안면신경 > 이비인후과

대한이과학회에서 드디어 “안면신경” 교과서를 출간합니다.

안면신경은 얼굴표정을 지음으로써 개인의 감정을 표현하고 의사소통의 기능을 수행하므로, 안면신경

에 문제가 생기면 미용적인 문제뿐만 아니라 사회적, 정신적인 문제까지 초래하게 됩니다. 이러한 안면신

경 질환에 대한 지식을 공유하고 관련 연구를 협력해서 수행하기 위해 대한이과학회에서는 2016년에 학회

산하에 안면신경연구회를 구성하였습니다. 안면신경연구회를 통하여 안면신경 질환에 관한 다양한 연구

및 진단, 치료에 대한 최신의 지식을 공유하고 있으며 또한 2021년에 서울에서 열리는 세계안면신경학회

(International Facial Nerve Symposium)를 함께 준비하고 있습니다.

안면신경에 대한 간행물로는 대한이과연구회 시절인 1995년도에 “안면신경 심포지움”이라는 책자가

발간되었으나 그 이후 후속 책자가 발간되지 않아 최신 지견을 정리하기 위해 주로 외국 서적에 의존하고

있었고, 따라서 한국에서 발간된 안면신경의 기능 및 질환을 소개하는 책자의 필요성이 대두되고 있었습니

다. 이에 안면신경연구회 회원을 주축으로 하고 안면신경의 진단과 치료에 관련이 있는 영상의학과, 성형

외과, 신경외과와 함께 협력하여 안면신경 교과서를 발간하게 되었습니다.

이번에 발간된 “안면신경 The Facial Nerve”는 3부 23장에 걸쳐서 32명의 집필진들이 안면신경과 관

련된 해부 및 생리, 안면신경의 기능 검사법, 다양한 안면신경 질환의 진단과 치료에 대한 지식을 다루었

고, 안면마비가 발생한 이후 이를 극복할 수 있는 최신 치료 방법을 소개하였습니다.

이 책의 발간을 위해 옥고를 써주신 집필진과 수고를 아끼지 않으신 조형호 편집위원장 겸 대한이과학

회 간행이사와 편집위원님들에게 깊은 감사의 말씀을 드립니다. 이 책을 통해 독자들이 안면신경 질환의

진단 및 치료에 대한 다양한 지식을 접하고 최상의 진료를 하시는 데 많은 참고가 되기를 기대합니다.

