{"id":6249,"date":"2018-07-24T14:11:57","date_gmt":"2018-07-24T07:11:57","guid":{"rendered":"https:\/\/yhoccongdong.org\/du-an-khac\/2018\/07\/24\/liet-day-than-kinh-mat\/"},"modified":"2024-03-17T04:30:04","modified_gmt":"2024-03-16T21:30:04","slug":"liet-day-than-kinh-mat","status":"publish","type":"post","link":"https:\/\/yhoccongdong.com\/du-an-khac\/liet-day-than-kinh-mat\/","title":{"rendered":"Li\u1ec7t d\u00e2y th\u1ea7n kinh m\u1eb7t"},"content":{"rendered":"<p>T\u1ed5n th\u01b0\u01a1ng d\u00e2y th\u1ea7n kinh m\u1eb7t &#8211; \u1edf neuron v\u1eadn \u0111\u1ed9ng tr\u00ean ho\u1eb7c neuron v\u1eadn \u0111\u1ed9ng d\u01b0\u1edbi (li\u1ec7t m\u1eb7t trung \u01b0\u01a1ng v\u00e0 li\u1ec7t m\u1eb7t ngo\u1ea1i bi\u00ean) &#8211; \u0111\u1ec1u g\u00e2y y\u1ebfu c\u00e1c c\u01a1 bi\u1ec3u c\u1ea3m \u1edf m\u1eb7t.<\/p>\n<h2>Gi\u1ea3i ph\u1eabu d\u00e2y th\u1ea7n kinh m\u1eb7t<\/h2>\n<p>D\u00e2y th\u1ea7n kinh s\u1ecd s\u1ed1 VII (d\u00e2y th\u1ea7n kinh m\u1eb7t) c\u00f3 ch\u1ee9c n\u0103ng ch\u1ee7 y\u1ebfu l\u00e0 v\u1eadn \u0111\u1ed9ng (ngo\u00e0i ra c\u00f2n c\u00f3 m\u1ed9t v\u00e0i s\u1ee3i c\u1ea3m gi\u00e1c t\u1eeb \u1ed1ng tai ngo\u00e0i, c\u00e1c s\u1ee3i ki\u1ec3m so\u00e1t ti\u1ebft n\u01b0\u1edbc b\u1ecdt v\u00e0 c\u00e1c s\u1ee3i v\u1ecb gi\u00e1c t\u1eeb ph\u1ea7n l\u01b0\u1ee1i ph\u00eda tr\u01b0\u1edbc-thu\u1ed9c nh\u00e1nh th\u1eebng nh\u0129). D\u00e2y th\u1ea7n kinh m\u1eb7t c\u0169ng cho nh\u00e1nh t\u1edbi c\u01a1 b\u00e0n \u0111\u1ea1p (do \u0111\u00f3 t\u1ed5n th\u01b0\u01a1ng ho\u00e0n to\u00e0n d\u00e2y VII s\u1ebd l\u00e0m thay \u0111\u1ed5i s\u1ef1 c\u1ea3m nh\u1eadn tinh t\u1ebf c\u1ee7a th\u00ednh gi\u00e1c \u1edf b\u00ean b\u1ecb \u1ea3nh h\u01b0\u1edfng). T\u1eeb nh\u00e2n d\u00e2y th\u1ea7n kinh m\u1eb7t \u1edf th\u00e2n n\u00e3o, c\u00e1c s\u1ee3i th\u1ea7n kinh v\u00f2ng qua nh\u00e2n d\u00e2y VI tr\u01b0\u1edbc khi r\u1eddi kh\u1ecfi c\u1ea7u n\u00e3o, \u1edf ph\u00eda trong so v\u1edbi d\u00e2y VIII v\u00e0 \u0111i qua \u1ed1ng tai trong. D\u00e2y VII \u0111i qua x\u01b0\u01a1ng \u0111\u00e1 trong \u1ed1ng th\u1ea7n kinh m\u1eb7t, ph\u00ecnh to l\u00ean \u1edf ph\u00eda trong c\u1ee7a tai gi\u1eefa \u0111\u1ec3 h\u00ecnh th\u00e0nh n\u00ean h\u1ea1ch g\u1ed1i (geniculate ganglion &#8211; ph\u1ee5 tr\u00e1ch v\u1ecb gi\u00e1c v\u00e0 s\u1ef1 ti\u1ebft n\u01b0\u1edbc b\u1ecdt), t\u1eeb \u0111\u00e2y n\u00f3 g\u1eadp g\u00f3c (c\u00f9ng c\u00e1c s\u1ee3i c\u1ee7a th\u1eebng nh\u0129) \u0111\u1ec3 \u0111i ra kh\u1ecfi tai gi\u1eefa v\u00e0 \u0111i v\u00e0o l\u1ed7 tr\u00e2m ch\u0169m \u0111\u1ec3 chi ph\u1ed1i t\u1ea5t c\u00e1c c\u01a1 bi\u1ec3u c\u1ea3m \u1edf m\u1eb7t, bao g\u1ed3m c\u1ea3 c\u01a1 b\u00e1m da c\u1ed5.<\/p>\n<h2>Bi\u1ec3u hi\u1ec7n c\u1ee7a li\u1ec7t d\u00e2y th\u1ea7n kinh m\u1eb7t<\/h2>\n<p><strong>Y\u1ebfu c\u00e1c c\u01a1 bi\u1ec3u c\u1ea3m n\u00e9t m\u1eb7t v\u00e0 c\u01a1 nh\u1eafm m\u1eaft<\/strong> (c\u01a1 v\u00f2ng mi). C\u00e1c n\u1ebfp r\u00e3nh \u1edf m\u1eb7t b\u1ecb k\u00e9o sang b\u00ean \u0111\u1ed1i di\u1ec7n khi ng\u01b0\u1eddi b\u1ec7nh c\u01b0\u1eddi. Ng\u01b0\u1eddi b\u1ec7nh kh\u00f4ng nh\u1eafm m\u1eaft \u0111\u01b0\u1ee3c, t\u1eeb \u0111\u00f3 d\u1ec5 b\u1ecb t\u1ed5n th\u01b0\u01a1ng gi\u00e1c m\u1ea1c v\u00e0 k\u1ebft m\u1ea1c.<\/p>\n<ul>\n<li>Li\u1ec7t m\u1ed9t ph\u1ea7n d\u00e2y th\u1ea7n kinh m\u1eb7t: Th\u01b0\u1eddng \u1ea3nh h\u01b0\u1edfng ph\u1ea7n m\u1eb7t d\u01b0\u1edbi.