Nimodipin unterstützt die schnelle funktionelle Regeneration bei peripherer Fazialisparese

Introduction: The loss of facial nerve (FN) function is associated with some negative accompanying effects on the patient. Besides the functional problems, the facial asymmetry and the inexpressiveness severely impair the psychosocial impact of the patient. Therefore a fast FN recovery after a surgical trauma is very important for the patient. Until now different treatment options have been discussed to accelerate the recovery of the FN function, but none of the described treatments have proved to be successful. Encouraged by animal and promising results of different clinical studies by neurosurgical departments, an "off-label" use of nimodipine (NimotopS®, Bayer AG, Leverkusen, Germany) was performed to expedite the process of FN recovery after postoperative peripheral nerve paresis. Methods: Thirteen patients (n=13) suffering from a moderate (1/13) up to a severe (12/13) peripheral FN paresis after maxillofacial surgery were treated with orally administered nimodipine. The anatomical main course of the FN was preserved in all patients with a 2nd to 3rd degree of Sunderland-injury. After no evidence of a spontaneous regeneration had shown, an oral medication with nimodipine was started as an "off-label" use. Results: An improvement of the FN function correlated to the start of the vasoactive medication and as a consequence a recovery of the FN function up to House-Brackmann (HB) grade I-II was ascertained in all observed patients within a period of two months after the beginning of treatment (p=0.00027). Conclusions: The clinical observations in these patients suggest a positive effect of nimodipine on the acceleration of peripheral FN regeneration after a surgically caused trauma. The results of this pilot-study are very promising. A prospective study with a bigger number of patients is planned to approve the beneficial effect of nimodipine on the peripheral FN in maxillofacial or otorhinolaryngological surgery. Parole chiave: regeneration N. fazialis, nimodipine