{"id":28979,"date":"2023-04-29T23:57:25","date_gmt":"2023-04-29T16:57:25","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=28979"},"modified":"2023-04-29T23:57:25","modified_gmt":"2023-04-29T16:57:25","slug":"day-vii-giai-phau-chuc-nang-va-trieu-chung-ton-thuong","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/29\/day-vii-giai-phau-chuc-nang-va-trieu-chung-ton-thuong\/","title":{"rendered":"D\u00e2y VII: Gi\u1ea3i ph\u1eabu, ch\u1ee9c n\u0103ng v\u00e0 tri\u1ec7u ch\u1ee9ng t\u1ed5n th\u01b0\u01a1ng"},"content":{"rendered":"

D\u00e2y th\u1ea7n kinh VII (c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 d\u00e2y th\u1ea7n kinh m\u1eb7t – facial nerve) l\u00e0 m\u1ed9t trong nh\u1eefng d\u00e2y th\u1ea7n kinh quan tr\u1ecdng nh\u1ea5t trong h\u1ec7 th\u1ea7n kinh. T\u1ed5n th\u01b0\u01a1ng d\u00e2y th\u1ea7n kinh VII c\u00f3 th\u1ec3 do nhi\u1ec1u nguy\u00ean nh\u00e2n, bao g\u1ed3m b\u1ec7nh l\u00fd nh\u01b0 b\u1ec7nh Bell, ch\u1ea5n th\u01b0\u01a1ng. \u0110i\u1ec1u tr\u1ecb t\u00f9y thu\u1ed9c v\u00e0o nguy\u00ean nh\u00e2n v\u00e0 m\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng, c\u00f3 th\u1ec3 bao g\u1ed3m thu\u1ed1c gi\u1ea3m \u0111au, ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng v\u00e0 ph\u1eabu thu\u1eadt.<\/strong><\/p>\n

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1. Gi\u1ea3i ph\u1eabu v\u00e0 sinh l\u00fd<\/strong><\/h2>\n

Th\u1ea7n kinh VII c\u00f3 ch\u1ee9c n\u0103ng v\u1eadn \u0111\u1ed9ng c\u01a1 v\u00f9ng m\u1eb7t, ph\u1ee5 tr\u00e1ch ti\u1ebft n\u01b0\u1edbc m\u1eaft v\u00e0 n\u01b0\u1edbc b\u1ecdt, c\u1ea3m gi\u00e1c v\u1ecb gi\u00e1c, v\u1ec1 ph\u01b0\u01a1ng di\u1ec7n gi\u1ea3i ph\u1eabu, th\u1ea7n kinh VII v\u1eadn \u0111\u1ed9ng t\u00e1ch r\u1eddi v\u1edbi ph\u1ea7n c\u1ea3m gi\u00e1c v\u00e0 giao c\u1ea3m (\u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 VII \u2019 hay th\u1ea7n kinh Wrisberg).<\/span><\/p>\n