대한이과학회 회장

조양선

PART 1 Basic sciences of facial nerve

CHAPTER 1

Anatomy of facial nerve 1

I. 서론 ··········································································· 1

II. 본론 ·········································································· 1

두개 내 안면신경 ··················································· 1

측두골 내의 안면신경 ············································· 2

측두골 외의 안면신경 ············································· 5

안면신경의 혈액 공급 ············································· 7

III. 결론 ········································································· 7

CHAPTER 2

Physiology of facial nerve 9

I. 구조적 단위 ······························································· 9

II. 안면신경의 손상 ······················································· 9

III. 신경 손상 후 변성과 재생 ······································· 11

신경 변성 ···························································11

신경재생 ····························································12

근육의 탈신경, 재신경 지배 및 재생 ···························12

IV. 생리학적 손상 및 회복의 측정 ································ 13

V. 신경재생의 생리학 ················································· 13

VI. 연합운동 ······························································· 13

CHAPTER 3

Anatomy of facial muscles 15

I. 서론 ········································································· 15

II. 본론 ········································································ 15

발생 ··································································15

얼굴널힘줄계통 ····················································15

안면 유지 인대 ·····················································15

안면근육계 ··························································17

안면신경 손상을 예방하기 위한 접근법 ·······················24

목가지 ·······························································25

III. 결론 ······································································· 26

CHAPTER 4

Facial nerve grading system 27

I. 서론 ········································································· 27

II. 본론 ········································································ 28

House-Brackmann grading scale ····························· 28

Facial nerve grading scale 2.0 (revised House-Brakmann

grading scale) ····················································   29

Sunny-brook facial grading scale ·····························29

Yanagihara grading scale ·······································29

eFACE ·······························································30

기타 ··································································30

III. 결론 ······································································· 30

CHAPTER 5

Electrophysiological measurement

of facial nerve function 31

I. 서론 ········································································· 31

II. 본론 ········································································ 31

신경흥분성 검사 ···················································32

최대자극 검사 ······················································32

신경전도 검사 ······················································32

근전도 검사 ·························································33

III. 결론 ······································································· 34

CHAPTER 6

Imaging study of

facial nerve disease 37

I. 서론 ········································································· 37

II. 본론 ········································································ 37

영상검사 ····························································37

영상해부학 ··························································37

안면신경의 정상 MR 소견 ·······································40

안면신경질환의 영상소견 ········································42

III. 결론 ······································································· 46

PART 2 Diseases of the facial nerve

CHAPTER 7

Facial nerve disease in

newborn and children 49

I. 신생아와 소아의 안면마비 ······································· 49

II. 선천성 안면마비 ····················································· 50

출생외상 ····························································50

Mobius 증후군 ·····················································52

Congenital unilateral lower lip paralysis ····················53

Melkersson-Rosenthal 증후군 ·································53

Goldenhar 증후군 ················································54

III. 후천성 안면마비 ···················································· 54

소아 벨마비 ·························································54

급성 중이염 ·························································55

라임병 ·······························································55

종양 ··································································55

측두골 골절 ·························································56

CHAPTER 8

Bell’s palsy 61

I. 원인 ········································································· 62

바이러스성 원인 ···················································62

허혈 ··································································63

자가면역 손상 ······················································64

II. 벨마비의 발생 기전 ················································· 64

III. 치료 ······································································· 64

눈관리 ·······························································64

약물요법 ····························································65

CHAPTER 9

Herpes zoster oticus 71

I. 서론 ········································································· 71

II. 본론 ········································································ 71

정의 ·································································71

발병빈도 ····························································71

임상 양상 ···························································72

소아 HZO ··························································73

진단 ··································································73

치료 ··································································74

예후 ··································································75

III. 결론 ······································································· 75

CHAPTER 10

Facial weakness as a complication

of otologic disease 77

I. 서론 ········································································· 77

II. 염증성 원인에 의한 안면신경마비 ··························· 77

급성 중이염에 의한 안면신경마비 ·····························77

만성 중이염에 의한 안면신경마비 ·····························78

악성 외이도염에 의한 안면신경마비 ···························81

III. 종양에 의한 안면신경마비 ······································ 81

양성 종양 ···························································81

악성 종양 ···························································82

전이성 종양 ·························································82

IV. 결론 ······································································· 82

CHAPTER 11

Trauma of the facial nerve 85

I. 서론 ········································································· 85

II. 본론 ········································································ 85

외상성 안면마비의 원인 ··········································85

의인성 안면신경마비 ·············································85

측두골내 안면신경 손상 ··········································86

평가 및 진단 ························································86

치료 ··································································87

III. 결론 ······································································· 88

