Full Text in Thai

Journal of Health Science
Vol. 22 No. 3 May - June 2013
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μ‘¥‡™◊ÈÕ cytomegalovirus, Epstein Barr virus, adenovirus, rubella virus, mumps, Influenza B and
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“‡Àμÿ∑“ß√–∫∫ª√– “∑Õ◊Ëπ Ê ‡°‘¥®“°‚√§ Ramsay
Hunt Syndrome(14) À√◊Õ‚√§ßŸ «—¥∑’ÀË Ÿ (Herpes zoster
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nerve root ·≈– extramedullary cranial nerve ganglia ∂â “ ºŸâ ∑’Ë ‡ §¬μ‘ ¥ ‡™◊È Õ √à “ ß°“¬·¢Á ß ·√ß ‰¡à ¡’ ¿ “«–
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ߟ «—¥ ´÷Ë߇√’¬°«à“Õ¬Ÿà„π√–¬– latent phase ∂â“√à“ß°“¬
¡’°“√‡®Á∫ªÉ«¬À√◊Õ¿Ÿ¡§‘ ¡ÿâ °—π≈¥≈ß°Á®–‡°‘¥°“√ reactivation ·≈–· ¥ßÕ“°“√ÕÕ°¡“‡ªìπߟ «—¥ ‚¥¬¢÷ÈπÕ¬Ÿà°—∫
«à“®–‰ª· ¥ßÕ“°“√∑’ˇ âπª√– “∑√–¥—∫„¥ Ramsay
Hunt Syndrome(14) §◊Õ°“√μ‘¥‡™◊ÈÕ Varicella-zoster
virus (VZV) ‚¥¬∑’‡Ë ™◊ÕÈ ‡¢â“‰ªÕ¬Ÿà„π geniculate ganglion
„π™à«ß∑’ˇªìπ chicken pox À≈—ß®“°π—Èπ¡’°“√ reactivate ·≈– replicate μ—«‡Õß·≈–‰ª∑’Ë peripheral facial
nerve ∑”„À⇰‘¥Õ“°“√Õ—¡æ“μ¢Õß„∫Àπâ“ (peripheral
facial palsy) ∑’Ë¡’≈—°…≥–‡™àπ‡¥’¬«°—∫„π Bellûs palsy
‚¥¬‚√§π’È·æ∑¬å®–«‘π‘®©—¬®“°º◊Ëπ À√◊Õμÿà¡πÈ”„ ¿“¬„π
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¥â«¬‚¥¬®–¡’Õ“°“√∑’Ë¡“°°«à“·≈–√ÿπ·√ß°«à“´÷Ëß®–·μ°
μà“ß®“° Bellûs palsy
Journal of Health Science 2013 Vol. 22 No. 3
‚√§ª≈“¬ª√– “∑§Ÿà∑’Ë 7 Õ—°‡ ∫À√◊ÕÕ—¡æ“μ„∫Àπâ“
Àπâ“∑’Ë¢Õ߇ âπª√– “∑ ¡ÕߧŸà∑’Ë 7 (facial nerve)
‡ âπª√– “∑ ¡ÕߧŸ∑à ’Ë 7 ®–ÕÕ°®“°°â“π ¡Õß ºà“π
„μâ∞“π°–‚À≈°»’√…–·≈â«·∑√°μ—«‡¢â“‰ª„πμàÕ¡πÈ”≈“¬
Àπâ“ÀŸ (parotid gland) ·≈â«·¬°ÕÕ°‡ªìπ 5 ·¢πß
¬àÕ¬‡æ◊ËÕ·¬°‰ª —Ëßß“π°≈â“¡‡π◊ÈÕ· ¥ß ’Àπâ“ (Muscles