<\/li>\n<li>Trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng, ng\u01b0\u1eddi b\u1ec7nh th\u01b0\u1eddng m\u1ea5t v\u1ecb gi\u00e1c hai ph\u1ea7n ba tr\u01b0\u1edbc l\u01b0\u1ee1i v\u00e0 kh\u00f4ng ch\u1ecbu \u0111\u01b0\u1ee3c c\u00e1c ti\u1ebfng \u1ed3n l\u1edbn ho\u1eb7c c\u00e1c \u00e2m thanh ch\u00f3i tai. N\u00f3 c\u00f3 th\u1ec3 g\u00e2y n\u00f3i kh\u00f3 m\u1ee9c \u0111\u1ed9 nh\u1eb9 v\u00e0 g\u00e2y kh\u00f3 kh\u0103n khi \u0103n.<\/li>\n<\/ul>\n<p><strong>Thang \u0111i\u1ec3m House-Brackmann<\/strong> th\u01b0\u1eddng \u0111\u01b0\u1ee3c d\u00f9ng nh\u1ea5t \u0111\u1ec3 m\u00f4 t\u1ea3 m\u1ee9c \u0111\u1ed9 li\u1ec7t, \u0111\u1ed9 1 l\u00e0 b\u00ecnh th\u01b0\u1eddng v\u00e0 \u0111\u1ed9 6 l\u00e0 li\u1ec7t ho\u00e0n to\u00e0n.<\/p>\n<p>Vi\u1ec7c nh\u1eadn bi\u1ebft \u0111\u01b0\u1ee3c b\u1ec7nh nh\u00e2n li\u1ec7t m\u1eb7t trung \u01b0\u01a1ng (sang th\u01b0\u01a1ng \u1edf neuron v\u1eadn \u0111\u1ed9ng tr\u00ean) hay ngo\u1ea1i bi\u00ean (sang th\u01b0\u01a1ng \u1edf neuron v\u1eadn \u0111\u1ed9ng d\u01b0\u1edbi) l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 gi\u00fap ch\u00fang ta nh\u1eadn bi\u1ebft \u0111\u01b0\u1ee3c nguy\u00ean nh\u00e2n.<\/p>\n<ul>\n<li>Trong tr\u01b0\u1eddng h\u1ee3p sang th\u01b0\u01a1ng \u1edf neuron v\u1eadn \u0111\u1ed9ng d\u01b0\u1edbi (LMN lesion), b\u1ec7nh nh\u00e2n kh\u00f4ng th\u1ec3 nh\u0103n tr\u00e1n- do \u0111\u01b0\u1eddng d\u1eabn truy\u1ec1n \u0111\u1ebfn c\u00e1c c\u01a1 b\u1ecb t\u1ed5n th\u01b0\u01a1ng. Sang th\u01b0\u01a1ng ph\u1ea3i n\u1eb1m \u1edf v\u1ecb tr\u00ed c\u1ea7u n\u00e3o ho\u1eb7c \u1edf ngo\u00e0i th\u00e2n n\u00e3o (h\u1ed1 sau, trong x\u01b0\u01a1ng s\u1ecd, tai gi\u1eefa v\u00e0 ngo\u00e0i s\u1ecd).<\/li>\n<li>Trong tr\u01b0\u1eddng h\u1ee3p sang th\u01b0\u01a1ng \u1edf neuron v\u1eadn \u0111\u1ed9ng tr\u00ean, c\u00e1c c\u01a1 m\u1eb7t ph\u00eda tr\u00ean \u0111\u01b0\u1ee3c b\u1ea3o t\u1ed3n do c\u00f2n nh\u1eefng \u0111\u01b0\u1eddng d\u1eabn truy\u1ec1n kh\u00e1c t\u1eeb th\u00e2n n\u00e3o b\u00ean kia, t\u1ee9c l\u00e0 b\u1ec7nh nh\u00e2n v\u1eabn c\u00f3 th\u1ec3 nh\u0103n tr\u00e1n \u0111\u01b0\u1ee3c (tr\u1eeb khi t\u1ed5n th\u01b0\u01a1ng \u1edf c\u1ea3 hai b\u00ean) v\u00e0 c\u00e1c r\u00e3nh m\u1eb7t kh\u00f4ng b\u1ecb k\u00e9o l\u1ec7ch r\u00f5 nh\u01b0 tr\u01b0\u1eddng h\u1ee3p sang th\u01b0\u01a1ng \u1edf neuron v\u1eadn \u0111\u1ed9ng d\u01b0\u1edbi. C\u00e1c v\u1eadn \u0111\u1ed9ng t\u1ef1 \u00fd v\u00e0 bi\u1ec3u l\u1ed9 c\u1ea3m x\u00fac c\u00f3 v\u1ebb nh\u01b0 \u0111\u01b0\u1ee3c chi ph\u1ed1i b\u1edfi nh\u1eefng \u0111\u01b0\u1eddng d\u1eabn truy\u1ec1n kh\u00e1c nhau.<\/li>\n<\/ul>\n<p>C\u00e1c tai bi\u1ebfn m\u1ea1ch m\u00e1u n\u00e3o hay l\u00e0m y\u1ebfu c\u00e1c v\u1eadn \u0111\u1ed9ng t\u1ef1 \u00fd v\u00e0 b\u1ea3o t\u1ed3n c\u00e1c v\u1eadn \u0111\u1ed9ng kh\u00f4ng t\u1ef1 \u00fd (v\u00ed d\u1ee5 \u0111\u1ed9ng t\u00e1c m\u1ec9m c\u01b0\u1eddi t\u1ef1 ph\u00e1t). Gi\u1ea3 li\u1ec7t d\u00e2y VII \u00edt g\u1eb7p h\u01a1n nhi\u1ec1u, ng\u01b0\u1eddi b\u1ec7nh ch\u1ec9 b\u1ecb m\u1ea5t ch\u1ecdn l\u1ecdc c\u00e1c c\u1eed \u0111\u1ed9ng bi\u1ec3u l\u1ed9 c\u1ea3m x\u00fac, th\u01b0\u1eddng l\u00e0 do t\u1ed5n th\u01b0\u01a1ng th\u00f9y tr\u00e1n ho\u1eb7c \u0111\u1ed3i th\u1ecb.<\/p>\n<h2><strong>Nguy\u00ean nh\u00e2n<\/strong><\/h2>\n<h3>Li\u1ec7t d\u00e2y VII ngo\u1ea1i bi\u00ean (sang th\u01b0\u01a1ng \u1edf neuron v\u1eadn \u0111\u1ed9ng d\u01b0\u1edbi).<\/h3>\n<ul>\n<li>V\u00f4 c\u0103n (Li\u1ec7t Bell):\n<ul>\n<li>Mang thai\u2013t\u0103ng nguy c\u01a1 li\u1ec7t d\u00e2y VII g\u1ea5p 3 l\u1ea7n.<\/li>\n<li>\u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng.<\/li>\n<\/ul>\n<\/li>\n<li>B\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u n\u00e3o (V\u00ed d\u1ee5: \u0111\u1ed9t qu\u1ecb v\u00f9ng th\u00e2n n\u00e3o).<\/li>\n<li>Do can thi\u1ec7p y khoa:\n<ul>\n<li>G\u00e2y t\u00ea t\u1ea1i ch\u1ed7 trong \u0111i\u1ec1u tr\u1ecb b\u1ec7nh l\u00fd r\u0103ng mi\u1ec7ng<\/li>\n<li>Do thu\u1ed1c\u00a0linezolid.<\/li>\n<\/ul>\n<\/li>\n<li>Nhi\u1ec5m tr\u00f9ng\n<ul>\n<li>Nhi\u1ec5m Herpesvirus (type 1).<\/li>\n<li>Herpes zoster (h\u1ed9i ch\u1ee9ng Ramsay Hunt).<\/li>\n<li>HIV<\/li>\n<li>Epstein-Barr virus.<\/li>\n<li>Cytomegalovirus.<\/li>\n<li>B\u1ec7nh Lyme (ngh\u0129 \u0111\u1ebfn nhi\u1ec1u khi li\u1ec7t c\u1ea3 hai b\u00ean, g\u1eb7p trong 36% c\u00e1c tr\u01b0\u1eddng h\u1ee3p).<\/li>\n<li>Vi\u00eam tai gi\u1eefa ho\u1eb7c vi\u00eam tai x\u01b0\u01a1ng ch\u0169m.<\/li>\n<\/ul>\n<\/li>\n<li>Ch\u1ea5n th\u01b0\u01a1ng:\n<ul>\n<li>V\u1ee1 n\u1ec1n s\u1ecd.<\/li>\n<li>Gi\u00fap sanh b\u1eb1ng Forceps<\/li>\n<li>T\u1ee5 m\u00e1u (Haematoma) sau ch\u00e2m c\u1ee9u.<\/li>\n<\/ul>\n<\/li>\n<li>B\u1ec7nh l\u00fd th\u1ea7n kinh:\n<ul>\n<li>H\u1ed9i ch\u1ee9ng Guillain-Barr\u00e9.<\/li>\n<li>B\u1ec7nh m\u1ed9t d\u00e2y th\u1ea7n kinh- v\u00ed d\u1ee5 do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, sarcoidosis ho\u1eb7c tho\u00e1i h\u00f3a d\u1ea1ng b\u1ed9t (amyloidosis).<\/li>\n<\/ul>\n<\/li>\n<li>Ung th\u01b0\n<ul>\n<li>C\u00e1c kh\u1ed1i u \u1edf h\u1ed1 sau-nguy\u00ean ph\u00e1t ho\u1eb7c th\u1ee9 ph\u00e1t.<\/li>\n<li>U tuy\u1ebfn mang tai.<\/li>\n<\/ul>\n<\/li>\n<li>T\u0103ng huy\u1ebft \u00e1p thai k\u1ef3 v\u00e0 ti\u1ec1n s\u1ea3n gi\u1eadt.<\/li>\n<li>Sarcoidosis.<\/li>\n<li>H\u1ed9i ch\u1ee9ng Sj\u00f6gren&#8217;s v\u00e0 vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p.<\/li>\n<li>H\u1ed9i ch\u1ee9ng Melkersson-Rosenthal (li\u1ec7t d\u00e2y th\u1ea7n kinh m\u1eb7t t\u00e1i ph\u00e1t, ph\u00f9 m\u1ea1n t\u00ednh m\u1eb7t v\u00e0 m\u00f4i,l\u01b0\u1ee1iph\u00ec \u0111\u1ea1i ho\u1eb7c n\u1ee9t).<\/li>\n<\/ul>\n<h3>Li\u1ec7t d\u00e2y VII trung \u01b0\u01a1ng (sang th\u01b0\u01a1ng \u1edf neuron v\u1eadn \u0111\u1ed9ng tr\u00ean).<\/h3>\n<ul>\n<li>B\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u n\u00e3o.<\/li>\n<li>C\u00e1c kh\u1ed1i u trong s\u1ecd (nguy\u00ean ph\u00e1t ho\u1eb7c th\u1ee9 ph\u00e1t).<\/li>\n<li>X\u01a1 c\u1ee9ng r\u1ea3i r\u00e1c (Multiple sclerosis).<\/li>\n<li>Giang mai.<\/li>\n<li>HIV.<\/li>\n<li>B\u1ec7nh l\u00fd vi\u00eam m\u1ea1ch.<\/li>\n<li>N\u1ebfu b\u1ecb c\u1ea3 hai b\u00ean, c\u1ea7n l\u01b0u \u00fd t\u1edbi t\u00ecnh tr\u1ea1ng suy gi\u1ea3m mi\u1ec5n d\u1ecbch (HIV), h\u1ed9i ch\u1ee9ng Guillain-Barr\u00e9 ho\u1eb7c b\u1ec7nh<\/li>\n<li>N\u1ebfu t\u00e1i ph\u00e1t, c\u1ea7n l\u01b0u \u00fd t\u1edbi Lymphoma, sarcoidosis v\u00e0 b\u1ec7nh Lyme.<\/li>\n<li>\u1ede tr\u1ebb em, c\u1ea7n l\u01b0u \u00fd t\u1edbi b\u1ec7nh Lyme v\u00e0 b\u1ec7nh l\u00fd tai gi\u1eefa.<\/li>\n<\/ul>\n<h2>C\u00e1c \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a li\u1ec7t d\u00e2y th\u1ea7n kinh m\u1eb7t<\/h2>\n<h3>Li\u1ec7t d\u00e2y VII ngo\u1ea1i bi\u00ean c\u1ea5p (acute LMN palsy)<\/h3>\n<p>Li\u1ec7t d\u00e2y VII ngo\u1ea1i bi\u00ean c\u1ea5p t\u00ednh c\u00f3 th\u1ec3 g\u1eb7p \u1edf m\u1ecdi l\u1ee9a tu\u1ed5i nh\u01b0ng ph\u1ed5 bi\u1ebfn nh\u1ea5t \u1edf \u0111\u1ed9 tu\u1ed5i t\u1eeb 15 \u0111\u1ebfn 60, nam v\u00e0 n\u1eef nh\u01b0 nhau.<\/p>\n<p>Khi th\u1ea5y li\u1ec7t m\u1ed9t b\u00ean m\u1eb7t kh\u1edfi ph\u00e1t nhanh:<\/p>\n<ul>\n<li>Y\u00eau c\u1ea7u ng\u01b0\u1eddi b\u1ec7nh nhe r\u0103ng.<\/li>\n<li>Y\u00eau c\u1ea7u ng\u01b0\u1eddi b\u1ec7nh ph\u1ed3ng m\u00e1.