Yasser Al-Ghabra, Ahmad Alkheder, Mohammad Hamdi, Adel Azar, Adham Bader Aldeen Mohsen, Abdulmajeed Yousfan
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引用次数: 0
Abstract
Objectives: This review consolidates all reported cases of facial nerve paralysis (FNP) complicating keratosis obturans (KO), a rare disorder characterized by keratin accumulation in the external auditory canal. The study aims to analyze clinical patterns, diagnostic findings, management outcomes, and prognostic factors to enhance understanding and guide evidence-based management of this underrecognized complication.
Methods: A comprehensive literature search of PubMed, Web of Science, Scopus, and Google Scholar (inception-December 2024) identified English-language case reports and observational studies linking KO to FNP. Two reviewers independently screened titles/abstracts, performed full-text assessments, and extracted data on demographics, clinical features, imaging, interventions, and outcomes.
Results: Seven cases (mean age: 32.4 years; 57.1% female) were analyzed. All exhibited left-sided FNP, with House-Brackmann grades III to VI at presentation. Hearing loss (71.4%) and keratin debris on otoscopy (71.4%) were common. High-resolution computed tomography (HRCT) revealed bony erosion (28.6%-57.1%) and soft-tissue involvement (57.1%). Surgical intervention (85.7%), primarily debridement or mastoidectomy, resulted in complete/partial FNP recovery in 85.7% of cases, while conservative management (14.3%) also showed improvement. Limitations of this review included the small number of cases, heterogeneity in management approaches, and lack of standardized outcome measures.
Conclusion: KO-related FNP, though rare, carries significant morbidity. Timely surgical decompression or conservative care may reverse neural injury, emphasizing early diagnosis via clinical-radiological correlation. The predominance of left-sided involvement and favorable outcomes postintervention warrant further investigation. Prospective studies are needed to establish standardized protocols and validate these findings in larger cohorts.
目的：本综述总结了所有报道的面神经麻痹（FNP）合并闭孔角化病（KO）的病例，这是一种以外耳道角蛋白积累为特征的罕见疾病。本研究旨在分析临床模式、诊断结果、管理结果和预后因素，以提高对这一未被充分认识的并发症的理解和指导循证管理。方法：综合检索PubMed、Web of Science、Scopus和谷歌Scholar的文献（开始- 2024年12月），确定将KO与FNP联系起来的英语病例报告和观察性研究。两位审稿人独立筛选标题/摘要，进行全文评估，并提取人口统计学、临床特征、影像学、干预和结果方面的数据。结果：7例，平均年龄32.4岁；57.1%为女性)。所有患者均表现为左侧FNP，报告时House-Brackmann评分为III至VI。耳镜检查中常见的有听力损失（71.4%）和角蛋白碎片（71.4%）。高分辨率计算机断层扫描（HRCT）显示骨质侵蚀（28.6%-57.1%）和软组织受累（57.1%）。手术干预（85.7%），主要是清创或乳突切除术，85.7%的病例完全或部分恢复FNP，而保守治疗（14.3%）也有改善。本综述的局限性包括病例数量少、管理方法的异质性以及缺乏标准化的结果测量。结论：ko相关性FNP虽罕见，但发病率较高。及时的手术减压或保守治疗可逆转神经损伤，强调通过临床-放射学相关性进行早期诊断。左侧受累的优势和干预后的良好结果值得进一步研究。需要前瞻性研究来建立标准化的方案，并在更大的队列中验证这些发现。
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