Delayed facial nerve decompression for Bell's palsy.

PubMed

Kim, Sang Hoon; Jung, Junyang; Lee, Jong Ha; Byun, Jae Yong; Park, Moon Suh; Yeo, Seung Geun

2016-07-01

Incomplete recovery of facial motor function continues to be long-term sequelae in some patients with Bell's palsy. The purpose of this study was to investigate the efficacy of transmastoid facial nerve decompression after steroid and antiviral treatment in patients with late stage Bell's palsy. Twelve patients underwent surgical decompression for Bell's palsy 21-70 days after onset, whereas 22 patients were followed up after steroid and antiviral therapy without decompression. Surgical criteria included greater than 90 % degeneration on electroneuronography and no voluntary electromyography potentials. This study was a retrospective study of electrodiagnostic data and medical chart review between 2006 and 2013. Recovery from facial palsy was assessed using the House-Brackmann grading system. Final recovery rate did not differ significantly in the two groups; however, all patients in the decompression group recovered to at least House-Brackmann grade III at final follow-up. Although postoperative hearing threshold was increased in both groups, there was no significant between group difference in hearing threshold. Transmastoid decompression of the facial nerve in patients with severe late stage Bell's palsy at risk for a poor facial nerve outcome reduced severe complications of facial palsy with minimal morbidity.

Neuro-ophthalmological approach to facial nerve palsy.

PubMed

Portelinha, Joana; Passarinho, Maria Picoto; Costa, João Marques

2015-01-01

Facial nerve palsy is associated with significant morbidity and can have different etiologies. The most common causes are Bell's palsy, Ramsay-Hunt syndrome and trauma, including surgical trauma. Incidence varies between 17 and 35 cases per 100,000. Initial evaluation should include accurate clinical history, followed by a comprehensive investigation of the head and neck, including ophthalmological, otological, oral and neurological examination, to exclude secondary causes. Routine laboratory testing and diagnostic imaging is not indicated in patients with new-onset Bell's palsy, but should be performed in patients with risk factors, atypical cases or in any case without resolution within 4 months. Many factors are involved in determining the appropriate treatment of these patients: the underlying cause, expected duration of nerve dysfunction, anatomical manifestations, severity of symptoms and objective clinical findings. Systemic steroids should be offered to patients with new-onset Bell's palsy to increase the chance of facial nerve recovery and reduce synkinesis. Ophthalmologists play a pivotal role in the multidisciplinary team involved in the evaluation and rehabilitation of these patients. In the acute phase, the main priority should be to ensure adequate corneal protection. Treatment depends on the degree of nerve lesion and on the risk of the corneal damage based on the amount of lagophthalmos, the quality of Bell's phenomenon, the presence or absence of corneal sensitivity and the degree of lid retraction. The main therapy is intensive lubrication. Other treatments include: taping the eyelid overnight, botulinum toxin injection, tarsorrhaphy, eyelid weight implants, scleral contact lenses and palpebral spring. Once the cornea is protected, longer term planning for eyelid and facial rehabilitation may take place. Spontaneous complete recovery of Bell's palsy occurs in up to 70% of cases. Long-term complications include aberrant regeneration with

Neuro-ophthalmological approach to facial nerve palsy

PubMed Central

Portelinha, Joana; Passarinho, Maria Picoto; Costa, João Marques

2014-01-01

Facial nerve palsy is associated with significant morbidity and can have different etiologies. The most common causes are Bell’s palsy, Ramsay–Hunt syndrome and trauma, including surgical trauma. Incidence varies between 17 and 35 cases per 100,000. Initial evaluation should include accurate clinical history, followed by a comprehensive investigation of the head and neck, including ophthalmological, otological, oral and neurological examination, to exclude secondary causes. Routine laboratory testing and diagnostic imaging is not indicated in patients with new-onset Bell’s palsy, but should be performed in patients with risk factors, atypical cases or in any case without resolution within 4 months. Many factors are involved in determining the appropriate treatment of these patients: the underlying cause, expected duration of nerve dysfunction, anatomical manifestations, severity of symptoms and objective clinical findings. Systemic steroids should be offered to patients with new-onset Bell’s palsy to increase the chance of facial nerve recovery and reduce synkinesis. Ophthalmologists play a pivotal role in the multidisciplinary team involved in the evaluation and rehabilitation of these patients. In the acute phase, the main priority should be to ensure adequate corneal protection. Treatment depends on the degree of nerve lesion and on the risk of the corneal damage based on the amount of lagophthalmos, the quality of Bell’s phenomenon, the presence or absence of corneal sensitivity and the degree of lid retraction. The main therapy is intensive lubrication. Other treatments include: taping the eyelid overnight, botulinum toxin injection, tarsorrhaphy, eyelid weight implants, scleral contact lenses and palpebral spring. Once the cornea is protected, longer term planning for eyelid and facial rehabilitation may take place. Spontaneous complete recovery of Bell’s palsy occurs in up to 70% of cases. Long-term complications include aberrant regeneration

Childhood Sarcoidosis Presenting as Recurrent Facial Palsy.

PubMed

Passi, Gouri Rao; Arora, Kriti; Gokhale, Narendra

2018-04-15

Recurrent facial palsy in a patient merits investigation for underlying etiology. 8-year-old boy with erythematous itchy skin lesion and recurrent facial palsy. He had a past history of aseptic meningitis and nephrocalcinosis. Raised angiotensin converting enzyme levels, interstitial lung disease on CT chest, and non caseating granulomas on skin biopsy clinched the diagnosis of sarcoidosis. Multisystem involvement and recurrent lower motor facial nerve palsy is a clinical clue for sarcoidosis.

Peripheral Facial Palsy in Emergency Department

PubMed Central

Ferreira-Penêda, José; Robles, Raquel; Gomes-Pinto, Isabel; Valente, Pedro; Barros-Lima, Nuno; Condé, Artur

2018-01-01

Introduction: Peripheral facial palsy (PFP) is commonly diagnosed in every emergency department. Despite being a benign condition in most cases, PFP causes loss in quality of life mostly due to facial dysmorphia. The etiology of PFP remains unknown in most cases, while medical opinion on epidemiology, risk factors and optimal treatment is not consensual. The aim of this study was to review the demographic characteristics of our patients and the medical care administered in our emergency department. Materials and Methods: Emergency episodes occurring in a 4-year period and codified as facial nerve pathology were analyzed. IBM SPSS software was used for statistical analysis. Results: In total, 582 emergency episodes were obtained. Due to inexpressive representation of other causes of PFP in our study, we focused our analyses on the 495 patients who were considered to have idiopathic PFP. There was equal distribution among genders, and all age ranges were affected. There were no clear epidemic phenomena. Hypertension was not a statistically significant risk factor for Bell's palsy. Most patients sought medical care in the early stages of the disease and complained of isolated facial weakness. Most patients had mild-to-moderate symptoms. Previous upper way infections (PUAI) were more frequent among children. There was a statistically significant difference regarding computed tomography (CT) scan requests among specialties. Conclusion: Epidemiologic findings were consistent with most literature on Bell's palsy. Drug therapy is widely used and follows current guidelines. The role of PUAI in the pediatric population must be investigated. Despite evidence of good medical practice, there was an excess of CT scans requested by physicians other than otorhinolaryngologists. PMID:29876329

Facial palsy after dental procedures - Is viral reactivation responsible?

PubMed

Gaudin, Robert A; Remenschneider, Aaron K; Phillips, Katie; Knipfer, Christian; Smeets, Ralf; Heiland, Max; Hadlock, Tessa A

2017-01-01

Herpes labialis viral reactivation has been reported following dental procedures, but the incidence, characteristics and outcomes of delayed peripheral facial nerve palsy following dental work is poorly understood. Herein we describe the unique features of delayed facial paresis following dental procedures. An institutional retrospective review was performed to identify patients diagnosed with delayed facial nerve palsy within 30 days of dental manipulation. Demographics, prodromal signs and symptoms, initial medical treatment and outcomes were assessed. Of 2471 patients with facial palsy, 16 (0.7%) had delayed facial paresis following ipsilateral dental procedures. Average age at presentation was 44 yrs and 56% (9/16) were female. Clinical evaluation was consistent with Bell's palsy in 14 (88%) and Ramsay-Hunt syndrome in 2 patients (12%). Patients developed facial paresis an average of 3.9 days after the dental procedure, with all individuals developing a flaccid paralysis (House Brackmann (HB) grade VI) during the acute stage. 50% of patients developed persistent facial palsy in the form of non-flaccid facial paralysis (HBIII-IV). Facial palsy, like herpes labialis, can occur in the days following dental procedures and may also be related to viral reactivation. In this small cohort, long-term facial outcomes appear worse than for spontaneous Bell's palsy. Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Facial Palsy Following Embolization of a Juvenile Nasopharyngeal Angiofibroma.

PubMed

Tawfik, Kareem O; Harmon, Jeffrey J; Walters, Zoe; Samy, Ravi; de Alarcon, Alessandro; Stevens, Shawn M; Abruzzo, Todd

2018-05-01

To describe a case of the rare complication of facial palsy following preoperative embolization of a juvenile nasopharyngeal angiofibroma (JNA). To illustrate the vascular supply to the facial nerve and as a result, highlight the etiology of the facial nerve palsy. The angiography and magnetic resonance (MR) imaging of a case of facial palsy following preoperative embolization of a JNA is reviewed. A 13-year-old male developed left-sided facial palsy following preoperative embolization of a left-sided JNA. Evaluation of MR imaging studies and retrospective review of the angiographic data suggested errant embolization of particles into the petrosquamosal branch of the middle meningeal artery (MMA), a branch of the internal maxillary artery (IMA), through collateral vasculature. The petrosquamosal branch of the MMA is the predominant blood supply to the facial nerve in the facial canal. The facial palsy resolved since complete infarction of the nerve was likely prevented by collateral blood supply from the stylomastoid artery. Facial palsy is a potential complication of embolization of the IMA, a branch of the external carotid artery (ECA). This is secondary to ischemia of the facial nerve due to embolization of its vascular supply. Clinicians should be aware of this potential complication and counsel patients accordingly prior to embolization for JNA.

Microcystic adnexal carcinoma (MAC)-like squamous cell carcinoma as a differential diagnosis to Bell´s palsy: review of guidelines for refractory facial nerve palsy.

PubMed

Mueller, S K; Iro, H; Lell, M; Seifert, F; Bohr, C; Scherl, C; Agaimy, A; Traxdorf, M

2017-01-05

Bell´s palsy is the most common cause of facial paralysis worldwide and the most common disorder of the cranial nerves. It is a diagnosis of exclusion, accounting for 60-75% of all acquired peripheral facial nerve palsies. Our case shows the first case of a microcystic adnexal carcinoma-like squamous cell carcinoma as a cause of facial nerve palsy. The patient, a 70-year-old Caucasian male, experienced subsequent functional impairment of the trigeminal and the glossopharyngeal nerve about 1½ years after refractory facial nerve palsy. An extensive clinical work-up and tissue biopsy of the surrounding parotid gland tissue was not able to determine the cause of the paralysis. Primary infiltration of the facial nerve with subsequent spreading to the trigeminal and glossopharyngeal nerve via neuroanastomoses was suspected. After discussing options with the patient, the main stem of the facial nerve was resected to ascertain the diagnosis of MAC-like squamous cell carcinoma, and radiochemotherapy was subsequently started. This case report shows that even rare neoplastic etiologies should be considered as a cause of refractory facial nerve palsy and that it is necessary to perform an extended diagnostic work-up to ascertain the diagnosis. This includes high-resolution MRI imaging and, as perilesional parotid biopsies might be inadequate for rare cases like ours, consideration of a direct nerve biopsy to establish the right diagnosis.

The asymmetric facial skin perfusion distribution of Bell's palsy discovered by laser speckle imaging technology.

PubMed

Cui, Han; Chen, Yi; Zhong, Weizheng; Yu, Haibo; Li, Zhifeng; He, Yuhai; Yu, Wenlong; Jin, Lei

2016-01-01

Bell's palsy is a kind of peripheral neural disease that cause abrupt onset of unilateral facial weakness. In the pathologic study, it was evidenced that ischemia of facial nerve at the affected side of face existed in Bell's palsy patients. Since the direction of facial nerve blood flow is primarily proximal to distal, facial skin microcirculation would also be affected after the onset of Bell's palsy. Therefore, monitoring the full area of facial skin microcirculation would help to identify the condition of Bell's palsy patients. In this study, a non-invasive, real time and full field imaging technology - laser speckle imaging (LSI) technology was applied for measuring facial skin blood perfusion distribution of Bell's palsy patients. 85 participants with different stage of Bell's palsy were included. Results showed that Bell's palsy patients' facial skin perfusion of affected side was lower than that of the normal side at the region of eyelid, and that the asymmetric distribution of the facial skin perfusion between two sides of eyelid is positively related to the stage of the disease (P <  0.001). During the recovery, the perfusion of affected side of eyelid was increasing to nearly the same with the normal side. This study was a novel application of LSI in evaluating the facial skin perfusion of Bell's palsy patients, and we discovered that the facial skin blood perfusion could reflect the stage of Bell's palsy, which suggested that microcirculation should be investigated in patients with this neurological deficit. It was also suggested LSI as potential diagnostic tool for Bell's palsy.

Facial nerve palsy after reactivation of herpes simplex virus type 1 in diabetic mice.

PubMed

Esaki, Shinichi; Yamano, Koji; Katsumi, Sachiyo; Minakata, Toshiya; Murakami, Shingo

2015-04-01

Bell's palsy is highly associated with diabetes mellitus (DM). Either the reactivation of herpes simplex virus type 1 (HSV-1) or diabetic mononeuropathy has been proposed to cause the facial paralysis observed in DM patients. However, distinguishing whether the facial palsy is caused by herpetic neuritis or diabetic mononeuropathy is difficult. We previously reported that facial paralysis was aggravated in DM mice after HSV-1 inoculation of the murine auricle. In the current study, we induced HSV-1 reactivation by an auricular scratch following DM induction with streptozotocin (STZ). Controlled animal study. Diabetes mellitus was induced with streptozotocin injection in only mice that developed transient facial nerve paralysis with HSV-1. Recurrent facial palsy was induced after HSV-1 reactivation by auricular scratch. After DM induction, the number of cluster of differentiation 3 (CD3)(+) T cells decreased by 70% in the DM mice, and facial nerve palsy recurred in 13% of the DM mice. Herpes simplex virus type 1 deoxyribonucleic acid (DNA) was detected in the facial nerve of all of the DM mice with palsy, and HSV-1 capsids were found in the geniculate ganglion using electron microscopy. Herpes simplex virus type 1 DNA was also found in some of the DM mice without palsy, which suggested the subclinical reactivation of HSV-1. These results suggested that HSV-1 reactivation in the geniculate ganglion may be the main causative factor of the increased incidence of facial paralysis in DM patients. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

[Effects of a Facial Muscle Exercise Program including Facial Massage for Patients with Facial Palsy].

PubMed

Choi, Hyoung Ju; Shin, Sung Hee

2016-08-01

The purpose of this study was to examine the effects of a facial muscle exercise program including facial massage on the facial muscle function, subjective symptoms related to paralysis and depression in patients with facial palsy. This study was a quasi-experimental research with a non-equivalent control group non-synchronized design. Participants were 70 patients with facial palsy (experimental group 35, control group 35). For the experimental group, the facial muscular exercise program including facial massage was performed 20 minutes a day, 3 times a week for two weeks. Data were analyzed using descriptive statistics, χ²-test, Fisher's exact test and independent sample t-test with the SPSS 18.0 program. Facial muscular function of the experimental group improved significantly compared to the control group. There was no significant difference in symptoms related to paralysis between the experimental group and control group. The level of depression in the experimental group was significantly lower than the control group. Results suggest that a facial muscle exercise program including facial massage is an effective nursing intervention to improve facial muscle function and decrease depression in patients with facial palsy.

[Surgical treatment in otogenic facial nerve palsy].

PubMed

Feng, Guo-Dong; Gao, Zhi-Qiang; Zhai, Meng-Yao; Lü, Wei; Qi, Fang; Jiang, Hong; Zha, Yang; Shen, Peng

2008-06-01

To study the character of facial nerve palsy due to four different auris diseases including chronic otitis media, Hunt syndrome, tumor and physical or chemical factors, and to discuss the principles of the surgical management of otogenic facial nerve palsy. The clinical characters of 24 patients with otogenic facial nerve palsy because of the four different auris diseases were retrospectively analyzed, all the cases were performed surgical management from October 1991 to March 2007. Facial nerve function was evaluated with House-Brackmann (HB) grading system. The 24 patients including 10 males and 14 females were analysis, of whom 12 cases due to cholesteatoma, 3 cases due to chronic otitis media, 3 cases due to Hunt syndrome, 2 cases resulted from acute otitis media, 2 cases due to physical or chemical factors and 2 cases due to tumor. All cases were treated with operations included facial nerve decompression, lesion resection with facial nerve decompression and lesion resection without facial nerve decompression, 1 patient's facial nerve was resected because of the tumor. According to HB grade system, I degree recovery was attained in 4 cases, while II degree in 10 cases, III degree in 6 cases, IV degree in 2 cases, V degree in 2 cases and VI degree in 1 case. Removing the lesions completely was the basic factor to the surgery of otogenic facial palsy, moreover, it was important to have facial nerve decompression soon after lesion removal.

[A young woman with central facial nerve palsy].

PubMed

Broere, Christiaan M; de Witte, B R René; Claes, J F H M Franka

2014-01-01

The distinction between central and peripheral facial nerve palsy can be difficult but is very important for the workup and treatment. A tumefactive demyelinating lesion (TDL) is a rare condition that can sometimes cause diagnostic difficulties due to its similarity to a brain tumour. We present a 20-year-old female patient who visited her GP with a discrete right-sided drooping corner of her mouth. The GP started treatment with oral glucorticoids because of presumed Bell's palsy and referred her to the neurology outpatient clinic. Repeated neurological examination showed central facial palsy on the right side of the face. An MRI study of the brain revealed a single large contrast-enhanced abnormality in the left hemisphere that was diagnosed as TDL after exclusion of other causes. In view of the limited number of clinical symptoms, an expectative policy was conducted. The patient recovered spontaneously and repeated MRI studies showed partial regression of TDL. TDL is often considered to be a first presentation of multiple sclerosis. Accurate analysis with MRI can help in making a diagnosis without the need for a biopsy.

Botulinum toxin treatment for facial palsy: A systematic review.

PubMed

Cooper, Lilli; Lui, Michael; Nduka, Charles

2017-06-01

Facial palsy may be complicated by ipsilateral synkinesis or contralateral hyperkinesis. Botulinum toxin is increasingly used in the management of facial palsy; however, the optimum dose, treatment interval, adjunct therapy and performance as compared with alternative treatments have not been well established. This study aimed to systematically review the evidence for the use of botulinum toxin in facial palsy. The Cochrane central register of controlled trials (CENTRAL), MEDLINE(R) (1946 to September 2015) and Embase Classic + Embase (1947 to September 2015) were searched for randomised studies using botulinum toxin in facial palsy. Forty-seven studies were identified, and three included. Their physical and patient-reported outcomes are described, and observations and cautions are discussed. Facial asymmetry has a strong correlation to subjective domains such as impairment in social interaction and perception of self-image and appearance. Botulinum toxin injections represent a minimally invasive technique that is helpful in restoring facial symmetry at rest and during movement in chronic, and potentially acute, facial palsy. Botulinum toxin in combination with physical therapy may be particularly helpful. Currently, there is a paucity of data; areas for further research are suggested. A strong body of evidence may allow botulinum toxin treatment to be nationally standardised and recommended in the management of facial palsy. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Peripheral facial palsy: Speech, communication and oral motor function.

PubMed

Movérare, T; Lohmander, A; Hultcrantz, M; Sjögreen, L

2017-02-01

The aim of the present study was to examine the effect of acquired unilateral peripheral facial palsy on speech, communication and oral functions and to study the relationship between the degree of facial palsy and articulation, saliva control, eating ability and lip force. In this descriptive study, 27 patients (15 men and 12 women, mean age 48years) with unilateral peripheral facial palsy were included if they were graded under 70 on the Sunnybrook Facial Grading System. The assessment was carried out in connection with customary visits to the ENT Clinic and comprised lip force, articulation and intelligibility, together with perceived ability to communicate and ability to eat and control saliva conducted through self-response questionnaires. The patients with unilateral facial palsy had significantly lower lip force, poorer articulation and ability to eat and control saliva compared with reference data in healthy populations. The degree of facial palsy correlated significantly with lip force but not with articulation, intelligibility, perceived communication ability or reported ability to eat and control saliva. Acquired peripheral facial palsy may affect communication and the ability to eat and control saliva. Physicians should be aware that there is no direct correlation between the degree of facial palsy and the possible effect on communication, eating ability and saliva control. Physicians are therefore recommended to ask specific questions relating to problems with these functions during customary medical visits and offer possible intervention by a speech-language pathologist or a physiotherapist. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

The history of facial palsy and spasm

PubMed Central

Sajadi, Mohamad-Reza M.; Tabatabaie, Seyed Mahmoud

2011-01-01

Although Sir Charles Bell was the first to provide the anatomic basis for the condition that bears his name, in recent years researchers have shown that other European physicians provided earlier clinical descriptions of peripheral cranial nerve 7 palsy. In this article, we describe the history of facial distortion by Greek, Roman, and Persian physicians, culminating in Razi's detailed description in al-Hawi. Razi distinguished facial muscle spasm from paralysis, distinguished central from peripheral lesions, gave the earliest description of loss of forehead wrinkling, and gave the earliest known description of bilateral facial palsy. In doing so, he accurately described the clinical hallmarks of a condition that we recognize as Bell palsy. PMID:21747074

A patient with bilateral facial palsy associated with hypertension and chickenpox: learning points.

PubMed

Al-Abadi, Eslam; Milford, David V; Smith, Martin

2010-11-26

Bilateral facial nerve paralysis is an uncommon presentation and even more so in children. There are reports of different causes of bilateral facial nerve palsy. It is well-established that hypertension and chickenpox causes unilateral facial paralysis and the importance of checking the blood pressure in children with facial nerve paralysis cannot be stressed enough. The authors report a boy with bilateral facial nerve paralysis in association with hypertension and having recently recovered from chickenpox. The authors review aspects of bilateral facial nerve paralysis as well as hypertension and chickenpox causing facial nerve paralysis.

Mask face: bilateral simultaneous facial palsy in an 11-year-old boy.

PubMed

Güngör, Serdal; Güngör Raif, Sabiha; Arslan, Müjgan

2013-04-01

Bilateral facial paralysis is an uncommon clinical entity especially in the pediatric age group and occurs frequently as a manifestation of systemic disease. The most important causes are trauma, infectious diseases, neurological diseases, metabolic, neoplastic, autoimmune diseases and idiopathic disease (Bell's palsy). We report a case of an 11-year-old boy presenting with bilateral simultaneous peripheral facial paralysis. All possible infectious causes were excluded and the patient was diagnosed as having Bell's palsy (idiopathic). The most important approach in these cases is to rule out a life-threatening disease. © 2013 The Authors. Pediatrics International © 2013 Japan Pediatric Society.

Bell palsy in lyme disease-endemic regions of canada: a cautionary case of occult bilateral peripheral facial nerve palsy due to Lyme disease.

PubMed

Ho, Karen; Melanson, Michel; Desai, Jamsheed A

2012-09-01

Lyme disease caused by the spirochete Borrelia burgdorferi is a multisystem disorder characterized by three clinical stages: dermatologic, neurologic, and rheumatologic. The number of known Lyme disease-endemic areas in Canada is increasing as the range of the vector Ixodes scapularis expands into the eastern and central provinces. Southern Ontario, Nova Scotia, southern Manitoba, New Brunswick, and southern Quebec are now considered Lyme disease-endemic regions in Canada. The use of field surveillance to map risk and endemic regions suggests that these geographic areas are growing, in part due to the effects of climate warming. Peripheral facial nerve palsy is the most common neurologic abnormality in the second stage of Lyme borreliosis, with up to 25% of Bell palsy (idiopathic peripheral facial nerve palsy) occurring due to Lyme disease. Here we present a case of occult bilateral facial nerve palsy due to Lyme disease initially diagnosed as Bell palsy. In Lyme disease-endemic regions of Canada, patients presenting with unilateral or bilateral peripheral facial nerve palsy should be evaluated for Lyme disease with serologic testing to avoid misdiagnosis. Serologic testing should not delay initiation of appropriate treatment for presumed Bell palsy.

Botulinum toxin to improve lower facial symmetry in facial nerve palsy

PubMed Central

Sadiq, S A; Khwaja, S; Saeed, S R

2012-01-01

Introduction In long-standing facial palsy, muscles on the normal side overcontract causing difficulty in articulation, eating, drinking, cosmetic embarrassment, and psychological effects as patients lack confidence in public. Methods We injected botulinum toxin A (BTXA) into the normal contralateral smile muscles to weaken them and restore symmetry to both active and passive movements by neutralising these overacting muscles. Results A total of 14 patients received BTXA (79% women, median age 47 years, average length of palsy 8 years). They were all difficult cases graded between 2 and 6 (average grade 3 House–Brackmann). All 14 patients reported improved facial symmetry with BTXA (dose altered in some to achieve maximum benefit). Average dose was 30 units, but varied from 10 to 80 units. Average time to peak effect was 6 days; average duration of effect was 11 weeks. Three patients had increased drooling (resolved within a few days). Conclusion The improvement in symmetry was observed by both patient and examining doctor. Patients commented on increased confidence, being more likely to allow photographs taken of themselves, and families reported improved legibility of speech. Younger patients have more muscle tone than older patients; the effect is more noticeable and the benefit greater for them. BTXA improves symmetry in patients with facial palsy, is simple and acceptable, and provides approximately 4 months of benefit. The site of injection depends on the dynamics of the muscles in each individual patient. PMID:22975654

A patient with bilateral facial palsy associated with hypertension and chickenpox: learning points

PubMed Central

Al-Abadi, Eslam; Milford, David V; Smith, Martin

2010-01-01

Bilateral facial nerve paralysis is an uncommon presentation and even more so in children. There are reports of different causes of bilateral facial nerve palsy. It is well-established that hypertension and chickenpox causes unilateral facial paralysis and the importance of checking the blood pressure in children with facial nerve paralysis cannot be stressed enough. The authors report a boy with bilateral facial nerve paralysis in association with hypertension and having recently recovered from chickenpox. The authors review aspects of bilateral facial nerve paralysis as well as hypertension and chickenpox causing facial nerve paralysis. PMID:22797481

Recurrent phosphaturic mesenchymal tumour of the temporal bone causing deafness and facial nerve palsy.

PubMed

Syed, M I; Chatzimichalis, M; Rössle, M; Huber, A M

2012-07-01

We describe the first reported case of a phosphaturic mesenchymal tumour, mixed connective tissue variant, invading the temporal bone. A female patient presented with increasing deafness. On examination there appeared to be a mass behind an intact tympanic membrane. Further radiological investigation showed a vascular mass occupying the middle ear, mastoid and internal auditory meatus. This was surgically resected and revealed to be a benign phosphaturic mesenchymal tumour, mixed connective tissue variant. The tumour recurred a year later, presenting as facial nerve palsy. A revision procedure was carried out; the tumour was excised with the sacrifice of a segment of the facial nerve, and a facial-hypoglossal nerve anastomosis was performed. This case report highlights the occurrence of this benign but sometimes aggressive tumour, of which both clinicians and pathologists should be aware. Early recognition of the condition remains of utmost importance to minimise the debilitating consequences of long-term osteomalacia in affected patients, and to prevent extracranial and intracranial complications caused by the tumour.

Quantitative Magnetic Resonance Imaging Volumetry of Facial Muscles in Healthy Patients with Facial Palsy

PubMed Central

Volk, Gerd F.; Karamyan, Inna; Klingner, Carsten M.; Reichenbach, Jürgen R.

2014-01-01

Background: Magnetic resonance imaging (MRI) has not yet been established systematically to detect structural muscular changes after facial nerve lesion. The purpose of this pilot study was to investigate quantitative assessment of MRI muscle volume data for facial muscles. Methods: Ten healthy subjects and 5 patients with facial palsy were recruited. Using manual or semiautomatic segmentation of 3T MRI, volume measurements were performed for the frontal, procerus, risorius, corrugator supercilii, orbicularis oculi, nasalis, zygomaticus major, zygomaticus minor, levator labii superioris, orbicularis oris, depressor anguli oris, depressor labii inferioris, and mentalis, as well as for the masseter and temporalis as masticatory muscles for control. Results: All muscles except the frontal (identification in 4/10 volunteers), procerus (4/10), risorius (6/10), and zygomaticus minor (8/10) were identified in all volunteers. Sex or age effects were not seen (all P > 0.05). There was no facial asymmetry with exception of the zygomaticus major (larger on the left side; P = 0.012). The exploratory examination of 5 patients revealed considerably smaller muscle volumes on the palsy side 2 months after facial injury. One patient with chronic palsy showed substantial muscle volume decrease, which also occurred in another patient with incomplete chronic palsy restricted to the involved facial area. Facial nerve reconstruction led to mixed results of decreased but also increased muscle volumes on the palsy side compared with the healthy side. Conclusions: First systematic quantitative MRI volume measures of 5 different clinical presentations of facial paralysis are provided. PMID:25289366

Transient facial nerve paralysis (Bell's palsy) following administration of hepatitis B recombinant vaccine: a case report.

PubMed

Paul, R; Stassen, L F A

2014-01-01

Bell's palsy is the sudden onset of unilateral transient paralysis of facial muscles resulting from dysfunction of the seventh cranial nerve. Presented here is a 26-year-old female patient with right lower motor neurone facial palsy following hepatitis B vaccination. Readers' attention is drawn to an uncommon cause of Bell's palsy, as a possible rare complication of hepatitis B vaccination, and steps taken to manage such a presentation.

Acoustic Reflex and House-Brackmann Rating Scale as Prognostic Indicators of Peripheral Facial Palsy in Neuroborreliosis.

PubMed

Sekelj, Alen; Đanić, Davorin

2017-09-01

Lyme borreliosis is a vector-borne infectious disease characterized by three disease stages. In the areas endemic for borreliosis, every acute facial palsy indicates serologic testing and implies specific approach to the disease. Th e aim of the study was to identify and confirm the value of acoustic refl ex and House-Brackman (HB) grading scale as prognostic indicators of facial palsy in neuroborreliosis. Th e study included 176 patients with acute facial palsy divided into three groups based on serologic testing: borreliosis, Bell's palsy, and facial palsy caused by herpes simplex virus type 1 (HSV-1). Study patients underwent baseline audiometry with tympanometry and acoustic reflex, whereas current state of facial palsy was assessed by the HB scale. Subsequently, the same tests were obtained on three occasions, i.e. in week 3, 6 and 12 of presentation. Th e patients diagnosed with borreliosis, Bell's palsy and HSV-1 differed according to the time to acoustic refl ex recovery, which took longest time in patients with borreliosis. Th ese patients had the highest percentage of suprastapedial lesions at all time points and recovery was achieved later as compared with the other two diagnoses. Th e mean score on the HB scale declined with time, also at a slower rate in borreliosis patients. Th e prognosis of acoustic refl ex and facial palsy recovery according to HB scale was not associated with the length of elapsed time. The results obtained in the present study strongly confirmed the role of acoustic reflex and HB grading scale as prognostic indicators of facial palsy in neuroborreliosis.

Facial palsy following trauma to the external ear: 3 case reports.

PubMed

Vögelin, E; Jones, B M

1997-12-01

We report two children and a young adult who developed unilateral facial palsy shortly after injury to the external ear. In two instances the paralysis followed a prominent ear correction and in the other a laceration to the concha. The trauma-triggered facial palsy was most likely idiopathic although the anatomy of the facial nerve near the ear leads one to speculate on a possible pathway of a virally induced palsy (Bell's palsy). Each patient recovered over a period of 6 months.

[Facial palsy: diagnosis and management by primary care physicians].

PubMed

Alvarez, V; Dussoix, P; Gaspoz, J-M

2009-01-28

The incidence of facial palsy is about 50/100000/year, i.e. 210 cases/year in Geneva. Clinicians can be puzzled by it, because it encompasses aetiologies with very diverse prognoses. Most patients suffer from Bell palsy that evolves favourably. Some, however, suffer from diseases such as meningitis, HIV infection, Lyme's disease, CVA, that require fast identification because of their severity and of the need for specific treatments. This article proposes an algorithm for pragmatic and evidence-based management of facial palsy.

Diagnostic relevance of transcranial magnetic and electric stimulation of the facial nerve in the management of facial palsy.

PubMed

Nowak, Dennis A; Linder, Stefan; Topka, Helge

2005-09-01

Earlier investigations have suggested that isolated conduction block of the facial nerve to transcranial magnetic stimulation early in the disorder represents a very sensitive and potentially specific finding in Bell's palsy differentiating the disease from other etiologies. Stimulation of the facial nerve was performed electrically at the stylomastoid foramen and magnetically at the labyrinthine segment of the Fallopian channel within 3 days from symptom onset in 65 patients with Bell's palsy, five patients with Zoster oticus, one patient with neuroborreliosis and one patient with nuclear facial nerve palsy due to multiple sclerosis. Absence or decreased amplitudes of muscle responses to early transcranial magnetic stimulation was not specific for Bell's palsy, but also evident in all cases of Zoster oticus and in the case of neuroborreliosis. Amplitudes of electrically evoked muscle responses were more markedly reduced in Zoster oticus as compared to Bell's palsy, most likely due to a more severe degree of axonal degeneration. The degree of amplitude reduction of the muscle response to electrical stimulation reliably correlated with the severity of facial palsy. Transcranial magnetic stimulation in the early diagnosis of Bell's palsy is less specific than previously thought. While not specific with respect to the etiology of facial palsy, transcranial magnetic stimulation seems capable of localizing the site of lesion within the Fallopian channel. Combined with transcranial magnetic stimulation, early electrical stimulation of the facial nerve at the stylomastoid foramen may help to establish correct diagnosis and prognosis.

Effect of Age and Severity of Facial Palsy on Taste Thresholds in Bell's Palsy Patients

PubMed Central

Park, Jung Min; Kim, Myung Gu; Jung, Junyang; Kim, Sung Su; Jung, A Ra; Kim, Sang Hoon

2017-01-01

Background and Objectives To investigate whether taste thresholds, as determined by electrogustometry (EGM) and chemical taste tests, differ by age and the severity of facial palsy in patients with Bell's palsy. Subjects and Methods This study included 29 patients diagnosed with Bell's palsy between January 2014 and May 2015 in our hospital. Patients were assorted into age groups and by severity of facial palsy, as determined by House-Brackmann Scale, and their taste thresholds were assessed by EGM and chemical taste tests. Results EGM showed that taste thresholds at four locations on the tongue and one location on the central soft palate, 1 cm from the palatine uvula, were significantly higher in Bell's palsy patients than in controls (p<0.05). In contrast, chemical taste tests showed no significant differences in taste thresholds between the two groups (p>0.05). The severity of facial palsy did not affect taste thresholds, as determined by both EGM and chemical taste tests (p>0.05). The overall mean electrical taste thresholds on EGM were higher in younger Bell's palsy patients than in healthy subjects, with the difference at the back-right area of the tongue differing significantly (p<0.05). In older individuals, however, no significant differences in taste thresholds were observed between Bell's palsy patients and healthy subjects (p>0.05). Conclusions Electrical taste thresholds were higher in Bell's palsy patients than in controls. These differences were observed in younger, but not in older, individuals. PMID:28417103

Electrical and transcranial magnetic stimulation of the facial nerve: diagnostic relevance in acute isolated facial nerve palsy.

PubMed

Happe, Svenja; Bunten, Sabine

2012-01-01

Unilateral facial weakness is common. Transcranial magnetic stimulation (TMS) allows identification of a conduction failure at the level of the canalicular portion of the facial nerve and may help to confirm the diagnosis. We retrospectively analyzed 216 patients with the diagnosis of peripheral facial palsy. The electrophysiological investigations included the blink reflex, preauricular electrical stimulation and the response to TMS at the labyrinthine part of the canalicular proportion of the facial nerve within 3 days after symptom onset. A similar reduction or loss of the TMS amplitude (p < 0.005) of the affected side was seen in each patient group. Of the 216 patients (107 female, mean age 49.7 ± 18.0 years), 193 were diagnosed with Bell's palsy. Test results of the remaining patients led to the diagnosis of infectious [including herpes simplex, varicella zoster infection and borreliosis (n = 13)] and noninfectious [including diabetes and neoplasma (n = 10)] etiology. A conduction block in TMS supports the diagnosis of peripheral facial palsy without being specific for Bell's palsy. These data shed light on the TMS-based diagnosis of peripheral facial palsy, an ability to localize the site of lesion within the Fallopian channel regardless of the underlying pathology. Copyright © 2012 S. Karger AG, Basel.

Quality of life assessment in facial palsy: validation of the Dutch Facial Clinimetric Evaluation Scale.

PubMed

Kleiss, Ingrid J; Beurskens, Carien H G; Stalmeier, Peep F M; Ingels, Koen J A O; Marres, Henri A M

2015-08-01

This study aimed at validating an existing health-related quality of life questionnaire for patients with facial palsy for implementation in the Dutch language and culture. The Facial Clinimetric Evaluation Scale was translated into the Dutch language using a forward-backward translation method. A pilot test with the translated questionnaire was performed in 10 patients with facial palsy and 10 normal subjects. Finally, cross-cultural adaption was accomplished at our outpatient clinic for facial palsy. Analyses for internal consistency, test-retest reliability, construct validity and responsiveness were performed. Ninety-three patients completed the Dutch Facial Clinimetric Evaluation Scale, the Dutch Facial Disability Index, and the Dutch Short Form (36) Health Survey. Cronbach's α, representing internal consistency, was 0.800. Test-retest reliability was shown by an intraclass correlation coefficient of 0.737. Correlations with the House-Brackmann score, Sunnybrook score, Facial Disability Index physical function, and social/well-being function were -0.292, 0.570, 0.713, and 0.575, respectively. The SF-36 domains correlate best with the FaCE social function domain, with the strongest correlation between the both social function domains (r = 0.576). The FaCE score did statistically significantly increase in 35 patients receiving botulinum toxin type A (P = 0.042, Student t test). The domains 'facial comfort' and 'social function' improved statistically significantly as well (P = 0.022 and P = 0.046, respectively, Student t-test). The Dutch Facial Clinimetric Evaluation Scale shows good psychometric values and can be implemented in the management of Dutch-speaking patients with facial palsy in the Netherlands. Translation of the instrument into other languages may lead to widespread use, making evaluation and comparison possible among different providers.

[Treatment of idiopathic peripheral facial nerve paralysis (Bell's palsy)].

PubMed

Meyer, Martin Willy; Hahn, Christoffer Holst

2013-01-28

Bell's palsy is defined as an idiopathic peripheral facial nerve paralysis of sudden onset. It affects 11-40 persons per 100,000 per annum. Many patients recover without intervention; however, up to 30% have poor recovery of facial muscle control and experience facial disfigurement. The aim of this study was to make an overview of which pharmacological treatments have been used to improve outcomes. The available evidence from randomized controlled trials shows significant benefit from treating Bell's palsy with corticosteroids but shows no benefit from antivirals.

Usefulness of BFB/EMG in facial palsy rehabilitation.

PubMed

Dalla Toffola, Elena; Bossi, Daniela; Buonocore, Michelangelo; Montomoli, Cristina; Petrucci, Lucia; Alfonsi, Enrico

2005-07-22

To analyze and to compare the recovery and the development of synkinesis in patients with idiopathic facial palsy (Bell's palsy) following treatment with two methods of rehabilitation, kinesitherapy (KT) and biofeedback/EMG (BFB/EMG). Retrospective cases--series review. Seventy-four patients with Bell' palsy were clinically evaluated within 1 month from onset of palsy and at 12 months after palsy (House scale and synkinesis evaluation). Electromyography (EMG) and Electroneurography (ENG) were performed about 4 weeks after palsy to better evaluate functional abnormalities due to facial nerve lesion. The patients followed two different protocols for rehabilitation: the first 32 patients were treated with therapeutic exercises performed by therapists (KT group), the latter 42 patients were treated using BFB/EMG methods (BFB group) with inhibition of synkinetic movement as the primary goal. KT and BFB patients were evaluated for clinical and neurophysiological characteristics before rehabilitative treatment. BFB patients showed better clinical recovery and minor synkinesis than KT patients. BFB/EMG seems to be more useful than KT in Bell's palsy treatment. This could be due to the fact that BFB/EMG gives more accurate information than KT on muscle activation with better modulation in voluntary recruitment of motor unit.

Clinical significance of quantitative analysis of facial nerve enhancement on MRI in Bell's palsy.

PubMed

Song, Mee Hyun; Kim, Jinna; Jeon, Ju Hyun; Cho, Chang Il; Yoo, Eun Hye; Lee, Won-Sang; Lee, Ho-Ki

2008-11-01

Quantitative analysis of the facial nerve on the lesion side as well as the normal side, which allowed for more accurate measurement of facial nerve enhancement in patients with facial palsy, showed statistically significant correlation with the initial severity of facial nerve inflammation, although little prognostic significance was shown. This study investigated the clinical significance of quantitative measurement of facial nerve enhancement in patients with Bell's palsy by analyzing the enhancement pattern and correlating MRI findings with initial severity of facial palsy and clinical outcome. Facial nerve enhancement was measured quantitatively by using the region of interest on pre- and postcontrast T1-weighted images in 44 patients diagnosed with Bell's palsy. The signal intensity increase on the lesion side was first compared with that of the contralateral side and then correlated with the initial degree of facial palsy and prognosis. The lesion side showed significantly higher signal intensity increase compared with the normal side in all of the segments except for the mastoid segment. Signal intensity increase at the internal auditory canal and labyrinthine segments showed correlation with the initial degree of facial palsy but no significant difference was found between different prognostic groups.

3D-Ultrasonography for evaluation of facial muscles in patients with chronic facial palsy or defective healing: a pilot study.

PubMed

Volk, Gerd Fabian; Pohlmann, Martin; Finkensieper, Mira; Chalmers, Heather J; Guntinas-Lichius, Orlando

2014-01-01

While standardized methods are established to examine the pathway from motorcortex to the peripheral nerve in patients with facial palsy, a reliable method to evaluate the facial muscles in patients with long-term palsy for therapy planning is lacking. A 3D ultrasonographic (US) acquisition system driven by a motorized linear mover combined with conventional US probe was used to acquire 3D data sets of several facial muscles on both sides of the face in a healthy subject and seven patients with different types of unilateral degenerative facial nerve lesions. The US results were correlated to the duration of palsy and the electromyography results. Consistent 3D US based volumetry through bilateral comparison was feasible for parts of the frontalis muscle, orbicularis oculi muscle, depressor anguli oris muscle, depressor labii inferioris muscle, and mentalis muscle. With the exception of the frontal muscle, the facial muscles volumes were much smaller on the palsy side (minimum: 3% for the depressor labii inferior muscle) than on the healthy side in patients with severe facial nerve lesion. In contrast, the frontal muscles did not show a side difference. In the two patients with defective healing after spontaneous regeneration a decrease in muscle volume was not seen. Synkinesis and hyperkinesis was even more correlated to muscle hypertrophy on the palsy compared with the healthy side. 3D ultrasonography seems to be a promising tool for regional and quantitative evaluation of facial muscles in patients with facial palsy receiving a facial reconstructive surgery or conservative treatment.

3D-Ultrasonography for evaluation of facial muscles in patients with chronic facial palsy or defective healing: a pilot study

PubMed Central

2014-01-01

Background While standardized methods are established to examine the pathway from motorcortex to the peripheral nerve in patients with facial palsy, a reliable method to evaluate the facial muscles in patients with long-term palsy for therapy planning is lacking. Methods A 3D ultrasonographic (US) acquisition system driven by a motorized linear mover combined with conventional US probe was used to acquire 3D data sets of several facial muscles on both sides of the face in a healthy subject and seven patients with different types of unilateral degenerative facial nerve lesions. Results The US results were correlated to the duration of palsy and the electromyography results. Consistent 3D US based volumetry through bilateral comparison was feasible for parts of the frontalis muscle, orbicularis oculi muscle, depressor anguli oris muscle, depressor labii inferioris muscle, and mentalis muscle. With the exception of the frontal muscle, the facial muscles volumes were much smaller on the palsy side (minimum: 3% for the depressor labii inferior muscle) than on the healthy side in patients with severe facial nerve lesion. In contrast, the frontal muscles did not show a side difference. In the two patients with defective healing after spontaneous regeneration a decrease in muscle volume was not seen. Synkinesis and hyperkinesis was even more correlated to muscle hypertrophy on the palsy compared with the healthy side. Conclusion 3D ultrasonography seems to be a promising tool for regional and quantitative evaluation of facial muscles in patients with facial palsy receiving a facial reconstructive surgery or conservative treatment. PMID:24782657

Ophthalmic profile and systemic features of pediatric facial nerve palsy.

PubMed

Patil-Chhablani, Preeti; Murthy, Sowmya; Swaminathan, Meenakshi

2015-12-01

Facial nerve palsy (FNP) occurs less frequently in children as compared to adults but most cases are secondary to an identifiable cause. These children may have a variety of ocular and systemic features associated with the palsy and need detailed ophthalmic and systemic evaluation. This was a retrospective chart review of all the cases of FNP below the age of 16 years, presenting to a tertiary ophthalmic hospital over the period of 9 years, from January 2000 to December 2008. A total of 22 patients were included in the study. The average age at presentation was 6.08 years (range, 4 months to 16 years). Only one patient (4.54%) had bilateral FNP and 21 cases (95.45%) had unilateral FNP. Seventeen patients (77.27%) had congenital palsy and of these, five patients had a syndromic association, three had birth trauma and nine patients had idiopathic palsy. Five patients (22.72%) had an acquired palsy, of these, two had a traumatic cause and one patient each had neoplastic origin of the palsy, iatrogenic palsy after surgery for hemangioma and idiopathic palsy. Three patients had ipsilateral sixth nerve palsy, two children were diagnosed to have Moebius syndrome, one child had an ipsilateral Duane's syndrome with ipsilateral hearing loss. Corneal involvement was seen in eight patients (36.36%). Amblyopia was seen in ten patients (45.45%). Neuroimaging studies showed evidence of trauma, posterior fossa cysts, pontine gliosis and neoplasms such as a chloroma. Systemic associations included hemifacial macrosomia, oculovertebral malformations, Dandy Walker syndrome, Moebius syndrome and cerebral palsy FNP in children can have a number of underlying causes, some of which may be life threatening. It can also result in serious ocular complications including corneal perforation and severe amblyopia. These children require a multifaceted approach to their care.

Facial nerve palsy: analysis of cases reported in children in a suburban hospital in Nigeria.

PubMed

Folayan, M O; Arobieke, R I; Eziyi, E; Oyetola, E O; Elusiyan, J

2014-01-01

The study describes the epidemiology, treatment, and treatment outcomes of the 10 cases of facial nerve palsy seen in children managed at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife over a 10 year period. It also compares findings with report from developed countries. This was a retrospective cohort review of pediatric cases of facial nerve palsy encountered in all the clinics run by specialists in the above named hospital. A diagnosis of facial palsy was based on International Classification of Diseases, Ninth Revision, Clinical Modification codes. Information retrieved from the case note included sex, age, number of days with lesion prior to presentation in the clinic, diagnosis, treatment, treatment outcome, and referral clinic. Only 10 cases of facial nerve palsy were diagnosed in the institution during the study period. Prevalence of facial nerve palsy in this hospital was 0.01%. The lesion more commonly affected males and the right side of the face. All cases were associated with infections: Mainly mumps (70% of cases). Case management include the use of steroids and eye pads for cases that presented within 7 days; and steroids, eye pad, and physical therapy for cases that presented later. All cases of facial nerve palsy associated with mumps and malaria infection fully recovered. The two cases of facial nerve palsy associated with otitis media only partially recovered. Facial nerve palsy in pediatric patients is more commonly associated with mumps in the study environment. Successes are recorded with steroid therapy.