<\/li>\n<li>Y\u00eau c\u1ea7u ng\u01b0\u1eddi b\u1ec7nh nh\u1eafm ch\u1eb7t m\u1eaft.<\/li>\n<li>Y\u00eau c\u1ea7u ng\u01b0\u1eddi b\u1ec7nh nh\u01b0\u1edbng m\u00e0y (s\u1ebd c\u00f2n l\u00e0m \u0111\u01b0\u1ee3c \u0111\u1ed9ng t\u00e1c n\u00e0y n\u1ebfu l\u00e0 li\u1ec7t VII trung \u01b0\u01a1ng \u2013 sang th\u01b0\u01a1ng \u1edf neuron v\u1eadn \u0111\u1ed9ng tr\u00ean).<\/li>\n<li>\u0110au nh\u1ee9c v\u00f9ng d\u01b0\u1edbi tai ho\u1eb7c x\u01b0\u01a1ng ch\u0169m c\u0169ng th\u01b0\u1eddng g\u1eb7p v\u00e0 g\u1ee3i \u00fd \u0111\u1ebfn c\u00e1c nguy\u00ean nh\u00e2n t\u1eeb tai gi\u1eefa ho\u1eb7c do Herpes.<\/li>\n<li>C\u00f3 th\u1ec3 b\u1ecb t\u0103ng nh\u1ea1y c\u1ea3m v\u1edbi k\u00edch th\u00edch th\u00ednh gi\u00e1c.<\/li>\n<li>C\u00e1c b\u1ec7nh nh\u00e2n b\u1ecb t\u1ed5n th\u01b0\u01a1ng sau h\u1ea1ch g\u1ed1i c\u00f3 th\u1ec3 m\u1ea5t kh\u1ea3 n\u0103ng ti\u1ebft n\u01b0\u1edbc m\u1eaft v\u00e0 m\u1ea5t v\u1ecb gi\u00e1c.<\/li>\n<\/ul>\n<h3>Li\u1ec7t Bell<\/h3>\n<p>\u0110\u00e2y l\u00e0 nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn nh\u1ea5t c\u1ee7a li\u1ec7t m\u1eb7t ngo\u1ea1i bi\u00ean, \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 \u0111\u1ea7u ti\u00ean b\u1edfi Ng\u00e0i Charles Bell v\u00e0o n\u0103m 1821.<\/p>\n<ul>\n<li>T\u1ec9 l\u1ec7 m\u1eafc ph\u1ea3i 11-40\/100000, v\u1edbi nguy c\u01a1 su\u1ed1t \u0111\u1eddi l\u00e0: c\u1ee9 60 ng\u01b0\u1eddi th\u00ec c\u00f3 1 ng\u01b0\u1eddi b\u1ecb b\u1ec7nh.<\/li>\n<li>C\u00f3 l\u1ebd nguy\u00ean nh\u00e2n l\u00e0 do ch\u00e8n \u00e9p g\u00e2y thi\u1ebfu m\u00e1u d\u00e2y th\u1ea7n kinh m\u1eb7t trong \u1ed1ng th\u1ea7n kinh m\u1eb7t, l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a t\u00ecnh tr\u1ea1ng vi\u00eam- th\u01b0\u1eddng g\u1eb7p nh\u1ea5t l\u00e0 do virus.<\/li>\n<li>Trong qu\u00e1 kh\u1ee9, kh\u00f4ng t\u00ecm th\u1ea5y nguy\u00ean nh\u00e2n \u1edf \u0111a s\u1ed1 b\u1ec7nh nh\u00e2n li\u1ec7t VII ngo\u1ea1i bi\u00ean v\u00e0 nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u00e0y \u0111\u01b0\u1ee3c cho l\u00e0 v\u00f4 c\u0103n (idiopathic), t\u1ee9c l\u00e0 li\u1ec7t. C\u00e1c t\u00e1c nh\u00e2n virus kh\u00e1c nhau ng\u00e0y c\u00e0ng \u0111\u01b0\u1ee3c nh\u1eadn bi\u1ebft, \u0111\u1eb7c bi\u1ec7t l\u00e0 herpes simplex t\u00fdp 1 ho\u1eb7c varicella (herpes) zoster.<\/li>\n<li>Kho\u1ea3ng 7% b\u1ec7nh nh\u00e2n b\u1ecb t\u00e1i ph\u00e1t.<\/li>\n<li>C\u00f3 y\u1ebfu t\u1ed1 gia \u0111\u00ecnh \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p li\u1ec7t d\u00e2y VII t\u00e1i ph\u00e1t, c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn b\u1ea5t th\u01b0\u1eddng v\u1ec1 gi\u1ea3i ph\u1eabu c\u1ee7a \u1ed1ng th\u1ea7n kinh m\u1eb7t.<\/li>\n<li>T\u1ec9 l\u1ec7 m\u1eafc ph\u1ea3i c\u1ee7a li\u1ec7t Bell cao h\u01a1n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng.<\/li>\n<\/ul>\n<h3>H\u1ed9i ch\u1ee9ng Ramsay Hunt<\/h3>\n<p>Li\u1ec7t d\u00e2y th\u1ea7n kinh m\u1eb7t v\u1edbi sang th\u01b0\u01a1ng \u1edf neuron v\u1eadn \u0111\u1ed9ng d\u01b0\u1edbi (li\u1ec7t d\u00e2y th\u1ea7n kinh VII ngo\u1ea1i bi\u00ean) c\u1ee5 th\u1ec3 do varicella (herpes) zoster ch\u00ednh l\u00e0 h\u1ed9i ch\u1ee9ng Ramsay Hunt. \u0110au th\u01b0\u1eddng l\u00e0 \u0111\u1eb7c \u0111i\u1ec3m n\u1ed5i b\u1eadt v\u00e0 c\u00e1c m\u1ee5n n\u01b0\u1edbc c\u00f3 th\u1ec3 th\u1ea5y \u1edf tai c\u00f9ng b\u00ean, \u1edf kh\u1ea9u c\u00e1i c\u1ee9ng v\u00e0\/ho\u1eb7c \u1edf 2\/3 tr\u01b0\u1edbc l\u01b0\u1ee1i. H\u1ed9i ch\u1ee9ng n\u00e0y c\u00f3 th\u1ec3 g\u1ed3m