Fasiyal Sinir Paralizisi
Özet
Fasiyal sinir, yüzün mimik kaslarını innerve eden ve en sık fonksiyonu bozulan kraniyal sinirdir. Periferik fasiyal paralizilerin %90'ını idiyopatik bir tablo olan Bell paralizisi oluşturmaktadır. Sinirin anatomik seyri intrakraniyal, meatal, labirentin, timpanik, mastoid ve ekstrakraniyal segmentlerden oluşur; en dar ve kısa olan labirentin segment patolojilerden ilk etkilenen kısımdır. Tanı ve takip süreçlerinde anomalileri belirlemek için odyolojik tetkikler, lezyon seviyesini belirlemek için topografik testler (Schirmer, Blatt vb.) ve sinir hasarının derecesini (nöropraksi, aksonotmezis, nörotmezis) ayırt etmek için elektrofizyolojik testler (SET, MST, ENoG, EMG) kullanılır. ENoG prognoz tayininde en değerli objektif araçken, 21. günden sonra yalnızca EMG bilgi verir. Bell paralizisi tedavisinde korneanın korunması, masaj, inflamasyonu ve ödemi azaltan kortikosteroidler ile antiviraller kombinasyonu esastır. İki hafta içinde %90 üzeri dejenerasyon saptanan ve EMG'de motor yanıt alınamayan vakalarda cerrahi dekompresyon düşünülür. Hastaların büyük kısmı ilk üç ayda spontan iyileşirken, ileri yaş ve komplet paralizi kötü prognostik faktörlerdir.
The facial nerve is the most frequently impaired cranial nerve, supplying innervation to the voluntary facial expression muscles. Bell's palsy, an idiopathic condition, accounts for 90% of peripheral facial nerve paralyses. Anatomically, the nerve is divided into intracranial, meatal, labyrinthine, tympanic, mastoid, and extracranial segments; the labyrinthine segment is the narrowest and shortest, making it highly susceptible to ischemia and vascular compression. Diagnosis and monitoring utilize audiological examinations, topographic tests (such as Schirmer and Blatt) for lesion localization, and electrophysiological tests (SET, MST, ENoG, EMG) to differentiate degrees of nerve injury. ENoG is considered the most valuable objective tool for prognosis evaluation, whereas EMG is the only informative test after the 21st day. Management protocols focus on corneal protection, physiotherapy, and medical therapy combining corticosteroids to reduce edema alongside antiviral agents. Surgical decompression via the middle fossa approach is reserved for cases showing over 90% degeneration within two weeks on ENoG and absent voluntary motor potentials on EMG. While 80-85% of patients recover spontaneously within three months, advanced age and complete paralysis represent poor prognostic indicators.
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