Bell's palsy and partial hypoglossal to facial nerve transfer: Case presentation and literature review

PubMed Central

Socolovsky, Mariano; Páez, Miguel Domínguez; Masi, Gilda Di; Molina, Gonzalo; Fernández, Eduardo

2012-01-01

Background: Idiopathic facial nerve palsy (Bell's palsy) is a very common condition that affects active population. Despite its generally benign course, a minority of patients can remain with permanent and severe sequelae, including facial palsy or dyskinesia. Hypoglossal to facial nerve anastomosis is rarely used to reinnervate the mimic muscle in these patients. In this paper, we present a case where a direct partial hypoglossal to facial nerve transfer was used to reinnervate the upper and lower face. We also discuss the indications of this procedure. Case Description: A 53-year-old woman presenting a spontaneous complete (House and Brackmann grade 6) facial palsy on her left side showed no improvement after 13 months of conservative treatment. Electromyography (EMG) showed complete denervation of the mimic muscles. A direct partial hypoglossal to facial nerve anastomosis was performed, including dissection of the facial nerve at the fallopian canal. One year after the procedure, the patient showed House and Brackmann grade 3 function in her affected face. Conclusions: Partial hypoglossal–facial anastomosis with intratemporal drilling of the facial nerve is a viable technique in the rare cases in which severe Bell's palsy does not recover spontaneously. Only carefully selected patients can really benefit from this technique. PMID:22574255

A View of the Therapy for Bell's Palsy Based on Molecular Biological Analyses of Facial Muscles.

PubMed

Moriyama, Hiroshi; Mitsukawa, Nobuyuki; Itoh, Masahiro; Otsuka, Naruhito

2017-12-01

Details regarding the molecular biological features of Bell's palsy have not been widely reported in textbooks. We genetically analyzed facial muscles and clarified these points. We performed genetic analysis of facial muscle specimens from Japanese patients with severe (House-Brackmann facial nerve grading system V) and moderate (House-Brackmann facial nerve grading system III) dysfunction due to Bell's palsy. Microarray analysis of gene expression was performed using specimens from the healthy and affected sides, and gene expression was compared. Changes in gene expression were defined as an affected side/healthy side ratio of >1.5 or <0.5. We observed that the gene expression in Bell's palsy changes with the degree of facial nerve palsy. Especially, muscle, neuron, and energy category genes tended to fluctuate with the degree of facial nerve palsy. It is expected that this study will aid in the development of new treatments and diagnostic/prognostic markers based on the severity of facial nerve palsy.

Increased seroprevalence of Toxoplasma gondii in a population of patients with Bell's palsy: a sceptical interpretation of the results regarding the pathogenesis of facial nerve palsy.

PubMed

Riga, Maria; Kefalidis, G; Chatzimoschou, A; Tripsianis, G; Kartali, S; Gouveris, H; Katotomichelakis, M; Danielides, V

2011-07-01

Facial nerve oedema and anatomical predisposition to compression within the fallopian tube seem to be the only generally accepted facts in the pathophysiology of Bell's palsy. Several infectious causes have been suggested as possible triggers of this oedema. Most of the suggested pathogens have been associated with facial nerve lesions during latent infections, reinfections or endogenous reactivations. The aim of this study was to investigate the seroprevalence of three such pathogens Toxoplasma gondii, Epstein-Barr virus (EBV) and cytomegalovirus (CMV) in a population of patients with facial nerve palsy. Fifty-six patients with Bell's palsy were included in the study. A group of 25 individuals with similar age and gender distribution was used as control. Seropositivity for T. gondii, EBV viral capsid antigen (VCA) and CMV-specific IgM and IgG antibodies was investigated 2-5 days after the onset of the palsy. Comparisons for both IgM and IgG antibodies against T. gondii attributed significantly higher seroprevalence in the patients' group than in the control group (p = 0.024 and 0.013, respectively). The respective examinations for EBV and CMV attributed no significant results. The roles of EBV and CMV in the pathogenesis of Bell's palsy were not confirmed by this study. However, a significantly higher seroprevalence of IgM- and IgG-specific T. gondii antibodies was detected in patients with Bell's palsy when compared to healthy controls. The possibility that facial nerve palsy might be a late complication of acquired toxoplasmosis may need to be addressed in further studies.

Hypereosinophilia and acute bilateral facial palsy: an unusual presentation of a common disease.

PubMed

Webb, Alastair John Stewart; Conlon, Chris; Briley, Dennis

2012-10-01

A 60-year-old man presented with an acute, pruritic, erythematous rash associated with marked hypereosinophilia (2.34×10(9)/l (0.04-0.40)). There was eosinophilic infiltration on hepatic, bone marrow and lymph node biopsies, with multiple lung nodules and mild splenomegaly. However, extensive investigation excluded parasitic or bacterial causes, specific allergens or the Fip1L1 mutation seen in myeloproliferative hypereosinophilia. Six months into the illness, he developed an acute, left, complete lower motor neurone facial palsy over hours, and an acute right lower motor neurone facial palsy 2 weeks later, without recovery. Over the subsequent 3 months, he developed complex partial seizures, a transient 72-h non-epileptic encephalopathy and episodic vertigo with ataxia. Further investigation showed bilateral enhancement of the VII nerves and labyrinthis on gadolinium-enhanced MR brain scan, cerebrospinal fluid lymphocytosis and neurophysiological evidence of polyradicolopathy. His eosinophil count fell with corticosteroids, hydroxycarbamide, imatinib and ultimately mepolezumab, but without symptomatic improvement. Repeat lymph node biopsy showed Kaposi's sarcoma, leading to a diagnosis of HIV-1 infection with a modestly reduced CD4 count of 413×10(6)/l (430-1690). Hypereosinophila and eosinophilic folliculitis are recognised features of advanced HIV infection, and transient bilateral facial palsy occasionally occurs at the time of seroconversion. This is the first report of a chronic bilateral facial palsy likely due to primary HIV infection, not occurring during seroconversion and in association with hypereosinophilia. This case emphasises the protean manifestations of HIV infection and the need for routine testing in atypical clinical presentations.

Automated and objective action coding of facial expressions in patients with acute facial palsy.

PubMed

Haase, Daniel; Minnigerode, Laura; Volk, Gerd Fabian; Denzler, Joachim; Guntinas-Lichius, Orlando

2015-05-01

Aim of the present observational single center study was to objectively assess facial function in patients with idiopathic facial palsy with a new computer-based system that automatically recognizes action units (AUs) defined by the Facial Action Coding System (FACS). Still photographs using posed facial expressions of 28 healthy subjects and of 299 patients with acute facial palsy were automatically analyzed for bilateral AU expression profiles. All palsies were graded with the House-Brackmann (HB) grading system and with the Stennert Index (SI). Changes of the AU profiles during follow-up were analyzed for 77 patients. The initial HB grading of all patients was 3.3 ± 1.2. SI at rest was 1.86 ± 1.3 and during motion 3.79 ± 4.3. Healthy subjects showed a significant AU asymmetry score of 21 ± 11 % and there was no significant difference to patients (p = 0.128). At initial examination of patients, the number of activated AUs was significantly lower on the paralyzed side than on the healthy side (p < 0.0001). The final examination for patients took place 4 ± 6 months post baseline. The number of activated AUs and the ratio between affected and healthy side increased significantly between baseline and final examination (both p < 0.0001). The asymmetry score decreased between baseline and final examination (p < 0.0001). The number of activated AUs on the healthy side did not change significantly (p = 0.779). Radical rethinking in facial grading is worthwhile: automated FACS delivers fast and objective global and regional data on facial motor function for use in clinical routine and clinical trials.

Anatomical study of the facial nerve canal in comparison to the site of the lesion in Bell's palsy.

PubMed

Dawidowsky, Krsto; Branica, Srećko; Batelja, Lovorka; Dawidowsky, Barbara; Kovać-Bilić, Lana; Simunić-Veselić, Anamarija

2011-03-01

The term Bell's palsy is used for the peripheral paresis of the facial nerve and is of unknown origin. Many studies have been performed to find the cause of the disease, but none has given certain evidence of the etiology. However, the majority of investigators agree that the pathophysiology of the palsy starts with the edema of the facial nerve and consequent entrapment of the nerve in the narrow facial canal in the temporal bone. In this study the authors wanted to find why the majority of the paresis are suprastapedial, i.e. why the entrapment of the nerve mainly occurs in the proximal part of the canal. For this reason they carried out anatomical measurements of the facial canal diameter in 12 temporal bones. By use of a computer program which measures the cross-sectional area from the diameter, they proved that the width of the canal is smaller at its proximal part. Since the nerve is thicker at that point because it contains more nerve fibers, the authors conclude that the discrepancy between the nerve diameter and the surrounding bony walls in the suprastapedial part of the of the canal would, in cases of a swollen nerve after inflammation, cause the facial palsy.

Bell's Palsy.

PubMed

Reich, Stephen G

2017-04-01

Bell's palsy is a common outpatient problem, and while the diagnosis is usually straightforward, a number of diagnostic pitfalls can occur, and a lengthy differential diagnosis exists. Recognition and management of Bell's palsy relies on knowledge of the anatomy and function of the various motor and nonmotor components of the facial nerve. Avoiding diagnostic pitfalls relies on recognizing red flags or features atypical for Bell's palsy, suggesting an alternative cause of peripheral facial palsy. The first American Academy of Neurology (AAN) evidence-based review on the treatment of Bell's palsy in 2001 concluded that corticosteroids were probably effective and that the antiviral acyclovir was possibly effective in increasing the likelihood of a complete recovery from Bell's palsy. Subsequent studies led to a revision of these recommendations in the 2012 evidence-based review, concluding that corticosteroids, when used shortly after the onset of Bell's palsy, were "highly likely" to increase the probability of recovery of facial weakness and should be offered; the addition of an antiviral to steroids may increase the likelihood of recovery but, if so, only by a very modest effect. Bell's palsy is characterized by the spontaneous acute onset of unilateral peripheral facial paresis or palsy in isolation, meaning that no features from the history, neurologic examination, or head and neck examination suggest a specific or alternative cause. In this setting, no further testing is necessary. Even without treatment, the outcome of Bell's palsy is favorable, but treatment with corticosteroids significantly increases the likelihood of improvement.

Effect of facial neuromuscular re-education on facial symmetry in patients with Bell's palsy: a randomized controlled trial.

PubMed

Manikandan, N

2007-04-01

To determine the effect of facial neuromuscular re-education over conventional therapeutic measures in improving facial symmetry in patients with Bell's palsy. Randomized controlled trial. Neurorehabilitation unit. Fifty-nine patients diagnosed with Bell's palsy were included in the study after they met the inclusion criteria. Patients were randomly divided into two groups: control (n = 30) and experimental (n = 29). Control group patients received conventional therapeutic measures while the facial neuromuscular re-education group patients received techniques that were tailored to each patient in three sessions per day for six days per week for a period of two weeks. All the patients were evaluated using a Facial Grading Scale before treatment and after three months. The Facial Grading Scale scores showed significant improvement in both control (mean 32 (range 9.7-54) to 54.5 (42.2-71.7)) and the experimental (33 (18-43.5) to 66 (54-76.7)) group. Facial Grading Scale change scores showed that experimental group (27.5 (20-43.77)) improved significantly more than the control group (16.5 (12.2-24.7)). Analysis of Facial Grading Scale subcomponents did not show statistical significance, except in the movement score (12 (8-16) to 24 (12-18)). Individualized facial neuromuscular re-education is more effective in improving facial symmetry in patients with Bell's palsy than conventional therapeutic measures.

Synkinesis assessment in facial palsy: validation of the Dutch Synkinesis Assessment Questionnaire.

PubMed

Kleiss, Ingrid J; Beurskens, Carien H G; Stalmeier, Peep F M; Ingels, Koen J A O; Marres, Henri A M

2016-06-01

The objective of this study is to validate an existing health-related quality of life questionnaire for patients with synkinesis in facial palsy for implementation in the Dutch language and culture. The Synkinesis Assessment Questionnaire was translated into the Dutch language using a forward-backward translation method. A pilot test with the translated questionnaire was performed in 10 patients with facial palsy and 10 normal subjects. Finally, cross-cultural adaption was accomplished at our outpatient clinic for facial palsy. Analyses for internal consistency, test-retest reliability, and construct validity were performed. Sixty-six patients completed the Dutch Synkinesis Assessment Questionnaire and the Dutch Facial Disability Index. Cronbach's α, representing internal consistency, was 0.80. Test-retest reliability was 0.53 (Spearman's correlation coefficient, P < 0.01). Correlations with the House-Brackmann score, Sunnybrook score, Facial Disability Index physical function, and social/well-being function were -0.29, 0.20, -0.29, and -0.32, respectively. Correlation with the Sunnybrook synkinesis subscore was 0.50 (Spearman's correlation coefficient). The Dutch Synkinesis Assessment Questionnaire shows good psychometric values and can be implemented in the management of Dutch-speaking patients with facial palsy and synkinesis in the Netherlands. Translation of the instrument into other languages may lead to widespread use, making evaluation, and comparison possible among different providers.

Recurrences of Bell's palsy.

PubMed

Cirpaciu, D; Goanta, C M; Cirpaciu, M D

2014-01-01

Bell's palsy in known as the most common cause of facial paralysis, determined by the acute onset of lower motor neuron weakness of the facial nerve with no detectable cause. With a lifetime risk of 1 in 60 and an annual incidence of 11-40/100,000 population, the condition resolves completely in around 71% of the untreated cases. Clinical trials performed for Bell's palsy have reported some recurrences, ipsilateral or contralateral to the side affected in the primary episode of facial palsy. Only few data are found in the literature. Melkersson-Rosenthal is a rare neuromucocutaneous syndrome characterized by recurrent facial paralysis, fissured tongue (lingua plicata), orofacial edema. We attempted to analyze some clinical and epidemiologic aspects of recurrent idiopathic palsy, and to develop relevant correlations between the existing data in literature and those obtained in this study. This is a retrospective study carried out on a 10-years period for adults and a five-year period for children. A number of 185 patients aged between 4 and 70 years old were analyzed. 136 of them were adults and 49 were children. 22 of 185 patients with Bell's palsy (12%) had a recurrent partial or complete facial paralysis with one to six episodes of palsy. From this group of 22 cases, 5 patients were diagnosed with Melkersson-Rosenthal syndrome. The patients' age was between 4 and 70 years old, with a medium age of 27,6 years. In the group studied, fifteen patients, meaning 68%, were women and seven were men. The majority of patients in our group with more than two facial palsy episodes had at least one episode on the contralateral side. Our study found a significant incidence of recurrences of idiopathic facial palsy. Recurrent idiopathic facial palsy and Melkersson-Rosenthal syndrome is diagnosed more often in young females. Recurrence is more likely to occur in the first two years from the onset, which leads to the conclusion that we should have a follow up of patients

Physical therapy for Bell's palsy (idiopathic facial paralysis).

PubMed

Teixeira, Lázaro J; Valbuza, Juliana S; Prado, Gilmar F

2011-12-07

Bell's palsy (idiopathic facial paralysis) is commonly treated by various physical therapy strategies and devices, but there are many questions about their efficacy. To evaluate physical therapies for Bell's palsy (idiopathic facial palsy). We searched the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2011), MEDLINE (January 1966 to February 2011), EMBASE (January 1946 to February 2011), LILACS (January 1982 to February 2011), PEDro (from 1929 to February 2011), and CINAHL (January 1982 to February 2011). We included searches in clinical trials register databases until February 2011. We selected randomised or quasi-randomised controlled trials involving any physical therapy. We included participants of any age with a diagnosis of Bell's palsy and all degrees of severity. The outcome measures were: incomplete recovery six months after randomisation, motor synkinesis, crocodile tears or facial spasm six months after onset, incomplete recovery after one year and adverse effects attributable to the intervention. Two authors independently scrutinised titles and abstracts identified from the search results. Two authors independently carried out risk of bias assessments, which , took into account secure methods of randomisation, allocation concealment, observer blinding, patient blinding, incomplete outcome data, selective outcome reporting and other bias. Two authors independently extracted data using a specially constructed data extraction form. We undertook separate subgroup analyses of participants with more and less severe disability. For this update to the original review, the search identified 65 potentially relevant articles. Twelve studies met the inclusion criteria (872 participants). Four trials studied the efficacy of electrical stimulation (313 participants), three trials studied exercises (199 participants), and five studies compared or combined some form of physical therapy

Management of synkinesis and asymmetry in facial nerve palsy: a review article.

PubMed

Pourmomeny, Abbas Ali; Asadi, Sahar

2014-10-01

The important sequelae of facial nerve palsy are synkinesis, asymmetry, hypertension and contracture; all of which have psychosocial effects on patients. Synkinesis due to mal regeneration causes involuntary movements during a voluntary movement. Previous studies have advocated treatment using physiotherapy modalities alone or with exercise therapy, but no consensus exists on the optimal approach. Thus, this review summarizes clinical controlled studies in the management of synkinesis and asymmetry in facial nerve palsy. Case-controlled clinical studies of patients at the acute stage of injury were selected for this review article. Data were obtained from English-language databases from 1980 until mid-2013. Among 124 articles initially captured, six randomized controlled trials involving 269 patients were identified with appropriate inclusion criteria. The results of all these studies emphasized the benefit of exercise therapy. Four studies considered electromyogram (EMG) biofeedback to be effective through neuromuscular re-education. Synkinesis and inconsistency of facial muscles could be treated with educational exercise therapy. EMG biofeedback is a suitable tool for this exercise therapy.

When is facial paralysis Bell palsy? Current diagnosis and treatment.

PubMed

Ahmed, Anwar

2005-05-01

Bell palsy is largely a diagnosis of exclusion, but certain features in the history and physical examination help distinguish it from facial paralysis due to other conditions: eg, abrupt onset with complete, unilateral facial weakness at 24 to 72 hours, and, on the affected side, numbness or pain around the ear, a reduction in taste, and hypersensitivity to sounds. Corticosteroids and antivirals given within 10 days of onset have been shown to help. But Bell palsy resolves spontaneously without treatment in most patients within 6 months.

Facial palsy in children: emergency department management and outcome.

PubMed

Wang, Cheng-Hsien; Chang, Yu-Che; Shih, Hong-Mo; Chen, Chun-Yu; Chen, Jih-Chang

2010-02-01

To describe the characteristics of children who present to an emergency department (ED) with facial palsy and determine the association of outcome with etiology, degree of initial paralysis, and ED management. This was a retrospective cohort study of children who presented to an ED with facial nerve paralysis (FNP). There were 85 patients with a mean age of 8.0 (SD, 6.1) years; 60% (n = 51) of the patients were male, and 65.9% (n = 56) were admitted to the hospital. Bell palsy (50.6%) was the most common etiology followed by infectious (22.4%), traumatic (16.5%), congenital (7.1%), and neoplastic etiologies (3.5%). Patients with Bell palsy had shorter recovery times (P = 0.049), and traumatic cases required a longer time for recovery (P = 0.016). Acute otitis media (AOM)-related pediatric FNP had shorter recovery times than non-AOM-related cases (P = 0.005) in infectious group. Patients given steroid therapy did not have a shorter recovery time (P = 0.237) or a better recovery (P = 0.269). There was no difference in recovery rate of pediatric patients with Bell palsy between hospitalization or not (P = 0.952). Bell palsy, infection, and trauma were most common etiologies of pediatric FNP. Recovery times were shorter in pediatric patients with Bell palsy and AOM-related FNP, whereas recovery took longer in traumatic cases. Steroid therapy did not seem beneficial for pediatric FNP. Hospitalization is not indicated for pediatric patients with Bell palsy.

Middle ear osteoma causing progressive facial nerve weakness: a case report.

PubMed

Curtis, Kate; Bance, Manohar; Carter, Michael; Hong, Paul

2014-09-18

Facial nerve weakness is most commonly due to Bell's palsy or cerebrovascular accidents. Rarely, middle ear tumor presents with facial nerve dysfunction. We report a very unusual case of middle ear osteoma in a 49-year-old Caucasian woman causing progressive facial nerve deficit. A subtle middle ear lesion was observed on otoscopy and computed tomographic images demonstrated an osseous middle ear tumor. Complete surgical excision resulted in the partial recovery of facial nerve function. Facial nerve dysfunction is rarely caused by middle ear tumors. The weakness is typically due to a compressive effect on the middle ear portion of the facial nerve. Early recognition is crucial since removal of these lesions may lead to the recuperation of facial nerve function.

[Petrous plasmacytoma revealed by a painful peripheral facial palsy].

PubMed

Lagarde, J; Cret, C; Karlin, L; Ameri, A

2011-01-01

The classical hypothesis of Bell's palsy, tempting in cases of peripheral facial palsy of rapid onset, must nevertheless be evoked with caution particularly if an intense pain is present, which should lead to search for a tumor of the skull base, especially the petrous bone. A 43-year-old man presented a peripheral facial palsy of rapidly progressive onset. A petrous bone tumor was diagnosed on the CT scan, which revealed an aspect of a glomic tumor or a metastatic lesion. The final histological diagnosis was plasmacytoma. This type of tumor has been rarely reported in this location. The radiological features are not specific at all, underlying the importance of searching for some associated signs such as a monoclonal protein and performing a histological examination when the firm diagnosis of a systemic disease like multiple myeloma has not been possible. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

IncobotulinumtoxinA treatment of facial nerve palsy after neurosurgery.

PubMed

Akulov, Mihail A; Orlova, Ol'ga R; Orlova, Aleksandra S; Usachev, Dmitrij J; Shimansky, Vadim N; Tanjashin, Sergey V; Khatkova, Svetlana E; Yunosha-Shanyavskaya, Anna V

2017-10-15

This study evaluates the effect of incobotulinumtoxinA in the acute and chronic phases of facial nerve palsy after neurosurgical interventions. Patients received incobotulinumtoxinA injections (active treatment group) or standard rehabilitation treatment (control group). Functional efficacy was assessed using House-Brackmann, Yanagihara System and Sunnybrook Facial Grading scales, and Facial Disability Index self-assessment. Significant improvements on all scales were seen after 1month of incobotulinumtoxinA treatment (active treatment group, р<0.05), but only after 3months of rehabilitation treatment (control group, р<0.05). At 1 and 2years post-surgery, the prevalence of synkinesis was significantly higher in patients in the control group compared with those receiving incobotulinumtoxinA treatment (р<0.05 and р<0.001, respectively). IncobotulinumtoxinA treatment resulted in significant improvements in facial symmetry in patients with facial nerve injury following neurosurgical interventions. Treatment was effective for the correction of the compensatory hyperactivity of mimic muscles on the unaffected side that develops in the acute period of facial nerve palsy, and for the correction of synkinesis in the affected side that develops in the long-term period. Appropriate dosing and patient education to perform exercises to restore mimic muscle function should be considered in multimodal treatment. Copyright © 2017 Elsevier B.V. All rights reserved.

Transient delayed facial nerve palsy after inferior alveolar nerve block anesthesia.

PubMed

Tzermpos, Fotios H; Cocos, Alina; Kleftogiannis, Matthaios; Zarakas, Marissa; Iatrou, Ioannis

2012-01-01

Facial nerve palsy, as a complication of an inferior alveolar nerve block anesthesia, is a rarely reported incident. Based on the time elapsed, from the moment of the injection to the onset of the symptoms, the paralysis could be either immediate or delayed. The purpose of this article is to report a case of delayed facial palsy as a result of inferior alveolar nerve block, which occurred 24 hours after the anesthetic administration and subsided in about 8 weeks. The pathogenesis, treatment, and results of an 8-week follow-up for a 20-year-old patient referred to a private maxillofacial clinic are presented and discussed. The patient's previous medical history was unremarkable. On clinical examination the patient exhibited generalized weakness of the left side of her face with a flat and expressionless appearance, and she was unable to close her left eye. One day before the onset of the symptoms, the patient had visited her dentist for a routine restorative procedure on the lower left first molar and an inferior alveolar block anesthesia was administered. The patient's medical history, clinical appearance, and complete examinations led to the diagnosis of delayed facial nerve palsy. Although neurologic occurrences are rare, dentists should keep in mind that certain dental procedures, such as inferior alveolar block anesthesia, could initiate facial nerve palsy. Attention should be paid during the administration of the anesthetic solution.

Recurrences of Bell's palsy

PubMed Central

Cirpaciu, D; Goanta, CM; Cirpaciu, MD

2014-01-01

Introduction. Bell’s palsy in known as the most common cause of facial paralysis, determined by the acute onset of lower motor neuron weakness of the facial nerve with no detectable cause. With a lifetime risk of 1 in 60 and an annual incidence of 11-40/100,000 population, the condition resolves completely in around 71% of the untreated cases. Clinical trials performed for Bell’s palsy have reported some recurrences, ipsilateral or contralateral to the side affected in the primary episode of facial palsy. Only few data are found in the literature. Melkersson-Rosenthal is a rare neuromucocutaneous syndrome characterized by recurrent facial paralysis, fissured tongue (lingua plicata), orofacial edema. Purpose. We attempted to analyze some clinical and epidemiologic aspects of recurrent idiopathic palsy, and to develop relevant correlations between the existing data in literature and those obtained in this study. Methods & Materials. This is a retrospective study carried out on a 10-years period for adults and a five-year period for children. Results. A number of 185 patients aged between 4 and 70 years old were analyzed. 136 of them were adults and 49 were children. 22 of 185 patients with Bell’s palsy (12%) had a recurrent partial or complete facial paralysis with one to six episodes of palsy. From this group of 22 cases, 5 patients were diagnosed with Melkersson-Rosenthal syndrome. The patients’ age was between 4 and 70 years old, with a medium age of 27,6 years. In the group studied, fifteen patients, meaning 68%, were women and seven were men. The majority of patients in our group with more than two facial palsy episodes had at least one episode on the contralateral side. Conclusions. Our study found a significant incidence of recurrences of idiopathic facial palsy. Recurrent idiopathic facial palsy and Melkersson-Rosenthal syndrome is diagnosed more often in young females. Recurrence is more likely to occur in the first two years from the onset, which

Clinical practice guideline: Bell's palsy.

PubMed

Baugh, Reginald F; Basura, Gregory J; Ishii, Lisa E; Schwartz, Seth R; Drumheller, Caitlin Murray; Burkholder, Rebecca; Deckard, Nathan A; Dawson, Cindy; Driscoll, Colin; Gillespie, M Boyd; Gurgel, Richard K; Halperin, John; Khalid, Ayesha N; Kumar, Kaparaboyna Ashok; Micco, Alan; Munsell, Debra; Rosenbaum, Steven; Vaughan, William

2013-11-01

Bell's palsy, named after the Scottish anatomist, Sir Charles Bell, is the most common acute mono-neuropathy, or disorder affecting a single nerve, and is the most common diagnosis associated with facial nerve weakness/paralysis. Bell's palsy is a rapid unilateral facial nerve paresis (weakness) or paralysis (complete loss of movement) of unknown cause. The condition leads to the partial or complete inability to voluntarily move facial muscles on the affected side of the face. Although typically self-limited, the facial paresis/paralysis that occurs in Bell's palsy may cause significant temporary oral incompetence and an inability to close the eyelid, leading to potential eye injury. Additional long-term poor outcomes do occur and can be devastating to the patient. Treatments are generally designed to improve facial function and facilitate recovery. There are myriad treatment options for Bell's palsy, and some controversy exists regarding the effectiveness of several of these options, and there are consequent variations in care. In addition, numerous diagnostic tests available are used in the evaluation of patients with Bell's palsy. Many of these tests are of questionable benefit in Bell's palsy. Furthermore, while patients with Bell's palsy enter the health care system with facial paresis/paralysis as a primary complaint, not all patients with facial paresis/paralysis have Bell's palsy. It is a concern that patients with alternative underlying etiologies may be misdiagnosed or have unnecessary delay in diagnosis. All of these quality concerns provide an important opportunity for improvement in the diagnosis and management of patients with Bell's palsy. The primary purpose of this guideline is to improve the accuracy of diagnosis for Bell's palsy, to improve the quality of care and outcomes for patients with Bell's palsy, and to decrease harmful variations in the evaluation and management of Bell's palsy. This guideline addresses these needs by encouraging

Long-Term Facial Nerve Outcomes after Microsurgical Resection of Vestibular Schwannomas in Patients with Preoperative Facial Nerve Palsy.

PubMed

Mooney, Michael A; Hendricks, Benjamin; Sarris, Christina E; Spetzler, Robert F; Almefty, Kaith K; Porter, Randall W

2018-06-01

Objectives  This study aimed at evaluating facial nerve outcomes in vestibular schwannoma patients presenting with preoperative facial nerve palsy. Design  A retrospective review. Setting  Single-institution cohort. Participants  Overall, 368 consecutive patients underwent vestibular schwannoma resection. Patients with prior microsurgery or radiosurgery were excluded. Main Outcome Measures  Incidence, House-Brackmann grade. Results  Of 368 patients, 9 had confirmed preoperative facial nerve dysfunction not caused by prior treatment, for an estimated incidence of 2.4%. Seven of these nine patients had Koos grade 4 tumors. Mean tumor diameter was 3.0 cm (range: 2.1-4.4 cm), and seven of nine tumors were subtotally resected. All nine patients were followed up clinically for ≥ 6 months. Of the six patients with a preoperative House-Brackmann grade of II, two improved to grade I, three were stable, and one patient worsened to grade III. Of the three patients with grade III or worse, all remained stable at last follow-up. Conclusions  Preoperative facial nerve palsy is rare in patients with vestibular schwannoma; it tends to occur in patients with relatively large lesions. Detailed long-term outcomes of facial nerve function after microsurgical resection for these patients have not been reported previously. We followed nine patients and found that eight (89%) of the nine patients had either stable or improved facial nerve outcomes after treatment. Management strategies varied for these patients, including rates of subtotal versus gross-total resection and the use of stereotactic radiosurgery in patients with residual tumor. These results can be used to help counsel patients preoperatively on expected outcomes of facial nerve function after treatment.

Novel pre-therapeutic scoring system using patient and haematological data to predict facial palsy prognosis.

PubMed

Wasano, K; Ishikawa, T; Kawasaki, T; Yamamoto, S; Tomisato, S; Shinden, S; Minami, S; Wakabayashi, T; Ogawa, K

2017-12-01

We describe a novel scoring system, the facial Palsy Prognosis Prediction score (PPP score), which we test for reliability in predicting pre-therapeutic prognosis of facial palsy. We aimed to use readily available patient data that all clinicians have access to before starting treatment. Multicenter case series with chart review. Three tertiary care hospitals. We obtained haematological and demographic data from 468 facial palsy patients who were treated between 2010 and 2014 in three tertiary care hospitals. Patients were categorised as having Bell's palsy or Ramsey Hunt's palsy. We compared the data of recovered and unrecovered patients. PPP scores consisted of combinatorial threshold values of continuous patient data (eg platelet count) and categorical variables (eg gender) that best predicted recovery. We created separate PPP scores for Bell's palsy patients (PPP-B) and for Ramsey Hunt's palsy patients (PPP-H). The PPP-B score included age (≥65 years), gender (male) and neutrophil-to-lymphocyte ratio (≥2.9). The PPP-H score included age (≥50 years), monocyte rate (≥6.0%), mean corpuscular volume (≥95 fl) and platelet count (≤200 000 /μL). Patient recovery rate significantly decreased with increasing PPP scores (both PPP-B and PPP-H) in a step-wise manner. PPP scores (ie PPP-B score and PPP-H score) ≥2 were associated with worse than average prognosis. Palsy Prognosis Prediction scores are useful for predicting prognosis of facial palsy before beginning treatment. © 2017 John Wiley & Sons Ltd.

Transient Delayed Facial Nerve Palsy After Inferior Alveolar Nerve Block Anesthesia

PubMed Central

Tzermpos, Fotios H.; Cocos, Alina; Kleftogiannis, Matthaios; Zarakas, Marissa; Iatrou, Ioannis

2012-01-01

Facial nerve palsy, as a complication of an inferior alveolar nerve block anesthesia, is a rarely reported incident. Based on the time elapsed, from the moment of the injection to the onset of the symptoms, the paralysis could be either immediate or delayed. The purpose of this article is to report a case of delayed facial palsy as a result of inferior alveolar nerve block, which occurred 24 hours after the anesthetic administration and subsided in about 8 weeks. The pathogenesis, treatment, and results of an 8-week follow-up for a 20-year-old patient referred to a private maxillofacial clinic are presented and discussed. The patient's previous medical history was unremarkable. On clinical examination the patient exhibited generalized weakness of the left side of her face with a flat and expressionless appearance, and she was unable to close her left eye. One day before the onset of the symptoms, the patient had visited her dentist for a routine restorative procedure on the lower left first molar and an inferior alveolar block anesthesia was administered. The patient's medical history, clinical appearance, and complete examinations led to the diagnosis of delayed facial nerve palsy. Although neurologic occurrences are rare, dentists should keep in mind that certain dental procedures, such as inferior alveolar block anesthesia, could initiate facial nerve palsy. Attention should be paid during the administration of the anesthetic solution. PMID:22428971

[Bilateral facial nerve palsy associated with Epstein-Barr virus infection in a 3-year-old boy].

PubMed

Grassin, M; Rolland, A; Leboucq, N; Roubertie, A; Rivier, F; Meyer, P

2017-06-01

Bilateral facial nerve palsy is a rare and sometimes difficult diagnosis. We describe a case of bilateral simultaneous facial nerve palsy associated with Epstein-Barr virus (EBV) infection in a 3-year-old boy. Several symptoms led to the diagnosis of EBV infection: the clinical situation (fever, stomachache, and throat infection), white blood cell count (5300/mm 3 with 70% lymphocyte count), seroconversion with EBV-specific antibodies, lymphocytic meningitis, and a positive blood EBV polymerase chain reaction (9.3×10 3 copies of EBV-DNA). An MRI brain scan showed bilateral gadolinium enhancement of the facial nerve. A treatment plan with IV antibiotics (ceftriaxone) and corticosteroids was implemented. Antibiotics were stopped after the diagnosis of Lyme disease was ruled out. The patient's facial weakness improved within a few weeks. Bilateral facial nerve palsy is rare and, unlike unilateral facial palsy, it is idiopathic in only 20% of cases. Therefore, it requires further investigation and examination to search for the underlying etiology. Lyme disease is the first infectious disease that should be considered in children, especially in endemic areas. An antibiotic treatment effective against Borrelia burgdorferi should be set up until the diagnosis is negated or confirmed. Further examination should include a blood test (such as immunologic testing, and serologic testing for viruses and bacterium with neurological tropism), a cerebrospinal fluid test, and an MRI brain scan to exclude any serious or curable underlying etiology. Facial bilateral nerve palsy associated with EBV is rarely described in children. Neurological complications have been reported in 7% of all EBV infections. The facial nerve is the most frequently affected of all cranial nerves. Facial palsy described in EBV infections is bilateral in 35% of all cases. The physiopathology is currently unknown. Prognosis is good most of the time. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Role of electrical stimulation added to conventional therapy in patients with idiopathic facial (Bell) palsy.

PubMed

Tuncay, Figen; Borman, Pinar; Taşer, Burcu; Ünlü, İlhan; Samim, Erdal

2015-03-01

The aim of this study was to determine the efficacy of electrical stimulation when added to conventional physical therapy with regard to clinical and neurophysiologic changes in patients with Bell palsy. This was a randomized controlled trial. Sixty patients diagnosed with Bell palsy (39 right sided, 21 left sided) were included in the study. Patients were randomly divided into two therapy groups. Group 1 received physical therapy applying hot pack, facial expression exercises, and massage to the facial muscles, whereas group 2 received electrical stimulation treatment in addition to the physical therapy, 5 days per week for a period of 3 wks. Patients were evaluated clinically and electrophysiologically before treatment (at the fourth week of the palsy) and again 3 mos later. Outcome measures included the House-Brackmann scale and Facial Disability Index scores, as well as facial nerve latencies and amplitudes of compound muscle action potentials derived from the frontalis and orbicularis oris muscles. Twenty-nine men (48.3%) and 31 women (51.7%) with Bell palsy were included in the study. In group 1, 16 (57.1%) patients had no axonal degeneration and 12 (42.9%) had axonal degeneration, compared with 17 (53.1%) and 15 (46.9%) patients in group 2, respectively. The baseline House-Brackmann and Facial Disability Index scores were similar between the groups. At 3 mos after onset, the Facial Disability Index scores were improved similarly in both groups. The classification of patients according to House-Brackmann scale revealed greater improvement in group 2 than in group 1. The mean motor nerve latencies and compound muscle action potential amplitudes of both facial muscles were statistically shorter in group 2, whereas only the mean motor latency of the frontalis muscle decreased in group 1. The addition of 3 wks of daily electrical stimulation shortly after facial palsy onset (4 wks), improved functional facial movements and electrophysiologic outcome measures at

Evaluation of a physiotherapeutic treatment intervention in "Bell's" facial palsy.

PubMed

Cederwall, Elisabet; Olsén, Monika Fagevik; Hanner, Per; Fogdestam, Ingemar

2006-01-01

The aim of this study was to evaluate a physiotherapeutic treatment intervention in Bell's palsy. A consecutive series of nine patients with Bell's palsy participated in the study. The subjects were enrolled 4-21 weeks after the onset of facial paralysis. The study had a single subject experimental design with a baseline period of 2-6 weeks and a treatment period of 26-42 weeks. The patients were evaluated using a facial grading score, a paresis index and a written questionnaire created for this study. Every patient was taught to perform an exercise program twice daily, including movements of the muscles surrounding the mouth, nose, eyes and forehead. All the patients improved in terms of symmetry at rest, movement and function. In conclusion, patients with remaining symptoms of Bell's palsy appear to experience positive effects from a specific training program. A larger study, however, is needed to fully evaluate the treatment.

Photographic Standards for Patients With Facial Palsy and Recommendations by Members of the Sir Charles Bell Society

PubMed Central

Santosa, Katherine B.; Fattah, Adel; Gavilán, Javier; Hadlock, Tessa A.; Snyder-Warwick, Alison K.

2017-01-01

IMPORTANCE There is no widely accepted assessment tool or common language used by clinicians caring for patients with facial palsy, making exchange of information challenging. Standardized photography may represent such a language and is imperative for precise exchange of information and comparison of outcomes in this special patient population. OBJECTIVES To review the literature to evaluate the use of facial photography in the management of patients with facial palsy and to examine the use of photography in documenting facial nerve function among members of the Sir Charles Bell Society—a group of medical professionals dedicated to care of patients with facial palsy. DESIGN, SETTING, AND PARTICIPANTS A literature search was performed to review photographic standards in patients with facial palsy. In addition, a cross-sectional survey of members of the Sir Charles Bell Society was conducted to examine use of medical photography in documenting facial nerve function. The literature search and analysis was performed in August and September 2015, and the survey was conducted in August and September 2013. MAIN OUTCOMES AND MEASURES The literature review searched EMBASE, CINAHL, and MEDLINE databases from inception of each database through September 2015. Additional studies were identified by scanning references from relevant studies. Only English-language articles were eligible for inclusion. Articles that discussed patients with facial palsy and outlined photographic guidelines for this patient population were included in the study. The survey was disseminated to the Sir Charles Bell Society members in electronic form. It consisted of 10 questions related to facial grading scales, patient-reported outcome measures, other psychological assessment tools, and photographic and videographic recordings. RESULTS In total, 393 articles were identified in the literature search, 7 of which fit the inclusion criteria. Six of the 7 articles discussed or proposed views specific

Photographic Standards for Patients With Facial Palsy and Recommendations by Members of the Sir Charles Bell Society.

PubMed

Santosa, Katherine B; Fattah, Adel; Gavilán, Javier; Hadlock, Tessa A; Snyder-Warwick, Alison K

2017-07-01

There is no widely accepted assessment tool or common language used by clinicians caring for patients with facial palsy, making exchange of information challenging. Standardized photography may represent such a language and is imperative for precise exchange of information and comparison of outcomes in this special patient population. To review the literature to evaluate the use of facial photography in the management of patients with facial palsy and to examine the use of photography in documenting facial nerve function among members of the Sir Charles Bell Society-a group of medical professionals dedicated to care of patients with facial palsy. A literature search was performed to review photographic standards in patients with facial palsy. In addition, a cross-sectional survey of members of the Sir Charles Bell Society was conducted to examine use of medical photography in documenting facial nerve function. The literature search and analysis was performed in August and September 2015, and the survey was conducted in August and September 2013. The literature review searched EMBASE, CINAHL, and MEDLINE databases from inception of each database through September 2015. Additional studies were identified by scanning references from relevant studies. Only English-language articles were eligible for inclusion. Articles that discussed patients with facial palsy and outlined photographic guidelines for this patient population were included in the study. The survey was disseminated to the Sir Charles Bell Society members in electronic form. It consisted of 10 questions related to facial grading scales, patient-reported outcome measures, other psychological assessment tools, and photographic and videographic recordings. In total, 393 articles were identified in the literature search, 7 of which fit the inclusion criteria. Six of the 7 articles discussed or proposed views specific to patients with facial palsy. However, none of the articles specifically focused on

Treatment and Prognosis of Facial Palsy on Ramsay Hunt Syndrome: Results Based on a Review of the Literature

PubMed Central

Monsanto, Rafael da Costa; Bittencourt, Aline Gomes; Bobato Neto, Natal José; Beilke, Silvia Carolina Almeida; Lorenzetti, Fabio Tadeu Moura; Salomone, Raquel

2016-01-01

Introduction Ramsay Hunt syndrome is the second most common cause of facial palsy. Early and correct treatment should be performed to avoid complications, such as permanent facial nerve dysfunction. Objective The objective of this study is to review the prognosis of the facial palsy on Ramsay Hunt syndrome, considering the different treatments proposed in the literature. Data Synthesis We read the abstract of 78 studies; we selected 31 studies and read them in full. We selected 19 studies for appraisal. Among the 882 selected patients, 621 (70.4%) achieved a House-Brackmann score of I or II; 68% of the patients treated only with steroids achieved HB I or II, versus 70.5% when treated with steroids plus antiviral agents. Among patients with complete facial palsy (grades V or VI), 51.4% recovered to grades I or II. The rate of complete recovery varied considering the steroid associated with acyclovir: 81.3% for methylprednisolone, 69.2% for prednisone; 61.4% for prednisolone; and 76.3% for hydrocortisone. Conclusions Patients with Ramsay-hunt syndrome, when early diagnosed and treated, achieve high rates of complete recovery. The association of steroids and acyclovir is better than steroids used in monotherapy. PMID:27746846

Comparison of Facial Nerve Paralysis in Adults and Children

PubMed Central

Cha, Chang Il; Hong, Chang Kee; Park, Moon Suh

2008-01-01

Purpose Facial nerve injury can occur in the regions ranging from the cerebral cortex to the motor end plate in the face, and from many causes including trauma, viral infection, and idiopathic factors. Facial nerve paralysis in children, however, may differ from that in adults. We, therefore, evaluated its etiology and recovery rate in children and adults. Materials and Methods We retrospectively evaluated the records of 975 patients, ranging in age from 0 to 88 years, who displayed facial palsy at Kyung Hee Medical Center between January 1986 and July 2005. Results The most frequent causes of facial palsy in adults were Bell's palsy (54.9%), infection (26.8%), trauma (5.9%), iatrogenic (2.0%), and tumors (1.8%), whereas the most frequent causes of facial palsy in children were Bell's palsy (66.2%), infection (14.6%), trauma (13.4%), birth trauma (3.2%), and leukemia (1.3%). Recovery rates in adults were 91.4% for Bell's palsy, 89.0% for infection, and 64.3% for trauma, whereas recovery rates in children were 93.1% for Bell's palsy, 90.9% for infection, and 42.9% for trauma. Conclusion These results show that causes of facial palsy are similar in adults and children, and recovery rates in adults and children are not significantly different. PMID:18972592

The treatment of facial palsy from the point of view of physical and rehabilitation medicine.

PubMed

Shafshak, T S

2006-03-01

There are evidences to support recommending the early intake of prednisone (in its appropriate dose of 1 mg/kg body weight for up to 70 or 80 mg/day) or the combined use of prednisone and acyclovir (or valacyclovir) within 72 h following the onset of paralysis in order to improve the outcome of Bell's palsy (BP). Although there may be a controversy about the role of physiotherapy in BP or facial palsy, it seemed that local superficial heat therapy, massage, exercises, electrical stimulation and biofeedback training have a place in the treatment of lower motor facial palsy. However, each modality has its indications. Moreover, some rehabilitative surgical methods might be of benefit for some patients with traumatic facial injuries or long standing paralysis without recovery, but early surgery in BP is usually not recommended. However, few may recommend early surgery in BP when there is 90-100% facial nerve degeneration. The efficacy of acupuncture, magnetic pellets and other modalities of physiotherapy needs further investigation. The general principles and the different opinions in treating and rehabilitating facial palsy are discussed and the need for further research in this field is suggested.

Bell's facial nerve palsy in pregnancy: a clinical review.

PubMed

Hussain, Ahsen; Nduka, Charles; Moth, Philippa; Malhotra, Raman

2017-05-01

Bell's facial nerve palsy (FNP) during pregnancy and the puerperium can present significant challenges for the patient and clinician. Presentation and prognosis can be worse in this group of patients. This article reviews the background, manifestation and management options of FNP. In particular, it focuses on the controversies that exist regarding corticosteroid use during pregnancy and outlines approaches to diagnosis and treatment. Based on this review, we recommend an early evidence-based approach using guidelines derived from non-pregnant populations. This includes assessment for atypical causes, a multidisciplinary input and early introduction of corticosteroids to limit progression and improve prognosis.

Raising the suborbicularis oculi fat (SOOF): its role in chronic facial palsy

PubMed Central

Olver, J.

2000-01-01

AIMS—To determine the adjuvant role of unilateral suborbicularis oculi fat (SOOF) lift in the periorbital rehabilitation of patients with chronic facial palsy.
METHODS—In a non-comparative prospective case series nine adult patients (seven male, two female) aged 34-90 years (mean 60.5) with chronic unrecovered facial palsy (over 1 year), who had not had any previous rehabilitative periorbital surgery, were studied. Lateral tarsal strip and adjuvant transconjunctival approach subperiosteal SOOF lift under local or general anaesthesia were performed; medial canthoplasty was performed where indicated. There was clinical observation of the long term (over 1 year) effect on the ptotic palpebral-malar sulcus and lower eyelid retraction.
RESULTS—The patients were followed up for 12-24 months (mean 16). Seven patients (77%) had sustained clinical reduction of palpebral-malar sulcus ptosis. All patients had sustained reduction of lagophthalmos. Early postoperative complications included conjunctival cheimosis in 77%. Three patients with persistent keratitis required further surgical procedures on their upper eyelid to reduce the palpebral aperture. There were no cases of infraorbital nerve anaesthesia or recurrent lower eyelid retraction.
CONCLUSIONS—The SOOF lift has an adjuvant role in chronic facial palsy with lower eyelid retraction and ptotic-palpebral malar sulcus. It supports the lower eyelid elevation and tightening achieved with the lateral tarsal strip. The best results were obtained in congenital facial palsy.

 PMID:11090482

Diagnosis and management of patients with Bell's palsy.

PubMed

Mooney, Tracy

Bell's palsy (idiopathic facial paralysis) is the most common cause of acute unilateral facial nerve paralysis. Although it is usually a self-limiting condition, it can be distressing for the patient. Many people who experience one-sided facial paralysis fear that it is a symptom of stroke. However, there are subtle differences between Bell's palsy and stroke. This article discusses potential causes of the condition and identifies the differences between Bell's palsy and stroke. In addition, appropriate strategies for the care of patients with the condition are suggested. Management includes antiviral medication, corticosteroid therapy, eye care, botulinum toxin type A injection, physiotherapy, surgery and acupuncture. Psychological and emotional care of these patients is also important because any facial disability caused by facial nerve paralysis can result in anxiety and stress.

[Hemiparesis and facial palsy caused by methotrexate].

PubMed

Rueda Arenas, E; García Corzo, J; Franco Ospina, L

2013-12-01

Methotrexate used in the treatment of acute lymphocytic leukemia, can cause neurotoxicity, including a rare presentation with hemiparesis. We describe two teenagers, who during the implementation of the M phase of the protocol, suffered hemiparesis, facial paresis and dysarthria which quickly reversed. Leukemia involvement of the central nervous system and stroke, were ruled out. We briefly review the pathophysiology of methotrexate neurotoxicity, the characteristics of the focal paresis presentation and magnetic resonance image findings. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

Mirror book therapy for the treatment of idiopathic facial palsy.

