正顎手術併發術後的暫時性顏面神經麻痺－病例報告

本病例為32歲女性，患有下顎骨過度增生與安格氏第三級異常咬合，經術前矯正治療後，接受雙側下顎骨直枝垂直截骨術與上下顎問固定。術後第二日發現，病人右後枕骨區及耳朵周圍脹痛，但無顏面部麻痺現象。術後第三日上午出院，當日下午患者發現右嘴角無法運動，右眼臉無法閉合。一星期後回診發現右臉表情肌虛弱，疑似貝爾氏麻痺，給予類固醇、血管擴張劑、維生素B1、B12治療，並安排會診眼科、復健科與神經內科進一步評估與診斷。經由理學與腦部斷層掃描檢查，無腦內出血、乳突與異常水腫或血腫、感染等其他病灶之發現，確診為貝爾氏麻痺。經過6個月的門診追蹤與藥物治療，患者之右眼險、鼻翼、口角皆逐漸恢復運動功能，觸診之疼痛感與皮膚感覺異常亦日漸改善。目前仍進行術後追蹤及齒列矯正。正穎手術後發生貝爾氏麻痺殊為罕見，此次提出經驗分享，以供診斷與治療之參考。

關鍵字

雙側下顎骨直枝垂直截骨術；貝爾氏麻痺；併發症

並列摘要

The patient was a 32 years old female with Angle's Class III malocc1usion and mandibular hyperplasia. A bi1ateral vertical ramus osteotomy surgery with intermaxillary fixation was performed on the patient. The day after the surgery the patient felt pain from the right posterior occipital region and swelling was evident in the periauricular area. Facial numbness was absent. However, the afternoon the patient was discharged from the hospital, which was day three post-surgery, she noticed involuntary droops on the ends of her right lips and was unable to close her right eyelid as well. A follow-up in the hospital revealed symptoms similar to Bell's palsy where the patient was experiencing facial paralysis resulting in the inability to contro1 the right facial musc1es. Corticosteroids, vasodilators, and vitamin B12 were administered. Referrals to the ophthalmology and neurology departments were initiated for consultation and further diagnosis. Clinical analysis and computed tomography scan of the head and neck was bestowed upon the patient. Subsequent findings revealed no internal bleeding of the brain or other pathologicallesion. The result confirmed a Bell's palsy. After 6 months of fo11ow-ups and pharmacological therapies, noticeable improvements were observed on the facial drooping. The motor functions of the patient's right face, eyes, nostril, and lip angle were gradually being recovered. Facial tingling and pain sensation were also improved. The patient is currently still undergoing post-surgery follow-ups and orthodontic treatment. Among the complications of post orthognathic surgery, Be11's palsy is considered a rare occurrence. Experience from this surgery is presented here for future reference on its diagnosis and treatment.

並列關鍵字

bilateral vertical ramus osteotomy ； Bell's palsy ； complication

國際替代計量

正顎手術併發術後的暫時性顏面神經麻痺－病例報告

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