Ph\u1ea7n v\u1eadn \u0111\u1ed9ng: Nh\u00e2n v\u1eadn \u0111\u1ed9ng c\u1ee7a th\u1ea7n kinh VII n\u1eb1m \u1edf ph\u00eda trong c\u1ee7a r\u1ec5 xu\u1ed1ng c\u1ee7a d\u00e2y V, ph\u00eda trong c\u1ee7a r\u1ec5 xu\u1ed1ng c\u1ee7a d\u00e2y V, ph\u00eda tr\u01b0\u1edbc v\u00e0 ngo\u00e0i c\u1ee7a nh\u00e2n VI v\u00e0 ph\u00eda sau nh\u00e2n olive tr\u00ean, c\u00d3 hai nh\u00f3m nh\u00e2n v\u1eadn \u0111\u1ed9ng : nh\u00e2n l\u01b0ng chi ph\u1ed1i c\u00e1c c\u01a1 tr\u00ean, c\u01a1 da m\u1eb7t tr\u00ean, n\u1eeda tr\u00ean c\u01a1 v\u00f2ng mi; nh\u00e2n b\u1ee5ng chi ph\u1ed1i c\u00e1c c\u01a1 ph\u1ea7n <\/span>d\u01b0\u1edbi m\u1eb7t, c\u01a1 plastyma(c\u01a1 b\u00e1m da v\u00f9ng c\u1ed5). R\u1ec5 v\u1eadn \u0111\u1ed9ng xu\u1ea5t ph\u00e1t t\u1eeb m\u1eb7t l\u01b0ng c\u1ee7a c\u00e1c nh\u00e2n, \u0111i v\u1ec1 ph\u00eda s\u00e0n n\u00e3o th\u1ea5t IV v\u00e0 bao quanh nh\u00e2n VI (g\u1ed1i th\u1ee9 nh\u1ea5t) sau \u0111\u00f3 h\u01b0\u1edbng ra tr\u01b0\u1edbc v\u00e0 ra ngo\u00e0i t\u1ecf m\u1eb7t ngo\u00e0i c\u1ea7u n\u00e3o (\u1edf gi\u1eefa h\u00e0nh v\u00e0 c\u1ea7u n\u00e3o) v\u00e0 \u1edf g\u00f3c c\u1ea7u ti\u1ec3u n\u00e3o, ph\u00eda ngo\u00e0i d\u00e2y VI v\u00e0 ph\u00eda trong d\u00e2y VIII .<\/span><\/p>\n

Th\u1ea7n kinh VII \u0111i v\u00e0o \u1ed1ng tai trong, \u1edf cu\u1ed1i \u1ed1ng tai n\u00f3 v\u00e0o \u1ed1ng th\u1ea7n kinh m\u1eb7t (k\u00eanh Fallope). \u0110\u1ea7u ti\u00ean TK VII \u0111i gi\u1eefa \u1ed1c tai v\u00e0 ti\u1ec1n \u0111\u00ecnh t\u1edbi v\u00e1ch trong th\u00f9ng nh\u0129 sau \u0111\u00f3 qu\u1eb9o m\u1ed9t g\u1ed1i th\u1ee9 nh\u1ecf \u1edf ph\u00eda sau th\u1eebng nh\u0129 v\u00e0 ra kh\u1ecfi s\u1ecd \u1edf l\u1ed7 tr\u00e2m ch\u0169m, \u0111i v\u00e0o tuy\u1ebfn mang tai.<\/span><\/p>\n

Trung t\u00e2m \u0111i\u1ec1u khi\u1ec3n nh\u00e2n VII \u0111i h\u1ed3i tr\u01b0\u1edbc r\u00e3nh trung t\u00e2m, cho c\u00e1c s\u1ee3i \u0111i theo b\u00f3 th\u00e1p b\u1eaft ch\u00e9o t\u1ea1i c\u1ea7u n\u00e3o. Nh\u00e2n l\u01b0ng nh\u00e2n s\u1ee3i t\u1eeb hai b\u00ean, nh\u00e2n b\u1ee5ng ch\u1ec9 nh\u1eadn s\u1ee3i t\u1eeb ph\u00eda \u0111\u1ed1i b\u00ean. Nh\u00e2n VII c\u00f2n nh\u1eadn s\u1ee3i chi ph\u1ed1i t\u1eeb h\u1ec7 ngo\u1ea1i th\u00e1p hai b\u00ean t\u1eeb v\u00f9ng v\u1ecf n\u00e3o ngo\u1ea1i th\u00e1p v\u00e0 c\u00e1c nh\u00e2n x\u00e1m n\u1ec1n s\u1ecd chi ph\u1ed1i c\u00e1c v\u1eadn \u0111\u1ed9ng t\u1ef1 \u0111\u1ed9ng c\u1ee7a m\u1eb7t.<\/span><\/p>\n