PubMed

Barth, Jodi Maron; Stezar, Gincy L; Acierno, Gabriela C; Kim, Thomas J; Reilly, Michael J

2014-09-01

We conducted a retrospective chart review to determine the effectiveness of treating idiopathic facial palsy with mirror book therapy in conjunction with facial physical rehabilitation. We compared outcomes in 15 patients who underwent mirror book therapy in addition to standard therapy with those of 10 patients who underwent standard rehabilitation therapy without the mirror book. Before and after treatment, patients in both groups were rated according to the Facial Grading System (FGS), the Facial Disability Index-Physical (FDIP), and the Facial Disability Index-Social (FDIS). Patients in the mirror therapy group had a mean increase of 24.9 in FGS score, 22.0 in FDIP score, and 25.0 in FDIS score, all of which represented statistically significant improvements over their pretreatment scores. Those who did not receive mirror book therapy had mean increases of 20.8, 19.0, 14.6, respectively; these, too, represented significant improvements over baseline, and thus there was no statistically significant difference in improvement between the two groups. Nevertheless, our results show that patients who used mirror book therapy in addition to standard facial rehabilitation therapy experienced significant improvements in the treatment of idiopathic facial palsy. While further studies are necessary to determine if it has a definitive, statistically significant advantage over standard therapy, we recommend adding this therapy to the rehabilitation program in view of its ease of use, low cost, and lack of side effects.

Alternating facial paralysis in a girl with hypertension: case report.

PubMed

Bağ, Özlem; Karaarslan, Utku; Acar, Sezer; Işgüder, Rana; Unalp, Aycan; Öztürk, Aysel

2013-12-01

Bell's palsy is the most common cause of acquired unilateral facial nerve palsy in childhood. Although the diagnosis depends on the exclusion of less common causes such as infectious, traumatic, malignancy associated and hypertension associated etiologies, pediatricians tend to diagnose idiopatic Bell's palsy whenever a child admits with acquired facial weakness. In this report, we present an eight year old girl, presenting with recurrent and alternant facial palsy as the first symptom of systemic hypertension. She received steroid treatment without measuring blood pressure and this could worsen hypertension. Clinicians should be aware of this association and not neglect to measure the blood pressure before considering steroid therapy for Bell's palsy. In addition, the less common causes of acquired facial palsy should be kept in mind, especially when recurrent and alternant courses occur.

Treatment and Prognosis of Facial Palsy on Ramsay Hunt Syndrome: Results Based on a Review of the Literature.

PubMed

Monsanto, Rafael da Costa; Bittencourt, Aline Gomes; Bobato Neto, Natal José; Beilke, Silvia Carolina Almeida; Lorenzetti, Fabio Tadeu Moura; Salomone, Raquel

2016-10-01

Introduction  Ramsay Hunt syndrome is the second most common cause of facial palsy. Early and correct treatment should be performed to avoid complications, such as permanent facial nerve dysfunction. Objective  The objective of this study is to review the prognosis of the facial palsy on Ramsay Hunt syndrome, considering the different treatments proposed in the literature. Data Synthesis  We read the abstract of 78 studies; we selected 31 studies and read them in full. We selected 19 studies for appraisal. Among the 882 selected patients, 621 (70.4%) achieved a House-Brackmann score of I or II; 68% of the patients treated only with steroids achieved HB I or II, versus 70.5% when treated with steroids plus antiviral agents. Among patients with complete facial palsy (grades V or VI), 51.4% recovered to grades I or II. The rate of complete recovery varied considering the steroid associated with acyclovir: 81.3% for methylprednisolone, 69.2% for prednisone; 61.4% for prednisolone; and 76.3% for hydrocortisone. Conclusions  Patients with Ramsay-hunt syndrome, when early diagnosed and treated, achieve high rates of complete recovery. The association of steroids and acyclovir is better than steroids used in monotherapy.

A non-surgical approach to the management of exposure keratitis due to facial palsy by using mini-scleral lenses.

PubMed

Zaki, Victor

2017-02-01

This is a retrospective study aimed to determine the efficacy of mini-scleral contact lens in protecting the cornea and improving vision in cases of facial palsy. Patients with facial palsy get exposure keratitis because the cornea is dry. They feel pain, discomfort and excessive watering. If left untreated, it leads to permanent damage to the cornea and loss of good functional vision. Mini-scleral lens keep the cornea covered by saline solution all wearing hours. Three patients (4 eyes) with acoustic neuroma, two unilateral and one bilateral, who underwent acoustic neuroma surgeries resulting in facial palsy, are presented.The gold implant and lateral tarsorrhaphy were not enough for corneal protection.Two patients (patients 1 and 2) suffered continuous pain and watering. They had to apply thick lubricant, Lacri-Lube ointment (Allergan, Inc., Dublin, Ireland), several times daily to the affected eye for 15 years. The vision of these patients in the affected eyes were counting fingers (CF) at one foot.Patient 3 with bilateral facial palsy had exposure keratitis in both eyes resulting in constant watering, pain and blurred vision. The 4 eyes were fitted with mini-scleral lenses. The lenses were 15.8 mm rigid gas permeable filled with preservative free saline solution that continuously covers the cornea all wearing hours. In patients 1 and 2 with unilateral facial palsy, vision improved through the mini-scleral lenses to 20/30 and all their symptoms disappeared.The keratitis in case 3 with bilateral facial palsy disappeared within one week of mini-scleral lens use.Follow up for 2 years showed that these patients maintained good vision with no side effects. Mini-scleral lenses protected the cornea, gave comfort and improved the vision and the quality of life of these three patients with facial palsy and should be considered for all patients with facial palsy.

Bell's Palsy

MedlinePlus

Bell's palsy is the most common cause of facial paralysis. It usually affects just one side of the face. Symptoms appear suddenly and are at their ... from mild to severe and ... inflamed. You are most likely to get Bell's palsy if you are pregnant, diabetic or sick ...

Physical therapy for Bell s palsy (idiopathic facial paralysis).

PubMed

Teixeira, Lázaro Juliano; Soares, Bernardo Garcia de Oliveira; Vieira, Vanessa Pedrosa; Prado, Gilmar F

2008-07-16

Bell's palsy (idiopathic facial paralysis) is commonly treated by physical therapy services with various therapeutic strategies and devices. There are many questions about their efficacy and effectiveness. To evaluate the efficacy of physical therapies on the outcome of Bell's palsy. We searched the Cochrane Neuromuscular Disease Group Trials Register (February 2008), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2007), MEDLINE (January 1966 to February 2008), EMBASE (January 1980 to February 2008), LILACS (January 1982 to February 2008), PEDro (from 1929 to February 2008), and CINAHL (January 1982 to February 2008). We selected randomised or quasi-randomised controlled trials involving any physical therapy. We included participants of any age with a diagnosis of Bell's palsy and all degrees of severity. The outcome measures were: incomplete recovery six months after randomisation, motor synkinesis, crocodile tears or facial spasm six months after onset, incomplete recovery after one year and adverse effects attributable to the intervention. Titles and abstracts identified from the register were scrutinized. The assessment of methodological quality took into account secure method of randomisation, allocation concealment, observer blinding, patient blinding, differences at baseline of the experimental groups, and completeness of follow-up. Data were extracted using a specially constructed data extraction form. Separate subgroup analyses of participants with more and less severe disability were undertaken. The search identified 45 potentially relevant articles. Six studies met the inclusion criteria. Three trials studied the efficacy of electrostimulation (294 participants) and three exercises (253 participants). Neither treatment produced significantly more improvement than the control treatment or no treatment. There was limited evidence that improvement began earlier in the exercise group. There is no evidence of significant

Integrating Spatial Epidemiology into a Decision Model for Evaluation of Facial Palsy in Children

PubMed Central

Fine, Andrew M.; Brownstein, John S.; Nigrovic, Lise E.; Kimia, Amir A.; Olson, Karen L.; Thompson, Amy D.; Mandl, Kenneth D.

2013-01-01

Objective To develop a novel diagnostic algorithm for Lyme disease among children with facial palsy by integrating public health surveillance data with traditional clinical predictors. Design Retrospective cohort study. Setting Children’s Hospital Boston emergency department,1995–2007 Patients 264 children under age 20 years presenting with peripheral facial palsy who were evaluated for Lyme disease Main outcome measures Multivariate regression was used to identify independent clinical and epidemiologic predictors of Lyme facial palsy. Results 65% of children from high-risk counties during Lyme season tested positive, compared to 5% of children without geographic or seasonal risk factors present. Among patients with both seasonal and geographic risk factors, 80% with one clinical risk factor (fever or headache) and 100% with two clinical factors had Lyme. Factors independently associated with Lyme facial palsy were presentation from June-November (odds ratio 25, 95% CI 8.3–113), residence in a county where the most recent three year average Lyme incidence exceeded 4 cases/100,000 (18, 6.5–69), fever (3.9, 1.5–11), and headache (2.7, 1.3–5.8). Clinical experts correctly treated 68/94 (72%) patients with Lyme facial palsy, but a tool incorporating geographical and seasonal risk identified all 94 cases. Conclusions Most clinicians intuitively integrate geographic information into Lyme disease management, but we demonstrate quantitatively how formal use of geographically-based incidence in a clinical algorithm improves diagnostic accuracy. These findings demonstrate potential for improved outcomes from investments in health information technology that foster bidirectional communication between public health and clinical settings. PMID:21199982

Severe Hemifacial Spasm is a Predictor of Severe Indentation and Facial Palsy after Microdecompression Surgery.

PubMed

Na, Boo Suk; Cho, Jin Whan; Park, Kwan; Kwon, Soonwook; Kim, Ye Sel; Kim, Ji Sun; Youn, Jinyoung

2018-04-27

Hemifacial spasm (HFS) is mostly caused by the compression of the facial nerve by cerebral vessels, but the significance of spasm severity remains unclear. We investigated the clinical significance of spasm severity in patients with HFS who underwent microvascular decompression (MVD). We enrolled 636 patients with HFS who underwent MVD between May 2010 and December 2013 at Samsung Medical Center (SMC), Seoul, Korea. Subjects were divided into two groups based on spasm severity: severe (SMC grade 3 or 4) and mild (SMC grade 1 or 2). We compared demographic, clinical, and surgical data between these two groups. The severe-spasm group was older and had a longer disease duration at the time of MVD compared to the mild-spasm group. Additionally, hypertension and diabetes mellitus were more common in the severe-spasm group than in the mild-spasm group. Regarding surgical findings, there were more patients with multiple offending vessels and more-severe indentations in the severe-spasm group than in the mild-spasm group. Even though the surgical outcomes did not differ, the incidence of delayed facial palsy after MVD was higher in the severe-spasm group than in the mild-spasm group. Logistic regression analysis showed that severe-spasm was correlated with longer disease duration, hypertension, severe indentation, multiple offending vessels, and delayed facial palsy after MVD. Spasm severity does not predict surgical outcomes, but it can be used as a marker of pathologic compression in MVD for HFS, and be considered as a predictor of delayed facial palsy after MVD. Copyright © 2018 Korean Neurological Association.

Corticosteroids for Bell's palsy (idiopathic facial paralysis).

PubMed

Salinas, Rodrigo A; Alvarez, Gonzalo; Daly, Fergus; Ferreira, Joaquim

2010-03-17

Inflammation and oedema of the facial nerve are implicated in causing Bell's palsy. Corticosteroids have a potent anti-inflammatory action which should minimise nerve damage. The objective of this review was to assess the effect of corticosteroid therapy in Bell's palsy. We searched the Cochrane Neuromuscular Disease Group Trials Specialized Register (9 December 2008) for randomised trials, as well as MEDLINE (January 1966 to December 2008), EMBASE (January 1980 to December 2008) and LILACS (9 December 2008). We contacted known experts in the field to identify additional published or unpublished trials. Randomised trials comparing different routes of administration and dosage schemes of corticosteroid or adrenocorticotrophic hormone therapy versus a control group where no therapy considered effective for this condition was administered, unless it was also given in a similar way to the experimental group. Two authors independently assessed eligibility, trial quality, and extracted the data. Eight trials with a total of 1569 participants were included. Allocation concealment was appropriate in six trials, and the data reported allowed an intention-to-treat analysis in four, while unpublished data from the fifth and sixth trials were provided by the authors. The data included in the main outcome of this meta-analysis were collected from seven trials with a total of 1507 participants. Overall 175/754 (23%) of the participants allocated to corticosteroids had incomplete recovery of facial motor function six months or more after randomisation, significantly less than 245/753 (33%) in the control group (risk ratio (RR) 0.71, 95% confidence interval (CI) 0.61 to 0.83). There was, also, a significant reduction in motor synkinesis during follow-up in those receiving corticosteroids (RR 0.6, 95% CI 0.44 to 0.81). The reduction in the proportion of patients with cosmetically disabling sequelae six months after randomisation, however, was not significant (RR 0.97, 95% CI 0

Rare encounter of unilateral facial nerve palsy in an adolescent with Guillain-Barré syndrome

PubMed Central

Iqbal, Mehtab; Sharma, Parnika; Charadva, Creana; Prasad, Manish

2016-01-01

Unilateral facial nerve palsy is rarely encountered in Guillain-Barré syndrome (GBS). We report a case of an adolescent girl who presented with peripheral ascending weakness, preceded by Campylobacter jejuni infection. After treatment with intravenous immunoglobulin, the peripheral weakness improved. Electro-diagnostic testing confirmed axonal dysfunction and the patient was positive for antiganglioside antibodies. However, the patient developed unilateral left-sided facial weakness. She was managed with further intravenous immunoglobulin and intensive physiotherapy. The outcome for facial palsy was very good, with almost complete resolution after 2 weeks. PMID:26823357

Serial neurophysiological and neurophysiological examinations for delayed facial nerve palsy in a patient with Fisher syndrome.

PubMed

Umekawa, Motoyuki; Hatano, Keiko; Matsumoto, Hideyuki; Shimizu, Takahiro; Hashida, Hideji

2017-05-27

The patient was a 47-year-old man who presented with diplopia and gait instability with a gradual onset over the course of three days. Neurological examinations showed ophthalmoplegia, diminished tendon reflexes, and truncal ataxia. Tests for anti-GQ1b antibodies and several other antibodies to ganglioside complex were positive. We made a diagnosis of Fisher syndrome. After administration of intravenous immunoglobulin, the patient's symptoms gradually improved. However, bilateral facial palsy appeared during the recovery phase. Brain MRI showed intensive contrast enhancement of bilateral facial nerves. During the onset phase of facial palsy, the amplitude of the compound muscle action potential (CMAP) in the facial nerves was preserved. During the peak phase, the facial CMAP amplitude was within the lower limit of normal values, or mildly decreased. During the recovery phase, the CMAP amplitude was normalized, and the R1 and R2 responses of the blink reflex were prolonged. The delayed facial nerve palsy improved spontaneously, and the enhancement on brain MRI disappeared. Serial neurophysiological and neuroradiological examinations suggested that the main lesions existed in the proximal part of the facial nerves and the mild lesions existed in the facial nerve terminals, probably due to reversible conduction failure.

[Neonatal facial palsy: identification of herpes simplex virus 1 in cerebrospinal fluid. Case report].

PubMed

Lubián López, Simón; Pérez Guerrero, Juan J; Salazar Oliva, Patricia; Benavente Fernández, Isabel

2018-06-01

Neonatal facial palsy is very uncommon and is generally diagnosed at birth. We present the first published case of neonatal facial palsy with identification of herpes simplex virus 1 in cerebrospinal fluid. A 35-day-old male was presented at the Emergency Department with mouth deviation to the left and impossibility of full closure of the right eye. There were no symptoms of infection or relevant medical history. Physical examination was compatible with peripheral facial palsy. Studies performed at admission were normal (blood count, biochemical analysis and coagulation blood tests and cerebrospinal fluid analysis). The patient was admitted on oral prednisolone and intravenous aciclovir. Cranial magnetic resonance was normal. Polymerase chain reaction test for herpes simplex virus 1 in cerebrospinal fluid was reported positive after 48 hours of admission. Patient followed good evolution and received prednisolone for 7 days and acyclovir for 21 days. At discharge, neurological examination was normal. Sociedad Argentina de Pediatría.

A Virtual Environment to Improve the Detection of Oral-Facial Malfunction in Children with Cerebral Palsy.

PubMed

Martín-Ruiz, María-Luisa; Máximo-Bocanegra, Nuria; Luna-Oliva, Laura

2016-03-26

The importance of an early rehabilitation process in children with cerebral palsy (CP) is widely recognized. On the one hand, new and useful treatment tools such as rehabilitation systems based on interactive technologies have appeared for rehabilitation of gross motor movements. On the other hand, from the therapeutic point of view, performing rehabilitation exercises with the facial muscles can improve the swallowing process, the facial expression through the management of muscles in the face, and even the speech of children with cerebral palsy. However, it is difficult to find interactive games to improve the detection and evaluation of oral-facial musculature dysfunctions in children with CP. This paper describes a framework based on strategies developed for interactive serious games that is created both for typically developed children and children with disabilities. Four interactive games are the core of a Virtual Environment called SONRIE. This paper demonstrates the benefits of SONRIE to monitor children's oral-facial difficulties. The next steps will focus on the validation of SONRIE to carry out the rehabilitation process of oral-facial musculature in children with cerebral palsy.

Bell's Palsy: Symptoms Preceding and Accompanying the Facial Paresis

PubMed Central

Mancini, Patrizia; Minni, Antonio; Prosperini, Luca; De Seta, Elio; Attanasio, Giuseppe; Covelli, Edoardo; De Carlo, Andrea; Filipo, Roberto

2014-01-01

This individual prospective cohort study aims to report and analyze the symptoms preceding and accompanying the facial paresis in Bell's palsy (BP). Two hundred sixty-nine patients affected by BP with a maximum delay of 48 hours from the onset were enrolled in the study. The evolution of the facial paresis expressed as House-Brackmann grade in the first 10 days and its correlation with symptoms were analyzed. At the onset, 136 patients presented postauricular pain, 114 were affected by dry eye, and 94 reported dysgeusia. Dry mouth was present in 54 patients (19.7%), facial pain, hyperlacrimation, aural fullness, and hyperacusis represented a smaller percentage of the reported symptoms. After 10 days, 39.9% of the group had a severe paresis while 10.2% reached a complete recovery. Dry mouth at the onset was correlated with severe grade of palsy and was prognostic for poor recovery in the early period. These outcomes lead to the deduction that the nervus intermedius plays an important role in the presentation of the BP and it might be responsible for most of the accompanying symptomatology of the paresis. Our findings could be of important interest to early address a BP patient to further examinations and subsequent therapy. PMID:25544960

Diagnostic Value of Facial Nerve Antidromic Evoked Potential in Patients With Bell's Palsy: A Preliminary Study

PubMed Central

Lee, Ji Hoon; Kim, Sun Mi; Yang, Hea Eun; Lee, Jang Woo

2014-01-01

Objective To assess the practical diagnostic value of facial nerve antidromic evoked potential (FNAEP), we compared it with the diagnostic value of the electroneurography (ENoG) test in Bell's palsy. Methods In total, 20 patients with unilateral Bell's palsy were recruited. Between the 1st and 17th days after the onset of facial palsy, FNAEP and ENoG tests were conducted. The degeneration ratio and FNAEP latency difference between the affected and unaffected sides were calculated in all subjects. Results In all patients, FNAEP showed prolonged latencies on the affected side versus the unaffected side. The difference was statistically significant. In contrast, there was no significant difference between sides in the normal control group. In 8 of 20 patients, ENoG revealed a degeneration ratio less than 50%, but FNAEP show a difference of more than 0.295±0.599 ms, the average value of normal control group. This shows FNAEP could be a more sensitive test for Bell's palsy diagnosis than ENoG. In particular, in 10 patients tested within 7 days after onset, an abnormal ENoG finding was noted in only four of them, but FNAEP showed a significant latency difference in all patients at this early stage. Thus, FANEP was more sensitive in detecting facial nerve injury than the ENoG test (p=0.031). Conclusion FNAEP has some clinical value in the diagnosis of facial nerve degeneration. It is important that FNAEP be considered in patients with facial palsy at an early stage and integrated with other relevant tests. PMID:25024963

Corticosteroids for Bell's palsy (idiopathic facial paralysis).

PubMed

Madhok, Vishnu B; Gagyor, Ildiko; Daly, Fergus; Somasundara, Dhruvashree; Sullivan, Michael; Gammie, Fiona; Sullivan, Frank

2016-07-18

Inflammation and oedema of the facial nerve are implicated in causing Bell's palsy. Corticosteroids have a potent anti-inflammatory action that should minimise nerve damage. This is an update of a review first published in 2002 and last updated in 2010. To determine the effectiveness and safety of corticosteroid therapy in people with Bell's palsy. On 4 March 2016, we searched the Cochrane Neuromuscular Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and LILACS. We reviewed the bibliographies of the randomised trials and contacted known experts in the field to identify additional published or unpublished trials. We also searched clinical trials registries for ongoing trials. Randomised trials and quasi-randomised trials comparing different routes of administration and dosage schemes of corticosteroid or adrenocorticotrophic hormone therapy versus a control group receiving no therapy considered effective for this condition, unless the same therapy was given in a similar way to the experimental group. We used standard Cochrane methodology. The main outcome of interest was incomplete recovery of facial motor function (i.e. residual facial weakness). Secondary outcomes were cosmetically disabling persistent sequelae, development of motor synkinesis or autonomic dysfunction (i.e. hemifacial spasm, crocodile tears) and adverse effects of corticosteroid therapy manifested during follow-up. We identified seven trials, with 895 evaluable participants for this review. All provided data suitable for the primary outcome meta-analysis. One of the trials was new since the last version of this Cochrane systematic review. Risk of bias in the older, smaller studies included some unclear- or high-risk assessments, whereas we deemed the larger studies at low risk of bias. Overall, 79/452 (17%) participants allocated to corticosteroids had incomplete recovery of facial motor function six months or more after randomisation

Survey of methods of facial palsy documentation in use by members of the Sir Charles Bell Society.

PubMed

Fattah, Adel Y; Gavilan, Javier; Hadlock, Tessa A; Marcus, Jeffrey R; Marres, Henri; Nduka, Charles; Slattery, William H; Snyder-Warwick, Alison K

2014-10-01

Facial palsy manifests a broad array of deficits affecting function, form, and psychological well-being. Assessment scales were introduced to standardize and document the features of facial palsy and to facilitate the exchange of information and comparison of outcomes. The aim of this study was to determine which assessment methodologies are currently employed by those involved in the care of patients with facial palsy as a first step toward the development of consensus on the appropriate assessments for this patient population. Online questionnaire. The Sir Charles Bell Society, a group of professionals dedicated to the care of patients with facial palsy, were surveyed to determine the scales used to document facial nerve function, patient reported outcome measures (PROM), and photographic documentation. Fifty-five percent of the membership responded (n = 83). Grading scales were used by 95%, most commonly the House-Brackmann and Sunnybrook scales. PROMs were used by 58%, typically the Facial Clinimetric Evaluation scale or Facial Disability Index. All used photographic recordings, but variability existed among the facial expressions used. Videography was performed by 82%, and mostly involved the same views as still photography; it was also used to document spontaneous movement and speech. Three-dimensional imaging was employed by 18% of respondents. There exists significant heterogeneity in assessments among clinicians, which impedes straightforward comparisons of outcomes following recovery and intervention. Widespread adoption of structured assessments, including scales, PROMs, photography, and videography, will facilitate communication and comparison among those who study the effects of interventions on this population. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

[Evidence of facial palsy and facial malformations in pottery from Peruvian Moche and Lambayeque pre-Columbian cultures].

PubMed

Carod-Artal, F J; Vázquez Cabrera, C B

2006-01-01

Moche (100-700 AD) and Lambayeque-Sicán (750-1100 AD) are pre-Columbian cultures from Regional States Period, developed in Northern Peru. Information about daily life, religion and medicine has been obtained through the study of Moche ceramics found in lords and priests tombs, pyramids and temples. To analyze archeological evidences of Moche Medicine and neurological diseases through ceramics. Representations of diseases in Moche and Lambayeque iconography and Moche pottery collections exposed in Casinelli museum from Trujillo, and Brüning National Archeological museum from Lambayeque, Peru, were studied. The most representative cases were analyzed and photographed, previous authorization from authorities and curators of the museums. The following pathologies were observed in ceramic collections: peripheral facial palsy, facial malformations such as cleft lip, hemifacial spasm, legs and arm amputations, scoliosis and Siamese patients. Male and females Moche doctors were also observed in the ceramics in ritual ceremonies treating patients. The main pathologies observed in Moche and Lambayeque pottery are facial palsy and cleft lip. These are one of the earliest registries of these pathologies in pre-Columbian cultures in South-America.

Clinical studies of photodynamic therapy for malignant brain tumors: facial nerve palsy after temporal fossa photoillumination

NASA Astrophysics Data System (ADS)

Muller, Paul J.; Wilson, Brian C.; Lilge, Lothar D.; Varma, Abhay; Bogaards, Arjen; Fullagar, Tim; Fenstermaker, Robert; Selker, Robert; Abrams, Judith

2003-06-01

In two randomized prospective studies of brain tumor PDT more than 180 patients have been accrued. At the Toronto site we recognized two patients who developed a lower motor neuron (LMN) facial paralysis in the week following the PDT treatment. In both cases a temporal lobectomy was undertaken and the residual tumor cavity was photo-illuminated. The surface illuminated included the temporal fossa floor, thus potentially exposing the facial nerve to the effect of PDT. The number of frontal, temporal, parietal, and occipital tumors in this cohort was 39, 24, 12 and 4, respectively. Of the 24 temporal tumors 18 were randomized to Photofrin-PDT. Of these 18 a temporal lobectomy was carried out exposing the middle fossa floor as part of the tumor resection. In two of the 10 patients where the lobectomy was carried out and the fossa floor was exposed to light there occurred a postoperative facial palsy. Both patients recovered facial nerve function in 6 and 12 weeks, respectively. 46 J/cm2 were used in the former and 130 J/cm2 in the latter. We did not encounter a single post-operative LMN facial plasy in the 101 phase 2 patients treated with Photofrin-PDT. Among 688 supratentorial brain tumor operations in the last decade involving all pathologies and all locations no case of early post-operative LMN facial palsy was identified in the absence of PDT. One further patient who had a with post-PDT facial palsy was identified at the Denver site. Although it is possible that these patients had incidental Bell's palsy, we now recommend shielding the temporal fossa floor during PDT.

Effect of neuromuscular electrical stimulation on facial muscle strength and oral function in stroke patients with facial palsy

PubMed Central

Choi, Jong-Bae

2016-01-01

[Purpose] The aim of this study was to investigate the effect of neuromuscular electrical stimulation on facial muscle strength and oral function in stroke patients with facial palsy. [Subjects and Methods] Nine subjects received the electrical stimulation and traditional dysphagia therapy. Electrical stimulation was applied to stimulate each subject’s facial muscles 30 minutes a day, 5 days a week, for 4 weeks. [Results] Subjects showed significant improvement in cheek and lip strength and oral function after the intervention. [Conclusion] This study demonstrates that electrical stimulation improves facial muscle strength and oral function in stroke patients with dysphagia. PMID:27799689

Outcome-dependent coactivation of lip and tongue primary somatosensory representation following hypoglossal-facial transfer after peripheral facial palsy.

PubMed

Rottler, Philipp; Schroeder, Henry W S; Lotze, Martin

2014-02-01

A hypoglossal-facial transfer is a common surgical strategy for reanimating the face after persistent total hemifacial palsy. We were interested in how motor recovery is associated with cortical reorganization of lip and tongue representation in the primary sensorimotor cortex after the transfer. Therefore, we used functional magnetic resonance imaging (fMRI) in 13 patients who underwent a hypoglossal-facial transfer after unilateral peripheral facial palsy. To identify primary motor and somatosensory tongue and lip representation sites, we measured repetitive tongue and lip movements during fMRI. Electromyography (EMG) of the perioral muscles during tongue and lip movements and standardized evaluation of lip elevation served as outcome parameters. We found an association of cortical representation sites in the pre- and postcentral gyrus (decreased distance of lip and tongue representation) with symmetry of recovered lip movements (lip elevation) and coactivation of the lip during voluntary tongue movements (EMG-activity of the lip during tongue movements). Overall, our study shows that hypoglossal-facial transfer resulted in an outcome-dependent cortical reorganization with activation of the cortical tongue area for restituded movement of the lip. Copyright © 2012 Wiley Periodicals, Inc.

Bell's palsy before Bell: Evert Jan Thomassen à Thuessink and idiopathic peripheral facial paralysis.

PubMed

van de Graaf, R C; IJpma, F F A; Nicolai, J-P A; Werker, P M N

2009-11-01

Bell's palsy is the eponym for idiopathic peripheral facial paralysis. It is named after Sir Charles Bell (1774-1842), who, in the first half of the nineteenth century, discovered the function of the facial nerve and attracted the attention of the medical world to facial paralysis. Our knowledge of this condition before Bell's landmark publications is very limited and is based on just a few documents. In 1804 and 1805, Evert Jan Thomassen à Thuessink (1762-1832) published what appears to be the first known extensive study on idiopathic peripheral facial paralysis. His description of this condition was quite accurate. He located several other early descriptions and concluded from this literature that, previously, the condition had usually been confused with other afflictions (such as 'spasmus cynicus', central facial paralysis and trigeminal neuralgia). According to Thomassen à Thuessink, idiopathic peripheral facial paralysis and trigeminal neuralgia were related, being different expressions of the same condition. Thomassen à Thuessink believed that idiopathic peripheral facial paralysis was caused by 'rheumatism' or exposure to cold. Many aetiological theories have since been proposed. Despite this, the cold hypothesis persists even today.

A Virtual Environment to Improve the Detection of Oral-Facial Malfunction in Children with Cerebral Palsy

PubMed Central

Martín-Ruiz, María-Luisa; Máximo-Bocanegra, Nuria; Luna-Oliva, Laura

2016-01-01

The importance of an early rehabilitation process in children with cerebral palsy (CP) is widely recognized. On the one hand, new and useful treatment tools such as rehabilitation systems based on interactive technologies have appeared for rehabilitation of gross motor movements. On the other hand, from the therapeutic point of view, performing rehabilitation exercises with the facial muscles can improve the swallowing process, the facial expression through the management of muscles in the face, and even the speech of children with cerebral palsy. However, it is difficult to find interactive games to improve the detection and evaluation of oral-facial musculature dysfunctions in children with CP. This paper describes a framework based on strategies developed for interactive serious games that is created both for typically developed children and children with disabilities. Four interactive games are the core of a Virtual Environment called SONRIE. This paper demonstrates the benefits of SONRIE to monitor children’s oral-facial difficulties. The next steps will focus on the validation of SONRIE to carry out the rehabilitation process of oral-facial musculature in children with cerebral palsy. PMID:27023561

Prognostic Value of Facial Nerve Antidromic Evoked Potentials in Bell Palsy: A Preliminary Study

PubMed Central

WenHao, Zhang; Minjie, Chen; Chi, Yang; Weijie, Zhang

2012-01-01

To analyze the value of facial nerve antidromic evoked potentials (FNAEPs) in predicting recovery from Bell palsy. Study Design. Retrospective study using electrodiagnostic data and medical chart review. Methods. A series of 46 patients with unilateral Bell palsy treated were included. According to taste test, 26 cases were associated with taste disorder (Group 1) and 20 cases were not (Group 2). Facial function was established clinically by the Stennert system after monthly follow-up. The result was evaluated with clinical recovery rate (CRR) and FNAEP. FNAEPs were recorded at the posterior wall of the external auditory meatus of both sides. Results. Mean CRR of Group 1 and Group 2 was 61.63% and 75.50%. We discovered a statistical difference between two groups and also in the amplitude difference (AD) of FNAEP. Mean ± SD of AD was −6.96% ± 12.66% in patients with excellent result, −27.67% ± 27.70% with good result, and −66.05% ± 31.76% with poor result. Conclusions. FNAEP should be monitored in patients with intratemporal facial palsy at the early stage. FNAEP at posterior wall of external auditory meatus was sensitive to detect signs of taste disorder. There was close relativity between FNAEPs and facial nerve recovery. PMID:22164176

WITHDRAWN: Corticosteroids for Bell's palsy (idiopathic facial paralysis).

PubMed

Salinas, Rodrigo A; Alvarez, Gonzalo; Ferreira, Joaquim

2009-04-15

Inflammation and oedema of the facial nerve are implicated in causing Bell's palsy. Corticosteroids have a potent anti-inflammatory action which should minimise nerve damage and thereby improve the outcome of patients suffering from this condition. The objective of this review was to assess the effect of steroid therapy in the recovery of patients with Bell's palsy. We searched the Cochrane Neuromuscular Disease Group register (searched November 2005) for randomised trials, as well as MEDLINE (January 1966 to November 2005), EMBASE (January 1980 to November 2005) and LILACS (January 1982 to November 2005). We contacted known experts in the field to identify additional published or unpublished trials. Randomised trials comparing different routes of administration and dosage schemes of corticosteroid or adrenocorticotrophic hormone therapy versus a control group where no therapy considered effective for this condition was administered, unless it was also given in a similar way to the experimental group. Two reviewers independently assessed eligibility, trial quality, and extracted the data. Four trials with a total of 179 patients were included. One trial compared cortisone acetate with placebo; one compared prednisone plus vitamins, with vitamins alone; one compared high-dose prednisone administered intravenously against saline solution, and one, not-placebo controlled, tested the efficacy of methylprednisolone. Allocation concealment was appropriate in two trials, and the data reported allowed an intention-to-treat analysis. The data included in the meta-analyses were collected from three trials with a total of 117 patients. Overall 13/59 (22%) of the patients allocated to steroid therapy had incomplete recovery of facial motor function six months after randomisation, compared with 15/58 (26%) in the control group. This reduction was not significant (relative risk 0.86, 95% confidence interval 0.47 to 1.59). The reduction in the proportion of patients with

[Correlation between facial nerve functional evaluation and efficacy evaluation of acupuncture treatment for Bell's palsy].

PubMed

Zhou, Zhang-ling; Li, Cheng-xin; Jiang, Yue-bo; Zuo, Cong; Cai, Yun; Wang, Rui

2012-09-01

To assess and grade facial nerve dysfunction according to the extent of facial paralysis in the clinical course of acupuncture treatment for Bell's palsy, and to observe the interrelationship between the grade, the efficacy and the period of treatment, as well as the effect on prognosis. The authors employed the House-Brackmann scale, a commonly used evaluation scale for facial paralysis motor function, and set standards for eye fissure and lips. According to the improved scale, the authors assessed and graded the degree of facial paralysis in terms of facial nerve dysfunction both before and after treatment. The grade was divided into five levels: mild, moderate, moderately severe, severe dysfunction and complete paralysis. The authors gave acupuncture treatment according to the state of the disease without artificially setting the treatment period. The observation was focused on the efficacy and the efficacy was evaluated throughout the entire treatment process. Fifty-three cases out of 68 patients with Bell's palsy were cured and the overall rate of efficacy was 97%. Statistically significant differences (P<0.01) were perceived among the efficacy of five levels of facial nerve dysfunction. Efficacy was correlated with the damage level of the disease (correlation coefficient r=0.423, P<0.01). The course of treatment also extended with the severity of facial nerve dysfunction (P<0.01). Differences exist in patients with Bell's palsy in terms of severity of facial nerve dysfunction. Efficacy is reduced in correlation with an increase in facial nerve dysfunction, and the period of treatment varies in need of different levels of facial nerve dysfunction. It is highly necessary to assess and grade patients before observation and treatment in clinical study, and choose corresponding treatment according to severity of damage of the disease.

Unilateral abducens and bilateral facial nerve palsies associated with posterior fossa exploration surgery

PubMed Central

Khalil, Ayman; Clerkin, James; Mandiwanza, Tafadzwa; Green, Sandra; Javadpour, Mohsen

2016-01-01

Multiple cranial nerves palsies following a posterior fossa exploration confined to an extradural compartment is a rare clinical presentation. This case report describes a young man who developed a unilateral abducens and bilateral facial nerve palsies following a posterior fossa exploration confined to an extradural compartment. There are different theories to explain this presentation, but the exact mechanism remains unclear. We propose that this patient cranial nerve palsies developed following cerebrospinal fluid (CSF) leak, potentially as a consequence of rapid change in CSF dynamics. PMID:26951144

Steroid use in Lyme disease-associated facial palsy is associated with worse long-term outcomes.

PubMed

Jowett, Nate; Gaudin, Robert A; Banks, Caroline A; Hadlock, Tessa A

2017-06-01

The purpose of this study was to determine whether differences in long-term facial function outcomes following acute Lyme disease-associated facial palsy (LDFP) exist between patients who received antibiotic monotherapy (MT); dual therapy (DT) with antibiotics and corticosteroids; and triple therapy (TT) with antibiotics, corticosteroids, and antivirals. Retrospective cohort. All patients with a prior diagnosis of unilateral LDFP who presented to our center between 2002 and 2015 were retrospectively assessed for inclusion. Two blinded experts graded static, dynamic, and synkinesis parameters of facial functions using standardized video documentation of facial function. Fifty-one patients were included. The mean time of assessment following LDFP onset was 15.1 months (range 0.3-84 months). Significantly worse facial outcomes were seen among those who received DT and TT as compared to those who received MT, most pronounced among those assessed 12 months or later following onset of LDFP (Dynamic-P = 0.031, post hoc MT vs. TT: mean difference [MD], 15.83; 95% confidence interval [CI], 1.54-30.13; P = 0.030. Synkinesis-P = 0.026, post hoc MT vs. DT: MD, 21.50; 95% CI, 0.68-42.32; P = 0.043, post hoc MT vs. TT: MD, 19.22; 95% CI, 2.23-36.22; P = 0.027). An association between corticosteroid use in acute LDFP and worse long-term facial function outcomes has been demonstrated. Care should be taken in differentiating viral or idiopathic facial palsy (e.g., Bell palsy) from LDFP. 4. Laryngoscope, 127:1451-1458, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

[Bell's palsy].

PubMed

Prud'hon, S; Kubis, N

2018-03-30

Idiopathic peripheral facial palsy, also named Bell's palsy, is the most common cause of peripheral facial palsy in adults. Although it is considered as a benign condition, its social and psychological impact can be dramatic, especially in the case of incomplete recovery. The main pathophysiological hypothesis is the reactivation of HSV 1 virus in the geniculate ganglia, leading to nerve edema and its compression through the petrosal bone. Patients experience an acute (less than 24 hours) motor deficit involving ipsilateral muscles of the upper and lower face and reaching its peak within the first three days. Frequently, symptoms are preceded or accompanied by retro-auricular pain and/or ipsilateral face numbness. Diagnosis is usually clinical but one should look for negative signs to eliminate central facial palsy or peripheral facial palsy secondary to infectious, neoplastic or autoimmune diseases. About 75% of the patients will experience spontaneous full recovery, this rate can be improved with oral corticotherapy when introduced within the first 72 hours. To date, no benefit has been demonstrated by adding an antiviral treatment. Hemifacial spasms (involuntary muscles contractions of the hemiface) or syncinesia (involuntary muscles contractions elicited by voluntary ones, due to aberrant reinnervation) may complicate the disease's course. Electroneuromyography can be useful at different stages: it can first reveal the early conduction bloc, then estimate the axonal loss, then bring evidence of the reinnervation process and, lastly, help for the diagnosis of complications. Copyright © 2018 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.

Measurement of facial movements with Photoshop software during treatment of facial nerve palsy.

PubMed

Pourmomeny, Abbas Ali; Zadmehr, Hassan; Hossaini, Mohsen

2011-10-01

Evaluating the function of facial nerve is essential in order to determine the influences of various treatment methods. The aim of this study was to evaluate and assess the agreement of Photoshop scaling system versus the facial grading system (FGS). In this semi-experimental study, thirty subjects with facial nerve paralysis were recruited. The evaluation of all patients before and after the treatment was performed by FGS and Photoshop measurements. The mean values of FGS before and after the treatment were 35 ± 25 and 67 ± 24, respectively (p < 0.001). In Photoshop assessment, mean changes of face expressions in the impaired side relative to the normal side in rest position and three main movements of the face were 3.4 ± 0.55 and 4.04 ± 0.49 millimeter before and after the treatment, respectively (p < 0.001). Spearman's correlation coefficient between different values in the two methods was 0.66 (p < 0.001). Evaluating the facial nerve palsy using Photoshop was more objective than using FGS. Therefore, it may be recommended to use this method instead.

Electrical stimulation treatment for facial palsy after revision pleomorphic adenoma surgery

PubMed Central

Goldie, Simon; Sandeman, Jack; Cole, Richard; Dennis, Simon; Swain, Ian

2016-01-01

Surgery for pleomorphic adenoma recurrence presents a significant risk of facial nerve damage that can result in facial weakness effecting patients’ ability to communicate, mental health and self-image. We report two case studies that had marked facial weakness after resection of recurrent pleomorphic adenoma and their progress with electrical stimulation. Subjects received electrical stimulation twice daily for 24 weeks during which photographs of expressions, facial measurements and Sunnybrook scores were recorded. Both subjects recovered good facial function demonstrating Sunnybrook scores of 54 and 64 that improved to 88 and 96, respectively. Neither subjects demonstrated adverse effects of treatment. We conclude that electrical stimulation is a safe treatment and may improve facial palsy in patients after resection of recurrent pleomorphic adenoma. Larger studies would be difficult to pursue due to the low incidence of cases. PMID:27106613

Facial nerve paralysis in children

PubMed Central

Ciorba, Andrea; Corazzi, Virginia; Conz, Veronica; Bianchini, Chiara; Aimoni, Claudia

2015-01-01

Facial nerve palsy is a condition with several implications, particularly when occurring in childhood. It represents a serious clinical problem as it causes significant concerns in doctors because of its etiology, its treatment options and its outcome, as well as in little patients and their parents, because of functional and aesthetic outcomes. There are several described causes of facial nerve paralysis in children, as it can be congenital (due to delivery traumas and genetic or malformative diseases) or acquired (due to infective, inflammatory, neoplastic, traumatic or iatrogenic causes). Nonetheless, in approximately 40%-75% of the cases, the cause of unilateral facial paralysis still remains idiopathic. A careful diagnostic workout and differential diagnosis are particularly recommended in case of pediatric facial nerve palsy, in order to establish the most appropriate treatment, as the therapeutic approach differs in relation to the etiology. PMID:26677445

Nerve crush but not displacement-induced stretch of the intra-arachnoidal facial nerve promotes facial palsy after cerebellopontine angle surgery.

PubMed

Bendella, Habib; Brackmann, Derald E; Goldbrunner, Roland; Angelov, Doychin N

2016-10-01

Little is known about the reasons for occurrence of facial nerve palsy after removal of cerebellopontine angle tumors. Since the intra-arachnoidal portion of the facial nerve is considered to be so vulnerable that even the slightest tension or pinch may result in ruptured axons, we tested whether a graded stretch or controlled crush would affect the postoperative motor performance of the facial (vibrissal) muscle in rats. Thirty Wistar rats, divided into five groups (one with intact controls and four with facial nerve lesions), were used. Under inhalation anesthesia, the occipital squama was opened, the cerebellum gently retracted to the left, and the intra-arachnoidal segment of the right facial nerve exposed. A mechanical displacement of the brainstem with 1 or 3 mm toward the midline or an electromagnet-controlled crush of the facial nerve with a tweezers at a closure velocity of 50 and 100 mm/s was applied. On the next day, whisking motor performance was determined by video-based motion analysis. Even the larger (with 3 mm) mechanical displacement of the brainstem had no harmful effect: The amplitude of the vibrissal whisks was in the normal range of 50°-60°. On the other hand, even the light nerve crush (50 mm/s) injured the facial nerve and resulted in paralyzed vibrissal muscles (amplitude of 10°-15°). We conclude that, contrary to the generally acknowledged assumptions, it is the nerve crush but not the displacement-induced stretching of the intra-arachnoidal facial trunk that promotes facial palsy after cerebellopontine angle surgery in rats.

Electrical stimulation treatment for facial palsy after revision pleomorphic adenoma surgery.

PubMed

Goldie, Simon; Sandeman, Jack; Cole, Richard; Dennis, Simon; Swain, Ian

2016-04-22

Surgery for pleomorphic adenoma recurrence presents a significant risk of facial nerve damage that can result in facial weakness effecting patients' ability to communicate, mental health and self-image. We report two case studies that had marked facial weakness after resection of recurrent pleomorphic adenoma and their progress with electrical stimulation. Subjects received electrical stimulation twice daily for 24 weeks during which photographs of expressions, facial measurements and Sunnybrook scores were recorded. Both subjects recovered good facial function demonstrating Sunnybrook scores of 54 and 64 that improved to 88 and 96, respectively. Neither subjects demonstrated adverse effects of treatment. We conclude that electrical stimulation is a safe treatment and may improve facial palsy in patients after resection of recurrent pleomorphic adenoma. Larger studies would be difficult to pursue due to the low incidence of cases. Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author 2016.

The management of peripheral facial nerve palsy: "paresis" versus "paralysis" and sources of ambiguity in study designs.

PubMed

Linder, Thomas E; Abdelkafy, Wael; Cavero-Vanek, Sandra

2010-02-01

Conservative management of idiopathic or herpetic acute peripheral facial palsy (herpes zoster oticus, HZO) often leads to a favorable outcome. However, recent multicenter studies have challenged the necessity of antivirals. Whereas large numbers of patients are required to reveal statistical differences in a disease with an overall positive outcome, surprisingly few studies differentiate between patients with paresis and paralysis. Analyzing our own prospective cohort of patients and reviewing the current literature on conservative treatment of Bell's palsy and HZO, we reveal the importance of initial baseline assessment of the disease course to predict the outcome and to validate the impact of medical treatment options. STUDY DESIGN AND DATA SOURCE: Prospective analysis of consecutive patients referred to 2 tertiary referral centers and research on the Cochrane Library for current updates of their previous reviews and search of MEDLINE (1976-2009) for randomized trials on conservative treatment of acute facial palsy were conducted. One hundred ninety-six patients with Bell's palsy or HZO were followed up prospectively until complete recovery or at least for 12 months. The numeric Fisch score (FS) was used to classify facial function, and patients were separated between incomplete palsy (=paresis) and complete paralysis. Electroneuronography (ENoG) was used to further subdivide patients with paralysis. The treatment protocol was independent of the ongoing investigation including prednisone and valacyclovir in most patients. A total of 250 previous studies on facial palsy outcome were evaluated regarding their distinction between different severity scores at baseline and its impact on treatment outcome. Trials not making the distinction between paresis and paralysis at baseline and with an insufficient follow-up of less than 12 months were excluded. In the Bell's and HZO paresis group, all except 1 patient recovered completely, most of them within 3 months

Measurement of facial movements with Photoshop software during treatment of facial nerve palsy*

PubMed Central

Pourmomeny, Abbas Ali; Zadmehr, Hassan; Hossaini, Mohsen

2011-01-01

BACKGROUND: Evaluating the function of facial nerve is essential in order to determine the influences of various treatment methods. The aim of this study was to evaluate and assess the agreement of Photoshop scaling system versus the facial grading system (FGS). METHODS: In this semi-experimental study, thirty subjects with facial nerve paralysis were recruited. The evaluation of all patients before and after the treatment was performed by FGS and Photoshop measurements. RESULTS: The mean values of FGS before and after the treatment were 35 ± 25 and 67 ± 24, respectively (p < 0.001). In Photoshop assessment, mean changes of face expressions in the impaired side relative to the normal side in rest position and three main movements of the face were 3.4 ± 0.55 and 4.04 ± 0.49 millimeter before and after the treatment, respectively (p < 0.001). Spearman's correlation coefficient between different values in the two methods was 0.66 (p < 0.001). CONCLUSIONS: Evaluating the facial nerve palsy using Photoshop was more objective than using FGS. Therefore, it may be recommended to use this method instead. PMID:22973325

Unilateral abducens and bilateral facial nerve palsies associated with posterior fossa exploration surgery.

PubMed

Khalil, Ayman; Clerkin, James; Mandiwanza, Tafadzwa; Green, Sandra; Javadpour, Mohsen

2016-03-06

Multiple cranial nerves palsies following a posterior fossa exploration confined to an extradural compartment is a rare clinical presentation. This case report describes a young man who developed a unilateral abducens and bilateral facial nerve palsies following a posterior fossa exploration confined to an extradural compartment. There are different theories to explain this presentation, but the exact mechanism remains unclear. We propose that this patient cranial nerve palsies developed following cerebrospinal fluid (CSF) leak, potentially as a consequence of rapid change in CSF dynamics. Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author 2016.

Electrical response grading versus House-Brackmann scale for evaluation of facial nerve injury after Bell's palsy: a comparative study.

