Effects Of Facial Nerve Block Via Stylomastoid Foramen Combined With Stellate Ganglion Block In The Treatment Of Moderate To Severe And Above Idiopathic Facial Nerve Palsy

Objective:Idiopathic facial nerve palsy（IFP）accounts for 60%～75%of peripheral facial palsy,which affects patients’life quality and mental health seriously.Facial nerve block via stylomastoid foramen is a common treatment modality for facial nerve related disorders.It can improve the prognosis of IFP with concentrated medicine around the facial nerve.Stellate ganglion block（SGB）can block sympathetic ganglia innervating the head,face,neck and upper limbs.SGB can alleviate local ischemia and hypoxia by increasing the blood supply within the block area,thereby it may improve the cure rate of IFP.Moderate to severe and above IFP seem to indicate an unsatisfactory prognosis and high incidence of sequelae.In this study,facial nerve block via stylomastoid foramen and facial nerve block via stylomastoid foramen combined with SGB were performed in moderate to severe and above IFP patients to evaluate the effects of these two methods on the treatment of moderate to severe and above IFP.Methods:Sixty-four patients,aged 18～70 years old,body mass index（BMI）18.5～29.9kg/m²,American society of anesthesiologists（ASA）statusⅠorⅡ,diagnosed with unilateral moderate to severe and above IFP,and onset time of 1～7 d,were recruited from March 2021 to March 2022 in the Affiliated Hospital of Yangzhou University.Patients were randomly divided into the facial nerve block combined with SGB group（Group FS）and the facial nerve block group（Group F）,with 30 cases in each group.The treatment course in both groups were once every 3 days for 3 times followed by once every 5 days for 6 times.Patients who met the criteria for cure before the end of the course of treatment were discontinued and only facial nerve function was assessed.Group F was treated with facial nerve block via stylomastoid foramen alone,and Group FS was treated with facial nerve block combined with SGB which was performed 30 min after facial nerve block.The following indexes were recorded.（1）The demographic data such as gender,age,onset side,BMI,ASA status,and the time of onset were recorded in both groups;（2）The House-Brackmann（H-B）grading system grades and the Sunnybrook facial grading system scores were recorded before treatment（T₀）,3 d（T₁）,6 d（T₂）,9 d（T₃）,14d（T₄）,19 d（T₅）,24 d（T₆）,29 d（T₇）,34 d（T₈）,39 d（T₉）after the first treatment and 6months(T₁₀)after the last treatment,respectively;（3）The cure rate was calculated at T₉ according to H-B grades:Cure rate=numbers of cure∕total numbers×100%;（4）The number of treatments for patients who met the cure criteria was also recorded.（5）The occurrence of complications including laryngospasm,hematoma,pneumothorax,hoarseness,epidural or subarachnoid block,and local anesthetic toxicity were recorded;（6）The IFP recurrence condition was recorded at T₁₀.Results:（1）There were no significant differences in demographic data,including gender,age,BMI,ASA status and disease course between the two groups（P>0.05）.（2）A comparison of clinical characteristics evaluation with H-B and Sunnybrook between the two groups showed no significant differences at T₀（P>0.05）.（3）Group FS showed significantly higher Sunnybrook scores at T₅～T₉,and significantly lower H-B grades at T₅,T₇,T₈ and T₉ than Group FS（P<0.05）.H-B grades were significantly decreased since T₂than T₀ in both groups（P<0.05）.Compared with T₀,the Sunnybrook scores were significantly increased in Group F and Group FS from T₂ and T₁ than T₀,respectively（P<0.05）.The cure rate was significantly increased in Group FS than in Group F（P<0.05）.（4）The treatment times when reaching cure was significantly decreased in Group FS than in Group F（P<0.05）.（5）Transient hoarseness occurred in 4 patients（18%）during the treatment period in Group FS.（6）No recurrence was noted in recovered patients of either group at T₁₀.Conclusion:Facial nerve block via the stylomastoid foramen combined with SGB improves the recovery rate and shortens the treatment time in patients with moderate to severe and above IFP,which is superior to facial nerve block alone.