c\u1ea3 \u0111i\u1ebfc v\u00e0 ch\u00f3ng m\u1eb7t, v\u00e0 c\u00e1c d\u00e2y th\u1ea7n kinh s\u1ecd kh\u00e1c c\u0169ng c\u00f3 th\u1ec3 b\u1ecb \u1ea3nh h\u01b0\u1edfng. T\u00ecnh tr\u1ea1ng kh\u00f4ng c\u00f3 ph\u00e1t ban \u0111\u01b0\u1ee3c bi\u1ebft \u0111\u1ebfn l\u00e0 \u201czoster sine herpete\u201d (t\u00ecnh tr\u1ea1ng \u0111au nh\u1ee9c v\u00e0 kh\u00f4ng ph\u00e1t ban); 2-23% tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n li\u1ec7t Bell th\u1eadt ra l\u00e0 c\u00f3 h\u1ed9i ch\u1ee9ng Ramsay Hunt. N\u00ean ngh\u0129 \u0111\u1ebfn t\u00ecnh tr\u1ea1ng \u201czoster sine herpete\u201d n\u00e0y khi b\u1ec7nh nh\u00e2n li\u1ec7t Bell c\u00f3 k\u00e8m \u0111au nh\u1ee9c nhi\u1ec1u, \u0111\u1eb7c bi\u1ec7t \u1edf nh\u1eefng ng\u01b0\u1eddi tr\u00ean 60 tu\u1ed5i. T\u00ecnh tr\u1ea1ng suy gi\u1ea3m mi\u1ec5n d\u1ecbch- ch\u1eb3ng h\u1ea1n HIV-l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 nguy c\u01a1.<\/p>\n<h2>C\u00e1c x\u00e9t nghi\u1ec7m kh\u1ea3o s\u00e1t<\/h2>\n<ul>\n<li>X\u00e9t nghi\u1ec7m huy\u1ebft thanh h\u1ecdc-Lyme, Herpes v\u00e0 Zoster (c\u00e1c m\u1eabu th\u1eed c\u00e1ch nhau 4-6 tu\u1ea7n). X\u00e9t nghi\u1ec7m n\u00e0y kh\u00f4ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn \u0111i\u1ec1u tr\u1ecb nh\u01b0ng c\u00f3 li\u00ean quan \u0111\u1ebfn c\u0103n nguy\u00ean b\u1ec7nh.<\/li>\n<li>Ki\u1ec3m tra huy\u1ebft \u00e1p \u1edf nh\u1eefng tr\u1ebb em b\u1ecb li\u1ec7t Bell (ghi nh\u1eadn c\u00f3 hai tr\u01b0\u1eddng h\u1ee3p h\u1eb9p eo \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 c\u00f3 li\u1ec7t d\u00e2y th\u1ea7n kinh m\u1eb7t v\u00e0 t\u0103ng huy\u1ebft \u00e1p).<\/li>\n<li>C\u00e1c ki\u1ec3m tra kh\u00e1c d\u00f9 hi\u1ebfm khi \u0111\u01b0\u1ee3c l\u00e0m nh\u01b0ng n\u1ebfu k\u1ebft h\u1ee3p ch\u00fang v\u1edbi nh\u1eefng hi\u1ec3u bi\u1ebft v\u1ec1 gi\u1ea3i ph\u1eabu th\u1ea7n kinh th\u00ec ch\u00fang ta c\u00f3 th\u1ec3 x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c m\u1ee9c \u0111\u1ed9 li\u1ec7t m\u1eb7t:<\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>Test n\u01b0\u1edbc m\u1eaft c\u1ee7a Schirmer (cho th\u1ea5y s\u1ef1 gi\u1ea3m ti\u1ebft n\u01b0\u1edbc m\u1eaft ph\u00eda b\u00ean li\u1ec7t, \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn d\u00e2y th\u1ea7n kinh kh\u1ea9u c\u00e1i l\u1edbn).<\/li>\n<li>Ph\u1ea3n x\u1ea1 c\u01a1 b\u00e0n \u0111\u1ea1p (l\u00e0 m\u1ed9t th\u1eed nghi\u1ec7m ki\u1ec3m tra th\u00ednh gi\u00e1c, m\u1ea5t n\u1ebfu c\u01a1 b\u00e0n \u0111\u1ea1p b\u1ecb \u1ea3nh h\u01b0\u1edfng).<\/li>\n<li>C\u00e1c test ch\u1ea9n \u0111o\u00e1n \u0111i\u1ec7n (th\u01b0\u1eddng d\u00f9ng trong nghi\u00ean c\u1ee9u) kh\u00f4ng t\u00ecm th\u1ea5y s\u1ef1 thay \u0111\u1ed5i c\u00e1c c\u01a1 m\u1eb7t trong 3 ng\u00e0y \u0111\u1ea7u nh\u01b0ng c\u00f3 gi\u1ea3m d\u1ea7n ho\u1ea1t \u0111\u1ed9ng \u0111i\u1ec7n x\u1ea3y ra trong tu\u1ea7n ti\u1ebfp theo v\u00e0 s\u1ebd c\u00f3 hi\u1ec7n t\u01b0\u1ee3ng tho\u00e1i h\u00f3a s\u1ee3i tr\u1ee5c trong 15% tr\u01b0\u1eddng h\u1ee3p.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h2>\u0110i\u1ec1u tr\u1ecb<\/h2>\n<p>Ngo\u00e0i c\u00e1c tr\u01b0\u1eddng h\u1ee3p nh\u1eb9 nh\u1ea5t, m\u1ed9t c\u00e1ch l\u00fd t\u01b0\u1edfng th\u00ec c\u00e1c tr\u01b0\u1eddng h\u1ee3p li\u1ec7t d\u00e2y m\u1eb7t n\u00ean \u0111\u01b0\u1ee3c ti\u1ebfp c\u1eadn \u0111i\u1ec1u tr\u1ecb t\u1eeb <strong>nhi\u1ec1u chuy\u00ean khoa<\/strong>, bao g\u1ed3m c\u00e1c b\u00e1c s\u0129 nh\u00e3n khoa, b\u00e1c s\u0129 tai m\u0169i h\u1ecdng, b\u00e1c s\u0129 ph\u1eabu thu\u1eadt th\u1ea9m m\u1ef9, b\u00e1c s\u0129 v\u1eadt l\u00fd tr\u1ecb li\u1ec7u v\u00e0 c\u00e1c nh\u00e0 t\u00e2m l\u00fd h\u1ecdc.