PubMed

Huang, Bin; Zhou, Zhang-ling; Wang, Li-li; Zuo, Cong; Lu, Yan; Chen, Yong

2014-07-01

There are no convenient techniques to evaluate the degree of facial nerve injury during a course of acupuncture treatment for Bell's palsy. Our previous studies found that observing the electrical response of specific facial muscles provided reasonable correlation with the prognosis of electroacupuncture treatment. Hence, we used the new method to evaluate the degree of facial nerve injury in patients with Bell's palsy in comparison with the House-Brackmann scale. The relationship between therapeutic effects and prognosis was analyzed to explore an objective method for evaluating Bell's palsy. The facial nerve function of 68 patients with Bell's palsy was assessed with both electrical response grading and the House-Brackmann scale before treatment. Then differences in evaluation results of the two methods were compared. All enrolled patients received electroacupuncture treatment with disperse-dense wave at 1/100 Hz for 4 weeks. After treatment, correlation analysis was conducted to find the relationship between electrical response and therapeutic effects or prognosis. Checking consistency between electrical response grading and House-Brackmann scale: Kappa value 0.028 (P = 0.578). Correlation analysis: the two methods were correlated with the prognosis, and electrical response grading (rER = 0.789) was better than the House-Brackmann scale (rHB = 0.423). Electrical response grading is superior to the House-Brackmann scale in efficacy and reliability, and can conveniently assess the degree of facial nerve injury. The House-Brackmann scale is suitable for the patients with mild facial nerve injury, but its evaluation quality for severe facial nerve injury is poor.

Bilateral Facial Paralysis: A 13-Year Experience.

PubMed

Gaudin, Robert A; Jowett, Nathan; Banks, Caroline A; Knox, Christopher J; Hadlock, Tessa A

2016-10-01

Bilateral facial palsy is a rare clinical entity caused by myriad disparate conditions requiring different treatment paradigms. Lyme disease, Guillain-Barré syndrome, and leukemia are several examples. In this article, the authors describe the cause, the initial diagnostic approach, and the management of long-term sequelae of bilateral paralysis that has evolved in the authors' center over the past 13 years. A chart review was performed to identify all patients diagnosed with bilateral paralysis at the authors' center between January of 2002 and January of 2015. Demographics, signs and symptoms, diagnosis, initial medical treatment, interventions for facial reanimation, and outcomes were reviewed. Of the 2471 patients seen at the authors' center, 68 patients (3 percent) with bilateral facial paralysis were identified. Ten patients (15 percent) presented with bilateral facial paralysis caused by Lyme disease, nine (13 percent) with Möbius syndrome, nine (13 percent) with neurofibromatosis type 2, five (7 percent) with bilateral facial palsy caused by brain tumor, four (6 percent) with Melkersson-Rosenthal syndrome, three (4 percent) with bilateral temporal bone fractures, two (3 percent) with Guillain-Barré syndrome, one (2 percent) with central nervous system lymphoma, one (2 percent) with human immunodeficiency virus infection, and 24 (35 percent) with presumed Bell palsy. Treatment included pharmacologic therapy, physical therapy, chemodenervation, and surgical interventions. Bilateral facial palsy is a rare medical condition, and treatment often requires a multidisciplinary approach. The authors outline diagnostic and therapeutic algorithms of a tertiary care center to provide clinicians with a systematic approach to managing these complicated patients.

Bell's Palsy as a Possible Complication of Hepatitis B Vaccination in A Child

PubMed Central

Tan, Hüseyin; Orbak, Zerrin

2009-01-01

Bell's Palsy is the sudden onset of unilateral temporary paralysis of facial muscles resulting from seventh cranial nerve dysfunction. Presented here is a two-year old female patient with right peripheral facial palsy following hepatitis B vaccination. Readers’ attention is drawn to an uncommon cause of Bell's Palsy, as a rare complication of hepatitis B vaccination. PMID:19902808

Primary Nasopharyngeal Tuberculosis Combined with Tuberculous Otomastoiditis and Facial Nerve Palsy

PubMed Central

Choi, Hee Young; Jang, Ji Hye; Lee, Kyung Mi; Choi, Woo Suk; Kim, Sang Hoon; Yeo, Seung Geun; Kim, Eui Jong

2016-01-01

Primary nasopharyngeal tuberculosis (TB) without pulmonary involvement is rare, even in endemic areas. Herein, we present a rare complication of primary nasopharyngeal TB accompanied with tuberculous otomastoiditis (TOM) and ipsilateral facial nerve palsy, in a 24-year-old female patient, with computed tomography and magnetic resonance imagery findings. PMID:27127580

[Idiopathic facial paralysis in children].

PubMed

Achour, I; Chakroun, A; Ayedi, S; Ben Rhaiem, Z; Mnejja, M; Charfeddine, I; Hammami, B; Ghorbel, A

2015-05-01

Idiopathic facial palsy is the most common cause of facial nerve palsy in children. Controversy exists regarding treatment options. The objectives of this study were to review the epidemiological and clinical characteristics as well as the outcome of idiopathic facial palsy in children to suggest appropriate treatment. A retrospective study was conducted on children with a diagnosis of idiopathic facial palsy from 2007 to 2012. A total of 37 cases (13 males, 24 females) with a mean age of 13.9 years were included in this analysis. The mean duration between onset of Bell's palsy and consultation was 3 days. Of these patients, 78.3% had moderately severe (grade IV) or severe paralysis (grade V on the House and Brackmann grading). Twenty-seven patients were treated in an outpatient context, three patients were hospitalized, and seven patients were treated as outpatients and subsequently hospitalized. All patients received corticosteroids. Eight of them also received antiviral treatment. The complete recovery rate was 94.6% (35/37). The duration of complete recovery was 7.4 weeks. Children with idiopathic facial palsy have a very good prognosis. The complete recovery rate exceeds 90%. However, controversy exists regarding treatment options. High-quality studies have been conducted on adult populations. Medical treatment based on corticosteroids alone or combined with antiviral treatment is certainly effective in improving facial function outcomes in adults. In children, the recommendation for prescription of steroids and antiviral drugs based on adult treatment appears to be justified. Randomized controlled trials in the pediatric population are recommended to define a strategy for management of idiopathic facial paralysis. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Validity of the Child Facial Coding System for the Assessment of Acute Pain in Children With Cerebral Palsy.

PubMed

Hadden, Kellie L; LeFort, Sandra; O'Brien, Michelle; Coyte, Peter C; Guerriere, Denise N

2016-04-01

The purpose of the current study was to examine the concurrent and discriminant validity of the Child Facial Coding System for children with cerebral palsy. Eighty-five children (mean = 8.35 years, SD = 4.72 years) were videotaped during a passive joint stretch with their physiotherapist and during 3 time segments: baseline, passive joint stretch, and recovery. Children's pain responses were rated from videotape using the Numerical Rating Scale and Child Facial Coding System. Results indicated that Child Facial Coding System scores during the passive joint stretch significantly correlated with Numerical Rating Scale scores (r = .72, P < .01). Child Facial Coding System scores were also significantly higher during the passive joint stretch than the baseline and recovery segments (P < .001). Facial activity was not significantly correlated with the developmental measures. These findings suggest that the Child Facial Coding System is a valid method of identifying pain in children with cerebral palsy. © The Author(s) 2015.

Diagnosis of Bell palsy with gadolinium magnetic resonance imaging.

PubMed

Becelli, R; Perugini, M; Carboni, A; Renzi, G

2003-01-01

Bell palsy is a condition resulting from a peripheral edematous compression on the nervous fibers of the facial nerve. This pathological condition often has clinical characteristics of no importance and spontaneously disappears in a short time in a high percentage of cases. Facial palsy concerning cranial nerve VII can also be caused by other conditions such as mastoid fracture, acoustic neurinoma, tumor spread to the temporal lobe (e.g., cholesteatoma), neoformation of the parotid gland, Melkersson-Rosenthal syndrome, and Ramsay-Hunt syndrome. Therefore, it is important to adopt an accurate diagnostic technique allowing the rapid detection of Bell palsy and the exclusion of causes of facial paralysis requiring surgical treatment. Magnetic resonance imaging (MRI) with medium contrast of the skull shows a marked increase in revealing lesions, even of small dimensions, inside the temporal bone and at the cerebellopontine angle. The authors present a clinical case to show the important role played by gadolinium MRI in reaching a diagnosis of Bell palsy in the differential diagnosis of the various conditions that determine paralysis of the facial nerve and in selecting the most suitable treatment or surgery to be adopted.

Effect of Weakening of Ipsilateral Depressor Anguli Oris on Smile Symmetry in Postparalysis Facial Palsy.

PubMed

Jowett, Nate; Malka, Ronit; Hadlock, Tessa A

2017-01-01

Aberrant depressor anguli oris (DAO) activity may arise after recovery from acute facial paralysis and restrict movement of the oral commissure. To quantify the degree to which DAO inhibition affects smile dynamics and perceived emotional state. In this prospective, pretest-posttest study performed at an academic tertiary referral hospital, patients with unilateral postparalysis facial palsy were studied from January 16 through April 30, 2016. Local anesthetic injection into the ipsilateral DAO. Healthy- and paretic-side commissure displacements from the midline lower vermillion border referenced to the horizontal plane were calculated from random-ordered photographs of full-effort smile before and after injection, and random-ordered hemifacial photographs of the paretic side were assessed as expressing positive, negative, or indiscernible emotion. Twenty patients were identified as having unilateral postparalysis facial palsy with marked synkinesis of the ipsilateral DAO. Patient mean age was 46 years (range, 24-67 years), with a male to female ratio of 1:3. Mean paretic-side commissure displacement increased from 27.45 mm at 21.65° above the horizontal plane to 29.35 mm at 23.58° after DAO weakening (mean difference, 1.90 mm; 95% CI, 1.26-2.54 mm; and 1.93°; 95% CI, 0.34°-3.51°; P < .001 and P = .20, respectively). Symmetry of excursion between sides improved by 2.00 mm (95% CI, 1.16-2.83 mm; P < .001) and 2.71° (95% CI, 1.38°-4.03°; P < .001). At baseline, observers assessed 7 of 20 paretic hemifaces (35%) as expressing positive emotion; this proportion increased to 13 of 20 (65%) after DAO weakening (P = .03). Ipsilateral DAO weakening results in significant improvements in smile dynamics and perceived expression of positive emotion on the paretic hemiface in postparalysis facial palsy. A trial of DAO weakening should be offered to patients with this disfiguring complication of Bell palsy and similar facial nerve insults. 3.

A case presentation of bilateral simultaneous Bell's palsy.

PubMed

Kilic, Rahmi; Ozdek, Ali; Felek, Sevim; Safak, M Asim; Samim, Erdal

2003-01-01

Bilateral simultaneous facial paralysis is an extremely rare clinical entity. Unlike the unilateral form, bilateral facial paralysis seldom falls into Bell's category. It is most often a special finding in a symptom complex of a systemic disease; many of them are potentially life-threatening, and therefore the condition warrants urgent medical intervention. Lyme disease, Guillian-Barre syndrome, Bell's palsy, leukemia, sarcoidosis, bacterial meningitis, syphilis, leprosy, Moebius syndrome, infectious mononucleosis, and skull fracture are the most common cause of bilateral facial paralysis. Here we present a 16-year-old patient with bilateral simultaneous Bell's palsy.

[Application of grading evaluation on facial nerve function of Bell's palsy treated with electroacupuncture].

PubMed

Zhou, Zhang-Ling; Zuo, Cong; Cheng, Shu-Luo; Shao, Wei-Wei; Liu, Li-Ping

2013-08-01

To explore the correlation of facial nerve injury degree with facial contraction degree induced by electric stimulation in the treatment of Bell's palsy with electroacupuncture, and the significance in elec tric reaction grading evaluation. Sixty-eight cases of Bell's palsy were enrolled. The positive and negative electrodes of the acupuncture treatment apparatus were attached to the needle handles at the 3 groups of points, named Taiyang (EX-HN 5)-Yangbai(GB 14), Xiaguan (ST 7)-Quanliao (SI 18) and Heliao (LI 19)-Jiachengjiang (Extra). The disperse-dense wave was applied. According to the severity of local muscle contraction after needling, the electric reaction was divided into 4 grades, named superior, moderate, poor and no reaction. After acupuncture and electroacupuncture, the efficacy was evaluated in accordance with the different electric reaction grades. The curative rate was 100.0% (44/44) in patients with superior electric reaction, was 100.0% (7/7) in patients with moderate electric reaction, was 18.2% (2/11) in patients with poor electric reaction and was 0 (0/6) in patients with noelectric reaction. The difference was significant statistically in comparison of 4 groups (P<0.01). The superiority correlation presented between the efficacy and electric reaction grade (P< 0.001). The higher the superiority of electric reaction grade was, the better the efficacy was. The difference in the efficacy among different electric reaction grades was significant statistically (P<0.001). And the course of treatment was the shortest for those with the high superiority of electric reaction. The reaction grade of electric stimulation is conform to the facial nerve injury grading in Bell's palsy. The contraction degree of facial mimetic muscle induced by electroacupuncture stimulation is closely correlated with severity of disease. Based on the electric reaction, the facial nerve injury severity can be understood generally and the prognosis be judged.

Bell's Palsy.

PubMed

Vakharia, Kavita; Vakharia, Kalpesh

2016-02-01

Bell's palsy is unilateral, acute onset facial paralysis that is a common condition. One in every 65 people experiences Bell's palsy in the course of their lifetime. The majority of patients afflicted with this idiopathic disorder recover facial function. Initial treatment involves oral corticosteroids, possible antiviral drugs, and protection of the eye from desiccation. A small subset of patients may be left with incomplete recovery, synkinesis, facial contracture, or hemifacial spasm. A combination of medical and surgical treatment options exist to treat the long-term sequelae of Bell's palsy. Copyright © 2016 Elsevier Inc. All rights reserved.

Acupuncture for Bell's palsy.

PubMed

Chen, Ning; Zhou, Muke; He, Li; Zhou, Dong; Li, N

2010-08-04

Bell's palsy or idiopathic facial palsy is an acute facial paralysis due to inflammation of the facial nerve. A number of studies published in China have suggested acupuncture is beneficial for facial palsy. The objective of this review was to examine the efficacy of acupuncture in hastening recovery and reducing long-term morbidity from Bell's palsy. We updated the searches of the Cochrane Neuromuscular Disease Group Trials Specialized Register (24 May 2010), The Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 2, 2010), MEDLINE (January 1966 to May 2010), EMBASE (January 1980 to May 2010), AMED (January 1985 to May 2010), LILACS (from January 1982 to May 2010) and the Chinese Biomedical Retrieval System (January 1978 to May 2010) for randomised controlled trials using 'Bell's palsy' and its synonyms, 'idiopathic facial paralysis' or 'facial palsy' as well as search terms including 'acupuncture'. Chinese journals in which we thought we might find randomised controlled trials relevant to our study were handsearched. We reviewed the bibliographies of the randomised trials and contacted the authors and known experts in the field to identify additional published or unpublished data. We included all randomised controlled trials involving acupuncture by needle insertion in the treatment of Bell's palsy irrespective of any language restrictions. Two review authors identified potential articles from the literature search, extracted data and assessed quality of each trial independently. All disagreements were resolved by discussion between the review authors. The literature search and handsearching identified 49 potentially relevant articles. Of these, six RCTs were included involving 537 participants with Bell's palsy. Two more possible trials were identified in the update than the previous version of this systematic review, but both were excluded because they were not real RCTs. Of the six included trials, five used acupuncture while the other one used

Bell palsy in a neonate with rapid response to oral corticosteroids: a case report.

PubMed

Saini, Arushi; Singhi, Pratibha; Sodhi, K S; Gupta, Ajit

2013-04-01

Idiopathic facial nerve palsy, also known as Bell palsy is rare in the neonatal age group. Other more common causes such as birth trauma; infections, especially otitis media; and congenital malformations need to be excluded. We present here a 4-week-old neonate with Bell palsy who responded rapidly to oral corticosteroids. Such an early presentation of idiopathic facial nerve palsy and use of corticosteroids in neonates is scarcely reported in the literature.

Bell's palsy and autoimmunity.

PubMed

Greco, A; Gallo, A; Fusconi, M; Marinelli, C; Macri, G F; de Vincentiis, M

2012-12-01

To review our current knowledge of the etiopathogenesis of Bell's palsy, including viral infection or autoimmunity, and to discuss disease pathogenesis with respect to pharmacotherapy. Relevant publications on the etiopathogenesis, clinical presentation, diagnosis and histopathology of Bell's palsy from 1975 to 2012 were analysed. Bell's palsy is an idiopathic peripheral nerve palsy involving the facial nerve. It accounts for 60 to 75% of all cases of unilateral facial paralysis. The annual incidence of Bell's palsy is 15 to 30 per 100,000 people. The peak incidence occurs between the second and fourth decades (15 to 45 years). The aetiology of Bell's palsy is unknown but viral infection or autoimmune disease has been postulated as possible pathomechanisms. Bell's palsy may be caused when latent herpes viruses (herpes simplex, herpes zoster) are reactivated from cranial nerve ganglia. A cell-mediated autoimmune mechanism against a myelin basic protein has been suggested for the pathogenesis of Bell's palsy. Bell's palsy may be an autoimmune demyelinating cranial neuritis, and in most cases, it is a mononeuritic variant of Guillain-Barré syndrome, a neurologic disorder with recognised cell-mediated immunity against peripheral nerve myelin antigens. In Bell's palsy and GBS, a viral infection or the reactivation of a latent virus may provoke an autoimmune reaction against peripheral nerve myelin components, leading to the demyelination of cranial nerves, especially the facial nerve. Given the safety profile of acyclovir, valacyclovir, and short-course oral corticosteroids, patients who present within three days of the onset of symptoms should be offered combination therapy. However it seems logical that in fact, steroids exert their beneficial effect via immunosuppressive action, as is the case in some other autoimmune disorders. It is to be hoped that (monoclonal) antibodies and/or T-cell immunotherapy might provide more specific treatment guidelines in the

Bell's palsy: data from a study of 70 cases.

PubMed

Cirpaciu, D; Goanta, C M

2014-01-01

Bell's palsy is a condition that affects the facial nerve, which is one of the twelve cranial nerves. Its main function is to control all the muscles of the facial expression. It is a unilateral, acute, partial or complete paralysis of the facial nerve. Bell's palsy remains the most common cause of facial nerve paralysis, more often encountered in females aged 17 to 30 years, recurrent in many cases and with poor associations with other pathologic conditions. In modern literature, the suspected etiology could be due to the reactivation of the latent herpes viral infections in the geniculate ganglia, and their subsequent migration to the facial nerve but, favorable outcome by using vasodilators, neurotrophic and corticosteroid therapy was recorded.

The association of Varicella zoster virus reactivation with Bell's palsy in children.

PubMed

Abdel-Aziz, Mosaad; Azab, Noha A; Khalifa, Badwy; Rashed, Mohammed; Naguib, Nader

2015-03-01

Bell's palsy is considered the most common cause of facial nerve paralysis in children. Although different theories have been postulated for its diagnosis, reactivation of the Varicella zoster virus (VZV) has been implicated as one of the causes of Bell's palsy. The aim of the study was to evaluate the association of Varicella-zoster virus infection with Bell's palsy and its outcome in children. A total of 30 children with Bell's palsy were recruited and were assayed for evidence of VZV infection. The severity of facial nerve dysfunction and the recovery rate were evaluated according to House-Brackmann Facial Nerve Grading Scale (HB FGS). Paired whole blood samples from all patients were obtained at their initial visit and 3 weeks later, and serum samples were analyzed for VZV IgG and IgM antibodies using ELISA. A significantly higher percentage of Bell's palsy patients were seropositive for VZV IgM antibodies than controls (36.6% of patients vs 10% of controls) while for VZV IgG antibodies the difference was statistically nonsignificant. HB FGS in Bell's palsy patients with serologic evidence of VZV recent infection or reactivation showed a statistiacally significant less cure rate than other patients. VZV reactivation may be an important cause of acute peripheral facial paralysis in children. The appropriate diagnosis of VZV reactivation should be done to improve the outcome and the cure rate by the early use of antiviral treatment. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

The role of facial canal diameter in the pathogenesis and grade of Bell's palsy: a study by high resolution computed tomography.

PubMed

Celik, Onur; Eskiizmir, Gorkem; Pabuscu, Yuksel; Ulkumen, Burak; Toker, Gokce Tanyeri

The exact etiology of Bell's palsy still remains obscure. The only authenticated finding is inflammation and edema of the facial nerve leading to entrapment inside the facial canal. To identify if there is any relationship between the grade of Bell's palsy and diameter of the facial canal, and also to study any possible anatomic predisposition of facial canal for Bell's palsy including parts which have not been studied before. Medical records and temporal computed tomography scans of 34 patients with Bell's palsy were utilized in this retrospective clinical study. Diameters of both facial canals (affected and unaffected) of each patient were measured at labyrinthine segment, geniculate ganglion, tympanic segment, second genu, mastoid segment and stylomastoid foramen. The House-Brackmann (HB) scale of each patient at presentation and 3 months after the treatment was evaluated from their medical records. The paired samples t-test and Wilcoxon signed-rank test were used for comparison of width between the affected side and unaffected side. The Wilcoxon signed-rank test was also used for evaluation of relationship between the diameter of facial canal and the grade of the Bell's palsy. Significant differences were established at a level of p=0.05 (IBM SPSS Statistics for Windows, Version 21.0.; Armonk, NY, IBM Corp). Thirty-four patients - 16 females, 18 males; mean age±Standard Deviation, 40.3±21.3 - with Bell's palsy were included in the study. According to the HB facial nerve grading system; 8 patients were grade V, 6 were grade IV, 11 were grade III, 8 were grade II and 1 patient was grade I. The mean width at the labyrinthine segment of the facial canal in the affected temporal bone was significantly smaller than the equivalent in the unaffected temporal bone (p=0.00). There was no significant difference between the affected and unaffected temporal bones at the geniculate ganglion (p=0.87), tympanic segment (p=0.66), second genu (p=0.62), mastoid segment (p=0

Diagnosis and management of Bell's palsy.

PubMed

Santos, Renata de Faria; Brasileiro, Bernardo Ferreira

2011-01-01

Bell's palsy (BP) is an idiopathic peripheral facial nerve paralysis of sudden onset. Its most alarming symptom is unilateral facial weakness, which can result in the inability to close the eyelids, smile, or whistle. The pathogenesis of BP is controversial and is believed to be caused by inflammation of the facial nerve at the geniculate ganglion. Many viruses, especially herpes simplex and herpes zoster, have been suggested as initiators of this inflammatory process; however, this has not been proven. This report describes the case of a 14-year-old girl with right hemifacial palsy who sought treatment one month after the onset of palsy. The patient experienced a satisfactory recovery within 30 days of treatment and has maintained a stable physical outcome after 15 months of follow-up. Early treatment based on careful investigation of BP, with particular attention given to the differential diagnosis of BP, can improve the patient's function and esthetics.

WITHDRAWN: Aciclovir or valaciclovir for Bell's palsy (idiopathic facial paralysis).

PubMed

Allen, David; Dunn, Louisa

2009-04-15

The most common disorder of the facial nerve is acute idiopathic facial paralysis or Bell's palsy and there may be significant morbidity or incomplete recovery associated with severe cases. To assess the efficacy of aciclovir or similar agents for treating Bell's palsy. We searched the Cochrane Neuromuscular Disease Group register (searched April 2003), MEDLINE (from January 1966 to April 2003), EMBASE (from January 1980 to April 2003) and LILACS (from January 1982 to April 2003). We also contacted authors of identified trials. Randomised or quasi-randomised trials of aciclovir or valaciclovir therapy, alone or in combination with any other drug, in patients with Bell's palsy. We identified six randomised trials. Three studies met our inclusion criteria, including 246 patients. One study evaluated aciclovir with corticosteroid versus corticosteroid alone, another study evaluated aciclovir alone versus corticosteroid and a further study evaluated valaciclovir with corticosteroid versus corticosteroid alone or versus placebo alone. Incomplete recovery after one year: data were not available. An analysis was performed on data reported at the end of the study period in each trial. The results from one study four months after the start of treatment significantly favoured the treatment group, whilst the results of the study three months after the start of treatment significantly favoured the control group. The results from the second study at four months showed no statistically significant difference between the three groups.Adverse events: relevant data were not reported in any of the three trials.Complete facial paralysis six months after start of treatment: only one patient had complete paralysis upon entering one of the studies. This patient was assigned to the control group and the level of recovery attained was not reported.Motor synkinesis or crocodile tears one year after start of treatment: data were available up to a maximum of four months after onset of

Bell's palsy.

PubMed

Holland, N Julian; Bernstein, Jonathan M

2014-04-09

Bell's palsy is characterised by an acute, unilateral, partial, or complete paralysis of the face. Bell's palsy occurs in a lower motor neurone pattern. The weakness may be partial or complete, and may be associated with mild pain, numbness, increased sensitivity to sound, and altered taste. Bell's palsy is idiopathic, but a proportion of cases may be caused by re-activation of herpes virus at the geniculate ganglion of the facial nerve. Bell's palsy is most common in people aged 15 to 40 years, with a 1 in 60 lifetime risk. Most people make a spontaneous recovery within 1 month, but up to 30% show delayed or incomplete recovery. We conducted a systematic review to answer the following clinical questions: What are the effects of drug treatments for Bell's palsy in adults and children? What are the effects of physical treatments for Bell's palsy in adults and children? We searched: Medline, Embase, The Cochrane Library, and other important databases up to October 2013 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). We found 13 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. In this systematic review, we present information relating to the effectiveness and safety of the following interventions: antiviral treatment, corticosteroids (alone or with antiviral treatment), hyperbaric oxygen therapy, and facial re-training.

Laser Phototherapy As Modality of Clinical Treatment in Bell's Palsy

NASA Astrophysics Data System (ADS)

Marques, A. M. C.; Soares, L. G. P.; Marques, R. C.; Pinheiro, A. L. B.; Dent, M.

2011-08-01

Bell's palsy is defined as a peripheral facial nerve palsy, idiophatic, and sudden onset and is considered the most common cause of this pathology. It is caused by damage to cranial nerves VII, resulting in complete or partial paralysis of the facial mimic. May be associated with taste disturbances, salivation, tearing and hyperacusis. It is diagnosed after ruling out all possible etiologies, because its cause is not fully understood.Some researches shows that herpes virus may cause this type of palsy due to reactivation of the virus or by imunnomediated post-viral nerve demielinization. Physical therapy, corticosteroids and antiviral therapy have become the most widely accepted treatments for Bell's palsy. Therapy with low-level laser (LLLT) may induce the metabolism of injured nerve tissue for the production of proteins associated with its growth and to improve nerve regeneration. The success of the treatment of Bell's palsy by using laser phototherapy isolated or in association with other therapeutic approach has been reported on the literature. In most cases, the recovery occurs without uneventfully (complications), the acute illness is not associated with serious disorders. We will present a clinical approach for treating this condition.

Bell's palsy syndrome: mimics and chameleons.

PubMed

Fuller, Geraint; Morgan, Cathy

2016-12-01

In this article we will explore the mimics and chameleons of Bell's palsy and in addition argue that we should use the term 'Bell's palsy syndrome' to help guide clinical reasoning when thinking about patients with facial weakness. The diagnosis of Bell's palsy can usually be made on clinical grounds without the need for further investigations. This is because the diagnosis is not one of exclusion (despite this being commonly how it is described), a lower motor neurone facial weakness where all alternative causes have been eliminated, but rather a positive recognition of a clinical syndrome, with a number of exclusions, which are described below. This perhaps would be more accurately referred to a 'Bell's palsy syndrome'. Treatment with corticosteroids improves outcome; adding an antiviral probably reduces the rates of long-term complications. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Outcome of patients presenting with idiopathic facial nerve paralysis (Bell's palsy) in a tertiary centre--a five year experience.

PubMed

Tang, I P; Lee, S C; Shashinder, S; Raman, R

2009-06-01

This is a retrospective study. The objective of this study is to review the factors influencing the outcome of treatment for the patients presented with idiopathic facial nerve paralysis. The demographic data, clinical presentation and management of 84 patients with idiopathic facial nerve paralysis (Bell's palsy) were collected from the medical record office, reviewed and analyzed from 2000 to 2005. Thirty-four (72.3%) out of 47 patients who were treated with oral prednisolone alone, fully recovered from Bell's palsy meanwhile 36 (97%) out of 37 patients who were treated with combination of oral prednisolone and acyclovir fully recovered. The difference was statistically significant. 42 (93.3%) out of 45 patients who presented within three days to our clinic, fully recovered while 28 (71.8%) out of 39 patients presented later then three days had full recovery from Bell's palsy. The difference was statistically significant. The outcome of full recovery is better with the patients treated with combined acyclovir and prednisolone compared with prednisolone alone. The patients who were treated after three days of clinical presentation, who were more than 50 years of age, who had concurrent chronic medical illness and facial nerve paralysis HB Grade IV to VI during initial presentation have reduced chance of full recovery of facial nerve paralysis.

Facial diplegia: a clinical dilemma.

PubMed

Chakrabarti, Debaprasad; Roy, Mukut; Bhattacharyya, Amrit K

2013-06-01

Bilateral facial paralysis is a rare clinical entity and presents as a diagnostic challenge. Unlike its unilateral counterpart facial diplegia is seldom secondary to Bell's palsy. Occurring at a frequency of 0.3% to 2% of all facial palsies it often indicates ominous medical conditions. Guillian-Barre syndrome needs to be considered as a differential in all given cases of facial diplegia where timely treatment would be rewarding. Here a case of bilateral facial palsy due to Guillian-Barre syndrome with atypical presentation is reported.

Bell’s palsy: data from a study of 70 cases

PubMed Central

Cirpaciu, D; Goanta, CM

2014-01-01

Bell’s palsy is a condition that affects the facial nerve, which is one of the twelve cranial nerves. Its main function is to control all the muscles of the facial expression. It is a unilateral, acute, partial or complete paralysis of the facial nerve. Bell's palsy remains the most common cause of facial nerve paralysis, more often encountered in females aged 17 to 30 years, recurrent in many cases and with poor associations with other pathologic conditions. In modern literature, the suspected etiology could be due to the reactivation of the latent herpes viral infections in the geniculate ganglia, and their subsequent migration to the facial nerve but, favorable outcome by using vasodilators, neurotrophic and corticosteroid therapy was recorded. PMID:25870668

Update on the Ophthalmic Management of Facial Paralysis.

PubMed

MacIntosh, Peter W; Fay, Aaron M

2018-06-07

Bell palsy is the most common neurologic condition affecting the cranial nerves. Lagophthalmos, exposure keratopathy, and corneal ulceration are potential complications. In this review, we evaluate various causes of facial paralysis as well as the level 1 evidence supporting the use of a short course of oral steroids for idiopathic Bell palsy to improve functional outcomes. Various surgical and nonsurgical techniques are also discussed for the management of residual facial dysfunction. Copyright © 2018. Published by Elsevier Inc.

Facial paralysis induced by ear inoculation of herpes simplex virus in rat.

PubMed

Fujiwara, Takashi; Matsuda, Seiji; Tanaka, Junya; Hato, Naohito

2017-02-01

Bell's palsy is caused by the reactivation of herpes simplex virus type 1 (HSV-1). Using Balb/c mice inoculated with the KOS strain of HSV-1, we previously developed an animal disease model that simulated mild Bell's palsy. The current study developed an animal disease model of more severe facial palsy than that seen in the mouse model. Three-week-old female Wister rats weighing 60-80g were inoculated on the auricle with HSV-1 and acyclovir was administered intraperitoneally to deactivate the infected HSV-1. Instead of HSV-1, phosphate-buffered saline was used for inoculation as a negative control. Quantitative polymerase chain reaction (PCR), behavior testing (blink reflex), electroneuronography, histopathology of the peripheral nerve, and immunohistochemistry of the facial nerve nucleus were evaluated. Facial palsy occurred 3-5 days after virus inoculation, and the severity of the facial palsy progressed for up to 7 days. Quantitative PCR showed an increase in HSV-1 DNA copies in the facial nerve from 24 to 72h, suggesting that HSV-1 infection occurred in the nerve. Electroneuronography values were 33.0±15.3% and 110.0±18.0% in HSV-1-inoculated and control rats, respectively. The histopathology of the peripheral nerve showed demyelination and loss of the facial nerve, and the facial nerve nucleus showed degeneration. Facial palsy developed in Wister rats following inoculation of the KOS strain of HSV-1 onto the auricles. The behavioral, histopathological, and electroneuronography data suggested that the severity of facial palsy was greater in our rats than in animals in the previous mouse disease model. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Bell's palsy

PubMed Central

2014-01-01

Introduction Bell's palsy is characterised by an acute, unilateral, partial, or complete paralysis of the face. Bell's palsy occurs in a lower motor neurone pattern. The weakness may be partial or complete, and may be associated with mild pain, numbness, increased sensitivity to sound, and altered taste. Bell's palsy is idiopathic, but a proportion of cases may be caused by re-activation of herpes virus at the geniculate ganglion of the facial nerve. Bell's palsy is most common in people aged 15 to 40 years, with a 1 in 60 lifetime risk. Most people make a spontaneous recovery within 1 month, but up to 30% show delayed or incomplete recovery. Methods and outcomes We conducted a systematic review to answer the following clinical questions: What are the effects of drug treatments for Bell's palsy in adults and children? What are the effects of physical treatments for Bell's palsy in adults and children? We searched: Medline, Embase, The Cochrane Library, and other important databases up to October 2013 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 13 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review, we present information relating to the effectiveness and safety of the following interventions: antiviral treatment, corticosteroids (alone or with antiviral treatment), hyperbaric oxygen therapy, and facial re-training. PMID:24717284

Herpes simplex virus type 1 and Bell's palsy-a current assessment of the controversy.

PubMed

Kennedy, Peter Ge

2010-02-01

Bell's palsy causes about two thirds of cases of acute peripheral facial weakness. Although the majority of cases completely recover spontaneously, about 30% of cases do not and are at risk from persisting severe facial paralysis and pain. It has been suggested that herpes simplex virus type 1 (HSV-1) may be the etiological agent that causes Bell's palsy. Although corticosteroid therapy is now universally recognized as improving the outcome of Bell's palsy, the question as to whether or not a combination of antiviral agents and corticosteroids result in a better rate of complete facial recovery compared with corticosteroids alone is now a highly contentious issue. The evidence obtained from laboratory studies of animals and humans that HSV-1 may be linked to facial nerve paralysis is first outlined. The discussion then focuses on the results of different clinical trials of the efficacy of antiviral agents combined with corticosteroids in increasing the rate of complete recovery in Bell's palsy. These have often given different results leading to opposite conclusions as to the efficacy of antivirals. Of three recent meta-analyses of previous trials, two concluded that antivirals produce no added benefit to corticosteroids alone in producing complete facial recovery, and one concluded that such combined therapy may be associated with additional benefit. Although it is probably not justified at the present time to treat patients with Bell's palsy with antiviral agents in addition to corticosteroids, it remains to be shown whether antivirals may be beneficial in treating patients who present with severe or complete facial paralysis.

Facial nerve decompression surgery using bFGF-impregnated biodegradable gelatin hydrogel in patients with Bell palsy.

PubMed

Hato, Naohito; Nota, Jumpei; Komobuchi, Hayato; Teraoka, Masato; Yamada, Hiroyuki; Gyo, Kiyofumi; Yanagihara, Naoaki; Tabata, Yasuhiko

2012-04-01

Basic fibroblast growth factor (bFGF) promotes the regeneration of denervated nerves. The aim of this study was to evaluate the regeneration-facilitating effects of novel facial nerve decompression surgery using bFGF in a gelatin hydrogel in patients with severe Bell palsy. Prospective clinical study. Tertiary referral center. Twenty patients with Bell palsy after more than 2 weeks following the onset of severe paralysis were treated with the new procedure. The facial nerve was decompressed between tympanic and mastoid segments via the mastoid. A bFGF-impregnated biodegradable gelatin hydrogel was placed around the exposed nerve. Regeneration of the facial nerve was evaluated by the House-Brackmann (H-B) grading system. The outcomes were compared with the authors' previous study, which reported outcomes of the patients who underwent conventional decompression surgery (n = 58) or conservative treatment (n = 43). The complete recovery (H-B grade 1) rate of the novel surgery (75.0%) was significantly better than the rate of conventional surgery (44.8%) and conservative treatment (23.3%). Every patient in the novel decompression surgery group improved to H-B grade 2 or better even when undergone between 31 and 99 days after onset. Advantages of this decompression surgery are low risk of complications and long effective period after onset of the paralysis. To the authors' knowledge, this is the first clinical report of the efficacy of bFGF using a new drug delivery system in patients with severe Bell palsy.

Unilateral facial paralysis caused by Ramsay Hunt syndrome.

PubMed

Pereira, Flávia P; Guskuma, Marcos H; Luvizuto, Eloá R; Faco, Eduardo F S; Magro-Filho, Osvaldo; Hochuli-Vieira, Eduardo

2011-09-01

The Ramsay Hunt syndrome is a rare disease caused by an infection of the geniculate ganglion by the varicella-zoster virus. The main clinical features of the syndrome are as follows: Bell palsy unilateral or bilateral, vesicular eruptions on the ears, ear pain, dizziness, preauricular swelling, tingling, tearing, loss of taste sensation, and nystagmus. We describe a 23-year-old white woman, who presented with facial paralysis on the left side of the face, pain, fever, ear pain, and swelling in the neck and auricular region on the left side. She received appropriate treatment with acyclovir, vitamin B complex, and CMP nucleus. After 30 days after presentation, the patient did not show any signs or symptoms of the syndrome. At follow-up at 1 year, she showed no relapse of the syndrome.

Bell's palsy: aetiology, clinical features and multidisciplinary care.

PubMed

Eviston, Timothy J; Croxson, Glen R; Kennedy, Peter G E; Hadlock, Tessa; Krishnan, Arun V

2015-12-01

Bell's palsy is a common cranial neuropathy causing acute unilateral lower motor neuron facial paralysis. Immune, infective and ischaemic mechanisms are all potential contributors to the development of Bell's palsy, but the precise cause remains unclear. Advancements in the understanding of intra-axonal signal molecules and the molecular mechanisms underpinning Wallerian degeneration may further delineate its pathogenesis along with in vitro studies of virus-axon interactions. Recently published guidelines for the acute treatment of Bell's palsy advocate for steroid monotherapy, although controversy exists over whether combined corticosteroids and antivirals may possibly have a beneficial role in select cases of severe Bell's palsy. For those with longstanding sequaelae from incomplete recovery, aesthetic, functional (nasal patency, eye closure, speech and swallowing) and psychological considerations need to be addressed by the treating team. Increasingly, multidisciplinary collaboration between interested clinicians from a wide variety of subspecialties has proven effective. A patient centred approach utilising physiotherapy, targeted botulinum toxin injection and selective surgical intervention has reduced the burden of long-term disability in facial palsy. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Bell palsy: Clinical examination and management.

PubMed

Patel, Donika K; Levin, Kerry H

2015-07-01

Bell palsy is a common neurologic disorder characterized by acute facial mononeuropathy of unclear cause presenting with unilateral facial weakness. Careful examination and a detailed history are important in making an accurate diagnosis. Early recognition is essential, as treatment with corticosteroids within 72 hours of onset has been shown to hasten recovery. Fortunately, most patients recover spontaneously within 3 weeks, even if untreated. Copyright © 2015 Cleveland Clinic.

Bell's palsy

PubMed Central

2011-01-01

Introduction Bell's palsy is characterised by an acute, unilateral, partial, or complete paralysis of the face (i.e., lower motor neurone pattern). The weakness may be partial (paresis) or complete (paralysis), and may be associated with mild pain, numbness, increased sensitivity to sound, and altered taste. Bell's palsy remains idiopathic, but a proportion of cases may be caused by reactivation of herpes viruses from the geniculate ganglion of the facial nerve. Bell's palsy is most common in people aged 15 to 40 years, with a 1 in 60 lifetime risk. Most make a spontaneous recovery within 1 month, but up to 30% show delayed or incomplete recovery. Methods and outcomes We conducted a systematic review to answer the following clinical question: What are the effects of treatments in adults and children? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 14 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: antiviral treatment, corticosteroids (alone or plus antiviral treatment), hyperbaric oxygen therapy, facial nerve decompression surgery, and facial retraining. PMID:21375786

Sound-induced facial synkinesis following facial nerve paralysis.

PubMed

Ma, Ming-San; van der Hoeven, Johannes H; Nicolai, Jean-Philippe A; Meek, Marcel F

2009-08-01

Facial synkinesis (or synkinesia) (FS) occurs frequently after paresis or paralysis of the facial nerve and is in most cases due to aberrant regeneration of (branches of) the facial nerve. Patients suffer from inappropriate and involuntary synchronous facial muscle contractions. Here we describe two cases of sound-induced facial synkinesis (SFS) after facial nerve injury. As far as we know, this phenomenon has not been described in the English literature before. Patient A presented with right hemifacial palsy after lesion of the facial nerve due to skull base fracture. He reported involuntary muscle activity at the right corner of the mouth, specifically on hearing ringing keys. Patient B suffered from left hemifacial palsy following otitis media and developed involuntary muscle contraction in the facial musculature specifically on hearing clapping hands or a trumpet sound. Both patients were evaluated by means of video, audio and EMG analysis. Possible mechanisms in the pathophysiology of SFS are postulated and therapeutic options are discussed.

Contralateral botulinum toxin injection to improve facial asymmetry after acute facial paralysis.

PubMed

Kim, Jin

2013-02-01

The application of botulinum toxin to the healthy side of the face in patients with long-standing facial paralysis has been shown to be a minimally invasive technique that improves facial symmetry at rest and during facial motion, but our experience using botulinum toxin therapy for facial sequelae prompted the idea that botulinum toxin might be useful in acute cases of facial paralysis, leading to improve facial asymmetry. In cases in which medical or surgical treatment options are limited because of existing medical problems or advanced age, most patients with acute facial palsy are advised to await spontaneous recovery or are informed that no effective intervention exists. The purpose of this study was to evaluate the effect of botulinum toxin treatment for facial asymmetry in 18 patients after acute facial palsy who could not be optimally treated by medical or surgical management because of severe medical or other problems. From 2009 to 2011, nine patients with Bell's palsy, 5 with herpes zoster oticus and 4 with traumatic facial palsy (10 men and 8 women; age range, 22-82 yr; mean, 50.8 yr) participated in this study. Botulinum toxin A (Botox; Allergan Incorporated, Irvine, CA, USA) was injected using a tuberculin syringe with a 27-gauge needle. The amount injected per site varied from 2.5 to 3 U, and the total dose used per patient was 32 to 68 U (mean, 47.5 +/- 8.4 U). After administration of a single dose of botulinum toxin A on the nonparalyzed side of 18 patients with acute facial paralysis, marked relief of facial asymmetry was observed in 8 patients within 1 month of injection. Decreased facial asymmetry and strengthened facial function on the paralyzed side led to an increased HB and SB grade within 6 months after injection. Use of botulinum toxin after acute facial palsy cases is of great value. Such therapy decreases the relative hyperkinesis contralateral to the paralysis, leading to greater symmetric function. Especially in patients with medical

Facial nerve paralysis associated with temporal bone masses.

PubMed

Nishijima, Hironobu; Kondo, Kenji; Kagoya, Ryoji; Iwamura, Hitoshi; Yasuhara, Kazuo; Yamasoba, Tatsuya

2017-10-01

To investigate the clinical and electrophysiological features of facial nerve paralysis (FNP) due to benign temporal bone masses (TBMs) and elucidate its differences as compared with Bell's palsy. FNP assessed by the House-Brackmann (HB) grading system and by electroneurography (ENoG) were compared retrospectively. We reviewed 914 patient records and identified 31 patients with FNP due to benign TBMs. Moderate FNP (HB Grades II-IV) was dominant for facial nerve schwannoma (FNS) (n=15), whereas severe FNP (Grades V and VI) was dominant for cholesteatomas (n=8) and hemangiomas (n=3). The average ENoG value was 19.8% for FNS, 15.6% for cholesteatoma, and 0% for hemangioma. Analysis of the correlation between HB grade and ENoG value for FNP due to TBMs and Bell's palsy revealed that given the same ENoG value, the corresponding HB grade was better for FNS, followed by cholesteatoma, and worst in Bell's palsy. Facial nerve damage caused by benign TBMs could depend on the underlying pathology. Facial movement and ENoG values did not correlate when comparing TBMs and Bell's palsy. When the HB grade is found to be unexpectedly better than the ENoG value, TBMs should be included in the differential diagnosis. Copyright © 2017 Elsevier B.V. All rights reserved.

[Bell's palsy and facial pain associated with toxocara infection].

PubMed

Bachtiar, Arian; Auer, Herbert; Finsterer, Josef

2012-10-01

Toxocarosis involving cranial nerves is extremely rare and almost exclusively concerns the optic nerve. Toxocarosis involving the seventh cranial nerve has not been reported. A 33y male developed left-sided Bell's palsy two days after left-sided otalgia 6y before. Despite extensive diagnostic work-up at that time the cause of Bell's palsy remained unknown. During the following years Bell's palsy slightly improved but retromandibular pain remained almost unchanged and he developed enlarged lymph nodes along the jugular veins, submandibularly, and in the trigonum caroticum. Re-evaluation 6y later revealed an increased titer of serum antibodies against Toxocara canis and a positive Westernblot for Toxocara canis ES-antigen. Despite absent eosinophilia in the serum, toxocarosis was diagnosed and a therapy with albendazole initiated, with benefit for retromandibular pain, but hardly for Bell's palsy or enlarged lymph nodes. CSF investigations after albendazole revealed a positive Westernblot for antibodies against toxocara but absent pleocytosis or eosinophilia, and negative PCR for Toxocara canis. Visceral larva migrans due to Toxocara canis may be associated with Bell's palsy, retromandibular pain, and lymphadenopathy. A causal relation between Bell's palsy and the helminthosis remains speculative. Adequate therapy years after onset of the infestation may be of limited benefit.

When the bell tolls on Bell's palsy: finding occult malignancy in acute-onset facial paralysis.

PubMed

Quesnel, Alicia M; Lindsay, Robin W; Hadlock, Tessa A

2010-01-01

This study reports 4 cases of occult parotid malignancy presenting with sudden-onset facial paralysis to demonstrate that failure to regain tone 6 months after onset distinguishes these patients from Bell's palsy patients with delayed recovery and to propose a diagnostic algorithm for this subset of patients. A case series of 4 patients with occult parotid malignancies presenting with acute-onset unilateral facial paralysis is reported. Initial imaging on all 4 patients did not demonstrate a parotid mass. Diagnostic delays ranged from 7 to 36 months from time of onset of facial paralysis to time of diagnosis of parotid malignancy. Additional physical examination findings, especially failure to regain tone, as well as properly protocolled radiologic studies reviewed with dedicated head and neck radiologists, were helpful in arriving at the diagnosis. An algorithm to minimize diagnostic delays in this subset of acute facial paralysis patients is presented. Careful attention to facial tone, in addition to movement, is important in the diagnostic evaluation of acute-onset facial paralysis. Copyright 2010 Elsevier Inc. All rights reserved.

Antiviral treatment for Bell's palsy (idiopathic facial paralysis).

PubMed

Lockhart, Pauline; Daly, Fergus; Pitkethly, Marie; Comerford, Natalia; Sullivan, Frank

2009-10-07

Antiviral agents against herpes simplex virus are widely used in the treatment of idiopathic facial paralysis (Bell's palsy), but their effectiveness is uncertain. Significant morbidity can be associated with severe cases. This review addresses the effect of antiviral therapy on Bell's palsy. We updated the search of the Cochrane Neuromuscular Disease Group Trials Register (December 2008), MEDLINE (from January 1966 to December 8 2008), EMBASE (from January 1980 to December 8 2008) and LILACS (from January 1982 to December 2008). Randomized trials of antivirals with and without corticosteroids versus control therapies for the treatment of Bell's palsy. Twenty-three papers were selected for consideration. Seven trials including 1987 participants met the inclusion criteria, adding five studies to the two in the previous review.Incomplete recovery at one year. There was no significant benefit in the rate of incomplete recovery from antivirals compared with placebo (n = 1886, RR 0.88, 95% CI 0.65 to 1.18). In meta-analyses with some unexplained heterogeneity, the outcome with antivirals was significantly worse than with corticosteroids (n = 768, RR 2.82, 95% CI 1.09 to 7.32) and the outcome with antivirals plus corticosteroids was significantly better than with placebo (n = 658, RR 0.56, 95% CI 0.41 to 0.76).Motor synkinesis or crocodile tears at one year. In single trials, there was no significant difference in long term sequelae comparing antivirals and corticosteroids with corticosteroids alone (n = 99, RR 0.39, 95% CI 0.14 to 1.07) or antivirals with corticosteroids (n = 101, RR 1.03, 95% CI 0.51 to 2.07).Adverse events.There was no significant difference in rates of adverse events between antivirals and placebo (n = 1544, RR 1.06, 95% CI 0.81 to 1.38), between antivirals and corticosteroids (n = 667, RR 0.96, 95% CI 0.65 to 1.41) or between the antiviral-corticosteroid combination and placebo (n = 658, RR 1.15, 95% CI 0.79 to 1.66). High quality evidence showed no

Medicine and art: facial palsy depicted in archaic Greek art on Crete.