of facial expression) ¡—¥μà“ß Ê(15) ‡™àπ
°≈â“¡‡π◊ÈÕ frontalis ∑”Àπâ“∑’ˬ—°§‘È« Àπ⓺“°¬àπ
°≈â“¡‡π◊ÈÕ orbicularis Oculi ∑”Àπâ“∑’ËÀ≈—∫μ“
°≈â“¡‡π◊ÈÕ corrugator supercillii ∑”Àπâ“∑’Ë¥÷ßÀ—«
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°≈â“¡‡π◊ÈÕ orbicularis Oris ∑”Àπâ“∑’ËÀÿ∫ª“° ‡¡â¡
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¢â“ß∑”„Àâ· ¥ß≈—°…≥–· ¬–¬‘È¡
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‚√§Õ—¡æ“μ„∫Àπâ“ à«π„À≠à®–§≈⓬ Ê °—π §◊Õ¡’‰¢âμË”
Ê ·≈–√Ÿâ ÷°ª«¥‡¡◊ËÕ¬‡π◊ÈÕμ—«≈—°…≥–§≈⓬‡À¡◊Õπ‡√‘Ë¡
«“√ “√«‘™“°“√ “∏“√≥ ÿ¢ Úııˆ ªï∑’Ë ÚÚ ©∫—∫∑’Ë Û
®–‡ªì π À«— ¥ (6) À≈— ß ®“°π—È π ®–¡’ Õ “°“√ª«¥∑’Ë ‡ â π
ª√– “∑∫√‘‡«≥À≈—ßÀŸ Õ“°“√ª«¥‡À¡◊Õπ‰ø™ÁÕμ ‰ª
®π∂÷ ß ¿“«–Õ— ¡ æ“μ„∫Àπâ “ §√÷Ë ß ´’ ° ∑’Ë ºŸâ ªÉ « ¬‰¡à “¡“√∂
§«∫§ÿ¡°≈â“¡‡π◊ÈÕ„∫Àπâ“¢Õßμ—«‡Õ߉¥â §◊Õ ¬‘È¡‰¡à ‰¥â °‘π
Õ“À“√≈”∫“° ¥◊Ë¡πÈ”·≈â«√—Ë«ÕÕ°¡“ À≈—∫쓉¡à π‘∑ ¡’
Õ“°“√· ∫μ“¢â“߇¥’¬«‡æ√“–‰¡à “¡“√∂ªî¥μ“‰¥â π‘∑
„π‡«≈“∂Ÿ°≈¡ §‘È«μ° ‡ª≈◊Õ°μ“μ°≈ßÀ√◊Õ‡¡◊ËÕ°‘πÕ“À“√
·≈â«πÈ”≈“¬‰À≈ÕÕ°∑“ß¡ÿ¡ª“°¢â“ß„¥¢â“ßÀπ÷Ëß μàÕ¡“
Õ“°“√¢Õß‚√§Õ“®®–‡ªìπ¡“°¢÷Èπ®πª“°‡∫’Ȭ«·≈–ªî¥
쓉¡à π‘∑ ∫“ß√“¬Õ“®¡’Õ“°“√¡“°®π‰¡à “¡“√∂¢¬—∫
¡ÿ¡ª“° À≈—∫μ“À√◊Õ¬—°§‘È«‰¥â‡≈¬(6,13) ∫“ߧπ¡“æ∫
·æ∑¬å‡æ√“– —߇°μ«à“查‰¡à™—¥À√◊Õº‘«ª“°‰¡à¥—ß À√◊Õ
¥◊Ë¡‡§√◊ËÕߥ◊Ë¡∑’Ë „™âÀ≈Õ¥¥Ÿ¥‰¡à ‰¥â ‡π◊ËÕß®“°°≈â“¡‡π◊ÈÕ„∫
Àπâ“¢â“ß„¥¢â“ßÀπ÷Ëß∑”ß“π‰¡à ‰¥â‡ªìπª√°μ‘‡™àπ‡¥‘¡ ºŸâªÉ«¬∫“ß§π¡’§«“¡√Ÿâ ÷°‡À¡◊ÕπÀπâ“∫«¡ μ÷ß·≈–™“Ê
∑’Ë„∫Àπⓧ√÷Ëß´’° ∑—Èßπ’È ‡ªìπ‡æ√“–‡«≈“°≈â“¡‡π◊ÈÕ„∫Àπâ“
‰¡à∑”ß“π°Á®–¡’º≈∑”„Àâ‡≈◊Õ¥¡“§—Ëß„π∫√‘‡«≥π—Èπ¡“°
°«à“ª√°μ‘ πÕ°®“°π’È ¬—ßÕ“®¡’Õ“°“√Õ◊ËπÊ ∑’ËÕ“®æ∫‰¥â
„πºŸâªÉ«¬Õ—¡æ“μ„∫Àπâ“Õ’°‡™àπ Õ“°“√™“≈‘Èπ·≈–‰¡à√Ÿâ√ ∑’Ë≈‘Èπ´’°‡¥’¬«°—∫¥â“π∑’Ë¡’Õ—¡æ“μ¢Õß„∫Àπâ“ Õ“°“√