<\/p>\n<p><strong>Ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb chung<\/strong><\/p>\n<ul>\n<li>Tr\u1ea5n an ng\u01b0\u1eddi b\u1ec7nh &#8211; ph\u1ea7n l\u1edbn c\u00e1c tr\u01b0\u1eddng h\u1ee3p li\u1ec7t m\u1eb7t l\u00e0 t\u1ef1 h\u1ed3i ph\u1ee5c.<\/li>\n<li>Ch\u0103m s\u00f3c m\u1eaft:\n<ul>\n<li>C\u00e1c b\u00e1c s\u0129 nh\u00e3n khoa \u0111\u00f3ng m\u1ed9t vai tr\u00f2 quan tr\u1ecdng trong vi\u1ec7c ng\u0103n ng\u1eeba m\u00f9 kh\u00f4ng h\u1ed3i ph\u1ee5c do t\u1ed5n th\u01b0\u01a1ng gi\u00e1c m\u1ea1c. \u0110\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c \u0111i\u1ec1u n\u00e0y c\u1ea7n s\u1eed d\u1ee5ng thu\u1ed1c nh\u1ecf m\u1eaft b\u00f4i tr\u01a1n m\u1ed7i gi\u1edd v\u00e0 thu\u1ed1c m\u1ee1 tra m\u1eaft v\u00e0o ban \u0111\u00eam \u00b1 m\u1ed9t mi\u1ebfng d\u00e1n m\u1eaft.<\/li>\n<li>C\u00f3 th\u1ec3 c\u1ea7n t\u1ea1m th\u1eddi botulinum toxin ho\u1eb7c ph\u1eabu thu\u1eadt (k\u00e9o mi tr\u00ean ho\u1eb7c kh\u00e2u d\u00ednh mi).<\/li>\n<li>Sau khi \u0111\u00e3 b\u1ea3o v\u1ec7 \u0111\u01b0\u1ee3c gi\u00e1c m\u1ea1c nh\u01b0ng li\u1ec7t m\u1eb7t kh\u00f4ng h\u1ed3i ph\u1ee5c th\u00ec c\u00f3 th\u1ec3 s\u1eafp x\u1ebfp chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1ec1 l\u00e2u d\u00e0i cho mi m\u1eaft v\u00e0 ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng m\u1eb7t.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h3><strong>\u0110i\u1ec1u tr\u1ecb li\u1ec7t Bell<\/strong><\/h3>\n<ul>\n<li><strong>Steroids<\/strong><strong>:<\/strong>\n<ul>\n<li>Steroids c\u00f3 hi\u1ec7u qu\u1ea3 trong \u0111i\u1ec1u tr\u1ecb li\u1ec7t d\u00e2y th\u1ea7n kinh m\u1eb7t. Trong s\u1ed1 29% tr\u01b0\u1eddng h\u1ee3p c\u00f3 kh\u1ea3 n\u0103ng kh\u00f4ng h\u1ed3i ph\u1ee5c ho\u00e0n to\u00e0n, m\u1ed9t ph\u1ea7n ba \u0111\u1ebfn m\u1ed9t n\u1eeda s\u1ebd h\u1ed3i ph\u1ee5c n\u1ebfu d\u00f9ng steroid.<\/li>\n<li>Prednisolone n\u00ean \u0111\u01b0\u1ee3c d\u00f9ng cho b\u1ec7nh nh\u00e2n tr\u00ean 16 tu\u1ed5i trong v\u00f2ng 72 gi\u1edd. Li\u1ec1u d\u00f9ng t\u1ed1i \u01b0u kh\u00f4ng \u0111\u01b0\u1ee3c bi\u1ebft nh\u01b0ng c\u00f3 v\u00e0i g\u1ee3i \u00fd d\u01b0\u1edbi \u0111\u00e2y:\n<ul>\n<li>25 mg hai l\u1ea7n m\u1ed7i ng\u00e0y trong 10 ng\u00e0y.<\/li>\n<li>60 mg m\u1ed7i ng\u00e0y trong 5 ng\u00e0y, sau \u0111\u00f3 gi\u1ea3m 10 mg m\u1ed7i ng\u00e0y.<\/li>\n<\/ul>\n<\/li>\n<li>Kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng \u1ee7ng h\u1ed9 cho vi\u1ec7c d\u00f9ng steroids sau 72 gi\u1edd.<\/li>\n<li>Kh\u00f4ng r\u00f5 steroids c\u00f3 hi\u1ec7u qu\u1ea3 \u1edf tr\u1ebb em hay kh\u00f4ng.<\/li>\n<\/ul>\n<\/li>\n<li>C\u00f3 b\u1eb1ng ch\u1ee9ng (\u1edf m\u1ee9c \u0111\u1ed9 trung b\u00ecnh) v\u1ec1 l\u1ee3i \u00edch c\u1ee7a thu\u1ed1c kh\u00e1ng vi-r\u00fat khi ph\u1ed1i h\u1ee3p v\u1edbi steroid v\u00e0 kh\u00f4ng c\u00f3 s\u1ef1 gia t\u0103ng \u0111\u00e1ng k\u1ec3 c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5. \u0110\u00e2y v\u1eabn l\u00e0 v\u1ea5n \u0111\u1ec1 c\u00f2n g\u00e2y tranh c\u00e3i. \u0110i\u1ec1u n\u00e0y hi\u1ec7n kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o t\u1ea1i Anh.<\/li>\n<li>V\u1eadt l\u00fd tr\u1ecb li\u1ec7u c\u00f3 th\u1ec3 c\u00f3 l\u1ee3i nh\u01b0ng kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng m\u1ea1nh \u0111\u1ec3 \u1ee7ng h\u1ed9 r\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p tr\u1ecb li\u1ec7u n\u00e0y c\u00f3 l\u1ee3i \u00edch \u0111\u00e1ng k\u1ec3 hay g\u00e2y h\u1ea1i.