Observation on the efficacy of facial nerve neurolysis in the treatment of spastic facial paralysis sequelae after Bell's palsy
Objective To investigate the therapeutic efficacy of facial nerve neurolysis in treating spastic facial paralysis sequelae after Bell's palsy,and to identify factors that may influence treatment outcomes.Methods A retrospective analysis was conducted on the clinical data of 32 patients with spastic facial paralysis sequelae following Bell's palsy,who underwent facial nerve neurolysis at the Department of Neurosurgery,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from July 2020 to January 2022.Preoperative House-Brackmann(H-B)grading showed 26 cases with grade Ⅱ and 6 cases with grade Ⅲ.There were 8 patients having a disease course＞1 year and 24 patients with the disease course≤1 year.The safety of the surgery was assessed by evaluating whether the severity of facial paralysis worsened one year postoperatively using the HB grading system.The overall alleviation of spastic facial paralysis sequelae was evaluated using a self-assessment scale,with a score of＜5 indicating no alleviation(non-alleviation group)and a score of ≥5 indicating effective alleviation(effective alleviation group).Factors potentially influencing the overall alleviation were analyzed.The effectiveness of symptom alleviation for six major symptoms,including facial tightness,facial stiffness,synkinesis,facial muscle twitching,difficulty in opening eyes,and smaller eye fissures was assessed using a self-assessment scale respectively,and the effective alleviation rates were also calculated.Results All 32 surgeries were successfully completed.Upon discharge,23 patients(71.9％)were classified as HB grade Ⅱ and 9 patients(28.1％)as HB grade Ⅲ.Postoperative complications included numbness in the skin of the postauricular region and auricle in 6 patients(18.8％)and mild pain in the postauricular skin in 5 patients(15.6％).One year postoperatively,all 32 patients were followed up clinically;28 patients(87.5％)were classified as H-B grade Ⅱ and 4 patients(12.5％)as HB grade Ⅲ;symptoms of numbness or mild pain in the ear region disappeared in all affected patients.Spastic facial paralysis sequelae were effectively alleviated in 26 patients(81.3％),while no alleviation was observed in 6 patients(18.7％).No statistically significant differences were found between the effective alleviation group and non-alleviation group in the gender,age,surgical side,and preoperative facial paralysis severity(all P＞0.05).However,the difference in disease course was statistically significant(P=0.023).The effective alleviation rates for the six major symptoms of spastic facial paralysis sequelae were,in the order mentioned above,93.8％(30/32),90.6％(29/32),81.3％(26/32),75.0％(24/32),50.0％(16/32),and 46.9％(15/32)respectively.Conclusion Preliminary observations suggest that facial nerve neurolysis can effectively alleviate the symptoms of spastic facial paralysis sequelae,with early surgical intervention potentially being key to improving surgical outcomes.
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