末梢性顔面神経麻痺回復遅延30例に対する減荷術

抄録

The efficacy of transmastoid facial nerve decompression surgery for severe peripheral facial nerve palsy has been under debate for a long time, and continues to remain controversial. Therefore, we conducted a retrospective review of the patients’ backgrounds, timing of surgery, intraoperative findings, and prognosis, in particular, 1) the effect of the period from the onset to surgery on the 1-year prognosis after surgery, and 2) the correlation between the intraoperative facial nerve monitor reaction and the prognosis in 30 cases of delayed recovery from peripheral facial nerve palsy treated by transmastoid facial nerve decompression surgery. The results showed that there was no significant difference in the Yanagihara score at six months after surgery between the patients operated within and over 50 days after the onset, however, in those operated over 60 days after the onset, the Yanagihara score was significantly lower than those operated within 60 days after the onset. There was also a significant correlation between the presence/absence of response to intraoperative NIM and the Yanagihara score at six months after surgery. In other words, patients who responded to intraoperative NIM fared significantly better than those who did not. On the other hand, the prognosis was significantly worse in patients who underwent surgery at more than 2 months after the onset than in patients who underwent surgery earlier, and it is important to make patients aware of this information. From now on, we will continue to do surgery only cases who show no satisfactory response to conservative treatment for severe paralysis and for whom there are no other effective treatment options, and only in cases where the family, including the patient, strongly desires to receive the treatment.