双侧茎突舌骨韧带骨化伴贝尔面瘫1例报道及文献回顾

Ossification of bilateral stylohyoid ligament with Bell facial paralysis:a case report and literature review

目的探讨茎突舌骨韧带骨化与贝尔面瘫的病因相关性,为临床诊治提供参考。方法报道1例双侧茎突舌骨韧带骨化伴贝尔面瘫的病例,通过临床表现、影像学检查明确诊断,进行茎突舌骨韧带骨化区及舌骨大角联合手术切除术,术后给予头孢西丁钠、甲泼尼龙琥珀酸钠激素、阿昔洛韦、甲钴胺治疗,并结合相关文献进行讨论分析。结果患者术前吞咽疼痛,右侧额纹消失、眼睑闭合不全、口角下垂。颅脑核磁平扫排除颅内占位性病变,诊断为贝尔面瘫;茎突高分辨CT诊断为双侧茎突舌骨韧带骨化。全身麻醉下行茎突截短术和舌骨部分切除术。术后半月患者咽痛及吞咽疼痛消失,右侧眼睑闭合功能恢复好,右口角下垂改善;术后1月患者面神经功能基本恢复正常。复习相关文献结果表明,茎突舌骨韧带骨化形成假关节膨隆,可局部压迫刺激周围面神经导致面瘫症状。结论茎突舌骨韧带骨化临床上常表现为咽痛,可结合影像学检查诊断;茎突舌骨韧带骨化伴发面瘫症状在临床上较少见,需明确诊断并行对症治疗。

Objective To investigate the correlation between the ossification of the styloid hyoid ligament and Bell’s facial paralysis and provide a reference for clinical diagnosis and treatment.Methods A case of ossification of the bilateral stylohyoid ligament with Bell's facial palsy caused by ossification of the bilateral stylohyoid ligament was diagnosed by clinical manifestations,differential diagnosis and imaging examination.The surgical plan was determined,and combined surgical resection of the ossified area of the styloid hyoid ligament and the greater horn of the hyoid was performed.Postoperative cefoxitin sodium anti-inflammatory treatment,methylprednisolone hormone treatment,acyclovir antiviral treatment,mecobalamin nutritional neurotherapy,and the relevant literature were analyzed.Results The patient experienced pain when swallowing before surgery,disappearance of right frontal ridges,incomplete eyelid closure,and ptosis of mouth corners.An MRI scan of the brain excluded intracranial space-occupying lesions and resulted in the diagnosis of Bell’s facial paralysis.High-resolution CT of the styloid process confirmed ossification of the styloid hyoid ligament.Styloid process shortening and partial hyoid resection were performed under general anesthesia.Half a month after discharge,the symptoms of sore throat and pain in swallowing disappeared,facial nerve function recovered well,right eyelid closure function recovered well,and right mouth droop improved.The facial nerve function basically returned to normal after 1 month of follow-up.A review of the relevant literature showed that ossification of the stylohyoid ligament to form pseudojoint dilation can locally stimulate the peripheral facial nerve and lead to facial paralysis symptoms.Conclusion Ossification of the styloid hyoid ligament is usually characterized by pharyngeal pain,which can be confirmed by imaging examination.Ossification of the styloid hyoid ligament with facial paralysis is rare in the clinic,so it is necessary to make a clear diagnosis and treat the symptoms.