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摘要


顏面神經麻痺是指單側或雙側顏面表情肌僵硬異常,患者會自訴無法閉眼、合嘴及顏面不對稱。除了顏面表情功能喪失外,也會因無法閉眼使角膜乾燥損傷;另外顏面的不對稱亦使患者擔憂是否罹患腦部病變而產生心理壓力,以及因為表情怪異而損害其社交功能。因此顏面神經麻痺對於患者的生理、心理以及社會層面都有極大的影響。顏面神經麻痺的病因可依照解剖位置分為中樞性及周邊性,臨床上首重排除中樞性病變,如出血、腫瘤、感染等。病史詢問、理學檢查及影像學檢查(腦部核磁共振、電腦斷層掃描)可初步排除嚴重的病因。學者經驗指出,治療上投予皮質類固醇有顯著的效果,若懷疑有病毒感染時,可加入抗病毒藥物並搭配物理復健治療。本科提出三顏面神經麻痺病例:第一例於施打下顎阻斷麻醉後發生顏面神經麻痺情形,懷疑與解剖位置異常有關;第二例有外傷病史,疑似因病毒感染導致顏面麻痺,經治療、觀察數週後患者逐漸復原;第三例患者於社會心理層面壓力極大,且有病毒感染病史,給予詳細檢查排除中樞病變及投予藥物並安排復健之後逐漸復原。此三例各有不同病史及病程,可供臨床上鑑別診斷、邏輯推演及治療上之參考。

並列摘要


Facial nerve palsy (FNP) is referred as extraordinary stiffness of unilateral or bilateral facial expression muscles. Patients suffered from it often declaim not be able to close their eyes, mouths and facial asymmetry. In addition to loss function of facial expression, the cornea will be dried and damaged due to inability to close eyes. Besides, facial asymmetry causes patients psychological stress resulting from anxiety about whether they have brain disease. Their social ability is also compromised due to weird facial expression. Therefore, FNP has profound impacts to patients' physical, mental and social status. The causes of FNP can be classified into central and peripheral lesions according to anatomic location. It is crucial to exclude central lesions, such as bleeding, tumor or infection. History taking, physical examination and imaging studies (brain MRI, CT scan) may initially rule out serious causes. According to some clinicians' experience, corticosteroid has significant effects as treatment modality. Antiviral drugs can be applied if viral infection is suspected and physical rehabilitation should be considered. We proposed three cases of FNP: The first one presented with FNP after mandible block anesthesia injection, which may be related to the anatomical variation. The second has trauma history, which was suspected FNP due to virus infection. The patient gradually recovered after management and observation for a few weeks. The third patient has great psychosocial pressure with history of virus infection. After detailed examination and investment to rule out central lesions, medication prescription and arrangements for the rehabilitation result in gradual good progress. The three cases have different history and disease course, which may provide reference for differential diagnosis, logical deduction and choosing of treatment modality.

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