery of the ear and temporal bone. Raven Press, New York, pp 71–77

  22. Laumans EPJ, Jongkees LB (1963) On the prognosis of peripheral facial paralysis of endotemporal origin. Part II. Electrical tests. Ann Otol Rhinol Laryngol 72: 621–636

    PubMed  CAS  Google Scholar 

  23. Leclaire R, Tremblay L, Dupuis M (1975) Prognostic value of nerve excitability test in Bell’s palsy. Can J Otolaryngol 4: 352–357

    PubMed  CAS  Google Scholar 

  24. Lewis BI, Adour KK, Kahn JM et al. (1991) Hilger facial nerve stimulator: a 25-year update. Laryngoscope 101: 71–74

    Article  PubMed  CAS  Google Scholar 

  25. Liston SL, Kleid S (1989) Histopathology of Bell’s palsy. Laryngoscope 99: 23–26

    PubMed  CAS  Google Scholar 

  26. May M (1972) Nerve excitability test in facial palsy: Limitations in its use, based on a study of 130 cases. Laryngoscope 82: 2122–2128

    Article  PubMed  CAS  Google Scholar 

  27. McKennan KX, Chole RA (1992) Facial paralysis in temporal bone trauma. Am J Otol 13: 167–172

    PubMed  CAS  Google Scholar 

  28. Peitersen E (1982) The natural history of Bell’s palsy. Am J Otol 4: 10–11

    Google Scholar 

  29. Sittel C, Guntinas-Lichius O, Streppel M et al. (1998) Variability of repeated facial nerve electroneurography in healthy subjects. Laryngoscope 108: 1177–1180

    Article  PubMed  CAS  Google Scholar 

  30. Smith IM, Health JP, Murray JA et al. (1988) Idiopathic facial (Bell’s) palsy: a clinical survey of prognostic factors. Clin Otolaryngol Allied Sci 13: 17–23

    Article  PubMed  CAS  Google Scholar 

  31. Takahashi K, Hara A, Kawase T et al. (1988) Relation of prognosis of peripheral facial nerve palsy to the period between onset of illness and date of denervation. Tohoku J Exp Med 155: 373–377

    Article  PubMed  CAS  Google Scholar 

  32. Thomander L, Stalberg E (1981) Electroneurography in the prognostication of Bell’s palsy. Acta Otolaryngol 92: 221–237

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Hals-Nasen-Ohren-Klinik, Kopf- und Halschirurgie, AHEPA-Hospital, Aristoteles-Universität, 54006, Thessaloniki, Griechenland, -

    G. Psillas,  J. Constantinidis, A. Printza & V. Vital

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  1. G. Psillas
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  2. J. Constantinidis
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  3. A. Printza
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Correspondence to J. Constantinidis.

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Psillas, G., Constantinidis, J., Printza, A. et al. Prognoseabschätzung der peripheren Fazialisparese. HNO 55, 625–629 (2007). https://doi.org/10.1007/s00106-006-1496-2

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  • DOI: https://doi.org/10.1007/s00106-006-1496-2

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