CHAPTER 12

Primary tumor of the facial nerve 91

I. 서론 ········································································· 91

II. 안면신경초종 ·························································· 91

안면신경초종의 증상 ·············································91

안면신경초종의 진단 ·············································92

안면신경초종의 치료 ·············································92

III. 슬신경절 혈관종 ···················································· 95

IV. 안면신경 사구체 종양 ············································ 95

CHAPTER 13

Extratemporal causes of

facial nerve paralysis 99

I. 서론 ········································································· 99

II. 본론 ········································································ 99

이하선 종양에서 안면신경 침범 ································99

이하선 종양의 수술 시 안면신경의 처치 ···················· 100

이하선 수술 중 안면신경 손상의 예방························ 100

수술 중 안면신경의 제거와 재건 ····························· 101

III. 결론 ····································································· 103

CHAPTER 14

Hemifacial spasm 105

I. 정의 ······································································· 105

II. 증상 ······································································ 105

III. 역학 ····································································· 105

IV. 원인 ····································································· 105

V. 병태생리 ······························································· 107

VI. 진단 ···································································· 107

VII. 치료 ··································································· 108

내과적 치료 ······················································ 108

외과적 치료 ······················································ 108

VIII. 합병증 ······························································· 110

IX. 예후 ···································································· 111

PART 3 Treatment of facial nerve paralysis

CHAPTER 15

Monitoring for surgical treatment 113

I. 서론 ····································································· 113

역사 ······························································· 113

적응증 ···························································· 113

II. 본론 ······································································ 113

신경 생리학적 방법 ············································ 113

술중 감시 ························································ 117

III. 결론 ····································································· 118

CHAPTER 16

Surgical indication for

facial paralysis 121

I. 서론 ······································································· 121

II. 본론 ······································································ 123

내인적 원인에 의한 마비 ······································ 123

외인적 요인에 의한 안면마비 ································ 125

III. 결론 ····································································· 126

CHAPTER 17

Facial nerve decompression 129

I. 서론 ······································································· 129

II. 본론 ······································································ 129

안면신경 감압술의 이론적 배경 ····························· 129

안면신경 감압술의 적응증 및 시기 ························ 129

안면신경 감압술의 부위 ······································· 130

안면신경 감압술의 방법 ······································· 130

안면신경 감압술에 대한 반론 ································· 135

III. 결론 ····································································· 136

CHAPTER 18

Facial nerve management

in skull base surgery 137

I. 서론 ······································································· 137

II. 안면신경 수술의 원칙 ··········································· 137

III. 안면신경의 전위 ·················································· 137

IV. 두개저 수술 시 안면신경의 조작 ·························· 138

중두개와 접근법 ················································ 138

경미로 접근법 ··················································· 139

경이 접근법 ······················································ 140

경와우 접근법 ··················································· 140

측두하와 접근법 ················································ 142

V. 안면신경 재건술 ··················································· 143

VI. 결론 ···································································· 143

CHAPTER 19

Nerve repair and nerve

substitution technique 145

I. 서론 ······································································· 145

II. 본론 ······································································ 145

직접 신경 문합술 ··············································· 145

신경 이식술 ······················································ 146

신경 전위술 ······················································ 148

증례 ······························································· 150

III. 결론 ····································································· 150

CHAPTER 20

Facial palsy;

Surgical reconstruction 155

I. 서론 ······································································· 155

II. 수술 전 검사 및 관리 ············································ 155

수술 전 검사 ····················································· 155

수술 전 관리 ····················································· 156

III. 수술적 치료법 ······················································ 156

정적 재건술 ······················································ 156

동적 재건술 ······················································ 158

IV. 합병증, 술 후 경과 및 결과 ································· 162

V. 결론 ······································································ 163

CHAPTER 21

Facial rejuvenation for facial palsy 165

I. 서론 ······································································· 165

II. 본론 ······································································ 166

III. 결론 ····································································· 171

CHAPTER 22

Physical therapy and

neuromuscular retraining 173

I. 서론 ······································································· 173

II. 본론 ······································································ 173

안면근육의 특징 ················································ 173

물리치료의 적응 ················································ 173

고전적 물리치료 ················································ 174

신경근 재훈련 ··················································· 174

신경근 재훈련 기법 ············································ 177

III. 결론 ····································································· 178

CHAPTER 23

Future treatment modalities 181

I. 서론 ······································································· 181

II. 본론 ······································································ 181

이상적인 신경유도도관으로서 갖추어야 할 특성 ········ 181

III. 신경유도도관의 성분에 따른 종류 ························ 182

Natural material ··············································· 182

Natural polymer ··············································· 182

합성 polymer 신경유도도관 ·································· 183

IV. 신경재생을 촉진시키기 위한 방법 ························ 183

슈반세포의 이식 ················································ 183

생리활성물질의 주입 ········································· 183

줄기세포의 주입 ················································ 183

물리적 자극의 병합 ············································ 183

V. 결론 ······································································ 184

찾아보기 ································································ 187