雙側面神經麻痺：病例報告暨文獻回顧

雙側週邊面神經麻痺(bilateral peripheral facial palsy, BPFP)在臨床上是一個罕見的症狀，佔面神經麻痺病人比例小於百分之一，年發生率約為每十萬人1.3-2人，發生病因與單側面神經麻痺略有不同，其診斷有賴完整的檢查。本文提出兩個雙側週邊面神經麻痺之病例：一為雙側交替發作型，一為雙側同時發作型。案例一是一個Guillain-Barre syndrome (GBS)，在四肢症狀完全消失後，仍遺存面神經麻痺症狀超過兩個月。另一位患者診斷為復發性貝爾氏麻痺。本文除討論此疾病外，並逐一討論其他可能之病因，包括Ramsay Hunt's syndrome、Heerfordt's syndrome、重症肌無力、腫瘤等。雙側週邊面神經麻痺最常見原因是GBS。貝爾氏麻痺佔第二位。而其他如感染、創傷、腫瘤等皆有文獻報告。所以完整的檢查對雙側週邊面神經麻痺患者是很重要的，要排除掉其他可能原因後才能歸類為貝爾氏麻痺。在預後評估方面主要靠神經傳導檢查，而治療處理以預防產生後遺症為最重要，另外電刺激治療、神經肌肉再訓練的手法有助於促進神經恢復。”雙側週邊面神經麻痺(bilateral peripheral facial palsy, BPFP)在臨床上是一個罕見的症狀，佔面神經麻痺病人比例小於百分之一，年發生率約為每十萬人1.3-2人，發生病因與單側面神經麻痺略有不同，其診斷有賴完整的檢查。本文提出兩個雙側週邊面神經麻痺之病例：一為雙側交替發作型，一為雙側同時發作型。案例一是一個Guillain-Barre syndrome (GBS)，在四肢症狀完全消失後，仍遺存面神經麻痺症狀超過兩個月。另一位患者診斷為復發性貝爾氏麻痺。本文除討論此疾病外，並逐一討論其他可能之病因，包括Ramsay Hunt's syndrome、Heerfordt's syndrome、重症肌無力、腫瘤等。雙側週邊面神經麻痺最常見原因是GBS。貝爾氏麻痺佔第二位。而其他如感染、創傷、腫瘤等皆有文獻報告。所以完整的檢查對雙側週邊面神經麻痺患者是很重要的，要排除掉其他可能原因後才能歸類為貝爾氏麻痺。在預後評估方面主要靠神經傳導檢查，而治療處理以預防產生後遺症為最重要，另外電刺激治療、神經肌肉再訓練的手法有助於促進神經恢復。

關鍵字

雙側週邊面神經麻痺； Guillain-Barr症候群；貝爾氏麻痺

並列摘要

Bilateral peripheral facial palsy (BPFP) is a rare disease. It occurs in less than one percent of patients with facial palsy. The average annual incidence rate is 0.13 to 0.2 persons per million. The etiologies of BPFP differ a little from those of unilateral peripheral facial palsy. The diagnosis depends on a series of complete examinations. We reported two cases with BPFP. One was bilateral simultaneous, and the other was bilateral alternating type. Case one was a patient with Guillain-Barre syndrome. His residual bilateral facial palsy lasted more than two months after the paresis of four limbs had subsided. The other was a case with recurrent Bell’s palsy. We also discussed Bell’s palsy and other potential diseases, such as Ramsay-Hunt’s syndrome, Heerfordt’s syndrome, myasthenia gravis, and neoplasm etc. The most common cause of BPFP is Guillain-Barre syndrome. Bell’s palsy is the second. Nevertheless, other etiologies are also reported in literatures, e.g. infection, trauma, and neoplasm etc. Because the diagnosis of Bell’s palsy is established after excluding other possible etiologic diseases, it is important to perform a series of complete examinations for patients with BPFP. The prognosis is predicted by electrodiagnostic tests. The amplitude of compound muscle action potentials was found to be the most valuable. The goal of treatment is to prevent the occurrence of the sequelae. Conservative treatment with electric stimulation and the manipulation of neuromuscular rehabilitation promote the recovery of the nerve function.

並列關鍵字

bilateral peripheral facial palsy ； Guillain-Barre syndrome ； Bell's palsy

國際替代計量

雙側面神經麻痺：病例報告暨文獻回顧

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