Isolierte Paresen der Fazialisendäste - Klinische Befunde, Ursachen und Differenzialdiagnose

Zusammenfassung

Klinische Befunde und Ursachen von Paresen der Fazialisendäste werden an 35 Patienten demonstriert. Aufgrund seiner exponierten Lage haben isolierte Läsionen vorrangig den Ramus marginalis mandibulae (n = 21) betroffen, gefolgt von denen bukkaler (n = 6) und zygomatiko-temporaler (n = 4) Äste. Zweimal haben komplexere Lähmungen der perioralen Muskulatur vorgelegen. Iatrogene Verletzungen (n = 25) rangieren in unserer Untersuchung vor tumorbedingten (n = 4), traumatischen (n = 2) und viral entzündlichen (n = 1) Läsionen sowie einer idiopathischen Parese. Bei 2 Patienten sind die Lähmungen als kongenital einzuordnen. Die Bedeutung der klinischen Untersuchung zur Abgrenzung von supranukleären Läsionen wird hervorgehoben.

Abstract

Clinical findings from 35 patients with isolated paralyses of distinct branches of the facial nerve are demonstrated. Presumably because of its position, the mandibular marginal ramus has most often been affected (n = 21) followed by buccal (n = 6) and temporal branches (n = 4). In two patients, the pattern of perioral muscular pareses was compatible with lesions of more than one branch. Causes for the facial nerve branch lesions were iatrogenic (n = 25), tumor (n = 4), trauma (n = 2), inflammatory (n = 1), idiopathic (n = 1) and congenital (n = 2). The impact of the clinical investigation to distinguish supranuclear lesions is emphasized.

