Periferna pareza ličnog živca

master's thesis

• Title (english): Peripheral facial nerve palsy
• Author: Nina Kopinč
• Mentor: Mihael Ries (mentor)
• Committee member: Jakov Ajduk (predsjednik povjerenstva)
• Committee member: Marko Velimir Grgić (član povjerenstva)
• Committee member: Mihael Ries (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Othorhinolaryngology and Head and Neck Surgery); Zagreb
• Defense date and country: 2022-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Otorhinolaryngology

Abstract

Lični živac sedmi je kranijalni živac čija se pareza očituje slabošću mimične muskulature i dodatnim simptomima poput hiperakuzije, smanjenog osjeta okusa i smanjenog stvaranja suza. Pareza može biti centralnog i perifernog porijekla. Centralna pareza podrazumijeva nastanak lezije između korteksa i jezgre ličnog živca, dok je u slučaju periferne pareze ispad funkcije u ili distalno od jezgre. Periferna pareza ličnog živca česta je bolest, s pojavnošću između 20 i 32 na 100.000 stanovnika u godini. Može se podijeliti na parezu poznate i nepoznate etiologije. Pareza nepoznate etiologije, poznata pod eponimom Bellova pareza, čini do 70% slučajeva. Drugi etiološki čimbenici periferne pareze su trauma, infekcije, komplikacije otoloških bolesti, tumori, nasljeđe, razvojni defekti i sistemske bolesti. Dijagnostički postupak podrazumijeva kvalitetnu anamnezu i klinički pregled koji su najčešće dovoljni u određivanju etiologije pareze. Dijagnoza Bellove pareze postavlja se isključivanjem alarmantnih simptoma i znakova koji upućuju na parezu poznate etiologije poput obostranog javljanja, spore progresije pareze do njezina maksimuma i pojavljivanja vezikularnih erupcija. U svrhu objektivizacije i praćenja oporavka, osmišljene su brojne ocjenske ljestvice od kojih se najčešće koristi House-Brackmannova i Sunnybrook. Bellova pareza liječi se kortikosteroidima sukladno pretpostavljenom patofiziološkom mehanizmu edema koji uzrokuje kompresiju. Pareze poznate etiologije liječe se sukladno uzroku primjerice antiviralnom i antibiotskom terapijom. Kirurško liječenje provodi se u pacijenata s traumatskom i tumorskom parezom, opsežnog edema živca te kod pacijenata s dugotrajnom parezom. Potporna terapija uključuje zaštitu rožnice i vježbe mimične muskulature. Prognoza ove bolesti većinom je dobra, osobito u pacijenata s Bellovom parezom.

Abstract (english)

The facial nerve is the seventh cranial nerve whose palsy manifests as weakness of the mimic muscles with additional symptoms such as hyperacusis, reduced taste sensation and decreased tear production. Palsy can be of central and peripheral origin. Central palsy originates from a nerve lesion between the cortex and the facial nerve nucleus, whereas a lesion distal from the nucleus indicates peripheral palsy. Peripheral facial palsy is a common disease with an incidence between 20 and 32 people per 100,000 inhabitants per year. It can be divided into palsy with known and unknown etiology. Palsy of unknown etiology, also known as Bell's palsy, constitutes up to 70 percent of cases. Other causes can be classified as traumatic, infectious, otogenic complications, tumors, inheritance, developmental defects and systemic. A high-quality medical history and exam are usually enough to determine the diagnosis. Bell's palsy is diagnosed by exclusion of red flag symptoms such as bilateral palsy, slow progression of the palsy and vesicular eruptions which point to other causes. Numerous scales were designed in history in order to objectify severity of the palsy and monitor the facial nerve recovery. Most commonly used scales are House-Brackmann and Sunnybrook scales. Since Bell's palsy proposed pathophysiological mechanism is swelling causing compression, corticosteroids are the first line of treatment. Palsy of known etiology is treated accordingly to its cause such as with antiviral or antibiotic therapeutics. Surgical treatment is reserved for patients with palsy related to trauma and tumors, in case of extensive swelling of the nerve and in patients with a long lasting palsy. Corneal protection and facial muscle exercises are used together with pharmacotherapy or surgery. Prognosis of facial nerve palsy is good, especially in Bell's palsy.

• Keywords: lični živac; Bellova pareza; House-Brackmannova ljestvica; terapija kortikosteroidima; reanimacija lica
• Keywords (english): facial nerve; Bell's palsy; House-Brackmannova scale; corticosteroid therapy; surgical treatment
• Language: croatian
• URN:NBN: urn:nbn:hr:105:205645
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-01-13 09:10:22