Ph\u1ea7n v\u1eadn \u0111\u1ed9ng chi ph\u1ed1i t\u1ea5t c\u1ea3 c\u00e1c c\u01a1 bi\u1ec3u hi\u1ec7n c\u1ea3m x\u00fac l\u00ean m\u1eb7t, c\u01a1 da c\u1ed5, c\u00e1c c\u01a1 c\u1ee7a tai, th\u00e2n sau c\u01a1 hai th\u00e2n, c\u01a1 tr\u00e2m quay, c\u01a1 b\u00e0n \u0111\u1ea1p. T\u1ea1i tuy\u1ebfn mang tai, th\u1ea7n kinh VII chia hai nh\u00e1nh, nh\u00e1nh th\u00e1i d\u01b0\u01a1ng-m\u1eb7t v\u00e0 nh\u00e1nh c\u1ed5-m\u1eb7t.<\/span><\/p>\n

Ph\u1ee5 tr\u00e1ch c\u1ea3m gi\u00e1c v\u00e0 giao c\u1ea3m, \u1edf ph\u00eda ngo\u00e0i v\u00e0 ph\u00eda sau c\u1ee7a r\u1ec5 v\u1eadn \u0111\u1ed9ng. H\u1ea1ch c\u1ea3m gi\u00e1c l\u00e0 h\u1ea1ch g\u1ed1i \u1edf trong \u1ed1ng th\u1ea7n kinh m\u1eb7t. C\u00e1c nh\u00e1nh ph\u1ee5 tr\u00e1ch c\u1ea3m gi\u00e1c x\u00fac gi\u00e1c t\u1eadn c\u00f9ng \u1edf nh\u00e2n b\u00f3 \u0111\u01a1n \u0111\u1ed9c. Th\u1ea7n kinh VII nh\u1eadn c\u1ea3m gi\u00e1c \u1ed1ng tai ngo\u00e0i, m\u00e0ng nh\u0129, v\u00f9ng Ramsay-Hunt \u1edf v\u00e0nh tai, c\u1ea3m gi\u00e1c v\u1ecb gi\u00e1c \u1edf 2\/3 tr\u01b0\u1edbc l\u01b0\u1ee1i, v\u00e0 th\u1ea7n kinh VII c\u00f2n ph\u1ee5 tr\u00e1ch c\u1ea3m gi\u00e1c s\u00e2u c\u1ee7a c\u00e1c c\u01a1 v\u00f9ng m\u1eb7t. Ch\u1ee9c n\u0103ng ti\u1ebft \u0111\u01b0\u1ee3c ph\u1ee5 tr\u00e1ch b\u1edfi nh\u00e2n n\u01b0\u1edbc b\u1ecdt tr\u00ean.<\/span><\/p>\n