πÈ” μ“·Àâ ß À√◊ Õ ‰¡à ¡’ πÈ” 쓉À≈¢â “ ߇¥’ ¬ «°— ∫ ∑’Ë ¡’ Õ— ¡ æ“μ
„∫Àπâ “ ·μà ∫ “ß√“¬°≈— ∫ ¡’ πÈ” 쓉À≈ÕÕ°¡“¡“°Õ— π
‡π◊ËÕß®“°¡’°“√√–§“¬‡§◊Õß®“°≈¡À√◊ÕΩÿÉπ≈–ÕÕß∑’Ë¡’º≈
μàÕ≈Ÿ°π—¬πåμ“∑’˪¡à π‘∑ ·≈–¡’Õ“°“√‡ ’¬ß¥—ß„πÀŸ¢â“ß
‡¥’¬«°—∫¥â“π∑’Ë¡’Õ—¡æ“μ¢Õß„∫Àπâ“(16)
°“√·¬°·¬–«à“‡ªìπ√Õ¬‚√§ à«πμâπÀ√◊Õ à«πª≈“¬
∂Ⓡªìπ√Õ¬‚√§ à«πμâπ (upper motor neuron lesion; UMN) √Õ¬‚√§®–Õ¬Ÿà‡Àπ◊Õ°«à“𑫇§≈’¬ ¢Õ߇ âπ
ª√– “∑ ¡ÕߧŸà∑’Ë 7 ∫√‘‡«≥æÕπ å Õ“°“√¢Õß‚√§§◊Õ
“¡“√∂¬àπÀπ⓺“°‰¥â·≈–À≈—∫쓉¥â π‘∑‡ªìπª√°μ‘
·μà®–¡’§«“¡º‘¥ª√°μ‘¢Õß°≈â“¡‡π◊ÈÕ· ¥ß ’Àπâ“ 1/2
à«π¢ÕßÀπâ“¥â“πμ√ߢⓡ°—∫√Õ¬‚√§∑”„Àâ¡ÿ¡ª“°μ°
à«π√Õ¬‚√§ à«πª≈“¬ (lower motor neuron lesion;
LMN) √Õ¬‚√§®–Õ¬ŸàμË”°«à“𑫇§≈’¬ ¢Õ߇ âπª√– “∑
¡ÕߧŸà∑’Ë 7 ºŸâªÉ«¬®–¡’°≈â“¡‡π◊ÈÕ· ¥ß ’Àπâ“¥â“π‡¥’¬«
ıÙ˘
Facial Nerve Paralysis or Facial Palsy
°—∫√Õ¬‚√§‰¡à “¡“√∂∑”ß“π‰¥â∑ß—È À¡¥∑”„Àâ ‰¡à “¡“√∂
¬àπÀπ⓺“°‰¥â À≈—∫쓉¡à π‘∑ ·≈–¡ÿ¡ª“°μ°(16)
欓°√≥å ‚√§
°“√欓°√≥å‚√§Õ—¡æ“μ„∫Àπâ“ ¡’§«“¡ —¡æ—π∏å
°—∫§«“¡√ÿπ·√ߢÕß√Õ¬‚√§(17) ‚¥¬∑—Ë«‰ª√Õ¬‚√§∑’Ë ‰¡à
¡∫Ÿ√≥å¡’·π«‚πâ¡∑’Ë®–øóôπμ—«‰¥â¥’ ®“° ∂‘μ‘ºŸâªÉ«¬‚√§
Õ—¡æ“μ„∫Àπâ“∑’Ë ‰¡à ‰¥â√∫— °“√√—°…“®”π«π 1011 √“¬ „π
§.». 1982(2) Àπ÷Ëß„π “¡¡’Õ—¡æ“μ„∫ÀπⓉ¡à ¡∫Ÿ√≥å
·≈– Õß„π “¡¡’Õ—¡æ“μ„∫Àπâ“Õ¬à“ß ¡∫Ÿ√≥å ¡’ºŸâªÉ«¬
√âÕ¬≈– 85 · ¥ß —≠≠“≥¢Õß°“√øóôπμ—«¿“¬„π 3
—ª¥“Àå „π¥â“π°“√øóôπμ—«¢Õß‚√§ √âÕ¬≈– 71 ¡’°“√
øóôπμ—«Õ¬à“ß ¡∫Ÿ√≥å √âÕ¬≈– 13 ¡’¿“«–·∑√°´âÕπμ“¡
¡“‡≈Á°πâÕ¬ ·≈–√âÕ¬≈– 16 ¬—ߧߡ’Õ“°“√ÕàÕπ·√ß∫“ß
à«π Õ“°“√À¥‡°√ÁߢÕß°≈â“¡‡π◊ÈÕ (synkinesis) ¬—ߧß
À≈߇À≈◊ÕÕ¬Ÿà ºŸâªÉ«¬∑’Ë¡’√Õ¬‚√§‰¡à ¡∫Ÿ√≥åøóôπμ—«°≈—∫ Ÿà
¿“懥‘¡√âÕ¬≈– 94 ¢≥–∑’˺ŸâªÉ«¬∑’Ë¡’√Õ¬‚√§ ¡∫Ÿ√≥å
øóôπμ—«°≈—∫ Ÿà ¿“懥‘¡‡æ’¬ß√âÕ¬≈– 60 ‡™◊ÈÕߟ «—¥¡’
§«“¡ —¡æ—π∏å°—∫§«“¡√ÿπ·√ߢÕßÕ“°“√Õ—¡æ“μ·≈–¡’
°“√欓°√≥å‚√§∑’Ë ‰¡à¥’‡¡◊ËÕ‡∑’¬∫°—∫Õ—¡æ“μ„∫Àπâ“∑’Ë ‰¡à
