末梢性顔面神経麻痺の臨床的研究--誘発(加算)筋電図検査,眼瞼振動検査,眼瞼微細振動測定による検討
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A completely ideal and handy diagnostic test for facial paralysis has not yet been established. The effectiveness of the electrical test has been reported. It has, however, a few faults. For example, its reliability, the uneasiness patients feel and the actual impossibility of daily and continual testing. We, therefore, had to devise a surer electrical method as well as some supplemental methods for easier and handier diagnosis of facial paralysis.(I) The averaged potentials of the orbicularis oris muscle (ORm) and the orbicularis oculi muscle (OLm) was registered which were evoked by supramaximal electrical stimulation (from 8 to 32 times) by way of coaxial needle electrodes. Statistically, the latencies from 60 normal subjects were less dispersed (mean 3.2msec, standard deviation 0.45; ORm: mean 2.9msec, Standard deviation 0.42; OLm) than both their duration and amplitude. There were variously oifferent features in 120 patients. In patients with moderate denervation longer latency and reduced amplitude were found. In patients with advanced denervation, reduction of amplitude and intermittent lack of response in the graph were occasionally observed.(II) The lid vibration test (vibration divided into four stages from "0" to "3" according to its intensity) was performed on 60 patients. Some patients healed completely. The vibration stage of these patients went down at first but without getting to "0" (no vibration at all) it recovered speedily to "3" (normal condition). Other patients whose vibration stage once reached "0" had difficulty in recovery except for 18% of the people. This lid vibration stage has a correlation with the NMU-spike-discharge stage of OLm in the process of recovery.(III) Twenty-two subjects were examined quantatively with respect to microvibration (MV) on the lid surface with a crystal pick up and analyzed by a data analyzer. Ordinarily, voluntary contraction of OLm brought enlarged amplitudes compared with that when not contracted. But in the case of paralyzed patients, the contraction did not show such noticeable amplitudes. Therefore, the ratio of the mean MV amplitude when contracted to the mean when not contracted showed whether a patient was recovering favorably or not.(IV) The lid vibration test is a handy and both diagnostically and prognostically effective method which supplements the electrical test. Quantative measurement of MV on the lid surface is also an effective diagnostic method.