Literatur

• 1 Rödel R, Lang J. Studies of the course of the marginal branch of the facial mandibular nerve.  Laryngo-Rhino-Otol. 1996;  75 (6) 368-371
• 2 Rödel R, Lang J. Die peripheren Äste des N. facialis im Wangen- und Kinnbereich.  HNO. 1996;  44 572-576
• 3 Toure S, Vacher C, Bertrand J C. Anatomy of the marginal mandibular branch of the facial nerve.  Rev Stomatol Chir Maxillofac. 2004;  105 (3) 149-152
• 4 Wilhelmi B J, Mowlavi A, Neumeister M W. The safe face lift with bony anatomic landmarks to elevate the SMAS.  Plast Reconstr Surg. 2003;  111 (5) 1723-1726
• 5 Salame K, Ouaknine G E, Arensburg B. et al . Microsurgical anatomy of the facial nerve trunk.  Clin Anat. 2002;  15 (2) 93-99
• 6 Nemeto Y, Sekino Y, Kaneko H. Facial nerve anatomy in eyelids and periorbit.  Jpn J Ophthalmol. 2001;  45 (5) 445-452
• 7 Rödel R, Laskawi R. Die isolierte Parese des Ramus marginalis mandibulae nervi facialis: Klinik, Ursachen. Diagnostik und Therapie.  Laryngo-Rhino-Otol. 1989;  77 115-121
• 8 Malin J P. Nervus facialis. In: Schmidt D, Malin JP (Hrsg). Erkrankungen der Hirnnerven. Stuttgart, New York: Georg Thieme 1995: 179
• 9 Mumenthaler M, Mattle H. (1997) Neurologie. Stuttgart, New York: Georg Thieme 2002: 688
• 10 Schliack H. (1986) Läsionen des Nervus facialis. In: Hopf HC, Poeck K, Schliack H (Hrsg). Neurologie in Praxis und Klinik. Stuttgart, New York: Georg Thieme 1986: 1107
• 11 Basar R, Sargon M F, Elhab A. The marginal mandibular branch of the facial nerve.  Surg Radiol Anat. 1997;  19 (5) 311-314
• 12 Cannon C R, Reploge W H, Schenk M P. Facial nerve in parotidectomy: a topographical analysis.  Laryngoscope. 2004;  114 (11) 2034-2037
• 13 Savary V, Robert R, Rogez J M. et al . The mandibular marginal ramus of the facial nerve: an anatomic and clinical study.  Surg Radiol Anat. 1997;  19 (2) 69-72
• 14 Eneroth C M, Andreasson L, Beran M. et al . Preoperativ facial paralysis in malignant parotid tumours.  J Otorhinolaryngol Relat Spec. 1977;  39 (5) 272-277
• 15 Caughey R J, May M, Schaitkin B M. Intraparotid facial nerve schwannoma: diagnosis and management.  Otolaryngol Head Neck Surg. 2004;  130 (5) 586-592
• 16 Chong K W, Chung Y F, Khoo M L. et al . Management of intraparotid facial nerve schwannomas.  Aust N J Surg. 2000;  70 (10) 732-734
• 17 De Lozier H L, Spinella M J, Johnson G D. Facial nerve paralysis with benign parotid masses.  Ann Oto Rhino Laryngol. 1989;  98 644-647
• 18 Fenton J E, Chin R Y, Tonkin J P. et al . Transtemporal facial nerve schwannoma without facial nerve paralysis.  J Laryngol Otol. 2001;  115 (7) 559-560
• 19 Fisch-Ponsot C, Sigal R, Schmutz G. et al . Intra-parotid neurogenic tumors of the facial nerve. Value of MRI.  J Radiol. 1997;  78 (2) 141-144
• 20 Eneroth C M. Facial nerve paralysis.  Arch Otolaryng. 1972;  95 300-304
• 21 Aimoni C, Lombardi L, Gastalo E. al. Preoperative and postoperative electroneurographic facial nerve monitoring in patients with parotid tumors.  Arch Otolyryngol Head Neck Surg. 2003;  129 (9) 940-943
• 22 Boahene D O, Olsen K D, Driskoll C. et al . Facial nerve paralysis secondary to occult malignant neoplasms.  Otolaryngol Head Neck Surg. 2004;  130 (4) 459-465
• 23 Broderick J P, Auger R G, DeSanto L W. Facial paralysis and occult parotid cancer.  Arch Otolaryngol Head Neck Surg. 1988;  114 (2) 195-197
• 24 Conley J, Hamarker R C. Prognosis of malignant tumors of the parotid gland with facial paralysis.  Arch Otolaryngol. 1975;  101 (1) 39-41
• 25 Vellin J F, Mom T, Kemeny J L. et al . Intraparotid facial nerve schwannoma : a case report.  Ann Otolaryngol Chir Cervicofac. 2003;  120 (4) 231-236
• 26 Ben Hajel H, Marsot-Dupuch K, Chabolle F. et al . Persistent facial paralysis: contribution of imaging to identification of perineural infiltrating tumor.  Ann Otolaryngol Chir Cervicofac. 1997;  114 (4) 125-129
• 27 Rallis G, Mourouzis C, Zachariades N. A study of 55 submandibular salivary glandexcisions.  Gen Dent. 2004;  52 (5) 420-423
• 28 Stehen V van de, Kuhweide R, Vlaminck S. et al . Varicella zoster virus: beyond facial paralysis.  Acta Otorhinolaryngol Belg. 2004;  58 (1) 61-66
• 29 Dutt , SN , Irving R M, Donaldson , L . Total decompression of facial nerve for Melkersson-Rosenthal syndrom.  J Laryngol Otol. 2000;  114 (11) 870-873
• 30 Heck A W, Phillips L H. Sarcoidosis and the nervous system.  Neurol Clin. 1989;  7 (3) 641-654
• 31 Mignogna M D, Fedele S, Russo L. et al . The multiform and variable patters of onset of orofacial granulomatosis.  J Oral Patho. 2003;  32 (4) 200-205