∑√“∫ “‡Àμÿ(8) °“√欓°√≥å‚√§¡’·π«‚πâ¡∑’¥Ë ∂’ “â °“√øóπô
μ—«ª√“°Æ„Àâ‡ÀÁπ∫â“ß¿“¬„π 21 «—π·√°μ—ßÈ ·μà‡√‘¡Ë ¡’Õ“°“√
¢÷Èπ°—∫ªí®®—¬∑“ߧ≈‘π‘°∫“ߪ√–°“√ ‡™à𠧫“¡√ÿπ·√ß
¢ÕßÕ—¡æ“μ°≈â“¡‡π◊ÈÕ„∫Àπâ“ °“√„Àâ°‘π¬“‡æ√Á¥π‘‚´‚≈π≈à“™â“À≈—ß¡’Õ“°“√ ª√–¡“≥√âÕ¬≈– 85 ¢ÕߺŸâ∑’Ë
‡ªìπ‚√§π’®È –¡’Õ“°“√¥’¢π÷È ®π‡ªìπª√°μ‘¿“¬„π 3- 6 ‡¥◊Õπ
À≈—ß°“√√—°…“ „πºŸªâ «É ¬∫“ß√“¬∑’¡Ë Õ’ “°“√√ÿπ·√ß¡“° ‡¡◊ÕË
À“¬Õ“®¡’‡ âπª√– “∑„À¡àßÕ°(regeneration) ·≈–¡’
Õ“°“√º‘¥ª√°μ‘∫“ߪ√–°“√ª√“°Ø„Àâ‡ÀÁπ(18) ‡™àπ
‡¡◊ÕË °√–æ√‘∫μ“¡ÿ¡ª“°®–°√–μÿ° (when you blink
your mouth may twitch)
‡¡◊ÕË ¬‘¡È μ“®–°≈—∫ªî¥≈ß (smiling may cause your
eye to close)
‡¡◊ËÕ¡’°“√À≈—ËßπÈ”≈“¬„π™àÕߪ“°°àÕπ°‘πÕ“À“√®–
¡’πÈ”μ“‰À≈ÕÕ°¡“ [when you salivate (eg. before
550
eating), tears may flow from one eye]
Õ¬à“߉√°Áμ“¡‚√§π’È¡—°°àÕ„À⇰‘¥§«“¡°—ß«≈·≈–
Ÿ≠‡ ’¬§«“¡¡—Ëπ„®„π°“√‡¢â“ —ߧ¡¢ÕߺŸâªÉ«¬ ®“°°“√
”√«®ºŸâªÉ«¬®”π«π 22,594 √“¬ ∑’ˇªìπÕ—¡æ“μ„∫Àπâ“
®“°§≈‘π‘° Edinburgh ºŸâªÉ«¬®”π«π§√÷ËßÀπ÷Ëß¡’Õ“°“√
‡§√’¬¥·≈–‰¡à§àÕ¬‡¢â“ —ߧ¡À≈—ß®“°ªÉ«¬¥â«¬‚√§π’(19)
È
°“√√—°…“¥â«¬¬“
√—°…“‚¥¬°“√„Àâ ‡μ’¬√Õ¬¥å™π‘¥°‘πμ—Èß·μà‡√‘Ë¡·√°
∑’Ë¡’Õ“°“√·°àºŸâªÉ«¬Õ—¡æ“μ„∫Àπâ“∑ÿ°√“¬ °“√√—°…“§«√
‡√‘Ë¡¿“¬„π 3 «—ππ—∫μ—Èß·μà‡√‘Ë¡¡’Õ“°“√ ¢π“¥¬“‡æ√Á¥π‘‚´‚≈π∑’Ë„Àâ 60 ∂÷ß 80 ¡‘≈≈‘°√—¡μàÕ«—π μ‘¥μàÕ°—ππ“π
7-10 «—π ®–∑”„Àâ≈¥°“√Õ—°‡ ∫ °“√∫«¡¢Õ߇ âπ
ª√– “∑‰¥â(20) ®“° “‡Àμÿ°“√‡°‘¥‚√§Õ—¡æ“μ„∫Àπâ“∑’Ë
‡™◊ËÕ«à“ ‡°‘¥®“°‰«√— °≈ÿà¡ herpes °“√√—°…“®÷ß¡’°“√„Àâ
¬“μâ“π‰«√— ‡™àπ acyclovir, valacyclovir √à«¡°—∫¬“
°≈ÿ¡à corticosteroid Õ¬à“߉√°Áμ“¡‰¥â¡°’ “√»÷°…“‡ª√’¬∫‡∑’¬∫°“√√—°…“¥â«¬¬“∑—ßÈ Õß°≈ÿ¡à „πºŸªâ «É ¬ ®”π«π 551
√“¬ ´÷Ë߇√‘Ë¡¡’Õ“°“√¿“¬„π 72 ™—Ë«‚¡ß ·∫àß°≈ÿà¡°“√
√—°…“ÕÕ°‡ªìπ 3 °≈ÿ¡à §◊Õ °≈ÿ¡à ∑’Ë 1 „Àâ‡æ√Á¥π‘‚´‚≈π¢π“¥