<\/li>\n<li><strong>Cho nh\u1eadp<\/strong><strong> vi\u1ec7n<\/strong><strong> &#8211; s\u1ebd ph\u1ee5 thu\u1ed9c v\u00e0o \u0111\u00e1nh gi\u00e1 l\u00e2m s\u00e0ng. M\u1ed9t b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 c\u1ea7n \u0111\u01b0\u1ee3c <\/strong><strong>nh\u1eadp<\/strong><strong> vi\u1ec7n ngay l\u1eadp t\u1ee9c &#8211; v\u00ed d\u1ee5 nh\u01b0 khi c\u00f3 b\u1ea5t k\u1ef3 <\/strong><strong>d\u1ea7u hi\u1ec7u<\/strong><strong> l\u00e2m s\u00e0ng n\u00e0o <\/strong><strong>nghi ng\u1edd <\/strong><strong>\u0111\u1ed9t qu<\/strong><strong>\u1ecb.<\/strong><\/li>\n<li>Chuy\u1ec3n ngay \u0111\u1ebfn khoa n\u1ed9i th\u1ea7n kinh ho\u1eb7c khoa tai m\u0169i h\u1ecdng n\u1ebfu c\u00f3:\n<ul>\n<li>B\u1ea5t k\u00ec nghi ng\u1edd g\u00ec v\u1ec1 ch\u1ea9n \u0111o\u00e1n.<\/li>\n<li>Li\u1ec7t Bell t\u00e1i ph\u00e1t.<\/li>\n<li>Li\u1ec7t Bell hai b\u00ean.<\/li>\n<\/ul>\n<\/li>\n<li>N\u1ebfu gi\u00e1c m\u1ea1c v\u1eabn b\u1ecb t\u1ed5n th\u01b0\u01a1ng d\u00f9 \u0111\u00e3 n\u1ed5 l\u1ef1c \u0111i\u1ec1u tr\u1ecb \u0111\u00f3ng m\u00ed m\u1eaft, h\u00e3y nhanh ch\u00f3ng chuy\u1ec3n sang khoa m\u1eaft.<\/li>\n<li>N\u1ebfu t\u00ecnh tr\u1ea1ng li\u1ec7t kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u c\u1ea3i thi\u1ec7n sau m\u1ed9t th\u00e1ng, ho\u1eb7c c\u00f3 nghi ng\u1edd ch\u1ea9n \u0111o\u00e1n m\u1ed9t b\u1ec7nh l\u00fd n\u1ec1n nghi\u00eam tr\u1ecdng (v\u00ed d\u1ee5 nh\u01b0 vi\u00eam tai x\u01b0\u01a1ng ch\u0169m, u tuy\u1ebfn mang tai, vi\u00eam tai ngo\u00e0i \u00e1c t\u00ednh), h\u00e3y nhanh ch\u00f3ng \u0111\u01b0a \u0111\u1ebfn chuy\u00ean khoa tai m\u0169i h\u1ecdng.<\/li>\n<li><strong>Ph\u1eabu thu\u1eadt<\/strong><strong>:<\/strong><\/li>\n<li>Ch\u1ecdn l\u1ef1a ph\u1eabu thu\u1eadt cho b\u1ec7nh nh\u00e2n li\u1ec7t d\u00e2y th\u1ea7n kinh m\u1eb7t kh\u00f4ng \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa bao g\u1ed3m gi\u1ea3i ch\u00e8n \u00e9p d\u00e2y th\u1ea7n kinh m\u1eb7t.<\/li>\n<li>N\u1ebfu li\u1ec7t m\u1eb7t c\u00f2n t\u1ed3n t\u1ea1i sau 6-9 th\u00e1ng, n\u00ean c\u00e2n nh\u1eafc chuy\u1ec3n b\u1ec7nh nh\u00e2n \u0111\u1ebfn m\u1ed9t b\u00e1c s\u0129 ph\u1eabu thu\u1eadt th\u1ea9m m\u0129 chuy\u00ean t\u00e1i t\u1ea1o khu\u00f4n m\u1eb7t. C\u00e1c m\u1ee5c ti\u00eau h\u1ed3i ph\u1ee5c c\u01a1 v\u1eabn c\u00f2n kh\u1ea3 thi n\u1ebfu gh\u00e9p n\u1ed1i ch\u00e9o d\u00e2y th\u1ea7n kinh trong v\u00f2ng 12-18 th\u00e1ng.<\/li>\n<li>Tr\u01b0\u1eddng h\u1ee3p d\u00e2y th\u1ea7n kinh kh\u00f4ng ph\u1ee5c h\u1ed3i, ph\u1eabu thu\u1eadt th\u1ea9m m\u1ef9 \u0111\u1ec3 n\u00e2ng mi\u1ec7ng ho\u1eb7c n\u1ed1i d\u00e2y th\u1ea7n kinh h\u1ea1 thi\u1ec7t (hypoglossal nerve) v\u00e0o d\u00e2y th\u1ea7n kinh m\u1eb7t c\u00f3 th\u1ec3 gi\u00fap \u00edch.<\/li>\n<\/ul>\n<h3>Li\u1ec7t m\u1eb7t \u1edf tr\u1ebb em<\/h3>\n<ul>\n<li>Li\u1ec7t m\u1eb7t \u1edf tr\u1ebb em th\u01b0\u1eddng l\u00e0 v\u00f4 c\u0103n, nh\u01b0ng x\u00e1c su\u1ea5t t\u00ecm \u0111\u01b0\u1ee3c nguy\u00ean nh\u00e2n c\u0169ng t\u0103ngn\u1ebfu ti\u1ebfn h\u00e0nh c\u00e1c kh\u1ea3o s\u00e1t m\u1ed9t c\u00e1ch to\u00e0n di\u1ec7n.<\/li>\n<li>C\u1ea7n kh\u1ea3o s\u00e1t h\u00ecnh \u1ea3nh h\u1ecdc n\u1ebfu b\u1ec7nh s\u1eed c\u00f3 ch\u1ea5n th\u01b0\u01a1ng.<\/li>\n<li>Ti\u00ean l\u01b0\u1ee3ng kh\u00e1c nhau t\u00f9y tr\u01b0\u1eddng h\u1ee3p nh\u01b0ng th\u01b0\u1eddng l\u00e0 ti\u00ean l\u01b0\u1ee3ng t\u1ed1t.<\/li>\n<\/ul>\n<h2>Ti\u00ean l\u01b0\u1ee3ng<\/h2>\n<ul>\n<li>85% t\u1ef1 c\u1ea3i thi\u1ec7n trong v\u00f2ng 3 tu\u1ea7n k\u1ec3 t\u1eeb khi kh\u1edfi ph\u00e1t.