2. Th\u0103m kh\u00e1m l\u00e2m s\u00e0ng <\/strong><\/h2>\n

2.1. Ch\u1ee9c n\u0103ng v\u1eadn \u0111\u1ed9ng<\/strong><\/h3>\n

Kh\u00e1m c\u00e1c c\u01a1 v\u1eadn \u0111\u1ed9ng c\u1ea3m x\u00fac v\u00f9ng m\u1eb7t, quan s\u00e1t s\u1ef1 m\u1ea5t c\u00e2n \u0111\u1ed1i c\u1ee7a n\u00e9t m\u1eb7t, kh\u00f3e m\u1eaft, b\u1ea3o b\u1ec7nh nh\u00e2n l\u00e0m c\u00e1c c\u1eed \u0111\u1ed9ng nh\u01b0\u1edbn m\u00e0y, nh\u0103n m\u1eb7t, c\u01b0\u1eddi. C\u00e1c c\u01a1 v\u00f9ng tai v\u00e0 c\u00e1c c\u01a1 da \u0111\u1ea7u v\u00e0 v\u00f9ng ch\u1ea9m kh\u00f4ng kh\u00e1m \u0111\u01b0\u1ee3c. C\u01a1 da c\u1ed5 kh\u00e1m b\u1eb1ng c\u00e1ch b\u1ea3o b\u1ec7nh nh\u00e2n nhe r\u0103ng v\u00e0 c\u1eafn m\u1ea1nh, \u1edf tr\u1ebb em ph\u1ea3i quan s\u00e1t khi ch\u00fang kh\u00f3c. N\u1ebfu b\u1ec7nh nh\u00e2n h\u00f4n m\u00ea th\u00ec l\u00e0m nghi\u1ec7m ph\u00e1p Pierre-Marie-Foix. <\/span>C\u01a1 tr\u00e2m quay kh\u00f4ng kh\u00e1m \u0111\u01b0\u1ee3c nh\u01b0ng n\u1ebfu li\u1ec7t th\u00ec nu\u1ed1t y\u1ebfu v\u00e0 c\u00f3 th\u1ec3 h\u01a1i s\u1eb7c. N\u1ebfu li\u1ec7t c\u01a1 b\u00e0n \u0111\u1ea1p th\u00ec c\u00f3 tri\u1ec7u ch\u1ee9ng \u00f9 tai: nghe ti\u1ebfng \u0111\u1ed9ng l\u00ean th\u00ec r\u1ea5t kh\u00f3 ch\u1ecbu v\u00e0 \u0111au nh\u00f3i tai.<\/span><\/p>\n

2.2. Ch\u1ee9c n\u0103ng c\u1ea3m gi\u00e1c<\/strong><\/h3>\n

Kh\u00e1m r\u1ea5t ph\u1ee9c t\u1ea1p. C\u1ea3m gi\u00e1c v\u00f9ng da \u1ed1ng tai ngo\u00e0i v\u00e0 m\u00e0ng nh\u0129 c\u00f2n nh\u1eadn s\u1ee3i chi ph\u1ed1i c\u1ee7a V, IX, X v\u00e0 th\u1ea7n kinh tai l\u1edbn (C2-C3); do \u0111\u00f3, \u00edt khi m\u1ea5t h\u1eb3n c\u1ea3m gi\u00e1c khi t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh VII. C\u00e1c c\u1ea3m gi\u00e1c s\u00e2u v\u00f9ng m\u1eb7t kh\u00f4ng kh\u00e1m \u0111\u01b0\u1ee3c. C\u00f3 th\u1ec3 kh\u00e1m c\u1ea3m gi\u00e1c ph\u1ea7n sau \u1ed1ng tai ngo\u00e0i v\u00e0 m\u00e0ng nh\u0129 v\u1edbi s\u1ee3i nylon.<\/span><\/p>\n

C\u1ea3m gi\u00e1c v\u1ecb gi\u00e1c 2\/3 tr\u01b0\u1edbc l\u01b0\u1ee1i c\u00f3 th\u1ec3 kh\u00e1m \u0111\u01b0\u1ee3c b\u1eb1ng 4 v\u1ecb c\u01a1 b\u1ea3n: ng\u1ecdt (d\u00f9ng \u0111\u01b0\u1eddng), m\u1eb7n (d\u00f9ng mu\u1ed1i), chua (d\u00f9ng chanh) v\u00e0 \u0111\u1eafng (d\u00f9ng quinine), \u1edf ng\u01b0\u1eddi b\u00ecnh th\u01b0\u1eddng th\u00ec l\u01b0\u1ee1i nh\u1ea1y c\u1ea3m v\u1edbi c\u1ea3m gi\u00e1c \u0111\u1eafng sau \u0111\u00f3 l\u00e0 chua, ng\u1ecdt v\u00e0 m\u1eb7n. Khi kh\u00e1m c\u00f3 th\u1ec3 vi\u1ebft ch\u1eef l\u00ean gi\u1ea5y cho b\u1ec7nh nh\u00e2n chi. C\u00e1c tri\u1ec7u ch\u1ee9ng khi t\u1ed5n th\u01b0\u01a1ng l\u00e0 m\u1ea5t v\u1ecb gi\u00e1c, g\u1eb7p trong t\u1ed5n th\u01b0\u01a1ng v n ngo\u1ea1i bi\u00ean; hypogeusia v\u00e0 parageusia(gi\u1ea3m v\u1ecb gi\u00e1c v\u00e0 v\u1ecb gi\u00e1c l\u1ea1) kh\u00f4ng c\u00f3 gi\u00e1 tr\u1ecb nhi\u1ec1u, c\u00f3 th\u1ec3 g\u1eb7p trong \u0111\u1ed9ng kinh th\u00e1i d\u01b0\u01a1ng, lo\u1ea1n t\u00e2m th\u1ea7n ho\u1eb7c hysterie.<\/span><\/p>\n