25 ¡‘≈≈‘°√—¡ «—π≈– 2 §√—Èß °≈ÿà¡∑’Ë 2 „Àâ acyclovir ¢π“¥
400 ¡‘≈≈‘°√—¡ «—π≈– 5 §√—Èß ·≈–°≈ÿà¡∑’Ë 3 „Àâ∑—È߇æ√Á¥
π‘‚´‚≈π, acyclovir ·≈– ¬“À≈Õ° ‡ªìπ‡«≈“ 10 «—π
®“°°“√μ‘¥μ“¡ºŸâªÉ«¬ ‰¥âº≈¢âÕ¡Ÿ≈ºŸâªÉ«¬ 496 √“¬
º≈°“√»÷°…“æ∫«à“¡’°“√øóôπμ—«Õ¬à“ß ¡∫Ÿ√≥å¢Õß°“√
∑”ß“π¢Õß„∫Àπâ“Õ¬à“ß¡’π—¬ ”§—≠„πºŸâ∑’Ë ‰¥â‡æ√Á¥π‘‚´‚≈π‡¡◊ÕË ‡∑’¬∫°—∫√“¬∑’Ë ‰¡à ‰¥â‡æ√Á¥π‘‚´‚≈π∑’√Ë –¬–‡«≈“ 3
‡¥◊Õπ (83% μàÕ 64%) ·≈–∑’Ë 9 ‡¥◊Õπ (94% μàÕ 82%)
·≈–æ∫«à“‰¡à¡’§«“¡·μ°μà“ßÕ¬à“ß¡’π—¬ ”§—≠„π°“√øóôπ
μ—«¢Õß„∫Àπâ“„πºŸâªÉ«¬∑’Ë ‰¥â√—∫°“√√—°…“¥â«¬ acyclovir
‡¡◊ËÕ‡∑’¬∫°—∫√“¬∑’Ë ‰¡à ‰¥â acyclovir ∑’Ë√–¬–‡«≈“ 3 ‡¥◊Õπ
(74% μàÕ 76%) À√◊Õ∑’Ë 9 ‡¥◊Õπ (85% μàÕ 91%) „π
∑”πÕ߇¥’¬«°—πº≈°“√√—°…“‰¡à·μ°μà“ß°—π®“°°“√„Àâ∑ß—È
acyclovir ·≈–‡æ√Á¥π‘‚´‚≈π√à«¡°—π‡¡◊ËÕ‡∑’¬∫°—∫°“√„Àâ
‡æ√Á¥π‘‚´‚≈πÕ¬à“߇¥’¬«(21)
Journal of Health Science 2013 Vol. 22 No. 3
‚√§ª≈“¬ª√– “∑§Ÿà∑’Ë 7 Õ—°‡ ∫À√◊ÕÕ—¡æ“μ„∫Àπâ“
°“√»÷°…“·∫∫ double-blind „πºŸâªÉ«¬Õ—¡æ“μ
„∫Àπâ“ ®”π«π 829 √“¬∑’ˇ√‘Ë¡¡’Õ“°“√„π 72 ™—Ë«‚¡ß
‚¥¬·∫à߇ªìπ 4 °≈ÿà¡
°≈ÿà¡∑’Ë 1 „À⬓À≈Õ° 2 ™π‘¥
°≈ÿà¡∑’Ë 2 „Àâ‡æ√Á¥π‘‚´‚≈π¢π“¥ 60 ¡‘≈≈‘°√—¡ «—π
≈–§√—ßÈ π“π 5 «—π À≈—ß®“°π—πÈ ≈¥≈߇À≈◊Õ 10 ¡‘≈≈‘°√—¡
«—π≈–§√—Èß π“π 10 «—π ·≈–¬“À≈Õ°
°≈ÿà¡∑’Ë 3 „Àâ valacyclovir ¢π“¥ 1000 ¡‘≈≈‘°√—¡
«—π≈– 3 §√—Èß π“π 7 «—π ·≈–¬“À≈Õ°
°≈ÿà¡∑’Ë 4 „Àâ‡æ√Á¥π‘‚´‚≈π¢π“¥ 60 ¡‘≈≈‘°√—¡ «—π
≈–§√—Èß π“π 10 «—π ·≈– valacyclovir ¢π“¥ 1000
¡‘≈≈‘°√—¡ «—π≈– 3 §√—Èß π“π 7 «—π
À≈—ß®“°μ‘¥μ“¡°“√√—°…“‡ªìπ‡«≈“Àπ÷Ëߪï æ∫«à“
√–¬–‡«≈“„π°“√øóπô μ—«¢ÕߺŸªâ «É ¬∑’√Ë °— …“¥â«¬‡æ√Á¥π‘‚´‚≈π ‡∑’¬∫°—∫°≈ÿà¡∑’Ë ‰¡à ‰¥â‡æ√Á¥π‘‚´‚≈ππâÕ¬°«à“Õ¬à“ß¡’
π—¬ ”§—≠ „π∑“ßμ√ߢⓡ√–¬–‡«≈“„π°“√øóôπμ—«„π
°≈ÿà¡∑’Ë ‰¥â·≈–‰¡à ‰¥â√—∫ valacyclovir ‰¡à¡’§«“¡·μ°μà“ß