<\/li>\n<li>71% h\u1ed3i ph\u1ee5c ho\u00e0n to\u00e0n.<\/li>\n<li>16% c\u00f3 di ch\u1ee9ng \u0111\u00e1ng k\u1ec3, 5% n\u1eb7ng:\n<ul>\n<li>M\u1ea5t c\u00e2n \u0111\u1ed1i khu\u00f4n m\u1eb7t<\/li>\n<li>Ch\u1ea3y n\u01b0\u1edbc m\u1eaft khi k\u00edch th\u00edch v\u1ecb gi\u00e1c (\u0103n, u\u1ed1ng,\u2026)<\/li>\n<li>M\u1ed9t b\u00ean m\u1eaft nh\u1eafm kh\u00f4ng k\u00edn<\/li>\n<li>X\u1ec7 l\u00f4ng m\u00e0y<\/li>\n<li>Ch\u1ea3y n\u01b0\u1edbc d\u00e3i<\/li>\n<li>Co th\u1eaft c\u01a1 n\u1eeda m\u1eb7t<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>C\u00e1c \u0111\u1eb7c t\u00ednh g\u1ee3i \u00fd ti\u00ean l\u01b0\u1ee3ng x\u1ea5u:<\/p>\n<ul>\n<li>Li\u1ec7t ho\u00e0n to\u00e0n ho\u1eb7c tho\u00e1i h\u00f3a n\u1eb7ng (tr\u00ean kh\u1ea3o s\u00e1t \u0111i\u1ec7n sinh l\u00fd).<\/li>\n<li>Kh\u00f4ng th\u1ea5y c\u00f3 d\u1ea5u hi\u1ec7u h\u1ed3i ph\u1ee5c sau 3 tu\u1ea7n.<\/li>\n<li>Tr\u00ean 60 tu\u1ed5i.<\/li>\n<li>\u0110au tr\u1ea7m tr\u1ecdng (c\u00f3 th\u1ec3 g\u1ee3i \u00fd t\u1edbi h\u1ed9i ch\u1ee9ng Ramsay Hunt).<\/li>\n<li>H\u1ed9i ch\u1ee9ng Ramsay Hunt (herpes zoster virus).<\/li>\n<li>Li\u00ean quan v\u1edbi t\u0103ng huy\u1ebft \u00e1p, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng ho\u1eb7c thai k\u1ef3.<\/li>\n<\/ul>\n<p>C\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u00f3 tho\u00e1i h\u00f3a s\u1ee3i tr\u1ee5c c\u00f3 th\u1ec3 kh\u00f4ng t\u00ecm th\u1ea5y s\u1ef1 t\u00e1i ph\u00e2n b\u1ed1 th\u1ea7n kinh n\u00e0o sau 3 th\u00e1ng v\u00e0 s\u1ef1 h\u1ed3i ph\u1ee5c c\u00f3 th\u1ec3 c\u00f3 m\u1ed9t ph\u1ea7n ch\u1ee9 kh\u00f4ng ho\u00e0n to\u00e0n. Hi\u1ec7n t\u01b0\u1ee3ng \u0111\u1ed3ng \u0111\u1ed9ng (synkinesis) l\u00e0 th\u01b0\u1eddng th\u1ea5y, v\u00ed d\u1ee5 nh\u01b0 nh\u00e1y m\u1eaft khi c\u1eed \u0111\u1ed9ng mi\u1ec7ng. S\u1ef1 t\u00e1i ph\u00e2n b\u1ed1 th\u1ea7n kinh d\u1ecb th\u01b0\u1eddng c\u0169ng c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c tri\u1ec7u ch\u1ee9ng nh\u01b0 ch\u1ea3y n\u01b0\u1edbc m\u1eaft khi k\u00edch th\u00edch v\u1ecb gi\u00e1c (&#8216;crocodile tears&#8217;- n\u01b0\u1edbc m\u1eaft c\u00e1 s\u1ea5u). C\u00e1c tri\u1ec7u ch\u1ee9ng c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n khi ti\u00eam botulinum v\u00e0o c\u01a1 ho\u1eb7c ti\u00eam d\u01b0\u1edbi da.<\/p>\n<h2><strong>T\u00e0i li\u1ec7u tham kh\u1ea3o<\/strong><\/h2>\n<p><a href=\"https:\/\/patient.info\/doctor\/facial-nerve-palsy\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/patient.info\/doctor\/facial-nerve-palsy<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Khi li\u1ec7t d\u00e2y th\u1ea7n kinh m\u1eb7t, c\u00e1c c\u01a1 bi\u1ec3u c\u1ea3m n\u00e9t m\u1eb7t v\u00e0 c\u01a1 nh\u1eafm m\u1eaft b\u1ecb y\u1ebfu. C\u00e1c n\u1ebfp r\u00e3nh \u1edf m\u1eb7t b\u1ecb k\u00e9o sang b\u00ean \u0111\u1ed1i di\u1ec7n khi ng\u01b0\u1eddi b\u1ec7nh c\u01b0\u1eddi&#8230;<\/p>\n","protected":false},"author":110,"featured_media":6250,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5249,3884,5148,5149,5230],"tags":[3885,4678,4679,4680,3899],"series":[1583],"coauthors":[1778],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.8 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Li\u1ec7t d\u00e2y th\u1ea7n kinh m\u1eb7t - Y H\u1ecdc C\u1ed9ng \u0110\u1ed3ng<\/title>\n<meta name=\"description\" content=\"Khi li\u1ec7t d\u00e2y th\u1ea7n kinh m\u1eb7t, c\u00e1c c\u01a1 bi\u1ec3u c\u1ea3m n\u00e9t m\u1eb7t v\u00e0 c\u01a1 nh\u1eafm m\u1eaft b\u1ecb y\u1ebfu. 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