PubMed

Pirsig, W; Helidonis, E; Velegrakis, G

1995-01-01

A small earthenware statuette was evacuated from the votive-depot of acropolis of Gortys, an ancient town in South-Crete/Greece. This ex-voto is dated approximately 7th to 6th century BC and very probably represents some symptoms of a stroke, especially the left facial palsy and the contracture of the left arm. Since the Minoan time until today, people of Crete have been offering ex-votos to gods or saints to ask for help in specific diseases.

Managing Bell's palsy.

PubMed

2006-07-01

Each year in the UK, around 1 in 5,000 people develop Bell's palsy--a unilateral lower motor neurone facial weakness of rapid onset that can be physically and psychologically disabling. While around 71% of patients recover normal function of the facial muscles without treatment, 13% are left with slight weakness and 16% with moderate to severe weakness resulting in major facial dysfunction. People who recover usually do so quickly, with 85% of them reporting some improvement in the first 3 weeks. There is longstanding controversy about what, if any, treatment should be initiated for Bell's palsy. Here we discuss the management of patients with this condition.

Facial Nerve Paralysis due to a Pleomorphic Adenoma with the Imaging Characteristics of a Facial Nerve Schwannoma

PubMed Central

Nader, Marc-Elie; Bell, Diana; Sturgis, Erich M.; Ginsberg, Lawrence E.; Gidley, Paul W.

2014-01-01

Background Facial nerve paralysis in a patient with a salivary gland mass usually denotes malignancy. However, facial paralysis can also be caused by benign salivary gland tumors. Methods We present a case of facial nerve paralysis due to a benign salivary gland tumor that had the imaging characteristics of an intraparotid facial nerve schwannoma. Results The patient presented to our clinic 4 years after the onset of facial nerve paralysis initially diagnosed as Bell palsy. Computed tomography demonstrated filling and erosion of the stylomastoid foramen with a mass on the facial nerve. Postoperative histopathology showed the presence of a pleomorphic adenoma. Facial paralysis was thought to be caused by extrinsic nerve compression. Conclusions This case illustrates the difficulty of accurate preoperative diagnosis of a parotid gland mass and reinforces the concept that facial nerve paralysis in the context of salivary gland tumors may not always indicate malignancy. PMID:25083397

Facial Nerve Paralysis due to a Pleomorphic Adenoma with the Imaging Characteristics of a Facial Nerve Schwannoma.

PubMed

Nader, Marc-Elie; Bell, Diana; Sturgis, Erich M; Ginsberg, Lawrence E; Gidley, Paul W

2014-08-01

Background Facial nerve paralysis in a patient with a salivary gland mass usually denotes malignancy. However, facial paralysis can also be caused by benign salivary gland tumors. Methods We present a case of facial nerve paralysis due to a benign salivary gland tumor that had the imaging characteristics of an intraparotid facial nerve schwannoma. Results The patient presented to our clinic 4 years after the onset of facial nerve paralysis initially diagnosed as Bell palsy. Computed tomography demonstrated filling and erosion of the stylomastoid foramen with a mass on the facial nerve. Postoperative histopathology showed the presence of a pleomorphic adenoma. Facial paralysis was thought to be caused by extrinsic nerve compression. Conclusions This case illustrates the difficulty of accurate preoperative diagnosis of a parotid gland mass and reinforces the concept that facial nerve paralysis in the context of salivary gland tumors may not always indicate malignancy.

Guillain-Barré Syndrome: A Variant Consisting of Facial Diplegia and Paresthesia with Left Facial Hemiplegia Associated with Antibodies to Galactocerebroside and Phosphatidic Acid

PubMed Central

Nishiguchi, Sho; Branch, Joel; Tsuchiya, Tsubasa; Ito, Ryoji; Kawada, Junya

2017-01-01

Patient: Male, 54 Final Diagnosis: Guillain-Barré syndrome Symptoms: Paresthesia of extremities • unilateral facial palsy Medication: — Clinical Procedure: — Specialty: Neurology Objective: Unusual clinical course Background: A rare variant of Guillain-Barré syndrome (GBS) consists of facial diplegia and paresthesia, but an even more rare association is with facial hemiplegia, similar to Bell’s palsy. This case report is of this rare variant of GBS that was associated with IgG antibodies to galactocerebroside and phosphatidic acid. Case Report: A 54-year-old man presented with lower left facial palsy and paresthesia of his extremities, following an upper respiratory tract infection. Physical examination confirmed lower left facial palsy and paresthesia of his extremities with hyporeflexia of his lower limbs and sensory loss of all four extremities. The differential diagnosis was between a variant of GBS and Bell’s palsy. Following initial treatment with glucocorticoids followed by intravenous immunoglobulin (IVIG), his sensory abnormalities resolved. Serum IgG antibodies to galactocerebroside and phosphatidic acid were positive in this patient, but not other antibodies to glycolipids or phospholipids were found. Five months following discharge from hospital, his left facial palsy had improved. Conclusions: A case of a rare variant of GBS is presented with facial diplegia and paresthesia and with unilateral facial palsy. This rare variant of GBS may which may mimic Bell’s palsy. In this case, IgG antibodies to galactocerebroside and phosphatidic acid were detected. PMID:28966341

Lyme disease with facial nerve palsy: rapid diagnosis using a nested polymerase chain reaction-restriction fragment length polymorphism analysis.

PubMed

Hashimoto, Y; Takahashi, H; Kishiyama, K; Sato, Y; Nakao, M; Miyamoto, K; Iizuka, H

1998-02-01

A 64-year-old woman with Lyme disease and manifesting facial nerve palsy had been bitten by a tick on the left frontal scalp 4 weeks previously. Erythema migrans appeared on the left forehead, accompanied by left facial paralysis. Nested polymerase chain reaction-restriction fragment length polymorphism analysis (nested PCR-RFLP) was performed on DNA extracted from a skin biopsy of the erythema on the left forehead. Borrelia flagellin gene DNA was detected and its RFLP pattern indicated that the organism was B. garinii, Five weeks later, B. garinii was isolated by conventional culture from the erythematous skin lesion, but not from the cerebrospinal fluid. After treatment with ceftriaxone intravenously for 10 days and oral administration of minocycline for 7 days, both the erythema and facial nerve palsy improved significantly. Nested PCR and culture taken after the lesion subsided, using skin samples obtained from a site adjacent to the original biopsy, were both negative. We suggest that nested PCR-RFLP analysis might be useful for the rapid diagnosis of Lyme disease and for evaluating therapy.

A Case Report of a Child with Bell's Palsy.

PubMed

Ramphul, Kamleshun; Mejias, Stephanie G; Ramphul-Sicharam, Yogeshwaree; Hamid, Ezatullah; Sonaye, Ruhi

2018-04-02

Bell's palsy is a neuropathy involving the seventh cranial nerve, also known as the facial nerve. It is usually caused by traumatic, infective, inflammatory or compressive conditions on the nerve. Many cases are also with no identifiable etiologies and are classified as idiopathic. Acute inflammation and edema of the cranial nerve seven can lead to the compression and eventual ischemia. The most common viral cause of Bell's palsy is herpes simplex virus but there are several reports of other viruses such as Epstein-Barr virus, human immunodeficiency virus and the hepatitis B virus involved in with similar presentation. Presentation of Bell's palsy in the pediatric population is quite rare and this makes early recognition and proper treatment important. We present a case of a three-year-old male with Bell's palsy.

Common questions about Bell palsy.

PubMed

Albers, Janet R; Tamang, Stephen

2014-02-01

Bell palsy is an acute affliction of the facial nerve, resulting in sudden paralysis or weakness of the muscles on one side of the face. Testing patients with unilateral facial paralysis for diabetes mellitus or Lyme disease is not routinely recommended. Patients with Lyme disease typically present with additional manifestations, such as arthritis, rash, or facial swelling. Diabetes may be a comorbidity of Bell palsy, but testing is not needed in the absence of other indications, such as hypertension. In patients with atypical symptoms, magnetic resonance imaging with contrast enhancement can be used to rule out cranial mass effect and to add prognostic value. Steroids improve resolution of symptoms in patients with Bell palsy and remain the preferred treatment. Antiviral agents have a limited role, and may improve outcomes when combined with steroids in patients with severe symptoms. When facial paralysis is prolonged, surgery may be indicated to prevent ocular desiccation secondary to incomplete eyelid closure. Facial nerve decompression is rarely indicated or performed. Physical therapy modalities, including electrostimulation, exercise, and massage, are neither beneficial nor harmful.

Guillain-Barré Syndrome: A Variant Consisting of Facial Diplegia and Paresthesia with Left Facial Hemiplegia Associated with Antibodies to Galactocerebroside and Phosphatidic Acid.

PubMed

Nishiguchi, Sho; Branch, Joel; Tsuchiya, Tsubasa; Ito, Ryoji; Kawada, Junya

2017-10-02

BACKGROUND A rare variant of Guillain-Barré syndrome (GBS) consists of facial diplegia and paresthesia, but an even more rare association is with facial hemiplegia, similar to Bell's palsy. This case report is of this rare variant of GBS that was associated with IgG antibodies to galactocerebroside and phosphatidic acid. CASE REPORT A 54-year-old man presented with lower left facial palsy and paresthesia of his extremities, following an upper respiratory tract infection. Physical examination confirmed lower left facial palsy and paresthesia of his extremities with hyporeflexia of his lower limbs and sensory loss of all four extremities. The differential diagnosis was between a variant of GBS and Bell's palsy. Following initial treatment with glucocorticoids followed by intravenous immunoglobulin (IVIG), his sensory abnormalities resolved. Serum IgG antibodies to galactocerebroside and phosphatidic acid were positive in this patient, but not other antibodies to glycolipids or phospholipids were found. Five months following discharge from hospital, his left facial palsy had improved. CONCLUSIONS A case of a rare variant of GBS is presented with facial diplegia and paresthesia and with unilateral facial palsy. This rare variant of GBS may which may mimic Bell's palsy. In this case, IgG antibodies to galactocerebroside and phosphatidic acid were detected.

Lyme disease and Bell's palsy: an epidemiological study of diagnosis and risk in England.

PubMed

Cooper, Lilli; Branagan-Harris, Michael; Tuson, Richard; Nduka, Charles

2017-05-01

Lyme disease is caused by a tick-borne spirochaete of the Borrelia species. It is associated with facial palsy, is increasingly common in England, and may be misdiagnosed as Bell's palsy. To produce an accurate map of Lyme disease diagnosis in England and to identify patients at risk of developing associated facial nerve palsy, to enable prevention, early diagnosis, and effective treatment. Hospital episode statistics (HES) data in England from the Health and Social Care Information Centre were interrogated from April 2011 to March 2015 for International Classification of Diseases 10th revision (ICD-10) codes A69.2 (Lyme disease) and G51.0 (Bell's palsy) in isolation, and as a combination. Patients' age, sex, postcode, month of diagnosis, and socioeconomic groups as defined according to the English Indices of Deprivation (2004) were also collected. Lyme disease hospital diagnosis increased by 42% per year from 2011 to 2015 in England. Higher incidence areas, largely rural, were mapped. A trend towards socioeconomic privilege and the months of July to September was observed. Facial palsy in combination with Lyme disease is also increasing, particularly in younger patients, with a mean age of 41.7 years, compared with 59.6 years for Bell's palsy and 45.9 years for Lyme disease ( P = 0.05, analysis of variance [ANOVA]). Healthcare practitioners should have a high index of suspicion for Lyme disease following travel in the areas shown, particularly in the summer months. The authors suggest that patients presenting with facial palsy should be tested for Lyme disease. © British Journal of General Practice 2017.

Bilateral Bell palsy as a presenting sign of preeclampsia.

PubMed

Vogell, Alison; Boelig, Rupsa C; Skora, Joanna; Baxter, Jason K

2014-08-01

Bell palsy is a facial nerve neuropathy that is a rare disorder but occurs at higher frequency in pregnancy. Almost 30% of cases are associated with preeclampsia or gestational hypertension. Bilateral Bell palsy occurs in only 0.3%-2.0% of cases of facial paralysis, has a poorer prognosis for recovery, and may be associated with a systemic disorder. We describe a case of a 24-year-old primigravid woman with a twin gestation at 35 weeks diagnosed initially with bilateral facial palsy and subsequently with preeclampsia. She then developed partial hemolysis, elevated liver enzymes, and low platelet count syndrome, prompting the diagnosis of severe preeclampsia, and was delivered. Bilateral facial palsy is a rare entity in pregnancy that may be the first sign of preeclampsia and suggests increased severity of disease, warranting close monitoring.

Imaging the Facial Nerve: A Contemporary Review

PubMed Central

Gupta, Sachin; Mends, Francine; Hagiwara, Mari; Fatterpekar, Girish; Roehm, Pamela C.

2013-01-01

Imaging plays a critical role in the evaluation of a number of facial nerve disorders. The facial nerve has a complex anatomical course; thus, a thorough understanding of the course of the facial nerve is essential to localize the sites of pathology. Facial nerve dysfunction can occur from a variety of causes, which can often be identified on imaging. Computed tomography and magnetic resonance imaging are helpful for identifying bony facial canal and soft tissue abnormalities, respectively. Ultrasound of the facial nerve has been used to predict functional outcomes in patients with Bell's palsy. More recently, diffusion tensor tractography has appeared as a new modality which allows three-dimensional display of facial nerve fibers. PMID:23766904

Restoration of facial symmetry in a patient with bell palsy using a modified maxillary complete denture: a case report.

PubMed

Bagchi, Gautam; Nath, Dilip Kumar

2012-01-01

Permanent facial paralysis can be devastating for a patient. Modern society's emphasis on appearance and physical beauty contributes to this problem and often leads to isolation of patients embarrassed by their appearance. Lagophthalmos with ocular exposure, loss of oral competence with resultant drooling, alar collapse with nasal airway obstruction, and difficulties with mastication and speech production are all potential consequences of facial paralysis. Affected patients are confronted with both a cosmetic defect and the functional deficits associated with loss of facial nerve function. In this case history report, a modified maxillary complete denture permitted a patient with Bell palsy to carry on daily activities with minimal facial distortion, pain, speech difficulty, and associated emotional trauma.

Small vestibular schwannomas presenting with facial nerve palsy.

PubMed

Espahbodi, Mana; Carlson, Matthew L; Fang, Te-Yung; Thompson, Reid C; Haynes, David S

2014-06-01

To describe the surgical management and convalescence of two patients presenting with severe facial nerve weakness associated with small intracanalicular vestibular schwannomas (VS). Retrospective review. Two adult female patients presenting with audiovestibular symptoms and subacute facial nerve paralysis (House-Brackmann Grade IV and V). In both cases, post-contrast T1-weighted magnetic resonance imaging revealed an enhancing lesion within the internal auditory canal without lateral extension beyond the fundus. Translabyrinthine exploration demonstrated vestibular nerve origin of tumor, extrinsic to the facial nerve, and frozen section pathology confirmed schwannoma. Gross total tumor resection with VIIth cranial nerve preservation and decompression of the labyrinthine segment of the facial nerve was performed. Both patients recovered full motor function between 6 and 8 months after surgery. Although rare, small VS may cause severe facial neuropathy, mimicking the presentation of facial nerve schwannomas and other less common pathologies. In the absence of labyrinthine extension on MRI, surgical exploration is the only reliable means of establishing a diagnosis. In the case of confirmed VS, early gross total resection with facial nerve preservation and labyrinthine segment decompression may afford full motor recovery-an outcome that cannot be achieved with facial nerve grafting.

Contemporary management of Bell palsy.

PubMed

Jowett, Nate; Hadlock, Tessa A

2015-04-01

Bell palsy (BP) is the most common diagnosis in acute and chronic facial palsy. Although most patients fully recover, more than one-quarter will have residual dysfunction. Of these, nearly half will demonstrate severe limitations in facial expression. Though significant attention has been paid to acute management and prognosis, a paucity of literature exists addressing management of the long-term sequelae of BP. This article describes contemporary use of physical therapy, injectables, and static and dynamic surgical procedures in facial reanimation of acute and chronic BP. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Value of electroneurography as a prognostic indicator for recovery in acute severe inflammatory facial paralysis: a prospective study of Bell's palsy and Ramsay Hunt syndrome.

PubMed

Byun, Hayoung; Cho, Yang-Sun; Jang, Jeon Yeob; Chung, Kyu Whan; Hwang, Soojin; Chung, Won-Ho; Hong, Sung Hwa

2013-10-01

To evaluate the prognostic and predictive value of electroneuronography (ENoG) in acute severe inflammatory facial paralysis, including Bell's palsy and Ramsay Hunt syndrome (RHS). Prospective observational study. Patients with acute severe facial paralysis of House-Brackmann (H-B) grade IV or worse and diagnosed with Bell's palsy or RHS were enrolled from August 2007 to July 2011. After treatment with oral corticosteroid, antiviral agent, and protective eye care, patients were followed up until recovery or 12 months from onset. Sixty-six patients with Bell's palsy and 22 with RHS were included. Multiple logistic regression analysis showed significant effect of ENoG value on recovery in both Bell's palsy and RHS. Values of ENoG were significantly worse in RHS than Bell's palsy. Chance of early recovery within 6 weeks after correction of ENoG effect was still significantly worse in RHS. Logistic regression analysis showed 90% chance of recovery within 6 months, expected with ENoG values of 69.2% degeneration (Bell's palsy) and 59.3% (RHS). The receiver operating characteristics (ROC) curves showed ENoG values of 82.5% (Bell's palsy) and 78.0% (RHS) as a critical cutoff value of nonrecovery until 1 year, with the best sensitivity and specificity. A higher chance of recovery was expected with better ENoG in Bell's palsy and RHS. Based on our data, nonrecovery is predicted in patients with ENoG value greater than 82.5% in Bell's palsy, and 78% in RHS. 4. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

Antiviral treatment for Bell's palsy (idiopathic facial paralysis).

PubMed

Gagyor, Ildiko; Madhok, Vishnu B; Daly, Fergus; Somasundara, Dhruvashree; Sullivan, Michael; Gammie, Fiona; Sullivan, Frank

2015-11-09

Corticosteroids are widely used in the treatment of idiopathic facial paralysis (Bell's palsy), but the effectiveness of additional treatment with an antiviral agent is uncertain. Significant morbidity can be associated with severe cases of Bell's palsy. This review was first published in 2001 and revised several times, most recently in 2009. This version replaces an update of the review in Issue 7 of the Cochrane Library subsequently withdrawn because of an ongoing investigation into the reliability of data from an included study. To assess the effects of antiviral treatments alone or in combination with any other therapy for Bell's palsy. On 7 October 2014 we searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL, MEDLINE, EMBASE, LILACS, DARE, NHS EED, and HTA. We also reviewed the bibliographies of the identified trials and contacted trial authors and known experts in the field and relevant drug companies to identify additional published or unpublished data. We searched clinical trials registries for ongoing studies. We considered randomised controlled trials or quasi-randomised controlled trials of antivirals with and without corticosteroids versus control therapies for the treatment of Bell's palsy. We excluded trials that had a high risk of bias in several domains. Pairs of authors independently assessed trials for relevance, eligibility, and risk of bias, using standard Cochrane procedures. Ten trials, including 2280 participants, met the inclusion criteria and are included in the final analysis. Some of the trials were small, and a number were at high or unclear risk of bias. Other trials did not meet current best standards in allocation concealment and blinding. Incomplete recoveryWe found a significant benefit from adding antivirals to corticosteroids in comparison with corticosteroids alone for people with Bell's palsy (risk ratio (RR) 0.61, 95% confidence interval (CI) 0.39 to 0.97, n = 1315). For people with severe Bell

Antiviral treatment for Bell's palsy (idiopathic facial paralysis).

PubMed

Gagyor, Ildiko; Madhok, Vishnu B; Daly, Fergus; Somasundara, Dhruvashree; Sullivan, Michael; Gammie, Fiona; Sullivan, Frank

2015-07-01

Corticosteroids are widely used in the treatment of idiopathic facial paralysis (Bell's palsy), but the effectiveness of additional treatment with an antiviral agent is uncertain. Significant morbidity can be associated with severe cases of Bell's palsy. To assess the effects of antiviral treatments alone or in combination with any other therapy for Bell's palsy. On 7 October 2014 we searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL, MEDLINE, EMBASE, LILACS, DARE, NHS EED, and HTA. We also reviewed the bibliographies of the identified trials and contacted trial authors and known experts in the field and relevant drug companies to identify additional published or unpublished data. We searched clinical trials registries for ongoing studies. We considered randomised controlled trials or quasi-randomised controlled trials of antivirals with and without corticosteroids versus control therapies for the treatment of Bell's palsy. We excluded trials that had a high risk of bias in several domains. Pairs of authors independently assessed trials for relevance, eligibility, and risk of bias, using standard Cochrane procedures. Eleven trials, including 2883 participants, met the inclusion criteria and are included in the final analysis. We added four studies to the previous review for this update. Some of the trials were small, and a number were at high or unclear risk of bias. Other trials did not meet current best standards in allocation concealment and blinding. Incomplete recoveryWe found no significant benefit from adding antivirals to corticosteroids in comparison with corticosteroids alone for people with Bell's palsy (risk ratio (RR) 0.69, 95% confidence interval (CI) 0.47 to 1.02, n = 1715). For people with severe Bell's palsy (House-Brackmann scores of 5 and 6 or the equivalent in other scales), we found a reduction in the rate of incomplete recovery at month six when antivirals plus corticosteroids were used (RR 0.64, 95% CI 0.41 to 0

Epidemiology and treatment of Bell's palsy in children in northern Taiwan.

PubMed

Tsai, Han Sheng; Chang, Luan Yin; Lu, Chun Yi; Lee, Ping Ing; Chen, Jong Min; Lee, Chin Yun; Huang, Li Min

2009-08-01

Bell's palsy is not uncommon in children. This study was performed to evaluate the epidemiology of Bell's palsy in the northern Taiwanese pediatric population, and the effectiveness of corticosteroid treatment. The medical records of pediatric patients with a primary diagnosis of facial palsy from April 2002 through March 2007 were reviewed. Patients with secondary facial palsy were excluded from the analysis. 289 episodes of facial palsy were identified and the clinical findings of 134 episodes among 132 patients were assessed. The median +/- standard deviation age was 9.9 +/- 4.9 years, and 58.2% of patients were girls. Children were more likely to have episodes of Bell's palsy during the cold season, with a peak in January. The left (67 episodes; 50.0%) and right (64 episodes; 47.8%) facial nerves were involved with similar frequency. Common symptoms were postauricular pain (11.2%) and facial hypoesthesia (9.0%). Of 51 episodes of Bell's palsy with complete follow-up, corticosteroids were given for 44 episodes. Thirty eight patients (86.4%) given corticosteroids had complete recovery and 4 patients (57.1%) recovered without corticosteroids. Rates of complete recovery did not differ significantly between the 2 groups (p = 0.08). There were no significant differences in the recovery rate between early (< or = 3 days) and late (4-7 days) administration. In northern Taiwan, childhood Bell's palsy peaks from January through March. The majority of children with Bell's palsy recovered completely. There was no significant effect of corticosteroid treatment for children with Bell's palsy.

Physical therapy for facial paralysis: a tailored treatment approach.

PubMed

Brach, J S; VanSwearingen, J M

1999-04-01

Bell palsy is an acute facial paralysis of unknown etiology. Although recovery from Bell palsy is expected without intervention, clinical experience suggests that recovery is often incomplete. This case report describes a classification system used to guide treatment and to monitor recovery of an individual with facial paralysis. The patient was a 71-year-old woman with complete left facial paralysis secondary to Bell palsy. Signs and symptoms were assessed using a standardized measure of facial impairment (Facial Grading System [FGS]) and questions regarding functional limitations. A treatment-based category was assigned based on signs and symptoms. Rehabilitation involved muscle re-education exercises tailored to the treatment-based category. In 14 physical therapy sessions over 13 months, the patient had improved facial impairments (initial FGS score= 17/100, final FGS score= 68/100) and no reported functional limitations. Recovery from Bell palsy can be a complicated and lengthy process. The use of a classification system may help simplify the rehabilitation process.

Diagnostic Lumbar Puncture Among Children With Facial Palsy in a Lyme Disease Endemic Area.

PubMed

Paydar-Darian, Niloufar; Kimia, Amir A; Lantos, Paul M; Fine, Andrew M; Gordon, Caroline D; Gordon, Catherine R; Landschaft, Assaf; Nigrovic, Lise E

2017-06-01

We identified 620 children with peripheral facial palsy of which 211 (34%) had Lyme disease. The 140 children who had a lumbar puncture performed were more likely to be hospitalized (73% LP performed vs 2% no LP) and to receive parenteral antibiotics (62% LP performed vs 6% no LP). © The Author 2016. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Analysis of Facial Injuries Caused by Power Tools.

PubMed

Kim, Jiye; Choi, Jin-Hee; Hyun Kim, Oh; Won Kim, Sug

2016-06-01

The number of injuries caused by power tools is steadily increasing as more domestic woodwork is undertaken and more power tools are used recreationally. The injuries caused by the different power tools as a consequence of accidents are an issue, because they can lead to substantial costs for patients and the national insurance system. The increase in hand surgery as a consequence of the use of power tools and its economic impact, and the characteristics of the hand injuries caused by power saws have been described. In recent years, the authors have noticed that, in addition to hand injuries, facial injuries caused by power tools commonly present to the emergency room. This study aimed to review the data in relation to facial injuries caused by power saws that were gathered from patients who visited the trauma center at our hospital over the last 4 years, and to analyze the incidence and epidemiology of the facial injuries caused by power saws. The authors found that facial injuries caused by power tools have risen continually. Facial injuries caused by power tools are accidental, and they cause permanent facial disfigurements and functional disabilities. Accidents are almost inevitable in particular workplaces; however, most facial injuries could be avoided by providing sufficient operator training and by tool operators wearing suitable protective devices. The evaluation of the epidemiology and patterns of facial injuries caused by power tools in this study should provide the information required to reduce the number of accidental injuries.

Lyme disease and Bell’s palsy: an epidemiological study of diagnosis and risk in England

PubMed Central

Cooper, Lilli; Branagan-Harris, Michael; Tuson, Richard; Nduka, Charles

2017-01-01

Background Lyme disease is caused by a tick-borne spirochaete of the Borrelia species. It is associated with facial palsy, is increasingly common in England, and may be misdiagnosed as Bell’s palsy. Aim To produce an accurate map of Lyme disease diagnosis in England and to identify patients at risk of developing associated facial nerve palsy, to enable prevention, early diagnosis, and effective treatment. Design and setting Hospital episode statistics (HES) data in England from the Health and Social Care Information Centre were interrogated from April 2011 to March 2015 for International Classification of Diseases 10th revision (ICD-10) codes A69.2 (Lyme disease) and G51.0 (Bell’s palsy) in isolation, and as a combination. Method Patients’ age, sex, postcode, month of diagnosis, and socioeconomic groups as defined according to the English Indices of Deprivation (2004) were also collected. Results Lyme disease hospital diagnosis increased by 42% per year from 2011 to 2015 in England. Higher incidence areas, largely rural, were mapped. A trend towards socioeconomic privilege and the months of July to September was observed. Facial palsy in combination with Lyme disease is also increasing, particularly in younger patients, with a mean age of 41.7 years, compared with 59.6 years for Bell’s palsy and 45.9 years for Lyme disease (P = 0.05, analysis of variance [ANOVA]). Conclusion Healthcare practitioners should have a high index of suspicion for Lyme disease following travel in the areas shown, particularly in the summer months. The authors suggest that patients presenting with facial palsy should be tested for Lyme disease. PMID:28396367

Risk Factors for Clinician-Diagnosed Lyme Arthritis, Facial Palsy, Carditis, and Meningitis in Patients From High-Incidence States

PubMed Central

Kwit, Natalie A; Max, Ryan; Mead, Paul S

2018-01-01

Abstract Background Clinical features of Lyme disease (LD) range from localized skin lesions to serious disseminated disease. Information on risk factors for Lyme arthritis, facial palsy, carditis, and meningitis is limited but could facilitate disease recognition and elucidate pathophysiology. Methods Patients from high-incidence states treated for LD during 2005–2014 were identified in a nationwide insurance claims database using the International Classification of Diseases, Ninth Revision code for LD (088.81), antibiotic treatment history, and clinically compatible codiagnosis codes for LD manifestations. Results Among 88022 unique patients diagnosed with LD, 5122 (5.8%) patients with 5333 codiagnoses were identified: 2440 (2.8%) arthritis, 1853 (2.1%) facial palsy, 534 (0.6%) carditis, and 506 (0.6%) meningitis. Patients with disseminated LD had lower median age (35 vs 42 years) and higher male proportion (61% vs 50%) than nondisseminated LD. Greatest differential risks included arthritis in males aged 10–14 years (odds ratio [OR], 3.5; 95% confidence interval [CI], 3.0–4.2), facial palsy (OR, 2.1; 95% CI, 1.6–2.7) and carditis (OR, 2.4; 95% CI, 1.6–3.6) in males aged 20–24 years, and meningitis in females aged 10–14 years (OR, 3.4; 95% CI, 2.1–5.5) compared to the 55–59 year referent age group. Males aged 15–29 years had the highest risk for complete heart block, a potentially fatal condition. Conclusions The risk and manifestations of disseminated LD vary by age and sex. Provider education regarding at-risk populations and additional investigations into pathophysiology could enhance early case recognition and improve patient management. PMID:29326960

Guide to Understanding Facial Palsy

MedlinePlus

... to many different facial muscles. These muscles control facial expression. The coordinated activity of this nerve and these ... involves a weakness of the muscles responsible for facial expression and side-to-side eye movement. Moebius syndrome ...

Overview of pediatric peripheral facial nerve paralysis: analysis of 40 patients.

PubMed

Özkale, Yasemin; Erol, İlknur; Saygı, Semra; Yılmaz, İsmail

2015-02-01

Peripheral facial nerve paralysis in children might be an alarming sign of serious disease such as malignancy, systemic disease, congenital anomalies, trauma, infection, middle ear surgery, and hypertension. The cases of 40 consecutive children and adolescents who were diagnosed with peripheral facial nerve paralysis at Baskent University Adana Hospital Pediatrics and Pediatric Neurology Unit between January 2010 and January 2013 were retrospectively evaluated. We determined that the most common cause was Bell palsy, followed by infection, tumor lesion, and suspected chemotherapy toxicity. We noted that younger patients had generally poorer outcome than older patients regardless of disease etiology. Peripheral facial nerve paralysis has been reported in many countries in America and Europe; however, knowledge about its clinical features, microbiology, neuroimaging, and treatment in Turkey is incomplete. The present study demonstrated that Bell palsy and infection were the most common etiologies of peripheral facial nerve paralysis. © The Author(s) 2014.

WITHDRAWN. Antiviral treatment for Bell's palsy (idiopathic facial paralysis).

PubMed

Gagyor, Ildiko; Madhok, Vishnu B; Daly, Fergus; Somasundara, Dhruvashree; Sullivan, Michael; Gammie, Fiona; Sullivan, Frank

2015-05-04

Corticosteroids are widely used in the treatment of idiopathic facial paralysis (Bell's palsy), but the effectiveness of additional treatment with an antiviral agent is uncertain. Significant morbidity can be associated with severe cases of Bell's palsy. To assess the effects of antiviral treatments alone or in combination with any other therapy for Bell's palsy. On 7 October 2014 we searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL, MEDLINE, EMBASE, LILACS, DARE, NHS EED, and HTA. We also reviewed the bibliographies of the identified trials and contacted trial authors and known experts in the field and relevant drug companies to identify additional published or unpublished data. We searched clinical trials registries for ongoing studies. We considered randomised controlled trials or quasi-randomised controlled trials of antivirals with and without corticosteroids versus control therapies for the treatment of Bell's palsy. We excluded trials that had a high risk of bias in several domains. Pairs of authors independently assessed trials for relevance, eligibility, and risk of bias, using standard Cochrane procedures. Eleven trials, including 2883 participants, met the inclusion criteria and are included in the final analysis. We added four studies to the previous review for this update. Some of the trials were small, and a number were at high or unclear risk of bias. Other trials did not meet current best standards in allocation concealment and blinding. Incomplete recoveryWe found no significant benefit from adding antivirals to corticosteroids in comparison with corticosteroids alone for people with Bell's palsy (risk ratio (RR) 0.69, 95% confidence interval (CI) 0.47 to 1.02, n = 1715). For people with severe Bell's palsy (House-Brackmann scores of 5 and 6 or the equivalent in other scales), we found a reduction in the rate of incomplete recovery at month six when antivirals plus corticosteroids were used (RR 0.64, 95% CI 0.41 to 0

Razi's description and treatment of facial paralysis.

PubMed

Tabatabaei, Seyed Mahmood; Kalantar Hormozi, Abdoljalil; Asadi, Mohsen

2011-01-01

In the modern medical era, facial paralysis is linked with the name of Charles Bell. This disease, which is usually unilateral and is a peripheral facial palsy, causes facial muscle weakness in the affected side. Bell gave a complete description of the disease; but historically other physicians had described it several hundred years prior although it had been ignored for different reasons, such as the difficulty of the original text language. The first and the most famous of these physicians who described this disease was Mohammad Ibn Zakaryya Razi (Rhazes). In this article, we discuss his opinion.

Prognostic factors of Bell's palsy: prospective patient collected observational study.

PubMed

Fujiwara, Takashi; Hato, Naohito; Gyo, Kiyofumi; Yanagihara, Naoaki

2014-07-01

The purpose of this study was to evaluate various parameters potentially influencing poor prognosis in Bell's palsy and to assess the predictive value for Bell's palsy. A single-center prospective patient collected observation and validation study was conducted. To evaluate the correlation between patient characteristics and poor prognosis, we performed univariate and multivariate analyzes of age, gender, side of palsy, diabetes mellitus, hypertension, and facial grading score 1 week after onset. To evaluate the accuracy of the facial grading score, we prepared a receiver operating characteristic (ROC) curve and calculated the area under the ROC curve (AUROC). We also calculated sensitivity, specificity, positive/negative likelihood ratio, and positive/negative predictive value. We included Bell's palsy patients who attended Ehime University Hospital within 1 week after onset between 1977 and 2011. We excluded patients who were less than 15 years old and lost-to-follow-up within 6 months. The main outcome was defined as non-recovery at 6 months after onset. In total, 679 adults with Bell's palsy were included. The facial grading score at 1 week showed a correlation with non-recovery in the multivariate analysis, although age, gender, side of palsy, diabetes mellitus, and hypertension did not. The AUROC of the facial grading score was 0.793. The Y-system score at 1 week moderate accurately predicted non-recovery at 6 months in Bell's palsy.

Effect of long-term electrical stimulation on motor recovery and improvement of clinical residuals in patients with unresolved facial nerve palsy.

PubMed

Targan, R S; Alon, G; Kay, S L

2000-02-01

This study investigated the efficacy of a pulsatile electrical current to shorten neuromuscular conduction latencies and minimize clinical residuals in patients with chronic facial nerve damage caused by Bell's palsy or acoustic neuroma excision. The study group included 12 patients (mean age 50.4 +/- 12. 3 years) with idiopathic Bell's palsy and 5 patients (mean age 45.6 +/- 10.7 years) whose facial nerves were surgically sacrificed. The mean time since the onset of paresis/paralysis was 3.7 years (range 1-7 years) and 7.2 years (range 6-9 years) for the Bell's and neuroma excision groups, respectively. Motor nerve conduction latencies, House-Brackmann facial recovery scores, and a 12-item clinical assessment of residuals were obtained 3 months before the onset of treatment, at the beginning of treatment, and after 6 months of stimulation. Patients were treated at home for periods of up to 6 hours daily for 6 months with a battery-powered stimulator. Stimulation intensity was kept at a submotor level throughout the study. Surface electrodes were secured over the most affected muscles. Groups and time factors were used in the analyses of the 3 outcome measures. No statistical differences were found between the two diagnostic groups with respect to any of the 3 outcome measures. Mean motor nerve latencies decreased by 1.13 ms (analysis of variance test, significant P = 0.0001). House-Brackmann scores were also significantly lower (Wilcoxon signed rank test, P = 0.0003) after treatment. Collective scores on the 12 clinical impairment measures decreased 28.7 +/- 8.1 points after 6 months [analysis of variance test, significant P = 0.0005). Eight patients showed more than 40% improvement, 4 better than 30%, and 5 less than 10% improvement in residuals score. These data are consistent with the notion that long-term electrical stimulation may facilitate partial reinnervation in patients with chronic facial paresis/paralysis. Additionally, residual clinical impairments

Human Evolution: The Real Cause for Birth Palsy

PubMed Central

Sreekanth, R; Thomas, BP

2015-01-01

ABSTRACT Objective: Birth palsy, otherwise known as obstetric brachial plexus paralysis (OBPP), is a closed stretch injury to the brachial plexus of nerves during the birth process resulting in varying degree of paralysis and contractures of the upper limb. The study aimed to find out the susceptibility of humans and small-bodied primates to birth palsy. Method: A comparative study on parturition in modern humans, hominoids, hominids, small-bodied primates and great apes was done to determine if changes in the female pelvis and neonatal head and shoulder during human evolution is the real cause for OBPP. Results: During evolution, the morphology of the female pelvis and birth canal changed into a narrow and twisted one and also the size of the fetal head increased. Thus, the narrow and twisted pelvis of the mother, and the relatively large head and broad shoulders of the newborn has made the birthing process of modern human and small bodied primates a precarious fine-tuned act with a very narrow margin for error. This has necessitated proper obstetric care to reduce or even at times obviate the incidence of birth injuries like OBPP. Conclusion: Human evolution has made human babies susceptible to birth palsy and thus is the real cause of birth palsy. PMID:26624599

Granulomatosis with polyangiitis presenting as facial nerve palsy in a teenager.

PubMed

Wang, James C; Leader, Brittany A; Crane, Ryan A; Koch, Bernadette L; Smith, Matthew M; Ishman, Stacey L

2018-04-01

Granulomatosis with polyangiitis (GPA, previously known as Wegener's granulomatosis) is an autoimmune systemic small-vessel vasculitis, associated with the presence of anti-neurophil cytoplasmic antibodies with a cytoplasmic staining pattern (c-ANCA). It is characterized by necrotizing granulomas, usually affecting the airways and kidneys. GPA should be considered when patients do not improve despite adequate treatment of otologic symptoms, when patients have unspecific symptoms suggesting systemic disease (e.g. fever, malaise), or when other organs are involved (kidney, lungs, etc.). We present an interesting case of a 14-year-old female with eight-weeks of bilateral otalgia, unilateral facial nerve palsy, decreased appetite, and fatigue refractory to steroid, anti-viral, and antibiotic treatment ultimately diagnosed with GPA. Copyright © 2018. Published by Elsevier B.V.

Role of Kabat rehabilitation in facial nerve palsy: a randomised study on severe cases of Bell's palsy.

PubMed

Monini, S; Iacolucci, C M; Di Traglia, M; Lazzarino, A I; Barbara, M

2016-08-01

The treatment of Bell's palsy (BP), based on steroids and/or antiviral drugs, may still leave a certain percentage of affected subjects with disfiguring sequelae due to incomplete recovery. The different procedures of physical rehabilitation have not been demonstrated to play a favourable role in this disorder. The aim of the present study was to compare functional outcomes in severe cases of Bell's palsy when treated by steroids alone or by steroids accompanied by Kabat physical rehabilitation. This prospective study included 94 subjects who showed sudden facial nerve (FN) palsy with House-Brackmann grade IV or V and who were divided into two groups on the basis of the therapeutic approach: one group (a) was treated by steroids, and the other (b) received steroids in combination with physical rehabilitation. Medical treatment consisted in administration of steroids at a dosage of 60 mg per day for 15 days; physical rehabilitative treatment consisted in proprioceptive neuromuscular facilitation according to Kabat, and was administered to one of the two groups of subjects. Recovery rate, degree of recovery and time for recovery were compared between the two groups using the Mann-Whitney and univariate logistic regression statistical tests (Ward test). Kabat patients (group b) had about 20 times the odds of improving by three HB grades or more (OR = 17.73, 95% CI = 5.72 to 54.98, p < 0.001) than patients who did not receive physical treatment (group a). The mean speed of recovery in group b was the half of that recorded for group a (non-Kabat subjects). No difference was observed in the incidence of synkineses between the two groups. Steroid treatment appears to provide better and faster recovery in severe cases (HB IV and V) of BP when complemented with Kabat physical rehabilitation. © Copyright by Società Italiana di Otorinolaringologia e Chirurgia Cervico-Facciale, Rome, Italy.

Bell's palsy: excluding serious illness in urgent and emergency care settings.

PubMed

Mower, Sean

2017-04-13

Bell's palsy is a relatively benign condition that affects about 20 in every 100,000 patients a year, and in most cases the signs and symptoms resolve fully within around six months. The defining characteristic of the condition is a unilateral facial palsy, but this is also apparent in other conditions with a more serious prognosis, including strokes, some viral infections and tumours. This article reviews the literature on recognition of Bell's palsy, examines the underlying pathology, and compares it with other conditions associated with facial palsy. The article critically analyses the evidence and guidelines to identify best practice, and considers areas for improvement. Finally, it discusses how this information can be incorporated into practice, and provides guidance for clinicians on differentiating between conditions in which patients present with facial palsy to ensure they are managed appropriately.

Bell's Palsy

MedlinePlus

... or paralysis. Bell's palsy is named for Sir Charles Bell, a 19th century Scottish surgeon who described ... confirm diagnosis of the disorder. Generally, a physician will examine the individual for upper and lower facial ...

A general practice approach to Bell's palsy.

PubMed

Phan, Nga T; Panizza, Benedict; Wallwork, Benjamin

2016-11-01

Bell's palsy is characterised by an acute onset of unilateral, lower motor neuron weakness of the facial nerve in the absence of an identifiable cause. Establishing the correct diagnosis is imperative and choosing the correct treatment options can optimise the likelihood of recovery. This article summarises our understanding of Bell's palsy and the evidence-based management options available for adult patients. The basic assessment should include a thorough history and physical examination as the diagnosis of Bell's palsy is based on exclusion. For confirmed cases of Bell's palsy, corticosteroids are the mainstay of treatment and should be initiated within 72 hours of symptom onset. Antiviral therapy in combination with corticosteroid therapy may confer a small benefit and may be offered on the basis of shared decision making. Currently, no recommendations can be made for acupuncture, physical therapy, electrotherapy or surgical decompression because well-designed studies are lacking and available data are of low quality.

Comparison of acyclovir and famciclovir for the treatment of Bell's palsy.

PubMed

Kim, Ho Joong; Kim, Sang Hoon; Jung, Junyang; Kim, Sung Su; Byun, Jae Yong; Park, Moon Suh; Yeo, Seung Geun

2016-10-01

The relative effectiveness of acyclovir and famciclovir in the treatment of Bell's palsy is unclear. This study therefore compared recovery outcomes in patients with Bell's palsy treated with acyclovir and famciclovir. The study cohort consisted of patients with facial palsy who visited the outpatient clinic between January 2006 and January 2014. Patients were treated with prednisolone plus either acyclovir (n = 457) or famciclovir (n = 245). Patient outcomes were measured using the House-Brackmann scale according to initial severity of disease and underlying disease. The overall recovery rate tended to be higher in the famciclovir than in the acyclovir group. The rate of recovery in patients with initially severe facial palsy (grades V and VI) was significantly higher in the famciclovir than in the acyclovir group (p = 0.01), whereas the rates of recovery in patients with initially moderate palsy (grade III-IV) were similar in the two groups. The overall recovery rates in patients without hypertension or diabetes mellitus were higher in the famciclovir than in the acyclovir group, but the difference was not statistically significant. Treatment with steroid plus famciclovir was more effective than treatment with steroid plus acyclovir in patients with severe facial palsy. Famciclovir may be the antiviral agent of choice in the treatment of patients with severe facial palsy.

Cutaneous cooling to manage botulinum toxin injection-associated pain in patients with facial palsy: A randomised controlled trial.

PubMed

Pucks, N; Thomas, A; Hallam, M J; Venables, V; Neville, C; Nduka, C

2015-12-01

Botulinum toxin injections are an effective, well-established treatment to manage synkinesis secondary to chronic facial palsy, but they entail painful injections at multiple sites on the face up to four times per year. Cutaneous cooling has long been recognised to provide an analgesic effect for cutaneous procedures, but evidence to date has been anecdotal or weak. This randomised controlled trial aims to assess the analgesic efficacy of cutaneous cooling using a cold gel pack versus a room-temperature Control. The analgesic efficacy of a 1-min application of a Treatment cold (3-5 °C) gel pack versus a Control (room-temperature (20 °C)) gel pack prior to botulinum toxin injection into the platysma was assessed via visual analogue scale (VAS) ratings of pain before, during and after the procedure. Thirty-five patients received both trial arms during two separate clinic appointments. Cold gel packs provided a statistically significant reduction in pain compared with a room-temperature Control (from 26.4- to 10.2-mm VAS improvement (p < 0.001)), with no variance noted secondary to age, the hemi-facial side injected or the order in which the Treatment or Control gel packs were applied. Cryoanalgesia using a fridge-cooled gel pack provides an effective, safe and cheap method for reducing pain at the botulinum toxin injection site in patients with facial palsy. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Clinical practice guideline: Bell's Palsy executive summary.

PubMed

Baugh, Reginald F; Basura, Gregory J; Ishii, Lisa E; Schwartz, Seth R; Drumheller, Caitlin Murray; Burkholder, Rebecca; Deckard, Nathan A; Dawson, Cindy; Driscoll, Colin; Gillespie, M Boyd; Gurgel, Richard K; Halperin, John; Khalid, Ayesha N; Kumar, Kaparaboyna Ashok; Micco, Alan; Munsell, Debra; Rosenbaum, Steven; Vaughan, William

2013-11-01

The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) has published a supplement to this issue featuring the new Clinical Practice Guideline: Bell's Palsy. To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 11 recommendations developed encourage accurate and efficient diagnosis and treatment and, when applicable, facilitate patient follow-up to address the management of long-term sequelae or evaluation of new or worsening symptoms not indicative of Bell's palsy. There are myriad treatment options for Bell's palsy; some controversy exists regarding the effectiveness of several of these options, and there are consequent variations in care. In addition, there are numerous diagnostic tests available that are used in the evaluation of patients with Bell's palsy. Many of these tests are of questionable benefit in Bell's palsy. Furthermore, while patients with Bell's palsy enter the health care system with facial paresis/paralysis as a primary complaint, not all patients with facial paresis/paralysis have Bell's palsy. It is a concern that patients with alternative underlying etiologies may be misdiagnosed or have an unnecessary delay in diagnosis. All of these quality concerns provide an important opportunity for improvement in the diagnosis and management of patients with Bell's palsy.

Mastoid bone fracture presenting as unusual delayed onset of facial nerve palsy.

PubMed

Hsu, Ko-Chiang; Wang, Ann-Ching; Chen, Shyi-Jou

2008-03-01

Delayed-onset facial nerve paralysis is a rather uncommon complication of a mastoid bone fracture for children younger than 10 years. We routinely arrange a cranial computed tomography (CT) for patients encountering initial loss of consciousness, severe headache, intractable vomiting, and/or any neurologic deficit arising from trauma to the head. However, minor symptomatic cranial nerve damage may be missed and the presenting symptom diagnosed as being a peripheral nerve problem. Herein, we report a case of a young boy who presented at our emergency department (ED) 3 days subsequent to his accident, complaining of hearing loss in the right ear and paralysis of the ipsilateral face. Unpredictably, we observed his cranial CT scan revealing a linear fracture of the skull over the right temporal bone involving the right mastoid air cells. The patient was treated conservatively and recovered well without any adverse neurologic consequences. We emphasize that ED physicians should arrange a cranial CT scan for a head-injured child with symptomatic facial nerve palsy, even if there are no symptoms such as severe headache, vomiting, Battle sign, and/or initial loss of consciousness.

Facial nerve paralysis secondary to occult malignant neoplasms.