Õ¬à“ß¡’π—¬ ”§—≠ √«¡∑—Èß√–¬–‡«≈“„π°“√øóôπμ—«„π°≈ÿà¡
∑’Ë ‰¥â valacyclovir ·≈–‡æ√Á¥π‘‚´‚≈π°Á ‰¡à¡’§«“¡·μ°
μà“ß°—∫°≈ÿà¡∑’Ë ‰¥â‡æ√Á¥π‘‚´‚≈πÕ¬à“߇¥’¬«‡™àπ°—π(22) „π
¢≥–∑’ËÕ’°°“√»÷°…“Àπ÷Ëß∑’Ëæ∫«à“‰¥âª√–‚¬™π宓°°“√
√—°…“¥â«¬¬“μâ“π‰«√— ¡’°“√ ÿࡇ≈◊Õ°ºŸâªÉ«¬ 221 √“¬∑’Ë
‡√‘Ë¡¡’Õ“°“√ºŸâªÉ«¬Õ—¡æ“μ„∫Àπâ“¿“¬„π 7 «—π ∑”°“√
»÷°…“∑“ß´’√—Ë¡«‘∑¬“ ·≈–°“√μ√«®À“ DNA ‚¥¬‡∑§π‘§
PCR ‡æ◊ËÕμ√«®À“‡™◊ÈÕ‰«√— ߟ «—¥„πºŸâªÉ«¬ ∑”°“√
»÷°…“‚¥¬·∫à߇ªìπ°≈ÿà¡∑’Ë „Àâ valacyclovir ¢π“¥ 500
¡‘≈≈‘°√—¡ «—π≈– 2 §√—Èß π“π 5 «—π √à«¡°—∫‡æ√Á¥π‘‚´‚≈π·≈–°≈ÿà¡∑’Ë „À⬓À≈Õ° √à«¡°—∫‡æ√Á¥π‘‚´‚≈πÕ—μ√“
°“√øóπô μ—«Õ¬à“ß ¡∫Ÿ√≥å„π°≈ÿ¡à ∑’ˉ¥â valacyclovir √à«¡°—∫
‡æ√Á¥π‘‚´‚≈π Ÿß°«à“°≈ÿ¡à ∑’Ë ‰¥â¬“À≈Õ°√à«¡°—∫‡æ√Á¥π‘‚´‚≈πÕ¬à“ß¡’π—¬ ”§—≠ (97% μàÕ 90%)(23) ·≈–°“√
»÷°…“„πª√–‡∑»‰∑¬¢Õߧ≥–·æ∑¬»“ μ√å ¡À“«‘∑¬“≈—¬
ߢ≈“π§√‘π∑√å ∑’»Ë °÷ …“ºŸªâ «É ¬Õ—¡æ“μ„∫Àπâ“™π‘¥ LMN
∑—ÈßÀ¡¥®”π«π 201 √“¬ À≈—ß®“°°‘𬓇æ√Á¥π‘‚´‚≈π
¢π“¥ 60 ¡‘≈≈‘°√—¡μàÕ«—ππ“π 7 «—π μ“¡¥â«¬°“√≈¥
«“√ “√«‘™“°“√ “∏“√≥ ÿ¢ Úııˆ ªï∑’Ë ÚÚ ©∫—∫∑’Ë Û
¢π“¥¬“¿“¬„π 5 «—π μ‘¥μ“¡º≈°“√√—°…“π“π 6 ‡¥◊Õπ
º≈°“√»÷°…“æ∫«à“¿“«–°≈â“¡‡π◊ÈÕ„∫Àπâ“ÕàÕπ·√ß¡’
°“√øóôπμ—«Õ¬à“ß¡’π—¬ ”§—≠¿“¬„π 12 —ª¥“Àå °“√
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Journal of Health Science 2013 Vol. 22 No. 3
‚√§ª≈“¬ª√– “∑§Ÿà∑’Ë 7 Õ—°‡ ∫À√◊ÕÕ—¡æ“μ„∫Àπâ“
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Abstract
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Facial Nerve Paralysis or Facial Palsy
Anchalee Choombuathong
Department of Biological Science, Faculty of Science and Technology, Huachiew Chalermprakiet
University
Journal of Health Science 2013; 22:547-553.