• 32 Richard B M, Corry P R. Cervical branch of the facial nerve in leprosy.  Int J Lepr Other Mycobact Dis. 1997;  65 (2) 170-177
• 33 Turkof E, Tambwekar S, Kamal S. et al . Leprosy affects facial nerves at main trunk: neurolysis can possibly avoid transfer procedures.  Plast Reconstr Surg. 1998;  102 (5) 1565-1573
• 34 Holmich L R, Medgyesi S. Congenital hereditary pareses of ramus marginalis nervi facialis in five generations.  Ann Plast Surg. 1994;  33 (1) 96-99
• 35 Dardour J C, Ktorza T. Endoscoping deep periorbital lifting: study and results based on 50 consecutive cases.  Aesthetic Plast Surg. 2000;  24 (4) 292-298
• 36 Zani R, Fadul R, Da Rocha M A. et al . Facial nerve in rhytidoplasty: anatomic study of its trajectory in the overlying skin and the most common site of injury.  Ann Plat Surg. 2003;  51 (3) 236-242
• 37 Lanigan D T, Hohn F I. Facial nerve injuries after sagittal split mandibular ramus osteotomies for advancement: a report of two cases and review of the literature.  J Oral Maxillofac Surg. 2004;  62 (4) 503-507
• 38 Zarafulla M Y. Iatrogenic facial nerve injury.  Int J Oral Surg. 1985;  14 (6) 544-546
• 39 deVries K, Devriese P P, Hovinga J. et al . Facial palsy after sagittal split osteotomies. A survey of 1747 sagittal split osteotomies.  J Craniomaxillofac Surg. 1993;  21 (2) 50-53
• 40 Flynn T C, Emmanouil P, Limmer B. (1999) Unilateral transient forehead paralysis following injury to the temporal branch of the facial nerve.  Int J Dermatol. 1999;  38 (6) 474-477
• 41 Bhatti M T, Goldstein M H. Facial nerve injury following superficial temporal artery biopsy.  Dermatol Surg. 2001;  27 (1) 15-17
• 42 Spiro J D, Spiro R H. Cancer of the parotid gland: role of 7th nerve preservation.  World J Surg. 2003;  27 (7) 836-837
• 43 Gaillard C, Perie S, Susini B. et al . Facial nerve dysfunction after parotidectomy: the role of local factors.  Laryngoscope. 2005;  115 (2) 287-291
• 44 Gardetto A, Kovacs P, Pieggaer J. et al . Direct coaptation of extensive facial nerve defects after removal of the superficial part of the parotid gland: an anatomic study.  Head Neck. 2002;  24 (12) 1047-1053
• 45 Glass W v., Pesch H, Braun R. et al . Zur Chirurgie des pleomorphen Adenoms der Ohrspeicheldrüse.  HNO. 1989;  3 426-431
• 46 Bron L P, O'Brien C J. Facial nerve function after parotidectomy.  Arch Otolaryngol Head Neck Surg. 1997;  123 (10) 1091-1096
• 47 Bernsen P L. Peripheral facial nerve paralysis after local upper dental anaesthesia.  Eur Neurol. 1993;  33 (1) 90-91
• 48 Cousin G C. Facial nerve palsy following intra-oral surgery performed with local anaesthesia.  J R Coll Surg Edinb. 2000;  45 (5) 330-333
• 49 Daane S, Owsley J. Incidence of cervical branch injury with „marginal mandibular nerve pseudo-paralysis in patients undergoing face lift.  Plast Reconstr Surg. 2003;  111 2414-2418
• 50 Hald J, Andeassen U. Submandibular gland excision: Short and long-term complications.  J Oto-Rhino-Laryngol. 1994;  56 (2) 87-91
• 51 Laskawi R, Ellies C, Arglebe A. et al . Surgical management of benign tumors of the submandibular gland: A follow up study.  J Oral-Max-Fac Surg. 1995;  53 506-508
• 52 Asadian A, Senekowitsch C, Pfaffelmeyer N. et al . Incidence of cranial nerve injuries after carotid eversion endarterectomy with a transverse skin incision under regional anaesthesia.  Eur J Vasc Surg. 2004;  28 (4) 421-424
• 53 Cunningham E J, Bond R, Mayberg M R. et al . Risk of persistent cranial nerve injury after carotid endarterectomy.  J Neurosurg. 2004;  101 (3) 445-448
• 54 Forsell C, Takolander R, Bergquist D. et al . Cranial nerve injuries. A prospective study.  Acta Chir Scand. 1985;  151 (7) 595-598
• 55 Ballotta E, Da Giau G, Renon L. et al . Cranial and cervical nerve injuries after carotid endarterectomy: a prospective study.  Surgery. 1999;  125 (1) 85-91
• 56 Zarafulla M Y. Iatrogenic facial nerve injury.  Int J Oral Surg. 1985;  14 (6) 544-546
• 57 Aldoori M I, Baird R N. Local neurological complication during carotid endarterectomy.  J Cardiovasc Surg (Torino). 1988;  29 (4) 432-436
• 58 Stöhr M. Iatrogene Nervenläsionen. Stuttgart, New York: Georg Thieme 1996: 93
• 59 Schauber M D, Fontenelle L J, Solomon J W. et al . Cranial/cervical nerve dysfunction after carotid endarterectomy.  J Vasc Surg. 1997;  25 (3) 481-487
• 60 Krennmair G, Moser G, Achinger O. et al . Periphere Hirnnervenlähmungen als Folge von Operationen an der A. carotis.  Wien Klin Wochenschr. 1995;  107 (10) 309-312
• 61 Massay E W, Heymann A, Utley D. et al . Cranial nerve paralysis following carotid endarterectomy.  Stroke. 1984;  15 (1) 157-159