顔面神経麻痺重症例に対する早期減荷術の有効性

抄録

Transmastoid decompression of the facial nerve is considered for patients with severe peripheral facial nerve paralysis. Early decompression is thought to salvage facial nerve fibers from showing progression to Wallerian degeneration, and to be more beneficial than decompression after a delay.

We performed transmastoid decompression of the facial nerve for 14 patients with severe Bell’s palsy, Ramsay Hunt syndrome, and zoster sine herpete within 14 days of the onset. All the patients had poor facial motor function and ≥90% degeneration of the facial nerve fibers according to electroneurography before the surgery. The operation in all the cases were performed by the senior author F. Matsumi and the facial nerve was decompressed from the geniculate ganglion to the stylomastoid foramen. We performed a retrospective chart review. Ten patients (71%) exhibited good recovery (House-Brackmann grade I or II) at the final visit postoperatively. The mean postoperative loss of hearing at 500, 1000, 2000 Hz was 0.2 dB.

Early transmastoid decompression of the facial nerve in patients with Bell’s palsy, Ramsay Hunt syndrome, zoster sine herpete which generally have poor neurophysiological prognoses, could provide a chance for good facial nerve restoration.