2.3. Ch\u1ee9c n\u0103ng ti\u1ebft n\u01b0\u1edbc b\u1ecdt v\u00e0 n\u01b0\u1edbc m\u1eaft<\/strong><\/h3>\n

T\u1ed5n th\u01b0\u01a1ng VII ngo\u1ea1i bi\u00ean l\u00e0m gi\u1ea3m ti\u1ebft n\u01b0\u1edbc b\u1ecdt v\u00e0 n\u01b0\u1edbc m\u1eaft. C\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n gi\u1ea3m ti\u1ebft n\u01b0\u1edbc m\u1eaft b\u1eb1ng nghi\u1ec7m ph\u00e1p Schirmer: \u0111\u1ec3 m\u1ed9t mi\u1ebfng gi\u1ea5y th\u1ea5m v\u00e0o t\u00fai c\u00f9ng mi d\u01b0\u1edbi sau \u0111\u00f3 quan s\u00e1t.<\/span><\/p>\n

3. T\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh VII<\/strong><\/h2>\n

– Li\u1ec7t trung \u01b0\u01a1ng: do t\u1ed5n th\u01b0\u01a1ng th\u00e1p m\u1ed9t b\u00ean, li\u1ec7t ch\u1ec9 b\u1ecb \u1edf ph\u1ea7n d\u01b0\u1edbi m\u1eb7t, b\u1ec7nh nh\u00e2n v\u1eabn c\u00f2n nh\u1eafm m\u1eaft \u0111\u01b0\u1ee3c, kh\u00f4ng \u1ea3nh h\u01b0\u1edfng t\u1edbi v\u1ecb gi\u00e1c v\u00e0 giao c\u1ea3m.<\/span><\/p>\n

– Li\u1ec7t VII ngo\u1ea1i bi\u00ean<\/a>: T\u1ea5t c\u1ea3 c\u00e1c c\u01a1 v\u00f9ng m\u1eb7t \u0111\u1ec1u li\u1ec7t, kh\u00f4ng nh\u1eafm m\u1eaft \u0111\u01b0\u1ee3c (c\u00f3 d\u1ea5u Charles Bell), c\u00f3 k\u00e8m r\u1ed1i lo\u1ea1n v\u1ecb gi\u00e1c ho\u1eb7c giao c\u1ea3m hay kh\u00f4ng l\u00e0 t\u00f9y v\u1ecb tr\u00ed t\u1ed5n th\u01b0\u01a1ng, n\u1ebfu li\u1ec7t k\u00e9o d\u00e0i c\u00f3 th\u1ec3 teo c\u01a1 m\u1eb7t.<\/span><\/p>\n

– Trong tr\u01b0\u1eddng h\u1ee3p li\u1ec7t nh\u1eb9, tri\u1ec7u ch\u1ee9ng c\u00f3 th\u1ec3 k\u00edn \u0111\u00e1o h\u01a1n, ta c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n c\u00e1c d\u1ea5u hi\u1ec7u sau:<\/span><\/p>\n