Bell’s palsy is a form of facial paralysis resulting from a dysfunction of facial nerve that results
in the inability to control facial muscles on the affected side. Symptoms of Bell’s palsy range in
severity from mild weakness to total paralysis on ipsilateral face of the lesion. Other symptoms may
include drooping of the eyelid and corner of the mouth, impairment of taste, and excessive tearing in
one eye. The definite etiology of the disorder has not been well understood. However, reactivation
of the herpes simplex virus infection, latented in the geniculate ganglion of the facial nerve, is a
widely accepted pathophysiological mechanism. Some studies have shown that corticosteroid such
as prednisone is used to reduce inflammation and swelling. Other drugs such as antivirus is used to
fight viral herpes infections. However, the current practice of treating Bell’s palsy with antivirus
treatment plus corticosteroid may lead to slightly higher recovery rates compared to treating with
corticosteroid alone. The prognosis of Bell’s palsy is related to the severity of the lesion. A simple
rule is that clinically incomplete lesions tend to recover. Typically, the symptoms will recover within
21 days after initial onset. Exceptions are made with some clinical factors such as severity of facial
weakness, delayed oral prednisolone treatment. Though up to 85 percent of the cases have favorable
outcome and recover completely within 3 to 6 months after treatment.
Key words:
Bell’s palsy, herpes simplex virus, paralysis, corticosteriod
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