PubMed

Boahene, Derek O; Olsen, Kerry D; Driscoll, Colin; Lewis, Jean E; McDonald, Thomas J

2004-04-01

This study reviewed patients with unilateral facial paralysis and normal clinical and imaging findings who underwent diagnostic facial nerve exploration. Study design and setting Fifteen patients with facial paralysis and normal findings were seen in the Mayo Clinic Department of Otorhinolaryngology. Eleven patients were misdiagnosed as having Bell palsy or idiopathic paralysis. Progressive facial paralysis with sequential involvement of adjacent facial nerve branches occurred in all 15 patients. Seven patients had a history of regional skin squamous cell carcinoma, 13 patients had surgical exploration to rule out a neoplastic process, and 2 patients had negative exploration. At last follow-up, 5 patients were alive. Patients with facial paralysis and normal clinical and imaging findings should be considered for facial nerve exploration when the patient has a history of pain or regional skin cancer, involvement of other cranial nerves, and prolonged facial paralysis. Occult malignancy of the facial nerve may cause unilateral facial paralysis in patients with normal clinical and imaging findings.

Bell's Palsy in Children: Role of the School Nurse in Early Recognition and Referral

ERIC Educational Resources Information Center

Gordon, Shirley C.

2008-01-01

Bell's palsy is the most common condition affecting facial nerves. It is an acute, rapidly progressing, idiopathic, unilateral facial paralysis that is generally self-limiting and non-life threatening that occurs in all age groups (Okuwobi, Omole, & Griffith, 2003). The school nurse may be the first person to assess facial palsy and muscle…

Acupuncture-induced changes in functional connectivity of the primary somatosensory cortex varied with pathological stages of Bell's palsy.

PubMed

He, Xiaoxuan; Zhu, Yifang; Li, Chuanfu; Park, Kyungmo; Mohamed, Abdalla Z; Wu, Hongli; Xu, Chunsheng; Zhang, Wei; Wang, Linying; Yang, Jun; Qiu, Bensheng

2014-10-01

Bell's palsy is the most common cause of acute facial nerve paralysis. In China, Bell's palsy is frequently treated with acupuncture. However, its efficacy and underlying mechanism are still controversial. In this study, we used functional MRI to investigate the effect of acupuncture on the functional connectivity of the brain in Bell's palsy patients and healthy individuals. The patients were further grouped according to disease duration and facial motor performance. The results of resting-state functional MRI connectivity show that acupuncture induces significant connectivity changes in the primary somatosensory region of both early and late recovery groups, but no significant changes in either the healthy control group or the recovered group. In the recovery group, the changes also varied with regions and disease duration. Therefore, we propose that the effect of acupuncture stimulation may depend on the functional connectivity status of patients with Bell's palsy.

Rehabilitation of Bells' palsy from a multi-team perspective.

PubMed

Hultcrantz, Malou

2016-01-01

Conclusions Defectively healed facial paralysis causes difficulties to talk and eat, involuntary spasms (synkinesis), and cosmetic deformities which can give rise both to severe psychological and physical trauma. A team consisting of Ear-Nose-Throat specialists, Plastic surgeons and Physiotherapists can offer better care, treatment and outcome for patients suffering from Bells' palsy. Objectives Patients suffering from Bells' palsy from all ENT hospitals in Sweden and the University Hospital in Helsinki has been included. Methods Results have been drawn and statistically processed for different outcomes from a prospective, double blind cross over study. Results from a pilot surgical study and therapeutic results from physiotherapy studies have been included. Ideas concerning different kinds of surgery will be reviewed and the role of physiotherapy discussed. Results According to common results, treatment with Prednisolone enhances the recovery rate and should, if possible, be used early in the course. Sunnybrook grading at 1 month after onset most accurately predicts non-recovery at 12 months in Bells' palsy and a risk factor curve will be presented in order to predict outcome and selection of patients for undergoing facial surgery. This report is focusing on how to handle patients with Bells' palsy from a multi-rehabilitation team point of view, and what will be recommended to provide these patients with the best clinical and surgical help.

Reproducibility of the dynamics of facial expressions in unilateral facial palsy.

PubMed

Alagha, M A; Ju, X; Morley, S; Ayoub, A

2018-02-01

The aim of this study was to assess the reproducibility of non-verbal facial expressions in unilateral facial paralysis using dynamic four-dimensional (4D) imaging. The Di4D system was used to record five facial expressions of 20 adult patients. The system captured 60 three-dimensional (3D) images per second; each facial expression took 3-4seconds which was recorded in real time. Thus a set of 180 3D facial images was generated for each expression. The procedure was repeated after 30min to assess the reproducibility of the expressions. A mathematical facial mesh consisting of thousands of quasi-point 'vertices' was conformed to the face in order to determine the morphological characteristics in a comprehensive manner. The vertices were tracked throughout the sequence of the 180 images. Five key 3D facial frames from each sequence of images were analyzed. Comparisons were made between the first and second capture of each facial expression to assess the reproducibility of facial movements. Corresponding images were aligned using partial Procrustes analysis, and the root mean square distance between them was calculated and analyzed statistically (paired Student t-test, P<0.05). Facial expressions of lip purse, cheek puff, and raising of eyebrows were reproducible. Facial expressions of maximum smile and forceful eye closure were not reproducible. The limited coordination of various groups of facial muscles contributed to the lack of reproducibility of these facial expressions. 4D imaging is a useful clinical tool for the assessment of facial expressions. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Masseteric-facial nerve transposition for reanimation of the smile in incomplete facial paralysis.

PubMed

Hontanilla, Bernardo; Marre, Diego

2015-12-01

Incomplete facial paralysis occurs in about a third of patients with Bell's palsy. Although their faces are symmetrical at rest, when they smile they have varying degrees of disfigurement. Currently, cross-face nerve grafting is one of the most useful techniques for reanimation. Transfer of the masseteric nerve, although widely used for complete paralysis, has not to our knowledge been reported for incomplete palsy. Between December 2008 and November 2013, we reanimated the faces of 9 patients (2 men and 7 women) with incomplete unilateral facial paralysis with transposition of the masseteric nerve. Sex, age at operation, cause of paralysis, duration of denervation, recipient nerves used, and duration of follow-up were recorded. Commissural excursion, velocity, and patients' satisfaction were evaluated with the FACIAL CLIMA and a questionnaire, respectively. The mean (SD) age at operation was 39 (±6) years and the duration of denervation was 29 (±19) months. There were no complications that required further intervention. Duration of follow-up ranged from 6-26 months. FACIAL CLIMA showed improvement in both commissural excursion and velocity of more than two thirds in 6 patients, more than one half in 2 patients and less than one half in one. Qualitative evaluation showed a slight or pronounced improvement in 7/9 patients. The masseteric nerve is a reliable alternative for reanimation of the smile in patients with incomplete facial paralysis. Its main advantages include its consistent anatomy, a one-stage operation, and low morbidity at the donor site. Copyright © 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

A PILOT STUDY OF DIAGNOSTIC NEUROMUSCULAR ULTRASOUND IN BELL'S PALSY

PubMed Central

TAWFIK, EMAN A.; WALKER, FRANCIS O.; CARTWRIGHT, MICHAEL S.

2015-01-01

Background and purpose Neuromuscular ultrasound of the cranial nerves is an emerging field which may help in the assessment of cranial neuropathies. The aim of this study was to evaluate the role of neuromuscular ultrasound in Bell's palsy. A second objective was to assess the possibility of any associated vagus nerve abnormality. Methods Twenty healthy controls and 12 Bell's palsy patients were recruited. The bilateral facial nerves, vagus nerves, and frontalis muscles were scanned using an 18 MHz linear array transducer. Facial nerve diameter, vagus nerve cross-sectional area, and frontalis thickness were measured. Results Mean facial nerve diameter was 0.8 ± 0.2 mm in controls and 1.1 ± 0.3 mm in patients group. The facial nerve diameter was significantly larger in patients than controls (p = 0.006, 95% CI for the difference between groups of 0.12-0.48), with a significant side-to-side difference in patients as well (p = 0.004, 95% CI for side-to-side difference of 0.08-0.52). ROC curve analysis of the absolute facial nerve diameter revealed a sensitivity of 75 % and a specificity of 70 %. No significant differences in vagus nerve cross-sectional area or frontalis thickness were detected between patients and controls. Conclusions Ultrasound can detect facial nerve enlargement in Bell's palsy and may have a role in assessment, or follow-up, of Bell's palsy and other facial nerve disorders. The low sensitivity of the current technique precludes its routine use for diagnosis, however, this study demonstrates its validity and potential for future research. PMID:26076910

Comparison of Direct Side-to-End and End-to-End Hypoglossal-Facial Anastomosis for Facial Nerve Repair.

PubMed

Samii, Madjid; Alimohamadi, Maysam; Khouzani, Reza Karimi; Rashid, Masoud Rafizadeh; Gerganov, Venelin

2015-08-01

The hypoglossal facial anastomosis (HFA) is the gold standard for facial reanimation in patients with severe facial nerve palsy. The major drawbacks of the classic HFA technique are lingual morbidities due to hypoglossal nerve transection. The side-to-end HFA is a modification of the classic technique with fewer tongue-related morbidities. In this study we compared the outcome of the classic end-to-end and the direct side-to-end HFA surgeries performed at our center in regards to the facial reanimation success rate and tongue-related morbidities. Twenty-six successive cases of HFA were enrolled. In 9 of them end-to-end anastomoses were performed, and 17 had direct side-to-end anastomoses. The House-Brackmann (HB) and Pitty and Tator (PT) scales were used to document surgical outcome. The hemiglossal atrophy, swallowing, and hypoglossal nerve function were assessed at follow-up. The original pathology was vestibular schwannoma in 15, meningioma in 4, brain stem glioma in 4, and other pathologies in 3. The mean interval between facial palsy and HFA was 18 months (range: 0-60). The median follow-up period was 20 months. The PT grade at follow-up was worse in patients with a longer interval from facial palsy and HFA (P value: 0.041). The lesion type was the only other factor that affected PT grade (the best results in vestibular schwannoma and the worst in the other pathologies group, P value: 0.038). The recovery period for facial tonicity was longer in patients with radiation therapy before HFA (13.5 vs. 8.5 months) and those with a longer than 2-year interval from facial palsy to HFA (13.5 vs. 8.5 months). Although no significant difference between the side-to-end and the end-to-end groups was seen in terms of facial nerve functional recovery, patients from the side-to-end group had a significantly lower rate of lingual morbidities (tongue hemiatrophy: 100% vs. 5.8%, swallowing difficulty: 55% vs. 11.7%, speech disorder 33% vs. 0%). With the side-to-end HFA

Facial paralysis for the plastic surgeon.

PubMed

Kosins, Aaron M; Hurvitz, Keith A; Evans, Gregory Rd; Wirth, Garrett A

2007-01-01

Facial paralysis presents a significant and challenging reconstructive problem for plastic surgeons. An aesthetically pleasing and acceptable outcome requires not only good surgical skills and techniques, but also knowledge of facial nerve anatomy and an understanding of the causes of facial paralysis.The loss of the ability to move the face has both social and functional consequences for the patient. At the Facial Palsy Clinic in Edinburgh, Scotland, 22,954 patients were surveyed, and over 50% were found to have a considerable degree of psychological distress and social withdrawal as a consequence of their facial paralysis. Functionally, patients present with unilateral or bilateral loss of voluntary and nonvoluntary facial muscle movements. Signs and symptoms can include an asymmetric smile, synkinesis, epiphora or dry eye, abnormal blink, problems with speech articulation, drooling, hyperacusis, change in taste and facial pain.With respect to facial paralysis, surgeons tend to focus on the surgical, or 'hands-on', aspect. However, it is believed that an understanding of the disease process is equally (if not more) important to a successful surgical outcome. The purpose of the present review is to describe the anatomy and diagnostic patterns of the facial nerve, and the epidemiology and common causes of facial paralysis, including clinical features and diagnosis. Treatment options for paralysis are vast, and may include nerve decompression, facial reanimation surgery and botulinum toxin injection, but these are beyond the scope of the present paper.

Facial paralysis for the plastic surgeon

PubMed Central

Kosins, Aaron M; Hurvitz, Keith A; Evans, Gregory RD; Wirth, Garrett A

2007-01-01

Facial paralysis presents a significant and challenging reconstructive problem for plastic surgeons. An aesthetically pleasing and acceptable outcome requires not only good surgical skills and techniques, but also knowledge of facial nerve anatomy and an understanding of the causes of facial paralysis. The loss of the ability to move the face has both social and functional consequences for the patient. At the Facial Palsy Clinic in Edinburgh, Scotland, 22,954 patients were surveyed, and over 50% were found to have a considerable degree of psychological distress and social withdrawal as a consequence of their facial paralysis. Functionally, patients present with unilateral or bilateral loss of voluntary and nonvoluntary facial muscle movements. Signs and symptoms can include an asymmetric smile, synkinesis, epiphora or dry eye, abnormal blink, problems with speech articulation, drooling, hyperacusis, change in taste and facial pain. With respect to facial paralysis, surgeons tend to focus on the surgical, or ‘hands-on’, aspect. However, it is believed that an understanding of the disease process is equally (if not more) important to a successful surgical outcome. The purpose of the present review is to describe the anatomy and diagnostic patterns of the facial nerve, and the epidemiology and common causes of facial paralysis, including clinical features and diagnosis. Treatment options for paralysis are vast, and may include nerve decompression, facial reanimation surgery and botulinum toxin injection, but these are beyond the scope of the present paper. PMID:19554190

New Predictive Parameters of Bell’s Palsy: Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio

PubMed Central

Atan, Doğan; İkincioğulları, Aykut; Köseoğlu, Sabri; Özcan, Kürşat Murat; Çetin, Mehmet Ali; Ensari, Serdar; Dere, Hüseyin

2015-01-01

Background: Bell’s palsy is the most frequent cause of unilateral facial paralysis. Inflammation is thought to play an important role in the pathogenesis of Bell’s palsy. Aims: Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are simple and inexpensive tests which are indicative of inflammation and can be calculated by all physicians. The aim of this study was to reveal correlations of Bell’s palsy and degree of paralysis with NLR and PLR. Study Design: Case-control study. Methods: The retrospective study was performed January 2010 and December 2013. Ninety-nine patients diagnosed as Bell’s palsy were included in the Bell’s palsy group and ninety-nine healthy individuals with the same demographic characteristics as the Bell’s palsy group were included in the control group. As a result of analyses, NLR and PLR were calculated. Results: The mean NLR was 4.37 in the Bell’s palsy group and 1.89 in the control group with a statistically significant difference (p<0.001). The mean PLR was 137.5 in the Bell’s palsy group and 113.75 in the control group with a statistically significant difference (p=0.008). No statistically significant relation was detected between the degree of facial paralysis and NLR and PLR. Conclusion: The NLR and the PLR were significantly higher in patients with Bell’s palsy. This is the first study to reveal a relation between Bell’s palsy and PLR. NLR and PLR can be used as auxiliary parameters in the diagnosis of Bell’s palsy. PMID:26167340

Prednisolone and acupuncture in Bell's palsy: study protocol for a randomized, controlled trial.

PubMed

Xia, Feng; Han, Junliang; Liu, Xuedong; Wang, Jingcun; Jiang, Zhao; Wang, Kangjun; Wu, Songdi; Zhao, Gang

2011-06-21

There are a variety of treatment options for Bell's palsy. Evidence from randomized controlled trials indicates corticosteroids can be used as a proven therapy for Bell's palsy. Acupuncture is one of the most commonly used methods to treat Bell's palsy in China. Recent studies suggest that staging treatment is more suitable for Bell's palsy, according to different path-stages of this disease. The aim of this study is to compare the effects of prednisolone and staging acupuncture in the recovery of the affected facial nerve, and to verify whether prednisolone in combination with staging acupuncture is more effective than prednisolone alone for Bell's palsy in a large number of patients. In this article, we report the design and protocol of a large sample multi-center randomized controlled trial to treat Bell's palsy with prednisolone and/or acupuncture. In total, 1200 patients aged 18 to 75 years within 72 h of onset of acute, unilateral, peripheral facial palsy will be assessed. There are six treatment groups, with four treated according to different path-stages and two not. These patients are randomly assigned to be in one of the following six treatment groups, i.e. 1) placebo prednisolone group, 2) prednisolone group, 3) placebo prednisolone plus acute stage acupuncture group, 4) prednisolone plus acute stage acupuncture group, 5) placebo prednisolone plus resting stage acupuncture group, 6) prednisolone plus resting stage acupuncture group. The primary outcome is the time to complete recovery of facial function, assessed by Sunnybrook system and House-Brackmann scale. The secondary outcomes include the incidence of ipsilateral pain in the early stage of palsy (and the duration of this pain), the proportion of patients with severe pain, the occurrence of synkinesis, facial spasm or contracture, and the severity of residual facial symptoms during the study period. The result of this trial will assess the efficacy of using prednisolone and staging acupuncture to

Iatrogenic facial palsy: the cost.

PubMed

Pulec, J L

1996-11-01

The cost of iatrogenic facial paralysis can be high. Ways to avoid facial nerve injury during surgery and, should it occur, ways to minimize the disability and cost are discussed. These include adequate preparation and training by the surgeon, the exercise of sound judgment, the presence of high morals by the surgeon, adequate preoperative diagnosis and surgical instrumentation and thorough preoperative oral and written informed consent. Should facial nerve injury occur, immediate consultation and reparative decompression, anastomosis or grafting should be performed to obtain the best ultimate result. The value of prompt, competent, sympathetic and continuing concern offered by the surgeon to the patient cannot be over emphasized.

Efficacy of Low-Dose Corticosteroid Therapy Versus High-Dose Corticosteroid Therapy in Bell's Palsy in Children.

PubMed

Arican, Pinar; Dundar, Nihal Olgac; Gencpinar, Pinar; Cavusoglu, Dilek

2017-01-01

Bell's palsy is the most common cause of acute peripheral facial nerve paralysis, but the optimal dose of corticosteroids in pediatric patients is still unclear. This retrospective study aimed to evaluate the efficacy of low-dose corticosteroid therapy compared with high-dose corticosteroid therapy in children with Bell's palsy. Patients were divided into 2 groups based on the dose of oral prednisolone regimen initiated. The severity of idiopathic facial nerve paralysis was graded according to the House-Brackmann Grading Scale. The patients were re-assessed in terms of recovery rate at the first, third, and sixth months of treatment. There was no significant difference in complete recovery between the 2 groups after 1, 3, and 6 months of treatment. In our study, we concluded that even at a dose of 1 mg/kg/d, oral prednisolone was highly effective in the treatment of Bell's palsy in children.

Facial paralysis due to an occult parotid abscess.

PubMed

Orhan, Kadir Serkan; Demirel, Tayfun; Kocasoy-Orhan, Elif; Yenigül, Kubilay

2008-01-01

Facial paralysis associated with benign diseases of the parotid gland is very rare. It has been reported in approximately 16 cases of acute suppurative parotitis or parotid abscess. We presented a 45-year-old woman who developed facial paralysis secondary to an occult parotid abscess. Initially, there was no facial paralysis and the signs and symptoms were suggestive of acute parotitis, for which medical treatment was initiated. Three days later, left-sided facial palsy of HB (House-Brackmann) grade 5 developed. Ultrasonography revealed a pretragal, hypoechoic mass, 10x8 mm in size, causing inflammation in the surrounding tissue. Fine needle aspiration biopsy obtained from the mass revealed polymorphonuclear leukocytes and lymphocytes. No malignant cells were observed. The lesion was diagnosed as an occult parotid abscess. After a week, the mass disappeared and facial paralysis improved to HB grade 4. At the end of the first month, facial paralysis improved to HB grade 1. At three months, facial nerve function was nearly normal.

Modern concepts in facial nerve reconstruction

PubMed Central

2010-01-01

Background Reconstructive surgery of the facial nerve is not daily routine for most head and neck surgeons. The published experience on strategies to ensure optimal functional results for the patients are based on small case series with a large variety of surgical techniques. On this background it is worthwhile to develop a standardized approach for diagnosis and treatment of patients asking for facial rehabilitation. Conclusion A standardized approach is feasible: Patients with chronic facial palsy first need an exact classification of the palsy's aetiology. A step-by-step clinical examination, if necessary MRI imaging and electromyographic examination allow a classification of the palsy's aetiology as well as the determination of the severity of the palsy and the functional deficits. Considering the patient's desire, age and life expectancy, an individual surgical concept is applicable using three main approaches: a) early extratemporal reconstruction, b) early reconstruction of proximal lesions if extratemporal reconstruction is not possible, c) late reconstruction or in cases of congenital palsy. Twelve to 24 months after the last step of surgical reconstruction a standardized evaluation of the therapeutic results is recommended to evaluate the necessity for adjuvant surgical procedures or other adjuvant procedures, e.g. botulinum toxin application. Up to now controlled trials on the value of physiotherapy and other adjuvant measures are missing to give recommendation for optimal application of adjuvant therapies. PMID:21040532

Intratemporal facial nerve ultrastructure in patients with idiopathic facial paralysis: viral infection evidence study.

PubMed

Florez, Rosangela Aló Maluza; Lang, Raquel; Veridiano, Adriano Mora; Zanini, Renato de Oliveira; Calió, Pedro Luiz; Simões, Ricardo Dos Santos; Testa, José Ricardo Gurgel

2010-01-01

The etiology of idiopathic peripheral facial palsy (IPFP) is still uncertain; however, some authors suggest the possibility of a viral infection. to analyze the ultrastructure of the facial nerve seeking viral evidences that might provide etiological data. We studied 20 patients with peripheral facial palsy (PFP), with moderate to severe FP, of both genders, between 18-60 years of age, from the Clinic of Facial Nerve Disorders. The patients were broken down into two groups - Study: eleven patients with IPFP and Control: nine patients with trauma or tumor-related PFP. The fragments were obtained from the facial nerve sheath or from fragments of its stumps - which would be discarded or sent to pathology exam during the facial nerve repair surgery. The removed tissue was fixed in 2% glutaraldehyde, and studied under Electronic Transmission Microscopy. In the study group we observed an intense repair cellular activity by increased collagen fibers, fibroblasts containing developed organelles, free of viral particles. In the control group this repair activity was not evident, but no viral particles were observed. There were no viral particles, and there were evidences of intense activity of repair or viral infection.

Bell's Palsy (For Kids)

MedlinePlus

... palsy was named after a Scottish doctor, Sir Charles Bell, who studied the two facial nerves that ... who focuses on how the nervous system works — will do a test called electromyography (say: eh-lek- ...

Outcome of facial physiotherapy in patients with prolonged idiopathic facial palsy.

PubMed

Watson, G J; Glover, S; Allen, S; Irving, R M

2015-04-01

This study investigated whether patients who remain symptomatic more than a year following idiopathic facial paralysis gain benefit from tailored facial physiotherapy. A two-year retrospective review was conducted of all symptomatic patients. Data collected included: age, gender, duration of symptoms, Sunnybrook facial grading system scores pre-treatment and at last visit, and duration of treatment. The study comprised 22 patients (with a mean age of 50.5 years (range, 22-75 years)) who had been symptomatic for more than a year following idiopathic facial paralysis. The mean duration of symptoms was 45 months (range, 12-240 months). The mean duration of follow up was 10.4 months (range, 2-36 months). Prior to treatment, the mean Sunnybrook facial grading system score was 59 (standard deviation = 3.5); this had increased to 83 (standard deviation = 2.7) at the last visit, with an average improvement in score of 23 (standard deviation = 2.9). This increase was significant (p < 0.001). Tailored facial therapy can improve facial grading scores in patients who remain symptomatic for prolonged periods.

Plasma Fibrinogen in Patients With Bell Palsy.

PubMed

Zhao, Hua; Zhang, Xin; Tang, Yinda; Li, Shiting

2016-10-01

To determine the plasma fibrinogen level in patients with Bell palsy and explore the significances of it in Bell palsy. One hundred five consecutive patients with facial paralysis were divided into 3 groups: group I (Bell palsy), group II (temporal bone fractures), and group III (facial nerve schwannoma). In addition, 22 volunteers were defined as control group. Two milliliters fasting venous blood from elbow was collected, and was evaluated by CA-7000 Full-Automatic Coagulation Analyzer. The plasma fibrinogen concentration was significantly higher in the group of patients with Bell palsy (HB IV-VI) than that in the control group (P <0.05). There was no significant difference between group II and control group (P >0.05); similarly, there was also no marked difference between group III and control group (P >0.05). In group I, the plasma fibrinogen levels became higher with the HB grading increase. The plasma fibrinogen level of HB-VI was highest. Plasma fibrinogen has an important clinical meaning in Bell palsy, which should be used as routine examination items. Defibrinogen in treatment for patients with high plasma fibrinogen content also should be suggested.

Social perception of morbidity in facial nerve paralysis.

PubMed

Li, Matthew Ka Ki; Niles, Navin; Gore, Sinclair; Ebrahimi, Ardalan; McGuinness, John; Clark, Jonathan Robert

2016-08-01

There are many patient-based and clinician-based scales measuring the severity of facial nerve paralysis and the impact on quality of life, however, the social perception of facial palsy has received little attention. The purpose of this pilot study was to measure the consequences of facial paralysis on selected domains of social perception and compare the social impact of paralysis of the different components. Four patients with typical facial palsies (global, marginal mandibular, zygomatic/buccal, and frontal) and 1 control were photographed. These images were each shown to 100 participants who subsequently rated variables of normality, perceived distress, trustworthiness, intelligence, interaction, symmetry, and disability. Statistical analysis was performed to compare the results among each palsy. Paralyzed faces were considered less normal compared to the control on a scale of 0 to 10 (mean, 8.6; 95% confidence interval [CI] = 8.30-8.86) with global paralysis (mean, 3.4; 95% CI = 3.08-3.80) rated as the most disfiguring, followed by the zygomatic/buccal (mean, 6.0; 95% CI = 5.68-6.37), marginal (mean, 6.5; 95% CI = 6.08-6.86), and then temporal palsies (mean, 6.9; 95% CI = 6.57-7.21). Similar trends were seen when analyzing these palsies for perceived distress, intelligence, and trustworthiness, using a random effects regression model. Our sample suggests that society views paralyzed faces as less normal, less trustworthy, and more distressed. Different components of facial paralysis are worse than others and surgical correction may need to be prioritized in an evidence-based manner with social morbidity in mind. © 2016 Wiley Periodicals, Inc. Head Neck 38:1158-1163, 2016. © 2016 Wiley Periodicals, Inc.

Cutaneous Sensibility Changes in Bell's Palsy Patients.

PubMed

Cárdenas Palacio, Carlos Andrés; Múnera Galarza, Francisco Alejandro

2017-05-01

Objective Bell's palsy is a cranial nerve VII dysfunction that renders the patient unable to control facial muscles from the affected side. Nevertheless, some patients have reported cutaneous changes in the paretic area. Therefore, cutaneous sensibility changes might be possible additional symptoms within the clinical presentation of this disorder. Accordingly, the aim of this research was to investigate the relationship between cutaneous sensibility and facial paralysis severity in these patients. Study Design Prospective longitudinal cohort study. Settings Tertiary care medical center. Subjects and Methods Twelve acute-onset Bell's palsy patients were enrolled from March to September 2009. In addition, 12 sex- and age-matched healthy volunteers were tested. Cutaneous sensibility was evaluated with pressure threshold and 2-point discrimination at 6 areas of the face. Facial paralysis severity was evaluated with the House-Brackmann scale. Results Statistically significant correlations based on the Spearman's test were found between facial paralysis severity and cutaneous sensitivity on forehead, eyelid, cheek, nose, and lip ( P < .05). Additionally, significant differences based on the Student's t test were observed between both sides of the face in 2-point discrimination on eyelid, cheek, and lip ( P < .05) in Bell's palsy patients but not in healthy subjects. Conclusion Such results suggest a possible relationship between the loss of motor control of the face and changes in facial sensory information processing. Such findings are worth further research about the neurophysiologic changes associated with the cutaneous sensibility disturbances of these patients.

Sudden onset odontoid fracture caused by cervical instability in hypotonic cerebral palsy.

PubMed

Shiohama, Tadashi; Fujii, Katsunori; Kitazawa, Katsuhiko; Takahashi, Akiko; Maemoto, Tatsuo; Honda, Akihito

2013-11-01

Fractures of the upper cervical spine rarely occur but carry a high rate of mortality and neurological disabilities in children. Although odontoid fractures are commonly caused by high-impact injuries, cerebral palsy children with cervical instability have a risk of developing spinal fractures even from mild trauma. We herein present the first case of an odontoid fracture in a 4-year-old boy with cerebral palsy. He exhibited prominent cervical instability due to hypotonic cerebral palsy from infancy. He suddenly developed acute respiratory failure, which subsequently required mechanical ventilation. Neuroimaging clearly revealed a type-III odontoid fracture accompanied by anterior displacement with compression of the cervical spinal cord. Bone mineral density was prominently decreased probably due to his long-term bedridden status and poor nutritional condition. We subsequently performed posterior internal fixation surgically using an onlay bone graft, resulting in a dramatic improvement in his respiratory failure. To our knowledge, this is the first report of an odontoid fracture caused by cervical instability in hypotonic cerebral palsy. Since cervical instability and decreased bone mineral density are frequently associated with cerebral palsy, odontoid fractures should be cautiously examined in cases of sudden onset respiratory failure and aggravated weakness, especially in hypotonic cerebral palsy patients. Copyright © 2012 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

Hyperbaric oxygen therapy for Bell's palsy.

PubMed

Holland, N Julian; Bernstein, Jonathan M; Hamilton, John W

2012-02-15

Bell's palsy is an idiopathic, acute unilateral facial weakness that evolves rapidly and is maximal within two days. Moderate ear discomfort, sensitivity to sound and reduced tearing may occur. To assess the effects of hyperbaric oxygen therapy on recovery of facial function in adults with moderate to severe Bell's palsy. We searched the Cochrane Neuromuscular Disease Group Specialized Register (January 2012), CENTRAL (2011, Issue 4), MEDLINE (January 1966 to January 2012), EMBASE (January 1980 to January 2012), CINAHL (1937 to January 2012), AMED (1985 to January 2012), LILACS (January 1982 to January 2012). In addition we made a systematic search for relevant controlled trials in specific hyperbaric literature sources. Randomised controlled trials or quasi-randomised controlled trials of adults (over 16 years of age) undergoing hyperbaric oxygen therapy for moderate to severe Bell's palsy. We considered studies to be of sufficient quality for inclusion in the review only if there was blinding in the assessment of the facial palsy grade. We planned to include studies of HBOT used as adjuvant therapy, or in addition to routine medical therapy (including corticosteroids or antivirals, or both). Both treatment and control groups were to receive the same baseline therapy. HBOT had to be delivered at concentrations greater than or equal to 1.2 ATA in a hyperbaric oxygen chamber as a series of dives of 30 to 120 minutes. Two reviewers independently assessed eligibility and study quality and extracted data. We contacted study authors for additional information. Our searches found no randomised controlled trials or quasi-randomised controlled trials that met the eligibility criteria for this review.There is very low quality evidence from one randomised trial involving 79 participants with acute Bell's palsy, but this study was excluded as the outcome assessor was not blinded to treatment allocation and thus did not meet pre-defined eligibility criteria. The trial compared

Prednisolone and acupuncture in Bell's palsy: study protocol for a randomized, controlled trial

PubMed Central

2011-01-01

Background There are a variety of treatment options for Bell's palsy. Evidence from randomized controlled trials indicates corticosteroids can be used as a proven therapy for Bell's palsy. Acupuncture is one of the most commonly used methods to treat Bell's palsy in China. Recent studies suggest that staging treatment is more suitable for Bell's palsy, according to different path-stages of this disease. The aim of this study is to compare the effects of prednisolone and staging acupuncture in the recovery of the affected facial nerve, and to verify whether prednisolone in combination with staging acupuncture is more effective than prednisolone alone for Bell's palsy in a large number of patients. Methods/Design In this article, we report the design and protocol of a large sample multi-center randomized controlled trial to treat Bell's palsy with prednisolone and/or acupuncture. In total, 1200 patients aged 18 to 75 years within 72 h of onset of acute, unilateral, peripheral facial palsy will be assessed. There are six treatment groups, with four treated according to different path-stages and two not. These patients are randomly assigned to be in one of the following six treatment groups, i.e. 1) placebo prednisolone group, 2) prednisolone group, 3) placebo prednisolone plus acute stage acupuncture group, 4) prednisolone plus acute stage acupuncture group, 5) placebo prednisolone plus resting stage acupuncture group, 6) prednisolone plus resting stage acupuncture group. The primary outcome is the time to complete recovery of facial function, assessed by Sunnybrook system and House-Brackmann scale. The secondary outcomes include the incidence of ipsilateral pain in the early stage of palsy (and the duration of this pain), the proportion of patients with severe pain, the occurrence of synkinesis, facial spasm or contracture, and the severity of residual facial symptoms during the study period. Discussion The result of this trial will assess the efficacy of using

The neurologist's dilemma: a comprehensive clinical review of Bell's palsy, with emphasis on current management trends.

PubMed

Zandian, Anthony; Osiro, Stephen; Hudson, Ryan; Ali, Irfan M; Matusz, Petru; Tubbs, Shane R; Loukas, Marios

2014-01-20

Recent advances in Bell's palsy (BP) were reviewed to assess the current trends in its management and prognosis. We retrieved the literature on BP using the Cochrane Database of Systematic Reviews, PubMed, and Google Scholar. Key words and phrases used during the search included 'Bell's palsy', 'Bell's phenomenon', 'facial palsy', and 'idiopathic facial paralysis'. Emphasis was placed on articles and randomized controlled trails (RCTs) published within the last 5 years. BP is currently considered the leading disorder affecting the facial nerve. The literature is replete with theories of its etiology, but the reactivation of herpes simplex virus isoform 1 (HSV-1) and/or herpes zoster virus (HZV) from the geniculate ganglia is now the most strongly suspected cause. Despite the advancements in neuroimaging techniques, the diagnosis of BP remains one of exclusion. In addition, most patients with BP recover spontaneously within 3 weeks. Corticosteroids are currently the drug of choice when medical therapy is needed. Antivirals, in contrast, are not superior to placebo according to most reliable studies. At the time of publication, there is no consensus as to the benefit of acupuncture or surgical decompression of the facial nerve. Long-term therapeutic agents and adjuvant medications for BP are necessary due to recurrence and intractable cases. In the future, large RCTs will be required to determine whether BP is associated with an increased risk of stroke.

High-frequency ultrasound as an adjunct to neural electrophysiology: Evaluation and prognosis of Bell's palsy.

PubMed

Li, Shuo; Guo, Rui-Jun; Liang, Xiao-Ning; Wu, Yue; Cao, Wen; Zhang, Zhen-Ping; Zhao, Wei; Liang, Hai-Dong

2016-01-01

Bell's palsy is a form of temporary facial nerve paralysis that occurs primarily in young adults. Previously, various methods were used to assess outcomes in facial nerve disease. The aim of the present study was to characterize the main branches of the normal and abnormal facial nerve using high-frequency ultrasonography (HFUS). A total of 104 healthy volunteers, 40 patients with acute onset of Bell's palsy and 30 patients who underwent 3-month routine therapy for Bell's palsy disease were included in the study. The healthy volunteers and patients were selected for HFUS examination and VII nerve conduction. The results showed significant differences in nerve diameter, echogenicity, delitescence and amplitude in different groups. Statistically significant correlations were identified for severity grading in one of the experimental groups during HFUS examinations. In conclusion, HFUS as a complementary technique paired with neural electrophysiology may establish the normal values of facial nerve. Additionally, HFUS was beneficial in the process of evaluation and prognosis of Bell's palsy disease.

[Residual states in 30 percent of adult patients with Bell's palsy. Early treatment with cortisone improves the healing process].

PubMed

Berg, Thomas; Stjernquist-Desatnik, Anna; Kanerva, Mervi; Hultcrantz, Malou; Engström, Mats; Jonsson, Lars

2015-01-06

Bell's palsy is an acute unilateral weakness or paralysis of the face of unknown cause. The incidence of the disease is 30 individuals per 100,000 per year. It is a diagnosis of exclusion and other known causes for acute peripheral facial palsy must be ruled out. The prognosis is overall favorable and about 70% of the patients recover completely within 6 months without treatment. Recent randomized controlled Bell's palsy trials have shown that treatment with corticosteroids shortens time to recovery and improves recovery rates while antiviral treatment alone is not more effective than placebo. The combination of corticosteroids and antivirals has not been proven more effective than corticosteroids alone. We present an update of Bell's palsy in adults with focus on diagnosis, treatment and follow-up of these patients.

Rehabilitation of Bell's palsy patient with complete dentures.

PubMed

Muthuvignesh, J; Kumar, N Suman; Reddy, D Narayana; Rathinavelu, Pradeep; Egammai, S; Adarsh, A

2015-08-01

Facial nerve disorders may be of sudden onset and more often of unknown etiology. Edema of the facial nerve within the fallopian canal results in Bell's palsy. This causes compression of the nerve and affects the microcirculation. Many authors have suggested treatment for facial nerve paralysis ranging from simple physiotherapy to complicated microvascular decompression. It more often results in symptoms like synkinesis and muscle spasm after the decompression surgery of the nerve because of the inability to arrange the nerve fibers within the canal. The treatment choice also depends on patient's age, extent of the nerve damage, and patient's needs and desires. Many patients who cannot be rehabilitated functionally can be treated for esthetics of the involved muscles. This case report elaborates about a patient who was rehabilitated for esthetics and to some extent for function.

Prognostic factors for recovery in Portuguese patients with Bell's palsy.

PubMed

Ferreira, Margarida; Firmino-Machado, João; Marques, Elisa A; Santos, Paula C; Simões, Ana Daniela; Duarte, José A

2016-10-01

The main aim of this study was to identify the prognostic factors that contribute to complete recovery at 6 weeks and 6 months in patients with Bell's palsy. This is a prospective, longitudinal, and descriptive study that included 123 patients diagnosed with facial nerve palsy (FNP) at a hospital in Guimarães, Portugal. However, only 73 patients with Bell's palsy (BP) were included in the assessment of recovery at 6 weeks and 6 months. We analyzed the demographic and clinical characteristics of the patients, including sex, age, paralyzed side, occupation, previous and associated symptoms, seasonal occurrence, familial facial palsy, patient perception, intervention options, and baseline grade according to the House-Brackmann facial grading system (HB-FGS). Of the 123 cases with FNP, 79 (64.2%) patients had BP. Age, sex, and baseline HB-FGS grades were significant predictors of complete recovery at 6 weeks. Patients with HB-FGS grade III or lower (6 weeks baseline) had significant recovery of function at 6 months. Baseline severity of BP, elderly patients, and male sex were early predictors of poor prognosis. Patients with mild and moderate dysfunction according to the HB-FGS achieved significant normal facial function at 6 months. Further prospective studies with longer observation periods and larger samples are needed to verify the results.

Comparison of Transcranial Magnetic Stimulation and Electroneuronography Between Bell's Palsy and Ramsay Hunt Syndrome in Their Acute Stages

PubMed Central

Hur, Dong Min; Lee, Young Hee; Kim, Sung Hoon; Park, Jung Mi; Kim, Ji Hyun; Yong, Sang Yeol; Shinn, Jong Mock; Oh, Kyung Joon

2013-01-01

Objective To examine the neurophysiologic status in patients with idiopathic facial nerve palsy (Bell's palsy) and Ramsay Hunt syndrome (herpes zoster oticus) within 7 days from onset of symptoms, by comparing the amplitude of compound muscle action potentials (CMAP) of facial muscles in electroneuronography (ENoG) and transcranial magnetic stimulation (TMS). Methods The facial nerve conduction study using ENoG and TMS was performed in 42 patients with Bell's palsy and 14 patients with Ramsay Hunt syndrome within 7 days from onset of symptoms. Denervation ratio was calculated as CMAP amplitude evoked by ENoG or TMS on the affected side as percentage of the amplitudes on the healthy side. The severity of the facial palsy was graded according to House-Brackmann facial grading scale (H-B FGS). Results In all subjects, the denervation ratio in TMS (71.53±18.38%) was significantly greater than the denervation ratio in ENoG (41.95±21.59%). The difference of denervation ratio between ENoG and TMS was significantly smaller in patients with Ramsay Hunt syndrome than in patients with Bell's palsy. The denervation ratio of ENoG or TMS did not correlated significantly with the H-B FGS. Conclusion In the electrophysiologic study for evaluation in patients with facial palsy within 7 days from onset of symptoms, ENoG and TMS are useful in gaining additional information about the neurophysiologic status of the facial nerve and may help to evaluate prognosis and set management plan. PMID:23525840

Bell's palsy

PubMed Central

2008-01-01

Introduction Bell's palsy is characterised by an acute, unilateral, partial or complete paralysis of the face, which may occur with mild pain, numbness, increased sensitivity to sound, and altered taste. Bell's palsy remains idiopathic, but a proportion may be caused by reactivation of herpes viruses from cranial nerve ganglia. Bell's palsy is most common in people aged 15-40 years, affecting 1 in 60 in their lifetime. Most make a spontaneous recovery within 1 month, but up to 30% have delayed or incomplete recovery. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments in adults and children? We searched: Medline, Embase, The Cochrane Library and other important databases up to February 2006 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found eight systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: antiviral treatment, corticosteroids (alone or plus antiviral treatment), facial nerve decompression surgery, and mime therapy. PMID:19450338

Recovery from Bell Palsy after Transplantation of Peripheral Blood Mononuclear Cells and Platelet-Rich Plasma.

PubMed

Seffer, Istvan; Nemeth, Zoltan

2017-06-01

Peripheral blood mononuclear cells (PBMCs) are multipotent, and plasma contains growth factors involving tissue regeneration. We hypothesized that transplantation of PBMC-plasma will promote the recovery of paralyzed facial muscles in Bell palsy. This case report describes the effects of PBMC-plasma transplantations in a 27-year-old female patient with right side Bell palsy. On the affected side of the face, the treatment resulted in both morphological and functional recovery including voluntary facial movements. These findings suggest that PBMC-plasma has the capacity of facial muscle regeneration and provides a promising treatment strategy for patients suffering from Bell palsy or other neuromuscular disorders.

[Black bone disease of the skull and facial bones].

PubMed

Laure, B; Petraud, A; Sury, F; Bayol, J-C; Marquet-Van Der Mee, N; de Pinieux, G; Goga, D

2009-11-01

We report the case of a patient with a craniofacial black bone disease. This was discovered accidentally during a coronal approach. A 38-year-old patient was referred to our unit for facial palsy having appeared 10 years before. Rehabilitation of the facial palsy was performed with a lengthening temporal myoplasty and lengthening of the upper eyelid elevator. An unusual black color of the skull was observed at incision of the coronal approach. Subperiostal dissection of skull and malars confirmed the presence of a black bone disease. A postoperative history revealed minocycline intake (200mg per day) during 3 years. This craniofacial black bone disease was caused by minocycline intake. The originality of this case is to see directly the entire craniofacial skeleton black. This abnormal pigmentation may affect various organs or tissues. Bone pigmentation is irreversible unlike that of the mouth mucosa or of the skin. This abnormal pigmentation is usually discovered accidentally.

Clinical features and management of facial nerve paralysis in children: analysis of 24 cases.

PubMed

Cha, H E; Baek, M K; Yoon, J H; Yoon, B K; Kim, M J; Lee, J H

2010-04-01

To evaluate the causes, treatment modalities and recovery rate of paediatric facial nerve paralysis. We analysed 24 cases of paediatric facial nerve paralysis diagnosed in the otolaryngology department of Gachon University Gil Medical Center between January 2001 and June 2006. The most common cause was idiopathic palsy (16 cases, 66.7 per cent). The most common degree of facial nerve paralysis on first presentation was House-Brackmann grade IV (15 of 24 cases). All cases were treated with steroids. One of the 24 cases was also treated surgically with facial nerve decompression. Twenty-two cases (91.6 per cent) recovered to House-Brackmann grade I or II over the six-month follow-up period. Facial nerve paralysis in children can generally be successfully treated with conservative measures. However, in cases associated with trauma, radiological investigation is required for further evaluation and treatment.

Unusual cause of brachial palsy with diaphragmatic palsy.

PubMed

Gupta, Vishal; Pandita, Aakash; Panghal, Astha; Hassan, Neha

2018-05-12

We report a preterm neonate born with respiratory distress. The neonate was found to have diaphragmatic palsy and brachial palsy. The neonate was born by caesarean section and there was no history of birth trauma. On examination, there was bilateral congenital talipes equinovarus and a scar was present on the forearm. The mother had a history of chickenpox during the 16 weeks of pregnancy for which no treatment was sought. On investigation, PCR for varicella was found to be positive in the neonate. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Infections in the differential diagnosis of Bell's palsy: a plea for performing CSF analysis.

PubMed

Henkel, Katrin; Lange, Peter; Eiffert, Helmut; Nau, Roland; Spreer, Annette

2017-04-01

Peripheral facial nerve palsy (FP) is the most common single nerve affection. Most cases are idiopathic, but a relevant fraction is caused by potentially treatable aetiologies including infections. Not all current diagnosis and treatment guidelines recommend routine cerebrospinal fluid (CSF) analysis in the diagnostic workup of this symptom. In this study, we evaluated frequency of aetiologies and relevance of CSF analysis in an interdisciplinary cohort. We retrospectively analysed all cases of newly diagnosed FP treated at a German university medical centre in a 3-year period. Diagnostic certainty was classified for infectious aetiologies according to clinical and CSF parameters. 380 patients with FP were identified, 63 children and 317 adults. Idiopathic Bell´s palsy was predominant in 61 %. 25 % of FP was attributed to infections, and other causes were identified in 14 %. Clinical presentation alone was not conclusive for infectious aetiology, in almost half of patients with infection-attributed FP the reported symptoms or clinical signs did not differ from common symptoms of idiopathic Bell`s palsy. Determination of C-reactive protein or white blood cell count was not helpful in the identification of infectious causes, and radiological imaging was performed in a high proportion of adult patients without conclusive results. Nuchal rigidity was found only in 7 % of patients with CSF pleocytosis. The predominant infectious agents were Borrelia burgdorferi, VZV and HSV, and in most of these cases diagnosis relied on the findings of CSF analysis. This study outlines the importance of careful differential diagnosis to identify infectious causes of facial nerve palsy. The high incidence and frequent unspecific clinical presentation of infectious FP underlines the importance of including CSF analysis in the diagnostic routine workup of FP.

Position as a Cause of Deformity in Children with Cerebral Palsy (1976)

ERIC Educational Resources Information Center

Scrutton, David

2008-01-01

Deformities in the child with cerebral palsy have been ascribed to muscle imbalance (Sharrard 1961) and increased tone (Pollock 1959) or to the type of cerebral palsy (Bobath and Bobath 1975). As far as we know, the position in which the child is nursed, especially during the first year of life, has not been considered as a cause of deformity. It…

Bell's palsy before Bell: Cornelis Stalpart van der Wiel's observation of Bell's palsy in 1683.

PubMed

van de Graaf, Robert C; Nicolai, Jean-Philippe A

2005-11-01

Bell's palsy is named after Sir Charles Bell (1774-1842), who has long been considered to be the first to describe idiopathic facial paralysis in the early 19th century. However, it was discovered that Nicolaus Anton Friedreich (1761-1836) and James Douglas (1675-1742) preceded him in the 18th century. Recently, an even earlier account of Bell's palsy was found, as observed by Cornelis Stalpart van der Wiel (1620-1702) from The Hague, The Netherlands in 1683. Because our current knowledge of the history of Bell's palsy before Bell is limited to a few documents, it is interesting to discuss Stalpart van der Wiel's description and determine its additional value for the history of Bell's palsy. It is concluded that Cornelis Stalpart van der Wiel was the first to record Bell's palsy in 1683. His manuscript provides clues for future historical research.

Peripheral Facial Palsy: Does Patients' Religiousness Matter for the Otorhinolaryngologist?

PubMed

Lucchetti, Giancarlo; De Rossi, Janaina; Gonçalves, Juliane P B; Lucchetti, Alessandra L Granero

2016-06-01

In order to deal with the suffering, a frequent strategy employed by patients is the use of religious beliefs and behaviors. Nevertheless, few studies in otorhinolaryngology have investigated this dimension. Therefore, the present study aims to investigate the role of religiousness on quality of life, mental health, self-esteem and appearance in 116 patients with peripheral facial palsy (PFP). A cross-sectional, single-center study was carried out between 2010 and 2012 in PFP outpatients. We assessed socio-demographic data, PFP characteristics, depression, anxiety, quality of life, self-esteem, appearance and religiosity. A linear regression (adjusted for confounders) was performed to investigate whether religiosity was associated with any outcomes. The present study found that religious attendance, but not other types of religiousness, was related to quality of life and mental health on PFP patients. In addition, ENT patients would like their doctors to ask them about their faith and religion as part of their medical care. These findings give further support to the importance of religious and spiritual beliefs on ENT patients. Otorhinolaryngologists should be aware of the positive and negative aspects of religion and be prepared to address these issues in clinical practice.

Update on managing Bell's palsy.

PubMed

2008-07-01

Each year in the UK, around 1 in 5,000 people develops Bell's palsy--idiopathic unilateral lower motor neurone facial weakness of rapid onset. Of those who are not treated, about 16% end up with permanent moderate to severe weakness, which can result in facial dysfunction and disfigurement, and psychological difficulties. There has been longstanding controversy about what, if any, treatment should be given, with potential alternatives including corticosteroids, antiviral drugs, acupuncture and physiotherapy. We last reviewed this condition in 2006, indicating that "published trials on the efficacy of drug treatments have been poor and no firm conclusions can be drawn about the benefit of any single drug", and "it is unclear what place, if any, acupuncture and physiotherapy have in the management of patients with Bell's palsy". Here we update our conclusions in the light of recently published evidence.

Bell's palsy during interferon alpha 2a treatment in a case with Behçet uveitis.

PubMed

Yalçindağ, Fatime Nilüfer; Alay, Cem

2013-01-01

To present a case who developed Bell's palsy while using interferon alpha 2a for Behçet uveitis. A patient with Behçet disease presented with decreased vision in his right eye. Ophthalmic examination, fundus fluorescein angiography and optical coherence tomography were performed. After developing facial paralysis while on interferon therapy, the patient was referred to our neurology service for differential diagnosis and treatment. Examination of right eye revealed panuveitis with branch retinal vein occlusion, so high dose steroids were prescribed. In three days there was no improvement in terms of vitreous inflammation and so steroids were replaced with interferon. At the seventh month, patient experienced a facial paralysis. After eliminating other causes, including viral infections, trauma, cold exposure and neurological evaluation with cranial MRI, the patient was diagnosed to have Bell's palsy by a neurologist. Interferon was replaced with mycophenolate mofetil and the Bell's palsy was treated with oral steroids. It is important to be alert to both common and rare complications while treating with interferon.

The benefits of steroids versus steroids plus antivirals for treatment of Bell's palsy: a meta-analysis.

PubMed

Quant, Eudocia C; Jeste, Shafali S; Muni, Rajeev H; Cape, Alison V; Bhussar, Manveen K; Peleg, Anton Y

2009-09-07

To determine whether steroids plus antivirals provide a better degree of facial muscle recovery in patients with Bell's palsy than steroids alone. Meta-analysis. PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials were searched for studies published in all languages from 1984 to January 2009. Additional studies were identified from cited references. Selection criteria Randomised controlled trials that compared steroids with the combination of steroids and antivirals for the treatment of Bell's palsy were included in this study. At least one month of follow-up and a primary end point of at least partial facial muscle recovery, as defined by a House-Brackmann grade of at least 2 (complete palsy is designated a grade of 6) or an equivalent score on an alternative recognised scoring system, were required. Review methods Two authors independently reviewed studies for methodological quality, treatment regimens, duration of symptoms before treatment, length of follow-up, and outcomes. Odds ratios with 95% confidence intervals were calculated and pooled using a random effects model. Six trials were included, a total of 1145 patients; 574 patients received steroids alone and 571 patients received steroids and antivirals. The pooled odds ratio for facial muscle recovery showed no benefit of steroids plus antivirals compared with steroids alone (odds ratio 1.50, 95% confidence interval 0.83 to 2.69; P=0.18). A one study removed analysis showed that the highest quality studies had the greatest effect on the lack of difference between study arms shown by the odds ratio. Subgroup analyses assessing causes of heterogeneity defined a priori (time from symptom onset to treatment, length of follow-up, and type of antiviral studied) showed no benefit of antivirals in addition to that provided by steroids. Antivirals did not provide an added benefit in achieving at least partial facial muscle recovery compared with steroids alone in patients with

Facial paralysis

MedlinePlus

... a physical, speech, or occupational therapist. If facial paralysis from Bell palsy lasts for more than 6 to 12 months, plastic surgery may be recommended to help the eye close and improve the appearance of the face. Alternative Names Paralysis of the face Images Ptosis, drooping of the ...

Acupuncture for the sequelae of Bell's palsy: a randomized controlled trial.

PubMed

Kwon, Hyo-Jung; Choi, Jun-Yong; Lee, Myeong Soo; Kim, Yong-Suk; Shin, Byung-Cheul; Kim, Jong-In

2015-06-03

Incomplete recovery from facial palsy results in social and physical disabilities, and the medical options for the sequelae of Bell's palsy are limited. Acupuncture is widely used for Bell's palsy patients in East Asia, but its efficacy is unclear. We performed a randomized controlled trial including participants with the sequelae of Bell's palsy with the following two parallel arms: an acupuncture group (n = 26) and a waiting list group (n = 13). The acupuncture group received acupuncture treatments for 8 weeks, whereas the waiting list group did not receive acupuncture treatments during the 8-week period after randomization. The primary outcome measure was change in the Facial Disability Index (FDI) social and well-being subscale at week 8. We also analyzed changes in the FDI physical function subscale, the House-Brackmann score, the Sunnybrook Facial Nerve Grading system, lip mobility and stiffness at 5 and 8 weeks after randomization. An intention-to-treat analysis was applied. The acupuncture group exhibited greater improvements in the FDI social score (mean difference, 23.54; 95% confidence interval, 12.99 to 34.08) and better results on the FDI physical function subscale (mean difference, 21.54; 95% confidence interval, 7.62 to 35.46), Sunnybrook Facial Nerve Grading score (mean difference, 14.77; 95% confidence interval, 5.05 to 24.49), and stiffness scale (mean difference, -1.58; 95% confidence interval,-2.26 to -0.89) compared with the waiting list group after 8 weeks. No severe adverse event occurred in either group. Compared with the waiting list group, acupuncture had better therapeutic effects on the social and physical aspects of sequelae of Bell's palsy. Current Controlled Trials ISRCTN43104115.

Prosthodontic Rehabilitation of Patients with Bell's Palsy: Our Experience.

PubMed

Rajapur, Anand; Mitra, Nirban; Prakash, V Jeevan; Rah, Sajad Ahmad; Thumar, Sagar

2015-01-01

Bell's palsy is an idiopathic unilateral lower motor neuron paresis or paralysis of the facial nerve of sudden onset. It involves loss of muscular control on the affected side of the face. This paper reports the prosthodontic management of patients with Bell's palsy and also describes a technique to stabilize the jaw movements in complete denture patients using interim dentures. A 65-year-old male edentulous patient and a 55-year-old female edentulous patient reported to the department of prosthodontics to get their missing teeth replaced. They both gave history of facial paralysis and were diagnosed for Bell's palsy. Interim training dentures with flat occlusal tables were fabricated first to correct and stabilize their mandibular movements. During initial 4 weeks, there was poor functioning of the interim dentures. Gradually by 8(th) week the patients started stabilizing the interim dentures and were functional. After observing the improvement when the patients had no pain and could stabilize and use the treatment dentures successfully, definitive complete dentures were fabricated. This case report presents a systematic approach to successively rehabilitate edentulous patients with Bell's palsy.

[Peripheral paralysis of facial nerve in children].

PubMed

Steczkowska-Klucznik, Małgorzata; Kaciński, Marek

2006-01-01

Peripheral facial paresis is one of the most common diagnosed neuropathies in adults and also in children. Many factors can trigger facial paresis and most frequent are infectious, carcinoma and demyelinisation diseases. Very important and interesting problem is an idiopathic facial paresis (Bell's palsy). Actually the main target of scientific research is to assess the etiology (infectious, genetic, immunologic) and to find the most appropriate treatment.

Investigating Psychosocial Causes of the Tendency for Facial Cosmetic Surgery.

PubMed

Babadi, Hadis; Fereidooni-Moghadam, Malek; Dashtbozorgi, Bahman; Cheraghian, Bahman

2018-01-22

Despite the importance of cosmetic surgery in improving body image and promoting individuals' physical and mental health, it is accompanied with some physical, mental, and economic problems, because it is an invasive procedure. Considering such extensive consequences and given the rising demand for performing such surgeries, it is essential to consider programs for reducing such requests. The present study aimed to investigate the psychosocial causes of the tendency for facial cosmetic surgery in patients referred to medical centers in Ahvaz in 2016-2017. This study was conducted on 385 facial cosmetic surgery applicants referred to medical centers in Ahvaz and were selected using a sequential non-probability sampling method. The data collection tool was a questionnaire divided into two sections namely: (1) demographic questions and (2) a questionnaire on the psychosocial causes of the tendency for facial cosmetic surgery. The mean scores of the psychological and social causes of the tendency for facial cosmetic surgery were 4.46 (SD = 1.67) and 3.44 (SD = 2.57), respectively. "Being interested in being beautiful" was the most frequent positive response of the participants regarding the cause of tending to undergo facial cosmetic surgery (88.6%) and the least frequent response was estimated to be 35.1% for the "inappropriate psychological state" cause. The results of this study showed that psychological factors affected the participants' tendency for facial cosmetic surgery more than social factors. Determining and identifying such psychological pressures and providing individual training and psychological support can prevent individuals from undergoing facial cosmetic surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The benefits of steroids versus steroids plus antivirals for treatment of Bell’s palsy: a meta-analysis

PubMed Central

Quant, Eudocia C; Jeste, Shafali S; Muni, Rajeev H; Cape, Alison V; Bhussar, Manveen K

2009-01-01

Objective To determine whether steroids plus antivirals provide a better degree of facial muscle recovery in patients with Bell’s palsy than steroids alone. Design Meta-analysis. Data sources PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials were searched for studies published in all languages from 1984 to January 2009. Additional studies were identified from cited references. Selection criteria Randomised controlled trials that compared steroids with the combination of steroids and antivirals for the treatment of Bell’s palsy were included in this study. At least one month of follow-up and a primary end point of at least partial facial muscle recovery, as defined by a House-Brackmann grade of at least 2 (complete palsy is designated a grade of 6) or an equivalent score on an alternative recognised scoring system, were required. Review methods Two authors independently reviewed studies for methodological quality, treatment regimens, duration of symptoms before treatment, length of follow-up, and outcomes. Odds ratios with 95% confidence intervals were calculated and pooled using a random effects model. Results Six trials were included, a total of 1145 patients; 574 patients received steroids alone and 571 patients received steroids and antivirals. The pooled odds ratio for facial muscle recovery showed no benefit of steroids plus antivirals compared with steroids alone (odds ratio 1.50, 95% confidence interval 0.83 to 2.69; P=0.18). A one study removed analysis showed that the highest quality studies had the greatest effect on the lack of difference between study arms shown by the odds ratio. Subgroup analyses assessing causes of heterogeneity defined a priori (time from symptom onset to treatment, length of follow-up, and type of antiviral studied) showed no benefit of antivirals in addition to that provided by steroids. Conclusions Antivirals did not provide an added benefit in achieving at least partial facial muscle

Role of Kabat physical rehabilitation in Bell's palsy: a randomized trial.

PubMed

Barbara, Maurizio; Antonini, Giovanni; Vestri, Annarita; Volpini, Luigi; Monini, Simonetta

2010-01-01

When applied at an early stage, Kabat's rehabilitation was shown to provide a better and faster recovery rate in comparison with non-rehabilitated patients. To assess the validity of an early rehabilitative approach to Bell's palsy patients. A randomized study involved 20 consecutive patients (10 males, 10 females; aged 35-42 years) affected by Bell's palsy, classified according to the House-Brackmann (HB) grading system and grouped on the basis of undergoing or not early physical rehabilitation according to Kabat, i.e. a proprioceptive neuromuscular rehabilitation. The evaluation was carried out by measuring the amplitude of the compound motor action potential (CMAP), as well as by observing the initial and final HB grade, at days 4, 7 and 15 after onset of facial palsy. Patients belonging to the rehabilitation group clearly showed an overall improvement of clinical stage at the planned final observation, i.e. 15 days after onset of facial palsy, without presenting greater values of CMAP.

Rhinoscintigraphic analysis of nasal mucociliary function in patients with Bell's palsy.

PubMed

Boynuegri, S; Ozer, S; Peksoy, I; Acikalin, A; Tuna, E Ü; Dursun, E; Eryilmaz, A

2016-01-01

Mucociliary transport (MCT) is an important defense mechanism of the respiratory tract. One of the major factors determining MCT is the ciliary activity of the respiratory epithelium. Rhinoscintigraphy is the most commonly used method for the analysis of mucociliary activity. The aim of this study was to investigate the effect of facial paralysis on the nasal mucociliary clearance. This study included 38 Bell's palsy patients as the study group and 10 subjects without any history of paranasal sinus disease or facial paralysis as the control group. A drop of technetium 99m-labeled macroaggregated albumin (Tc-99m MAA) was placed posterior to the head of the inferior turbinate and followed with a gamma camera. MCT rate was measured as the velocity of Tc-99m MAA drop. The mean MCT rate was 4.27 ± 0.76 millimeters per minute (mm/min) on 20 sides of 10 healthy controls, 4.11 ± 2.91 mm/min on the affected sides of the patients with Bell's palsy, and 6.03 ± 3.13 mm/min on the nonparalyzed sides of the patients. MCT rate was statistically significantly faster in the nonparalyzed side when compared to the paralyzed side in Bell's palsy patients (P = 0.001). MCT rates were not significantly different in the control group and paralyzed sides of the Bell's palsy patients (P = 0.810). The MCT rate was statistically significantly faster in the nonparalyzed sides of Bell's palsy patients when compared to the controls (P = 0.017). This study showed a faster MCT rate on the nonparalyzed side in Bell's palsy patients when compared to the paralyzed side and the control subjects. A compensatory mechanism could be the underlying reason for faster MCT on the nonparalyzed side. Further studies on larger patient groups are needed to investigate the effect of facial paralysis on the MCT and changes of facial nerve function on the opposite, nonparalyzed side of the face.

Association between recovery from Bell's palsy and body mass index.

PubMed

Choi, S A; Shim, H S; Jung, J Y; Kim, H J; Kim, S H; Byun, J Y; Park, M S; Yeo, S G

2017-06-01

Although many factors have been found to be involved in recovery from Bell's palsy, no study has investigated the association between recovery from Bell's palsy and obesity. This study therefore evaluated the association between recovery from Bell's palsy and body mass index (BMI). Subjects were classified into five groups based on BMI (kg/m 2 ). Demographic and clinical characteristics were compared among these groups. Assessed factors included sex, age, time from paralysis to visiting a hospital, the presence of comorbidities such as diabetes mellitus and hypertension, degree of initial facial nerve paralysis by House-Brackmann (H-B) grade and neurophysiological testing, and final recovery rate. Based on BMI, 37 subjects were classified as underweight, 169 as normal weight, 140 as overweight, 155 as obese and 42 as severely obese. Classification of the degree of initial facial nerve paralysis as moderate or severe, according to H-B grade and electroneurography, showed no difference in severity of initial facial paralysis among the five groups (P > 0.05). However, the final recovery rate was significantly higher in the normal weight than in the underweight or obese group (P < 0.05). Obesity or underweight had no effect on the severity of initial facial paralysis, but the final recovery rate was lower in the obese and underweight groups than in the normal group. © 2016 John Wiley & Sons Ltd.

Extracranial Facial Nerve Schwannoma Treated by Hypo-fractionated CyberKnife Radiosurgery.

PubMed

Sasaki, Ayaka; Miyazaki, Shinichiro; Hori, Tomokatsu

2016-09-21

Facial nerve schwannoma is a rare intracranial tumor. Treatment for this benign tumor has been controversial. Here, we report a case of extracranial facial nerve schwannoma treated successfully by hypo-fractionated CyberKnife (Accuray, Sunnyvale, CA) radiosurgery and discuss the efficacy of this treatment. A 34-year-old female noticed a swelling in her right mastoid process. The lesion enlarged over a seven-month period, and she experienced facial spasm on the right side. She was diagnosed with a facial schwannoma via a magnetic resonance imaging (MRI) scan of the head and neck and was told to wait until the facial nerve palsy subsides. She was referred to our hospital for radiation therapy. We planned a fractionated CyberKnife radiosurgery for three consecutive days. After CyberKnife radiosurgery, the mass in the right parotid gradually decreased in size, and the facial nerve palsy disappeared. At her eight-month follow-up, her facial spasm had completely disappeared. There has been no recurrence and the facial nerve function has been normal. We successfully demonstrated the efficacy of CyberKnife radiosurgery as an alternative treatment that also preserves neurofunction for facial nerve schwannomas.

[Etiology of cerebral palsy].

PubMed

Jaisle, F

1996-01-01

The "perinatal asphyxia" is regarded to be one of the causes of cerebral palsy, though in the very most of the children with cerebral palsy there is found no hypoxia during labour. It should be mentioned, that the definition of "perinatal" and "asphyxia" neither are unic nor concret. And also there is no correlation between nonreassuring fetal heart rate patterns and acidosis in fetal blood with the incidence of cerebral palsy. Numerous studies in pregnant animals failed in proving an acute intrapartal hypoxia to be the origin of the cerebral palsy. Myers (1975) describes four patterns of anatomic brain damage after different injuries. Only his so called oligo-acidotic hypoxia, which is protracted and lasts over a longer time is leading to brain injury, which can be regarded in analogy to the injury of children with cerebral palsy. Summarising the update publications about the causes of cerebral palsy and the studies in pregnant animals there is no evidence that hypoxia during labour may be the cause of cerebral palsy. There is a great probability of a pre(and post-)natal origin of brain injury (for instance a periventricular leucomalacia found after birth) which leads to cerebral palsy. Short after labour signs of a so called "asphyxia" may occur in addition to this preexisting injury and misrepresent the cause of cerebral palsy. Finally the prepartal injury may cause both: Cerebral palsy and hypoxia.

Effects of electroacupuncture therapy for Bell's palsy from acute stage: study protocol for a randomized controlled trial.

PubMed

Liu, Zhi-dan; He, Jiang-bo; Guo, Si-si; Yang, Zhi-xin; Shen, Jun; Li, Xiao-yan; Liang, Wei; Shen, Wei-dong

2015-08-25

Although many patients with facial paralysis have obtained benefits or completely recovered after acupuncture or electroacupuncture therapy, it is still difficult to list intuitive evidence besides evaluation using neurological function scales and a few electrophysiologic data. Hence, the aim of this study is to use more intuitive and reliable detection techniques such as facial nerve magnetic resonance imaging (MRI), nerve electromyography, and F waves to observe changes in the anatomic morphology of facial nerves and nerve conduction before and after applying acupuncture or electroacupuncture, and to verify their effectiveness by combining neurological function scales. A total of 132 patients with Bell's palsy (grades III and IV in the House-Brackmann [HB] Facial Nerve Grading System) will be randomly divided into electroacupuncture, manual acupuncture, non-acupuncture, and medicine control groups. All the patients will be given electroacupuncture treatment after the acute period, except for patients in the medicine control group. The acupuncture or electroacupuncture treatments will be performed every 2 days until the patients recover or withdraw from the study. The primary outcome is analysis based on facial nerve functional scales (HB scale and Sunnybrook facial grading system), and the secondary outcome is analysis based on MRI, nerve electromyography and F-wave detection. All the patients will undergo MRI within 3 days after Bell's palsy onset for observation of the signal intensity and facial nerve swelling of the unaffected and affected sides. They will also undergo facial nerve electromyography and F-wave detection within 1 week after onset of Bell's palsy. Nerve function will be evaluated using the HB scale and Sunnybrook facial grading system at each hospital visit for treatment until the end of the study. The MRI, nerve electromyography, and F-wave detection will be performed again at 1 month after the onset of Bell's palsy. Chinese Clinical Trials

A close look at an integrative treatment package for Bell's palsy in Korea.

PubMed

Lee, Seung Min Kathy; Lee, Suji; Park, Jun Hyeong; Park, Jongbae J; Lee, Sanghoon

2017-02-01

To provide an overview of the integrative treatment package for Bell's palsy provided at Kyung Hee University Korean Medicine Hospital (KHU KMH). The Facial Palsy Center at KHU KMH has been providing integrative treatment for Bell's palsy patients during the past three decades. Within 72 h of symptom onset, corticosteroids are recommended but complementary treatment including acupuncture and herbal medicine can be used to help suppress inflammation and nerve degeneration. If patients suffer from postauricular pain, pharmacopuncture and cupping is utilized. During the subacute or chronic periods, different acupuncture types are selected accordingly, and herbal medicine and moxibustion helps to improve immune functions and relieve accessory symptoms. Qigong programs are also provided to help relieve facial tension and paralysis. Although rigorous research is warranted, with limited treatment options, we highly suggest that it is worth applying integrative medicine to Bell's palsy patients. Copyright © 2016 Elsevier Ltd. All rights reserved.

Delayed presentation of traumatic facial nerve (CN VII) paralysis.

PubMed

Napoli, Anthony M; Panagos, Peter

2005-11-01

Facial nerve paralysis (Cranial Nerve VII, CN VII) can be a disfiguring disorder with profound impact upon the patient. The etiology of facial nerve paralysis may be congenital, iatrogenic, or result from neoplasm, infection, trauma, or toxic exposure. In the emergency department, the most common cause of unilateral facial paralysis is Bell's palsy, also known as idiopathic facial paralysis (IFP). We report a case of delayed presentation of unilateral facial nerve paralysis 3 days after sustaining a traumatic head injury. Re-evaluation and imaging of this patient revealed a full facial paralysis and temporal bone fracture extending into the facial canal. Because cranial nerve injuries occur in approximately 5-10% of head-injured patients, a good history and physical examination is important to differentiate IFP from another etiology. Newer generation high-resolution computed tomography (CT) scans are commonly demonstrating these fractures. An understanding of this complication, appropriate patient follow-up, and early involvement of the Otolaryngologist is important in management of these patients. The mechanism as well as the timing of facial nerve paralysis will determine the proper evaluation, consultation, and management for the patient. Patients with total or immediate paralysis as well as those with poorly prognostic audiogram results are good candidates for surgical repair.

[Study on relationship between operation timing and clinical prognosis of cases with Bell palsy].

PubMed

Liu, Sufu; Li, Jiandong; Wang, Xueyong; Zhao, Liang; Ji, Wei; Wang, Jia; Bai, Juan; Wei, Bojun

2013-07-01

To study on relationship between diverse handling time following onset and clinical prognosis of cases with Bell palsy. Two hundred and sixteen cases with Bell palsy, who were admitted in our department between Jun. 2006 and Dec. 2009, were collected and divided into 6 groups according to disease time: 1-2 months, > 2 - 3 months, > 3 - 4 months, > 4 - 5 months, > 5 - 6 months, and > 6 months. Cases in all groups received subtotal course decompression of facial nerve and other compound treatment, and the relationship between handling timing and clinical prognosis were compared. It was found that the difference of prognosis and handling timing was statistically significant, after comparison between all groups with Facial Grading Standards (H-B) as the standard to assess prognosis. Clinical prognosis of cases with Bell palsy was related to alternative handling time, and subtotal course decompression of facial nerve was recommended to be performed as early as possible for those cases who were irresponsive after conservative treatment for one month.

Accommodation and convergence palsy caused by lesions in the bilateral rostral superior colliculus.

PubMed

Ohtsuka, Kenji; Maeda, Sachie; Oguri, Naomi

2002-03-01

To report a patient who developed accommodation and convergence palsy caused by lesions in the bilateral rostral superior colliculus. Observational case report. A 30-year-old right-handed man experienced sudden onset of diplopia and blurred vision at near vision. The patient showed accommodation and convergence palsy. Magnetic resonance imaging revealed lesions located in the bilateral rostral superior colliculus. These findings suggest that the rostral superior colliculus is involved in the control of accommodation and vergence eye movements.

Unexpected rare complication of the facial paralysis in a patient with an antrochoanal polyp following canine fossa puncture.

PubMed

Kim, Ah-Young; Choi, Myoung Su

2015-05-14

Canine fossa puncture (CFP) combined with endoscopic sinus surgery is a simple and effective method for treating antrochoanal polyps, particularly those that originate in the anterior, inferior or medial aspect of the antrum. Several complications can occur following CFP, including facial paraesthesia and dental numbness. However, facial palsy is extremely rare after CFP. We postulated that a possible mechanism of facial palsy is pressure injury to the soft tissues adjacent to the puncture site, which can damage the buccal branch of the facial nerve during CFP. 2015 BMJ Publishing Group Ltd.

Cranial Nerve Palsy after Onyx Embolization as a Treatment for Cerebral Vascular Malformation

PubMed Central

Lee, Jong Min; Whang, Kum; Cho, Sung Min; Kim, Jong Yeon; Oh, Ji Woong; Koo, Youn Moo; Hu, Chul; Pyen, Jinsoo

2017-01-01

The Onyx liquid embolic system is a relatively safe and commonly used treatment for vascular malformations, such as arteriovenous fistulas and arteriovenous malformations. However, studies on possible complications after Onyx embolization in patients with vascular malformations are limited, and the occurrence of cranial nerve palsy is occasionally reported. Here we report the progress of two different types of cranial nerve palsy that can occur after embolization. In both cases, Onyx embolization was performed to treat vascular malformations and ipsilateral oculomotor and facial nerve palsies were observed. Both patients were treated with steroids and exhibited symptom improvement after several months. The most common types of neuropathy that can occur after Onyx embolization are facial nerve palsy and trigeminal neuralgia. Although the mechanisms underlying these neuropathies are not clear, they may involve traction injuries sustained while extracting the microcatheter, mass effects resulting from thrombi and edema, or Onyx reflux into the vasa nervorum. In most cases, the neuropathy spontaneously resolves several months following the procedure. PMID:29159152

Cranial Nerve Palsy after Onyx Embolization as a Treatment for Cerebral Vascular Malformation.

PubMed

Lee, Jong Min; Whang, Kum; Cho, Sung Min; Kim, Jong Yeon; Oh, Ji Woong; Koo, Youn Moo; Hu, Chul; Pyen, Jinsoo; Choi, Jong Wook

2017-09-01

The Onyx liquid embolic system is a relatively safe and commonly used treatment for vascular malformations, such as arteriovenous fistulas and arteriovenous malformations. However, studies on possible complications after Onyx embolization in patients with vascular malformations are limited, and the occurrence of cranial nerve palsy is occasionally reported. Here we report the progress of two different types of cranial nerve palsy that can occur after embolization. In both cases, Onyx embolization was performed to treat vascular malformations and ipsilateral oculomotor and facial nerve palsies were observed. Both patients were treated with steroids and exhibited symptom improvement after several months. The most common types of neuropathy that can occur after Onyx embolization are facial nerve palsy and trigeminal neuralgia. Although the mechanisms underlying these neuropathies are not clear, they may involve traction injuries sustained while extracting the microcatheter, mass effects resulting from thrombi and edema, or Onyx reflux into the vasa nervorum. In most cases, the neuropathy spontaneously resolves several months following the procedure.

Acupuncture and Kinesio Taping for the acute management of Bell's palsy: A case report.

PubMed

Alptekin, Derya Özmen

2017-12-01

Bell's palsy is an idiopathic, acute peripheral palsy of the facial nerve that supplies the muscles of facial expression. Despite an expected 70% full recovery rate, up to 30% of patients are left with potentially disfiguring facial weakness, involuntary movements, or persistent lacrimation. The most frequently used treatment options are corticosteroids and antiviral drugs. However, accompanying clinical conditions, such as uncontrolled diabetes, hypertension, gastrointestinal disturbances, polypharmacy of geriatric patients, and significant sequelae ratios, indicate the need for safe and effective complementary therapies that would enhance the success of the conventional interventions. A 26-year-old female presented with numbness and earache on the left side of the face; these symptoms had been ongoing for 8-10h. Physical examination revealed peripheral facial paralysis of House-Brackmann grade III and corticosteroid-valacyclovir treatment was initiated. On the same day, Kinesio Taping was applied to the affected nerve and muscle area with the aim of primarily neurofacilitation and edema-pain relief. On the fifth day, acupuncture treatment was started and was continued for 3 consecutive days. A physical therapy program was administered for the subsequent 10days. At the 3-week follow-up examination, Bell's palsy was determined as grade I, and the treatment was stopped. Acupuncture and Kinesio Taping, in conjunction with physical therapy modalities, are safe and promising complementary therapies for the acute management of Bell's palsy. However, further large scale and randomized controlled studies are necessary to assess whether these complementary interventions have significant additive or synergistic effect for complete recovery of patients with Bell's palsy. Copyright © 2017 Elsevier Ltd. All rights reserved.

Prosthodontic Rehabilitation of Patients with Bell’s Palsy: Our Experience

PubMed Central

Rajapur, Anand; Mitra, Nirban; Prakash, V Jeevan; Rah, Sajad Ahmad; Thumar, Sagar

2015-01-01

Bell’s palsy is an idiopathic unilateral lower motor neuron paresis or paralysis of the facial nerve of sudden onset. It involves loss of muscular control on the affected side of the face. This paper reports the prosthodontic management of patients with Bell’s palsy and also describes a technique to stabilize the jaw movements in complete denture patients using interim dentures. A 65-year-old male edentulous patient and a 55-year-old female edentulous patient reported to the department of prosthodontics to get their missing teeth replaced. They both gave history of facial paralysis and were diagnosed for Bell’s palsy. Interim training dentures with flat occlusal tables were fabricated first to correct and stabilize their mandibular movements. During initial 4 weeks, there was poor functioning of the interim dentures. Gradually by 8th week the patients started stabilizing the interim dentures and were functional. After observing the improvement when the patients had no pain and could stabilize and use the treatment dentures successfully, definitive complete dentures were fabricated. This case report presents a systematic approach to successively rehabilitate edentulous patients with Bell’s palsy. PMID:26668488

Lower facial reanimation techniques following cancer resection and free flap reconstruction.

PubMed

Kejner, Alexandra E; Rosenthal, Eben L

2016-09-01

Evaluate outcomes of the standard static sling and orthodromic temporalis tendon transfer reanimation for facial nerve paralysis. Retrospective case series at a tertiary care hospital of head and neck cancer patients with facial nerve palsy secondary to malignancy or resection. From 2004 to 2014, patients undergoing resection of malignancy that involved facial nerve palsy requiring facial reanimation were identified. All procedures were performed by the senior author (e.l.r.). Demographics, methods, revision rates, combination with other procedures, and complications were evaluated. A total of 77 patients underwent 92 procedures, with two patients requiring more than one revision, for a total of 20 revisions. Average time to revision was 9 months. Age, sex, race, side of repair, paralysis prior to procedure, sling type or method, timing of procedure, and radiation therapy were not significantly different between those requiring revision and those who did not. There was no difference in complications between patients who received radiation and those who did not (P = .5), nor between static versus orthodromic temporalis muscle transfer (P = .5). Complication rate was low at 5.4%. Sling procedures can be successfully performed in patients with facial nerve palsy secondary to cancer resection with radiation therapy, with a low revision rate and few complications. 4 Laryngoscope, 126:1990-1994, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Effects of exercises on Bell's palsy: systematic review of randomized controlled trials.

PubMed

Cardoso, Jefferson Rosa; Teixeira, Elsie Cobra; Moreira, Michelle Damasceno; Fávero, Francis Meire; Fontes, Sissy Veloso; Bulle de Oliveira, Acary Souza

2008-06-01

This study examined the effects of facial exercises associated either with mirror or electromyogram (EMG) biofeedback with respect to complications of delayed recovery in Bell's palsy. Patients with unilateral idiopathic facial palsy were included in this review. Facial exercises associated with mirror and/or EMG biofeedback as treatment. Report of facial symmetry, synkinesis, lip mobility, and physical and social aspects. Four studies of 132 met the eligibility criteria. The studies described mime therapy versus control (n = 50), mirror biofeedback exercise versus control (n = 27), "small" mirror movements versus conventional neuromuscular retraining (n = 10), and EMG biofeedback + mirror training versus mirror training alone. The treatment length varied from 1 to 12 months. Because of the small number of randomized controlled trials, it was not possible to analyze if the exercises, associated either with mirror or EMG biofeedback, were effective. In summary, the available evidence from randomized controlled trials is not yet strong enough to become integrated into clinical practice.

[Early diagnosis and prognosis evaluation of Bell palsy with blink reflex ].

PubMed

Xie, Dan-dan; Li, Xiao-song; Liu, Yuan-yuan

2014-11-01

To determine the value of blink reflex in early diagnosis and prognosis evaluation of Bell palsy. Blink reflex and facial nerve conduction were examined in 58 patients with Bell palsy within one week after symptom onset. The patients without response of R1 , R2 and R2 ' waves were classified as complete efferent retardarce (Group A, 30 cases), and those with response of R1 , R2 and R2 ' waves were classified as incomplete efferent anomalies (Group B, 28 cases). The clinical outcomes after three months of systemic therapy were evaluated using the House-Blackmann (H-B) scale. Efferent anomalies of blink reflex occurred in ail of the 58 patients. Abnormal results of facial nerve conduction appeared in 23 (39. 7%) patients. The three months therapy was effective in 93% patients in Group B and 70% patients in Group A (P<0. 05). Blink reflex can play a significant role in early diagnosis and prognosis evaluation of Bell palsy.

Large Intratemporal Facial Nerve Schwannoma without Facial Palsy: Surgical Strategy of Tumor Removal and Functional Reconstruction.

PubMed

Yetiser, Sertac

2018-06-08

 Three patients with large intratemporal facial schwannomas underwent tumor removal and facial nerve reconstruction with hypoglossal anastomosis. The surgical strategy for the cases was tailored to the location of the mass and its extension along the facial nerve.  To provide data on the different clinical aspects of facial nerve schwannoma, the appropriate planning for management, and the predictive outcomes of facial function.  Three patients with facial schwannomas (two men and one woman, ages 45, 36, and 52 years, respectively) who presented to the clinic between 2009 and 2015 were reviewed. They all had hearing loss but normal facial function. All patients were operated on with radical tumor removal via mastoidectomy and subtotal petrosectomy and simultaneous cranial nerve (CN) 7- CN 12 anastomosis.  Multiple segments of the facial nerve were involved ranging in size from 3 to 7 cm. In the follow-up period of 9 to 24 months, there was no tumor recurrence. Facial function was scored House-Brackmann grades II and III, but two patients are still in the process of functional recovery.  Conservative treatment with sparing of the nerve is considered in patients with small tumors. Excision of a large facial schwannoma with immediate hypoglossal nerve grafting as a primary procedure can provide satisfactory facial nerve function. One of the disadvantages of performing anastomosis is that there is not enough neural tissue just before the bifurcation of the main stump to provide neural suturing without tension because middle fossa extension of the facial schwannoma frequently involves the main facial nerve at the stylomastoid foramen. Reanimation should be processed with extensive backward mobilization of the hypoglossal nerve. Georg Thieme Verlag KG Stuttgart · New York.

Report of 121 Cases of Bell's Palsy Referred to the Emergency Department

PubMed Central

Zohrevandi, Behzad; Monsef Kasmaee, Vahid; Asadi, Payman; Tajik, Hosna

2014-01-01

Introduction: According to the high incidence of Bell's palsy (IFP) and lack of clinical data regarding different aspects of disease, the present study investigated 121 Iranian patients with peripheral facial paralysis referred to the emergency department. Methods: In this retrospective study, all patients with peripheral facial paralysis, referred to the emergency department of Poursina hospital, Rasht, Iran, from August 2012 to August 2013, were enrolled. For all patients with diagnosis of Bell's palsy variables such as age, sex, occupation, clinical symptoms, comorbid disease, grade of paralysis, and the severity of the facial palsy were reviewed and analyzed using STATA version 11.0. Results: 121 patients with peripheral facial paralysis were assessed with a mean age of 47.14±18.45 years (52.9% male). The majority of patients were observed in the summer (37.2%) and autumn (33.1%) and the recurrence rate was 22.3%. The most common grades of nerve damage were IV and V based on House-Brackman grading scale (47.1%). Also, the most frequent signs and symptoms were ear pain (43.8%), taste disturbance (38.8%), hyperacusis (15.7%) and increased tearing (11.6%). There were not significant correlations between the severity of palsy with age (p= 0.08), recurrence rate (p=0.18), season (p=0.9), and comorbid disease including hypertension (p=0.18), diabetes (p=0.29), and hyperlipidemia (p=0.94). The patients with any of following symptoms such as ear pain (p<0.001), taste disturbance (p<0.001), increased tearing (p=0.03), and Hyperacusis (p<0.001) have more severe palsy. Conclusion: There was equal gender and occupational distribution, higher incidence in fourth decade of life, higher incidence in summer and autumn, higher grade of nerve damage (grade V and VI), and higher incidence of ear pain and taste disturbance in patients suffered from IFP. In addition, there was significant association between severity of nerve damage and presence of any simultaneous symptoms. PMID

The masseteric nerve: a versatile power source in facial animation techniques.

PubMed

Bianchi, B; Ferri, A; Ferrari, S; Copelli, C; Salvagni, L; Sesenna, E

2014-03-01

The masseteric nerve has many advantages including low morbidity, its proximity to the facial nerve, the strong motor impulse, its reliability, and the fast reinnervation that is achievable in most patients. Reinnervation of a neuromuscular transplant is the main indication for its use, but it has been used for the treatment of recent facial palsies with satisfactory results. We have retrospectively evaluated 60 patients who had facial animation procedures using the masseteric nerve during the last 10 years. The patients included those with recent, and established or congenital, unilateral and bilateral palsies. The masseteric nerve was used for coaptation of the facial nerve either alone or in association with crossfacial nerve grafting, or for the reinnervation of gracilis neuromuscular transplants. Reinnervation was successful in all cases, the mean (range) time being 4 (2-5) months for facial nerve coaptation and 4 (3-7) months for neuromuscular transplants. Cosmesis was evaluated (moderate, n=10, good, n=30, and excellent, n=20) as was functional outcome (no case of impairment of masticatory function, all patients able to smile, and achievement of a smile independent from biting). The masseteric nerve has many uses, including in both recent, and established or congenital, cases. In some conditions it is the first line of treatment. The combination of combined techniques gives excellent results in unilateral palsies and should therefore be considered a valid option. Copyright © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Acupuncture for sequelae of Bell's palsy: a randomized controlled trial protocol.

PubMed

Kwon, Hyo-Jung; Kim, Jong-In; Lee, Myeong Soo; Choi, Jun-Yong; Kang, Sungkeel; Chung, Jie-Yoon; Kim, Young-Jin; Lee, Seung-Hoon; Lee, Sanghoon; Nam, Dongwoo; Kim, Yong-Suk; Lee, Jae-Dong; Choi, Do-Young

2011-03-09

Incomplete recovery from facial palsy has a long-term impact on the quality of life, and medical options for the sequelae of Bell's palsy are limited. Invasive treatments and physiotherapy have been employed to relieve symptoms, but there is limited clinical evidence for their effectiveness. Acupuncture is widely used on Bell's palsy patients in East Asia, but there is insufficient evidence for its effectiveness on Bell's palsy sequelae. The objective is to evaluate the efficacy and safety of acupuncture in patients with sequelae of Bell's palsy. This study consists of a randomized controlled trial with two parallel arms: an acupuncture group and a waitlist group. The acupuncture group will receive acupuncture treatment three times per week for a total of 24 sessions over 8 weeks. Participants in the waitlist group will not receive any acupuncture treatments during this 8 week period, but they will participate in the evaluations of symptoms at the start of the study, at 5 weeks and at 8 weeks after randomization, at which point the same treatment as the acupuncture group will be provided. The primary outcome will be analyzed by the change in the Facial Disability Index (FDI) from baseline to week eight. The secondary outcome measures will include FDI from baseline to week five, House-Brackmann Grade, lip mobility, and stiffness scales.

[The new S2k AWMF guideline for the treatment of Bell's palsy in commented short form].

PubMed

Heckmann, J G; Lang, C; Glocker, F X; Urban, P; Bischoff, C; Weder, B; Reiter, G; Meier, U; Guntinas-Lichius, O

2012-11-01

A new S2k AWMF guideline for the treatment of idiopathic facial palsy has been published. An accurate differential diagnosis is indispensable as 25-40% of all facial palsy cases are of non-idiopathic origin. It is explicitly recommended to treat patients with idiopathic facial palsy with steroids. Steroids favour a complete recovery, decrease the risk of synkinesis, autonomic sequelae and contractures. Adjuvant antiviral therapy cannot be recommended. On current data there is not sufficient evidence that the combination of steroids with antiviral drugs has a benefit for the patients. Even when not supported by randomized trials, adjuvant symptomatic therapy to protect the cornea and to avoid complications is recommended. There is no scientific evidence that physical therapy has any benefit but it should be taken into account because of psychological reasons. A benefit of acupuncture has not been proven. If eye closure remains incomplete as result of defective healing, one therapeutic option is lid loading of the upper eye lid. Moreover, in case of severe persistent palsy, several well-established microsurgical nerve and muscle plasty procedures are available. © Georg Thieme Verlag KG Stuttgart · New York.

Correlations between impairment, psychological distress, disability, and quality of life in peripheral facial palsy.

PubMed

Díaz-Aristizabal, U; Valdés-Vilches, M; Fernández-Ferreras, T R; Calero-Muñoz, E; Bienzobas-Allué, E; Moracén-Naranjo, T

2017-05-23

This paper analyses the correlations between scores on scales assessing impairment, psychological distress, disability, and quality of life in patients with peripheral facial palsy (PFP). We conducted a retrospective cross-sectional study including 30 patients in whom PFP had not resolved completely. We used tools for assessing impairment (Sunnybrook Facial Grading System [FGS]), psychological distress (Hospital Anxiety and Depression Scale [HADS]), disability (Facial Disability Index [FDI]), and quality of life (Facial Clinimetric Evaluation [FaCE] scale). We found no correlations between FGS and HADS scores, or between FGS and FDI social function scores. However, we did find a correlation between FGS and FDI physical function scores (r=0.54; P<.01), FDI total score (r=0.4; P<.05), FaCE total scores (ρ=0.66; P<.01), and FaCE social function scores (ρ=0.5; P<.01). We also observed a correlation between HADS Anxiety scores and FDI physical function (r=-0.47; P<.01), FDI social function (r=-0.47; P<.01), FDI total (r=-0.55; P<.01), FaCE total (ρ=-0.49; P<.01), and FaCE social scores (ρ=-0.46; P<.05). Significant correlations were also found between HADS Depression scores and FDI physical function (r=-0.61; P<.01), FDI social function (r=-0.53; P<.01), FDI total (r=-0.66; P<.01), FaCE total (ρ=-0.67; P<.01), and FaCE social scores (ρ=-0.68; P<.01), between FDI physical function scores and FaCE total scores (ρ=0.87; P<.01) and FaCE social function (ρ=0.74; P<.01), between FDI social function and FaCE total (ρ=0.66; P<.01) and FaCE social function scores (ρ=0.72; P<.01), and between FDI total scores and FaCE total (ρ = 0,87; P<.01) and FaCE social function scores (ρ=0.84; P<.01). In our sample, patients with more severe impairment displayed greater physical and global disability and poorer quality of life without significantly higher levels of social disability and psychological distress. Patients with more disability experienced greater psychological

Ramus marginalis mandibulae nervus facialis palsy in hemifacial microsomia.

PubMed

Silvestri, A; Mariani, G; Vernucci, R A

2008-12-01

The paralysis of the ramus marginalis mandibulae nervus facialis may occur in Hemifacial Microsomia (HM); the combination of both HM and palsy contributes to an elongation of the mandibular body. This study explores a possible correlation between neurological deficit, muscular atony, and structural deficiency. Of 58 patients with HM who had come to the University of Rome (Sapienza) Pre-surgical Orthodontics Unit, 4 patients were afflicted with Hemifacial Microsomia and ramus marginalis mandibulae nervus palsy; these patients underwent physical, neurological, opthamologic and systemic examinations. The results were then analysed in order to determine a possible correlation between neuro-muscular and structural deficit. Electroneurographic and electromyographic examinations were performed to estimate facial nerve and muscles involvement. Neuroelectrographic exam showed a damage of the nervous motor fibres of the facial nerve ipsilateral to HM, with an associated damage of the muscular function, while neuro-muscular functions on the healthy side were normal. The peripheral nervous and muscular deficits affect the function of facial soft tissues and the growth of mandibular body with an asymmetry characterised by a hypodevelopment of the ramus (due to the HM) and by an elongation of the mandibular body (due to ramus marginalis mandibulae nerve palsy), so that the chin deviation is contralateral to HM. In these forms, a neurological examination is necessary to assess the neurological damage on the HM side. Neuromuscular deficiency can also contribute to a relapse tendency after a surgical-orthodontic treatment.

The localization of facial motor impairment in sporadic Möbius syndrome.

PubMed

Cattaneo, L; Chierici, E; Bianchi, B; Sesenna, E; Pavesi, G

2006-06-27

To investigate the neurophysiologic aspects of facial motor control in patients with sporadic Möbius syndrome defined as nonprogressive congenital facial and abducens palsy. The authors assessed 24 patients with sporadic Möbius syndrome by performing a complete clinical examination and neurophysiologic tests including facial nerve conduction studies, needle electromyography examination of facial muscles, and recording of the blink reflex and of the trigeminofacial inhibitory reflex. Two distinct groups of patients were identified according to neurophysiologic testing. The first group was characterized by increased facial distal motor latencies (DMLs) and poor recruitment of small and polyphasic motor unit action potentials (MUAPs). The second group was characterized by normal facial DMLs and neuropathic MUAPs. It is hypothesized that in the first group, the disorder is due to a rhombencephalic maldevelopment with selective sparing of small-size MUs, and in the second group, the disorder is related to an acquired nervous injury during intrauterine life, with subsequent neurogenic remodeling of MUs. The trigeminofacial reflexes showed that in most subjects of both groups, the functional impairment of facial movements was caused by a nuclear or peripheral site of lesion, with little evidence of brainstem interneuronal involvement. Two different neurophysiologically defined phenotypes can be distinguished in sporadic Möbius syndrome, with different pathogenetic implications.

What is expected from a facial trauma caused by violence?

PubMed

Goulart, Douglas Rangel; Colombo, Lucas do Amaral; de Moraes, Márcio; Asprino, Luciana

2014-01-01

The aim of this retrospective study was to compare the peculiarities of maxillofacial injuries caused by interpersonal violence with other etiologic factors. Medical records of 3,724 patients with maxillofacial injuries in São Paulo state (Brazil) were retrospectively analyzed. The data were submitted to statistical analysis (simple descriptive statistics and Chi-squared test) using SPSS 18.0 software. Data of 612 patients with facial injuries caused by violence were analyzed. The majority of the patients were male (81%; n = 496), with a mean age of 31.28 years (standard deviation of 13.33 years). These patients were more affected by mandibular and nose fractures, when compared with all other patients (P < 0.01), although fewer injuries were recorded in other body parts (χ(2) = 17.54; P < 0.01); Victims of interpersonal violence exhibited more injuries when the neurocranium was analyzed in isolation (χ(2) = 6.85; P < 0.01). Facial trauma due to interpersonal violence seem to be related to a higher rate of facial fractures and lacerations when compared to all patients with facial injuries. Prominent areas of the face and neurocranium were more affected by injuries.

[Peripheral facial nerve lesion induced long-term dendritic retraction in pyramidal cortico-facial neurons].

PubMed

Urrego, Diana; Múnera, Alejandro; Troncoso, Julieta

2011-01-01

Little evidence is available concerning the morphological modifications of motor cortex neurons associated with peripheral nerve injuries, and the consequences of those injuries on post lesion functional recovery. Dendritic branching of cortico-facial neurons was characterized with respect to the effects of irreversible facial nerve injury. Twenty-four adult male rats were distributed into four groups: sham (no lesion surgery), and dendritic assessment at 1, 3 and 5 weeks post surgery. Eighteen lesion animals underwent surgical transection of the mandibular and buccal branches of the facial nerve. Dendritic branching was examined by contralateral primary motor cortex slices stained with the Golgi-Cox technique. Layer V pyramidal (cortico-facial) neurons from sham and injured animals were reconstructed and their dendritic branching was compared using Sholl analysis. Animals with facial nerve lesions displayed persistent vibrissal paralysis throughout the five week observation period. Compared with control animal neurons, cortico-facial pyramidal neurons of surgically injured animals displayed shrinkage of their dendritic branches at statistically significant levels. This shrinkage persisted for at least five weeks after facial nerve injury. Irreversible facial motoneuron axonal damage induced persistent dendritic arborization shrinkage in contralateral cortico-facial neurons. This morphological reorganization may be the physiological basis of functional sequelae observed in peripheral facial palsy patients.

Facial Nerve Schwannoma: A Case Report, Radiological Features and Literature Review.

PubMed

Pilloni, Giulia; Mico, Barbara Massa; Altieri, Roberto; Zenga, Francesco; Ducati, Alessandro; Garbossa, Diego; Tartara, Fulvio

2017-12-22

Facial nerve schwannoma localized in the middle fossa is a rare lesion. We report a case of a facial nerve schwannoma in a 30-year-old male presenting with facial nerve palsy. Magnetic resonance imaging (MRI) showed a 3 cm diameter tumor of the right middle fossa. The tumor was removed using a sub-temporal approach. Intraoperative monitoring allowed for identification of the facial nerve, so it was not damaged during the surgical excision. Neurological clinical examination at discharge demonstrated moderate facial nerve improvement (Grade III House-Brackmann).

Clinical management of microstomia due to the static treatment of facial paralysis and oral rehabilitation with dental implants.

PubMed

Selvi, Firat; Guven, Erdem; Mutlu, Deniz

2011-05-01

Facial-nerve paralysis is seldom seen and may occur because of a broad spectrum of causes. The most commonly seen cause of facial paralysis is the Bell palsy; iatrogenic causes and tumors are relatively rare. Facial asymmetry, drooling, garbled speech, and difficulty in feeding: all adversely affect the psychosocial conditions of the patients. Fascial and tendon sling procedures may be performed for the static treatment of the unilateral permanent facial paralysis. These techniques are used both for the correction of the asymmetry of the face, especially by providing static support for the corner of the mouth, and to prevent drooling. Microstomia after a sling procedure is not a previously observed complication in the literature. A patient is presented with the surgical management of the complication of microstomia that had risen because of a static treatment of his unilateral facial paralysis via a tendon that passes circularly through his orbicularis oris muscle. Oral rehabilitation thereafter was maintained with the support of dental implants and fixed prosthodontics. The most efficient treatment protocol was decided with an interdisciplinary consultation of the oral and maxillofacial surgeon, the plastic surgeon, and the prosthodontist.

Evidence-based guideline update: steroids and antivirals for Bell palsy: report of the Guideline Development Subcommittee of the American Academy of Neurology.

PubMed

Gronseth, Gary S; Paduga, Remia

2012-11-27

To review evidence published since the 2001 American Academy of Neurology (AAN) practice parameter regarding the effectiveness, safety, and tolerability of steroids and antiviral agents for Bell palsy. We searched Medline and the Cochrane Database of Controlled Clinical Trials for studies published since January 2000 that compared facial functional outcomes in patients with Bell palsy receiving steroids/antivirals with patients not receiving these medications. We graded each study (Class I-IV) using the AAN therapeutic classification of evidence scheme. We compared the proportion of patients recovering facial function in the treated group with the proportion of patients recovering facial function in the control group. Nine studies published since June 2000 on patients with Bell palsy receiving steroids/antiviral agents were identified. Two of these studies were rated Class I because of high methodologic quality. For patients with new-onset Bell palsy, steroids are highly likely to be effective and should be offered to increase the probability of recovery of facial nerve function (2 Class I studies, Level A) (risk difference 12.8%-15%). For patients with new-onset Bell palsy, antiviral agents in combination with steroids do not increase the probability of facial functional recovery by >7%. Because of the possibility of a modest increase in recovery, patients might be offered antivirals (in addition to steroids) (Level C). Patients offered antivirals should be counseled that a benefit from antivirals has not been established, and, if there is a benefit, it is likely that it is modest at best.

Bell's palsy in Singapore: a view from the patient's perspective.

PubMed

Charn, Tze Choong; Subramaniam, Somasundaram; Yuen, Heng-Wai

2013-02-01

Bell's palsy is a well-recognised disease with robust research on its possible aetiologies and epidemiology, but scant information on patients' concerns and concepts regarding the condition is available. We aimed to evaluate the ideas, concerns and expectations of patients with Bell's palsy in Singapore. A cross-sectional study was conducted at a single tertiary-care hospital in Singapore. Participants were all patients with newly diagnosed Bell's palsy referred to the otolaryngology department either from the emergency department or by general practitioners. Participants were given a self-administered questionnaire and their facial nerve palsies were graded by the consultant doctor. A total of 52 patients were recruited, of which 41 were available for analysis. 78.0% of patients were concerned that they were having a stroke upon presentation of the symptoms. Other beliefs about the cause of the disease included overwork or stress (36.6%), something that the patient had eaten (9.8%) and supernatural forces (2.4%). About 50% of patients had tried some form of complementary or alternative therapy other than the steroids/medicines prescribed by their general practitioner or emergency physician. While 39.0% of patients agreed that the Internet had helped them understand more about their condition in addition to the information provided by the physician, 9.8% of them specifically disagreed with this statement. We have found that patients with Bell's palsy in Singapore are not very knowledgeable about the disease. Although the Internet is a useful resource, a physician's explanation of the disease and its natural progression remains of utmost importance.

Acupuncture for sequelae of Bell's palsy: a randomized controlled trial protocol

PubMed Central

2011-01-01

Objective Incomplete recovery from facial palsy has a long-term impact on the quality of life, and medical options for the sequelae of Bell's palsy are limited. Invasive treatments and physiotherapy have been employed to relieve symptoms, but there is limited clinical evidence for their effectiveness. Acupuncture is widely used on Bell's palsy patients in East Asia, but there is insufficient evidence for its effectiveness on Bell's palsy sequelae. The objective is to evaluate the efficacy and safety of acupuncture in patients with sequelae of Bell's palsy. Method/Design This study consists of a randomized controlled trial with two parallel arms: an acupuncture group and a waitlist group. The acupuncture group will receive acupuncture treatment three times per week for a total of 24 sessions over 8 weeks. Participants in the waitlist group will not receive any acupuncture treatments during this 8 week period, but they will participate in the evaluations of symptoms at the start of the study, at 5 weeks and at 8 weeks after randomization, at which point the same treatment as the acupuncture group will be provided. The primary outcome will be analyzed by the change in the Facial Disability Index (FDI) from baseline to week eight. The secondary outcome measures will include FDI from baseline to week five, House-Brackmann Grade, lip mobility, and stiffness scales. Trial registration Current Controlled-Trials ISRCTN43104115; registration date: 06 July 2010; the date of the first patient's randomization: 04 August 2010 PMID:21388554

Our experience with facial nerve monitoring in vestibular schwannoma surgery under partial neuromuscular blockade.

PubMed

Vega-Céliz, Jorge; Amilibia-Cabeza, Emili; Prades-Martí, José; Miró-Castillo, Nuria; Pérez-Grau, Marta; Pintanel Rius, Teresa; Roca-Ribas Serdà, Francesc

2015-01-01

Facial nerve monitoring is fundamental in the preservation of the facial nerve in vestibular schwannoma surgery. Our objective was to analyse the usefulness of facial nerve monitoring under partial neuromuscular blockade. This was a retrospective analysis of 69 patients operated in a tertiary hospital. We monitored 100% of the cases. In 75% of the cases, we could measure an electromyographic response after tumour resection. In 17 cases, there was an absence of electromyographic response. Fifteen of them had an anatomic lesion with loss of continuity of the facial nerve and, in 2 cases, there was a lesion with preservation of the nerve. Preoperative facial palsy (29% 7%; P=.0349), large tumour size (88 vs. 38%; P=.0276), and a non-functional audition (88 vs. 51%; P=.0276) were significantly related with an absence of electromyographic response. Facial nerve monitoring under neuromuscular blockade is possible and safe in patients without previous facial palsy. If the patient had an electromyographic response after tumour excision, they developed better facial function in the postoperative period and after a year of follow up. Copyright © 2014 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved.

A novel homozygous HOXB1 mutation in a Turkish family with hereditary congenital facial paresis.

PubMed

Sahin, Yavuz; Güngör, Olcay; Ayaz, Akif; Güngör, Gülay; Sahin, Bedia; Yaykasli, Kursad; Ceylaner, Serdar

2017-02-01

Hereditary congenital facial paresis (HCFP) is characterized by isolated dysfunction of the facial nerve (CN VII) due to congenital cranial dysinnervation disorders. HCFP has genetic heterogeneity and HOXB1 is the first identified gene. We report the clinical, radiologic and molecular investigations of three patients admitted for HCFP in a large consanguineous Turkish family. High-throughput sequencing and Sanger sequencing of all patients revealed a novel homozygous mutation p.Arg230Trp (c.688C>T) within the HOXB1 gene. The report of the mutation brings the total number of HOXB1 mutations identified in HCFP to four. The results of this study emphasize that in individuals with congenital facial palsy accompanied by hearing loss and dysmorphic facial features, HOXB1 mutation causing HCFP should be kept in mind. Copyright © 2016 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

Choosing the best rehabilitation treatment for Bell's palsy.

PubMed

Dalla Toffola, E; Tinelli, C; Lozza, A; Bejor, M; Pavese, C; Degli Agosti, I; Petrucci, L

2012-12-01

It is useful to perform neurophysiologic electromyography and electroneurography (EMG/ENG) on patients with peripheral facial palsy during the acute phase of paralysis in order to assess the severity of their nerve lesion and thus plan rehabilitation treatment and evaluate its results. To evaluate the motor recovery of patients with Bell's palsy with respect to the severity of their neurological lesion and to compare the results of two different rehabilitation treatments, with electromyographic biofeedback (EMG-BFB) and mirror visual biofeedback (mirror-BFB), in patients with Bell's palsy and neurophysiologic pattern of axonotmesis. Cohort study on retrospective clinical records. 102 patients with Bell's facial palsy were clinically assessed according to the House scale both during the acute phase of paralysis and 12 months after onset. All patients underwent EMG/ENG examination 3-4 weeks after the onset of paralysis; 29 patients had an EMG pattern of neurapraxia and were not given rehabilitation treatment; 73 patients who presented with signs of denervation had an EMG pattern of axonotmesis. The group, which was homogenous in terms of lesion severity, was divided into two parts: 38 patients were treated with electromyographic biofeedback (EMG-BFB) and 35 were treated with mirror visual feedback (mirror-BFB). All 29 patients with neurapraxia made a full spontaneous recovery; Although the 73 patients with axonotmesis received different types of rehabilitation treatment, they obtained similar results regarding quality of recovery, development of synkinesis, rehabilitation timing and resources used. Rehabilitation treatment is not necessary for patients with neurapraxia. The two biofeedback methods used to treat patients with axonotmesis resulted in similar rehabilitation outcomes.

Bell's palsy: a summary of current evidence and referral algorithm.

PubMed

Glass, Graeme E; Tzafetta, Kallirroi

2014-12-01

Spontaneous idiopathic facial nerve (Bell's) palsy leaves residual hemifacial weakness in 29% which is severe and disfiguring in over half of these cases. Acute medical management remains the best way to improve outcomes. Reconstructive surgery can improve long term disfigurement. However, acute and surgical options are time-dependent. As family practitioners see, on average, one case every 2 years, a summary of this condition based on common clinical questions may improve acute management and guide referral for those who need specialist input. We formulated a series of clinical questions likely to be of use to family practitioners on encountering this condition and sought evidence from the literature to answer them. The lifetime risk is 1 in 60, and is more common in pregnancy and diabetes mellitus. Patients often present with facial pain or paraesthesia, altered taste and intolerance to loud noise in addition to facial droop. It is probably caused by ischaemic compression of the facial nerve within the meatal segment of the facial canal probably as a result of viral inflammation. When given early, high dose corticosteroids can improve outcomes. Neither antiviral therapy nor other adjuvant therapies are supported by evidence. As the facial muscles remain viable re-innervation targets for up to 2 years, late referrals require more complex reconstructions. Early recognition, steroid therapy and early referral for facial reanimation (when the diagnosis is secure) are important features of good management when encountering these complex cases. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

[Treatment of Bell's palsy with combination of traditional Chinese medicine and western medicine].

PubMed

Wang, Xiao-hong; Zhang, Li-ming; Han, Mei; Zhang, Ke-qing; Jiang, Jiao-jiao

2004-06-01

To evaluation the clinical effect of combination of traditional Chinese medicine and western medicine on Bell's palsy. 83 patients with Bell's palsy were randomly divided into two groups (trail group 54 cases and control group 29 cases). Patients in two groups were treated with medicine, acupuncture, physiotherapy, while patients in the trail group were treated with massage and functional exercise as the same time. The results of both groups were evaluated according to Portmann's Simple Scale. The score before treatment of trail group was 2.907 +/- 1.794, while control group was 2.931 +/- 2.034. And the score after treatment of trail group was 18.593 +/- 1.743, while control group was 9.862 +/- 3.091. Score of the function of facial muscles obtained from trail group was distinctly higher than that was from the control group (P < 0.01), as well as the improvement index (P < 0.01, trail group: 0.844 +/- 0.095, control group: 0.712 +/- 0.129). There is significant curative effect and suitability in the treatment of Bell's palsy with combination of traditional Chinese medicine and western medicine. The improvement of facial muscles' motive function pre- and post-treatment and quantitative evaluation of curative effect can be objectively obtained by evaluation of facial muscles' function.

Do oral steroids aid recovery in children with Bell's palsy?

PubMed

Ismail, Abdul Qader; Alake, Oluwaseyi; Kallappa, Chetana

2014-10-01

There is growing evidence that steroids are not beneficial for treatment of paediatric patients with Bell's palsy. To investigate, we conducted a retrospective longitudinal study examining notes of 100 children, over 12 years coded for facial nerve palsy. Of the 79 diagnosed with Bell's palsy, all recovered, and for 46 patients we had data on interval from onset of symptoms to resolution (median duration in treated group = 5 weeks, range = 39; median duration in untreated group = 6 weeks, range = 11; P = .86). From our results, we conclude that all children with Bell's palsy recovered, with or without steroid treatment, with no statistically significant difference in symptoms duration. Complications of unresolved Bell's palsy can have important long-term functional and psychosocial consequences. Therefore, we need further research on use of steroids in children with complete/severe cases; it would be a shame to omit treatment due to "absence of evidence" rather than "evidence of absence." © The Author(s) 2013.

Bell's Palsy (For Teens)

MedlinePlus

... español Parálisis de Bell What Is Bell's Palsy? Bell's palsy is a temporary weakness or paralysis of the muscles on one side of the ... of your body. Some other conditions can cause paralysis that's more serious than Bell's palsy. Tell the doctor if you are having ...

Human herpesvirus-6 and -7 DNA in cerebrospinal fluid of facial palsy patients.

PubMed

Kanerva, Mervi; Jääskeläinen, Anne J; Suvela, Minna; Piiparinen, Heli; Vaheri, Antti; Pitkäranta, Anne

2008-04-01

Finding human herpesvirus (HHV)-7 and dual HHV-6A and -6B DNA in cerebrospinal fluid (CSF) of two facial palsy (FP) patients is intriguing but does not allow etiologic conclusions as such. HHV-6 or -7 DNA was revealed in 10% of the CSF samples tested from 70 immunocompetent adolescents and adults; a highly unusual result. How these findings are associated with the diseases they accompany remains to be defined. To determine whether herpes simplex virus (HSV)-1 and -2, varicella-zoster virus (VZV), HHV-6A, -6B, and -7, Epstein-Barr virus (EBV), and cytomegalovirus (CMV) DNA could be found in CSF of FP patients or controls. In all, 33 peripheral FP patients (26 idiopathic, 5 with herpesvirus infection, 1 puerperal, 1 Melkersson-Rosenthal syndrome) (34 CSF samples) and 36 controls (16 nonidiopathic FP, 7 hearing loss, 6 vertigo, 5 headache, 2 other) previously tested for HSV-1, VZV, and HHV-6 DNA by polymerase chain reaction (PCR) were tested with highly sensitive multiplex-PCR and an oligonucleotide microarray method. One FP patient had HHV-7 DNA and another had HHV-6A and -6B DNA simultaneously. In the control group, one HHV-7, one HHV-6A, and three HHV-6B DNA-positive specimens were found.

[Facial nerve injuries cause changes in central nervous system microglial cells].

PubMed

Cerón, Jeimmy; Troncoso, Julieta

2016-12-01

Our research group has described both morphological and electrophysiological changes in motor cortex pyramidal neurons associated with contralateral facial nerve injury in rats. However, little is known about those neural changes, which occur together with changes in surrounding glial cells. To characterize the effect of the unilateral facial nerve injury on microglial proliferation and activation in the primary motor cortex. We performed immunohistochemical experiments in order to detect microglial cells in brain tissue of rats with unilateral facial nerve lesion sacrificed at different times after the injury. We caused two types of lesions: reversible (by crushing, which allows functional recovery), and irreversible (by section, which produces permanent paralysis). We compared the brain tissues of control animals (without surgical intervention) and sham-operated animals with animals with lesions sacrificed at 1, 3, 7, 21 or 35 days after the injury. In primary motor cortex, the microglial cells of irreversibly injured animals showed proliferation and activation between three and seven days post-lesion. The proliferation of microglial cells in reversibly injured animals was significant only three days after the lesion. Facial nerve injury causes changes in microglial cells in the primary motor cortex. These modifications could be involved in the generation of morphological and electrophysiological changes previously described in the pyramidal neurons of primary motor cortex that command facial movements.

Agreement between the Facial Nerve Grading System 2.0 and the House-Brackmann Grading System in Patients with Bell Palsy.

PubMed

Lee, Ho Yun; Park, Moon Suh; Byun, Jae Yong; Chung, Ji Hyun; Na, Se Young; Yeo, Seung Geun

2013-09-01

We have analyzed the correlation between the House-Brackmann (HB) scale and Facial Nerve Grading System 2.0 (FNGS 2.0) in patients with Bell palsy, and evaluated the usefulness of the new grading system. Sixty patients diagnosed with Bell palsy from May 2009 to December 2010 were evaluated using the HB scale and FNGS 2.0 scale during their initial visit, and after 3 and 6 weeks and 3 months. The overall intraclass correlation coefficient (ICC) was 0.908 (P=0.000) and the Spearman correlation coefficient (SCC) was 0.912 (P<0.05). ICC and SCC displayed differences over time, being 0.604 and 0.626, respectively, at first visit; 0.834 and 0.843, respectively, after 3 weeks; 0.844 and 0.848, respectively, after 6 weeks; and 0.808 and 0.793, respectively, after 3 months. There was a significant difference in full recovery, depending on the scale used (HB, P=0.000; FNGS 2.0, P<0.05). The exact agreements between regional assessment and FNGS 2.0 for the mouth, eyes, and brow were 72%, 63%, and 52%, respectively. FNGS 2.0 shows moderate agreement with HB grading. Regional assessment, rather than HB grading, yields stricter evaluation, resulting in better prognosis and determination of grade.

Infrared thermography and meridian-effect evidence and explanation in Bell's palsy patients treated by moxibustion at the Hegu (LI4) acupoint

PubMed Central

Guan, Ling; Li, Gaobo; Yang, Yiling; Deng, Xiufang; Cai, Peisi

2012-01-01

Subjects with Bell's palsy and healthy individuals were treated with moxibustion thermal stimulation on the Hegu (LI4) acupoint; an infrared thermal imaging system was used to observe facial-temperature changes. Bell's palsy patients developed low or high temperatures at the affected side, with poor symmetry. Healthy people showed high temperatures on the forehead, medial angle of the eye, nasal ala and around the lips, but low temperatures on bilateral cheeks, thus forming a “T-type hot area” in the face, with good temperature symmetry. Moxibustion treatment for 11 minutes significantly improved high asymmetry in temperature in the faces of Bell's palsy patients. This evidence indicates that moxibustion treatment on Hegu enables increases in facial temperatures in healthy people and Bell's palsy patients, especially around the lips. Moxibustion stimulation at the Hegu not only improves the global circulation but also has specific effects on the lips in Bell's palsy patients, but the underlying mechanism needs further investigation. PMID:25745463

Effects of electrical stimulation on House-Brackmann scores in early Bell's palsy.

PubMed

Alakram, Prisha; Puckree, Threethambal

2010-04-22

ABSTRACT Limited evidence may support the application of electrical stimulation in the subacute and chronic stages of facial palsy, yet some physiotherapists in South Africa have been applying this modality in the acute stage in the absence of published evidence of clinical efficacy. This preliminary study's aim was to determine the safety and potential efficacy of applying electrical stimulation to the facial muscles during the early phase of Bells palsy. A pretest posttest control vs. experimental groups design composed of 16 patients with Bell's palsy of less than 30 days' duration. Adult patients with clinical diagnosis of Bell's palsy were systematically (every second patient) allocated to the control and experimental groups. Each group (n = 8) was pretested and posttested using the House-Brackmann index. Both groups were treated with heat, massage, exercises, and a home program. The experimental group also received electrical stimulation. The House-Brackmann Scale of the control group improved between 17% and 50% with a mean of 30%. The scores of the experimental group ranged between 17% and 75% with a mean of 37%. The difference between the groups was not statistically significant (two-tailed p = 0.36). Electrical stimulation as used in this study during the acute phase of Bell's palsy is safe but may not have added value over spontaneous recovery and multimodal physiotherapy. A larger sample size or longer stimulation time or both should be investigated.

Diagnosis and surgical outcomes of intraparotid facial nerve schwannoma showing normal facial nerve function.

PubMed

Lee, D W; Byeon, H K; Chung, H P; Choi, E C; Kim, S-H; Park, Y M

2013-07-01

The findings of intraparotid facial nerve schwannoma (FNS) using preoperative diagnostic tools, including ultrasonography (US)-guided fine needle aspiration biopsy, computed tomography (CT) scan, and magnetic resonance imaging (MRI), were analyzed to determine if there are any useful findings that might suggest the presence of a lesion. Treatment guidelines are suggested. The medical records of 15 patients who were diagnosed with an intraparotid FNS were retrospectively analyzed. US and CT scans provide clinicians with only limited information; gadolinium enhanced T1-weighted images from MRI provide more specific findings. Tumors could be removed successfully with surgical exploration, preserving facial nerve function at the same time. Gadolinium-enhanced T1-weighted MRI showed more characteristic findings for the diagnosis of intraparotid FNS. Intraparotid FNS without facial palsy can be diagnosed with MRI preoperatively, and surgical exploration is a suitable treatment modality which can remove the tumor and preserve facial nerve function. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

Comparison of the Efficacy of Combination Therapy of Prednisolone - Acyclovir with Prednisolone Alone in Bell's Palsy.

PubMed

Khajeh, Ali; Fayyazi, Afshin; Soleimani, Gholamreza; Miri-Aliabad, Ghasem; Shaykh Veisi, Sara; Khajeh, Behrouz

2015-01-01

Bell's palsy is a rapid onset, usually, unilateral paralysis of the facial nerve that causes significant changes in an individual's life such as a decline in personal, social, and educational performance. This study compared efficacy of combined prednisolone and acyclovir therapy with prednisolone alone. This study is a randomized controlled trial conducted on 43 Children (2-18 years old) with Bell's palsy. The first group of 23 patients was treated with prednisolone and the remaining patients were treated with a combination of prednisolone and acyclovir. The required data were extracted, using an informational form based on the House-Brackmann Scale, which grades facial nerve paralysis. The data were analyzed with Mann-Whitney test using SPSS version 16. The mean age of the first and second group were 8.65 ± 5.07 and 8.35 ± 4.92 years, respectively, (p=0.84). Sixty one percent and 39% of patients in the first group, and 45% and 55% of patients in the second group were male and female, respectively. No significant differences exist between the groups in terms of age and gender. The rate of complete recovery was 65.2% in group I and 90% in the group II (p=0.04). The results of this study showed that the combined prednisolone and acyclovir therapy of patients with Bell's palsy is far more effective than treatment with prednisolone alone. Actually, age and gender had no impact on the rate of recovery.

Steroid-antiviral treatment improves the recovery rate in patients with severe Bell's palsy.

PubMed

Lee, Ho Yun; Byun, Jae Yong; Park, Moon Suh; Yeo, Seung Geun

2013-04-01

The extent of facial nerve damage is expected to be more severe in higher grades of facial palsy, and the outcome after applying different treatment methods may reveal obvious differences between severe Bell's palsy and mild to moderate palsy. This study aimed to systematically evaluate the effects of different treatment methods and related prognostic factors in severe to complete Bell's palsy. This randomized, prospective study was performed in patients with severe to complete Bell's palsy. Patients were assigned randomly to treatment with a steroid or a combination of a steroid and an antiviral agent. We collected data about recovery and other prognostic factors. The steroid treatment group (S group) comprised 107 patients, and the combination treatment group (S+A group) comprised 99 patients. There were no significant intergroup differences in age, sex, accompanying disease, period from onset to treatment, or results of an electrophysiology test (P >.05). There was a significant difference in complete recovery between the 2 groups. The recovery (grades I and II) of the S group was 66.4% and that of the S+A group was 82.8% (P=.010). The S+A group showed a 2.6-times higher possibility of complete recovery than the S group, and patients with favorable electromyography showed a 2.2-times higher possibility of complete recovery. Combined treatment with a steroid and an antiviral agent is more effective in treating severe to complete Bell's palsy than steroid treatment alone. Copyright © 2013 Elsevier Inc. All rights reserved.

Electrophysiologic and functional evaluations of regenerated facial nerve defects with a tube containing dental pulp cells in rats.

PubMed

Sasaki, Ryo; Matsumine, Hajime; Watanabe, Yorikatsu; Takeuchi, Yuichi; Yamato, Masayuki; Okano, Teruo; Miyata, Mariko; Ando, Tomohiro

2014-11-01

Dental pulp tissue contains Schwann and neural progenitor cells. Tissue-engineered nerve conduits with dental pulp cells promote facial nerve regeneration in rats. However, no nerve functional or electrophysiologic evaluations were performed. This study investigated the compound muscle action potential recordings and facial functional analysis of dental pulp cell regenerated nerve in rats. A silicone tube containing rat dental pulp cells in type I collagen gel was transplanted into a 7-mm gap of the buccal branch of the facial nerve in Lewis rats; the same defect was created in the marginal mandibular branch, which was ligatured. Compound muscle action potential recordings of vibrissal muscles and facial functional analysis with facial palsy score of the nerve were performed. Tubulation with dental pulp cells showed significantly lower facial palsy scores than the autograft group between 3 and 10 weeks postoperatively. However, the dental pulp cell facial palsy scores showed no significant difference from those of autograft after 11 weeks. Amplitude and duration of compound muscle action potentials in the dental pulp cell group showed no significant difference from those of the intact and autograft groups, and there was no significant difference in the latency of compound muscle action potentials between the groups at 13 weeks postoperatively. However, the latency in the dental pulp cell group was prolonged more than that of the intact group. Tubulation with dental pulp cells could recover facial nerve defects functionally and electrophysiologically, and the recovery became comparable to that of nerve autografting in rats.

Osteopathic manipulative treatment of a 26-year-old woman with Bell's palsy.

PubMed

Lancaster, David G; Crow, William Thomas

2006-05-01

Bell's palsy is caused by a lesion of the facial nerve and results in unilateral paralysis or paresis of the face. The condition affects approximately 23 in 100,000 persons, with onset typically occurring between the ages of 10 and 40 years. The authors report the case of a 26-year-old woman with Bell's palsy, whom they treated with osteopathic manipulative treatment that was focused on the enhancement of lymphatic circulation. The osteopathic manipulative procedures used involved reducing restrictions around four key diaphragms (thoracic outlet, respiratory diaphragm, suboccipital diaphragm, cerebellar tentorium), as well as applying the thoracic pump, muscle energy, primary respiratory mechanism, and osteopathy in the cranial field. The authors, who were guided by the four principles of osteopathic philosophy, report that the patient's symptoms resolved within 2 weeks, during which two sessions of osteopathic manipulative treatment, each lasting approximately 20 minutes, were held. Patient recovery occurred without the use of pharmaceuticals.

Deep Temporal Nerve Transfer for Facial Reanimation: Anatomic Dissections and Surgical Case Report.

PubMed

Mahan, Mark A; Sivakumar, Walavan; Weingarten, David; Brown, Justin M

2017-09-08

Facial nerve palsy is a disabling condition that may arise from a variety of injuries or insults and may occur at any point along the nerve or its intracerebral origin. To examine the use of the deep temporal branches of the motor division of the trigeminal nerve for neural reconstruction of the temporal branches of the facial nerve for restoration of active blink and periorbital facial expression. Formalin-fixed human cadaver hemifaces were dissected to identify landmarks for the deep temporal branches and the tension-free coaptation lengths. This technique was then utilized in 1 patient with a history of facial palsy due to a brainstem cavernoma. Sixteen hemifaces were dissected. The middle deep temporal nerve could be consistently identified on the deep side of the temporalis, within 9 to 12 mm posterior to the jugal point of the zygoma. From a lateral approach through the temporalis, the middle deep temporal nerve could be directly coapted to facial temporal branches in all specimens. Our patient has recovered active and independent upper facial muscle contraction, providing the first case report of a distinct distal nerve transfer for upper facial function. The middle deep temporal branches can be readily identified and utilized for facial reanimation. This technique provided a successful reanimation of upper facial muscles with independent activation. Utilizing multiple sources for neurotization of the facial muscles, different potions of the face can be selectively reanimated to reduce the risk of synkinesis and improved control. Copyright © 2017 by the Congress of Neurological Surgeons

Acupuncture and vitamin B12 injection for Bell's palsy: no high-quality evidence exists.

PubMed

Wang, Li-Li; Guan, Ling; Hao, Peng-Liang; Du, Jin-Long; Zhang, Meng-Xue

2015-05-01

To assess the efficacy of acupuncture combined with vitamin B12 acupoint injection versus acupuncture alone to reduce incomplete recovery in patients with Bell's palsy. A computer-based online retrieval of Medline, Web of Science, CNKI, CBM databases until April 2014 was performed for relevant trials, using the key words "Bell's palsy or idiopathic facial palsy or facial palsy" and "acupuncture or vitamin B12 or methylcobalamin". All randomized controlled trials that compared acupuncture with acupuncture combined with vitamin B12 in patients with Bell's palsy were included in the meta-analysis. The initial treatment lasted for at least 4 weeks. The outcomes of incomplete facial recovery were monitored. The scoring index varied and the definition of healing was consistent. The combined effect size was calculated by using relative risk (RR) with 95% confidence interval (CI) using the fixed effect model of Review Manager. Incomplete recovery rates were chosen as the primary outcome. Five studies involving 344 patients were included in the final analysis. Results showed that the incomplete recovery rate of Bell's palsy patients was 44.50% in the acupuncture combined with vitamin B12 group but 62.57% in the acupuncture alone group. The major acupoints were Taiyang (EX-HN5), Jiache (ST6), Dicang (ST4) and Sibai (ST2). The combined effect size showed that acupuncture combined with vitamin B12 was better than acupuncture alone for the treatment of Bell's palsy (RR = 0.71, 95%CI: 0.58-0.87; P = 0.001), this result held true when 8 patients lost to follow up in one study were included into the analyses (RR = 0.70, 95%CI: 0.58-0.86; P = 0.0005). In the subgroup analyses, the therapeutic effect in patients of the electroacupuncture subgroup was better than in the non-electroacupuncture subgroup (P = 0.024). There was no significant difference in the incomplete recovery rate by subgroup analysis on drug types and treatment period. Most of the included studies were moderate or

[Peripheral facial paralysis: the role of physical medicine and rehabilitation].

PubMed

Matos, Catarina

2011-12-01

Peripheral facial paralysis (PFP) is a consequence of the peripheral neuronal lesion of the facial nerve (FN). It can be either primary (Bell`s Palsy) or secondary. The classical clinical presentation typically involves both stages of the hemiface. However, there may be other symptoms (ex. xerophthalmia, hyperacusis, phonation and deglutition changes) that one should recall. Clinical evaluation includes rigorous muscle tonus and sensibility search in the FN territory. Some useful instruments allow better objectivity in the patients' evaluation (House-Brackmann System, Facial Grading System, Functional Evaluation). There are clear referral criteria to Physical Medicine and Rehabilitation. Treatment of Bell`s Palsy may include pharmacotherapy, neuromuscular training (NMT), physical methods and surgery. In the NMT field the several treatment techniques are systematized. Therapeutic strategies should be problem-oriented and adjusted to the patient's symptoms and signs. Physical methods are reviewed. In about 15-20 % of patients permanent sequelae subside after 3 months of evolution. PFP is commonly a multidisciplinary condition. Therefore, it is important to review strategies that Physical Medicine and Rehabilitation may offer.

[Advances in genetic research of cerebral palsy].

PubMed

Wang, Fang-Fang; Luo, Rong; Qu, Yi; Mu, De-Zhi

2017-09-01

Cerebral palsy is a group of syndromes caused by non-progressive brain injury in the fetus or infant and can cause disabilities in childhood. Etiology of cerebral palsy has always been a hot topic for clinical scientists. More and more studies have shown that genetic factors are closely associated with the development of cerebral palsy. With the development and application of various molecular and biological techniques such as chromosome microarray analysis, genome-wide association study, and whole exome sequencing, new achievements have been made in the genetic research of cerebral palsy. Chromosome abnormalities, copy number variations, susceptibility genes, and single gene mutation associated with the development of cerebral palsy have been identified, which provides new opportunities for the research on the pathogenesis of cerebral palsy. This article reviews the advances in the genetic research on cerebral palsy in recent years.

Inpatient treatment of patients with acute idiopathic peripheral facial palsy: A population-based healthcare research study.

PubMed

Plumbaum, K; Volk, G F; Boeger, D; Buentzel, J; Esser, D; Steinbrecher, A; Hoffmann, K; Jecker, P; Mueller, A; Radtke, G; Witte, O W; Guntinas-Lichius, O

2017-12-01

To determine the inpatient management for patients with acute idiopathic facial palsy (IFP) in Thuringia, Germany. Population-based study. All inpatients with IFP in all hospitals with departments of otolaryngology and neurology in 2012, in the German federal state, Thuringia. Patients' characteristics and treatment were compared between departments, and the probability of recovery was tested. A total of 291 patients were mainly treated in departments of otolaryngology (55%) and neurology (36%). Corticosteroid treatment was the predominant therapy (84.5%). The probability to receive a facial nerve grading (odds ratio [OR=12.939; 95% confidence interval [CI]=3.599 to 46.516), gustatory testing (OR=6.878; CI=1.064 to 44.474) and audiometry (OR=32.505; CI=1.485 to 711.257) was significantly higher in otolaryngology departments, but lower for cranial CT (OR=0.192; CI=0.061 to 0.602), cerebrospinal fluid examination (OR=0.024; CI=0.006 to 0.102). A total of 131 patients (45%) showed a recovery to House-Brackmann grade≤II. A pathological stapedial reflex test (Hazard ratio [HR]=0.416; CI=0.180 to 0.959) was the only independent diagnostic predictor of worse outcome. Prednisolone dose >500 mg (HR=0.579; CI 0.400 to 0.838) and no adjuvant physiotherapy (HR=0.568; CI=0.407 to 0.794) were treatment-related predictors of worse outcome. Inpatient treatment of IFP seems to be highly variable in daily practice, partly depending on the treating discipline and despite the availability of evidence-based guidelines. The population-based recovery rate was worse than reported in clinical trials. © 2017 John Wiley & Sons Ltd.

Lip and Lower Lid Supporting Prosthetic Appliance: A Unique Approach of Treating Unilateral Facial Paralysis

PubMed Central

Pawah, Salil; Sikri, Arpit; Rexwal, Pushpanjali; Aggarwal, Prachi

2017-01-01

Along with function, aesthetics plays an important role in treating partially or completely edentulous patients. Ageing, trauma, tooth loss and neuromuscular disorders have a high impact on tonicity of facial musculature, elasticity of skin as well as function of muscles. Patients affected with Bell’s palsy face functional, aesthetic as well as psychological impairment. Common problems are the partial closure of upper eyelid, sagging of lower eyelid and drooping of angle of mouth leading to facial asymmetry, along with difficulty in eating, drinking and speaking. The key to aesthetic restoration is to support and harmonize the collapsed facial musculature with the help of various prosthodontic treatment approaches. This case report attempts to focus on treating completely edentulous patient affected with Bell’s palsy with special prosthesis supporting angle of mouth and lower eyelid using novel technique. PMID:28658922

[Bell and his palsy].

PubMed

van Gijn, Jan; Gijselhart, Joost P

2011-01-01

Unlike his eponymous fame suggests, Sir Charles Bell (1774-1842) was an anatomist, draughtsman and surgeon rather than purely a physiologist. He was born and educated in Edinburgh but spent most of his working life in London (1804 to 1836). It was there he started a School of Anatomy, alongside a fledgling surgical practice, just as his elder brother John had done in Edinburgh. In 1814 he joined the surgical staff at the Middlesex Hospital. In 1810 he surmised from occasional animal experiments that the anterior and posterior spinal roots differed in function. Yet it was left to the Frenchman Magendie to identify that these functions were motor and sensory: a discovery that induced Bell into an ungentlemanly feud. Bell also slightly erred on the functions of the trigeminal and facial nerve, but his description of the features of idiopathic facial palsy is unrivalled.

Steroid/Antiviral for the treatment of Bell's palsy: Double blind randomized clinical trial.

PubMed

Khedr, Eman Mohamed; Badry, Reda; Ali, Anwer Mohamed; Abo El-Fetoh, Noha; El-Hammady, Dina Hatem; Ghandour, Abeer Mohamed; Abdel-Haleem, Ahmed

2016-11-22

A large number of patients with Bell's palsy fail to recover facial function completely after steroid therapy. Only a few small trials have been conducted to test whether outcomes can be improved by the addition of antiviral therapy. To evaluate the efficacy of treatment with steroid alone versus steroid + antiviral in a group of patients with moderately severe to severe acute Bell's palsy. Fifty eligible patients out of a total of 65 with acute onset Bell's palsy were randomized to receive the two treatments. Evaluation was performed before starting treatment, after 2 weeks of treatment and 3 months after onset, using the House and Brackmann facial nerve grading system (HB) and the Sunnybrook grading system.This study was registered with ClinicalTrials.gov, number NCT02328079. Both treatments had comparable demographics and clinical scores at baseline. There was greater improvement in the mean HB and Sunnybrook scores of the steroid + antiviral group in comparison to steroid group at 3 months. At the end of the 3rd month, 17 patients (68%) had good recovery and 8 patients (32%) had poor recovery in the steroid group compared with 23 patients (92%) and 2 (8%) respectively in the steroid and antiviral group (p = 0.034). The combination of steroid and antiviral treatment increases the possibility of recovery in moderately severe to complete acute Bell's palsy.

Serial electrophysiological studies in a Guillain-Barré subtype with bilateral facial neuropathy.

PubMed

Chan, Yee-Cheun; Therimadasamy, Aravind-Kannan; Sainuddin, Nurul M; Wilder-Smith, Einar; Yuki, Nobuhiro

2016-02-01

Bifacial weakness with paraesthesias subtype of Guillain-Barré syndrome (GBS) is thought to be demyelinating in nature but the evolution of serial nerve conduction study (NCS) findings has not been studied. We retrospectively analyzed the changes on serial NCS of patients with bilateral facial neuropathy. We described the clinical features, serial blink reflex, facial nerve and limb NCS of such patients. Five patients fulfilled our study criteria. Patients 1 and 2 were diagnosed clinically to have bilateral Bell's palsy, patients 3 and 4 as bifacial GBS subtype and patient 5 as facial palsy associated with acute HIV infection. In all, the initial neurophysiological tests showed absent blink response and normal facial NCS. Patient 1's repeat tests were normal. Patient 2's repeat blink reflex showed mildly prolonged latency. Repeat blink reflex latency of patients 3, 4 and 5 were in the demyelinating range. Patient 3 also had prolonged facial nerve latency. Patients 3 and 4 had serial limb NCS showing progressively prolonged latency. Serial NCS suggests that the bifacial GBS subtype is demyelinating in nature. This study provides further evidence for a bifacial subtype of GBS with a demyelinating pathophysiology. Copyright © 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

A randomized controlled trial of acupuncture and moxibustion to treat Bell's palsy according to different stages: design and protocol.

PubMed

Chen, Xiaoqin; Li, Ying; Zheng, Hui; Hu, Kaming; Zhang, Hongxing; Zhao, Ling; Li, Yan; Liu, Lian; Mang, Lingling; Yu, Shuyuan

2009-07-01

Acupuncture to treat Bell's palsy is one of the most commonly used methods in China. There are a variety of acupuncture treatment options to treat Bell's palsy in clinical practice. Since Bell's palsy has three different path-stages (acute stage, resting stage and restoration stage), so whether acupuncture is effective in the different path-stages and which acupuncture treatment is the best method are major issues in acupuncture clinical trials about Bell's palsy. In this article, we report the design and protocol of a large sample multi-center randomized controlled trial to treat Bell's palsy with acupuncture. There are five acupuncture groups, with four according to different path-stages and one not. In total, 900 patients with Bell's palsy are enrolled in this study. These patients are randomly assigned to receive one of the following four treatment groups according to different path-stages, i.e. 1) staging acupuncture group, 2) staging acupuncture and moxibustion group, 3) staging electro-acupuncture group, 4) staging acupuncture along yangming musculature group or non-staging acupuncture control group. The outcome measurements in this trial are the effect comparison achieved among these five groups in terms of House-Brackmann scale (Global Score and Regional Score), Facial Disability Index scale, Classification scale of Facial Paralysis, and WHOQOL-BREF scale before randomization (baseline phase) and after randomization. The result of this trial will certify the efficacy of using staging acupuncture and moxibustion to treat Bell's palsy, and to approach a best acupuncture treatment among these five different methods for treating Bell's palsy.

Sphenoid sinus mucocele as a cause of isolated pupil-sparing oculomotor nerve palsy mimicking diabetic ophthalmoplegia.

PubMed

Mohebbi, Alireza; Jahandideh, Hesam; Harandi, Ali Amini

2013-12-01

A 37-year-old woman presented with isolated right-sided oculomotor nerve palsy. Neurologic examination revealed no other disorder. Computed tomography of the paranasal sinuses demonstrated complete opacification of the sphenoid sinus. Dense mucoid fluid was drained from the sphenoid sinus via an endoscopic transseptal sphenoidotomy. A biopsy confirmed the diagnosis of sphenoid sinus mucocele. At follow-up 4 weeks postoperatively, the patient's ocular symptoms were markedly alleviated. Considering rare causes of isolated oculomotor nerve palsy, such as sphenoid sinus mucocele, is important in the differential diagnosis, even in patients with well-known risk factors such as diabetes mellitus.

Vertical muscle transposition with silicone band belting in VI nerve palsy

PubMed Central

Freitas, Cristina

2016-01-01

A woman aged 60 years developed a Millard-Gubler syndrome after a diagnosis of a cavernous angioma in the median and paramedian areas of the pons. In this context, she presented a right VI nerve palsy, right conjugate gaze palsy, facial palsy and left hemiparesis. To improve the complete VI nerve palsy, we planned a modified transposition approach, in which procedure we made a partial transposition of vertical rectus with a silicone band that was fixated posteriorly. After the procedure, the patient gained the ability to slightly abduct the right eye. We found no compensatory torticollis in the primary position of gaze. There was also an improvement of elevation and depression movements of the right eye. We obtained satisfactory results with a theoretically reversible technique, which is adjustable intraoperatively with no need of muscle detachment, preventing anterior segment ischaemia and allowing simultaneous recession of the medial rectus muscles, if necessary. PMID:27974341

Comparison of the Efficacy of Combination Therapy of Prednisolone - Acyclovir with Prednisolone Alone in Bell’s Palsy

PubMed Central

KHAJEH, Ali; FAYYAZI, Afshin; SOLEIMANI, Gholamreza; MIRI-ALIABAD, Ghasem; SHAYKH VEISI, Sara; KHAJEH, Behrouz

2015-01-01

Objective Bell’s palsy is a rapid onset, usually, unilateral paralysis of the facial nerve that causes significant changes in an individual’s life such as a decline in personal, social, and educational performance. This study compared efficacy of combined prednisolone and acyclovir therapy with prednisolone alone. Materials & Methods This study is a randomized controlled trial conducted on 43 Children (2–18 years old) with Bell’s palsy. The first group of 23 patients was treated with prednisolone and the remaining patients were treated with a combination of prednisolone and acyclovir. The required data were extracted, using an informational form based on the House-Brackmann Scale, which grades facial nerve paralysis. The data were analyzed with Mann-Whitney test using SPSS version 16. Results The mean age of the first and second group were 8.65 ± 5.07 and 8.35 ± 4.92 years, respectively, (p=0.84). Sixty one percent and 39% of patients in the first group, and 45% and 55% of patients in the second group were male and female, respectively. No significant differences exist between the groups in terms of age and gender. The rate of complete recovery was 65.2% in group I and 90% in the group II (p=0.04). Conclusion The results of this study showed that the combined prednisolone and acyclovir therapy of patients with Bell’s palsy is far more effective than treatment with prednisolone alone. Actually, age and gender had no impact on the rate of recovery. PMID:26221158

Bell's Palsy

MedlinePlus

... hours to days Facial droop and difficulty making facial expressions, such as closing your eye or smiling Drooling Pain around the jaw or in or behind your ear on the affected side Increased ... if you experience facial weakness or drooping to determine the underlying cause ...

[Regeneration and repair of peripheral nerves: clinical implications in facial paralysis surgery].

PubMed

Hontanilla, B; Vidal, A

2000-01-01

Peripheral nerve lesions are one of the most frequent causes of chronic incapacity. Upper or lower limb palsies due to brachial or lumbar plexus injuries, facial paralysis and nerve lesions caused by systemic diseases are one of the major goals of plastic and reconstructive surgery. However, the poor results obtained in repaired peripheral nerves during the Second World War lead to a pessimist vision of peripheral nerve repair. Nevertheless, a well understanding of microsurgical principles in reconstruction and molecular biology of nerve regeneration have improved the clinical results. Thus, although the results obtained are quite far from perfect, these procedures give to patients a hope in the recuperation of their lesions and then on function. Technical aspects in nerve repair are well established; the next step is to manipulate the biology. In this article we will comment the biological processes which appear in peripheral nerve regeneration, we will establish the main concepts on peripheral nerve repair applied in facial paralysis cases and, finally, we will proportionate some ideas about how clinical practice could be affected by manipulation of the peripheral nerve biology.

Lyme disease presenting with facial palsy and myocarditis mimicking myocardial infarction.

PubMed

Gilson, Julieta; Khalighi, Koroush; Elmi, Farhad; Krishnamurthy, Mahesh; Talebian, Amirsina; Toor, Rubinder S

2017-01-01

A 45-year-old woman presented with a sudden episode of typical chest pain, radiating to her neck. The patient denied premature coronary artery disease in the family. Initial EKG showed normal sinus rhythm with a 1 mm ST-elevation involving lead II and lead aVF and a 1 mm ST-depression in lead V1 with associated T-wave inversion. Initial Troponin I (normal <0.4 ng/mL) and CK-MB (normal <7.7 ng/mL) were elevated at 7.82 ng/mL and 55.2 ng/mL, respectively. Six hours later, Troponin I increased to 13.44 ng/mL and CK-MB to 75.7 ng/mL. The patient underwent cardiac catheterization which did not show any significant obstructive coronary artery disease. Two days later the patient developed right-sided facial palsy. Diagnosis of Lyme disease was confirmed by ELISA with positive IgM and IgG antibodies. Treatment with intravenous ceftriaxone and oral steroids was started. Eventually resolution of symptoms and, normalization of cardiac markers and EKG changes, were achieved. This is a rare case of Lyme myocarditis associated with markedly elevated Troponin I, normal left ventricle function, and an absence of conduction abnormalities. To the best of our knowledge, Lyme myocarditis mimicking acute coronary syndrome with such high levels of Troponin I and neurologic compromise has not been previously described. Lyme myocarditis may be a challenging diagnosis in endemic areas especially in patients with coronary artery disease risk factors, presenting with typical chest pain, EKG changes and positive cardiac biomarkers. Therefore, it should be considered a differential diagnosis in patients presenting with clinical symptoms suggestive of acute coronary syndrome. Abbreviations AV: Atrioventricular; CK-MB: Creatinine Kinase-MB; EKG: Electrocardiogram; ELISA: Enzyme-Linked Immunosorbent Assay; IgG: Immunoglobulin G; IgM: Immunoglobulin M.

Efficacy of the red blood cell distribution width for predicting the prognosis of Bell palsy: a pilot study.

PubMed

Horibe, Yuichiro; Tanigawa, Tohru; Shibata, Rei; Nonoyama, Hiroshi; Kano, Fumiya; Yamaguchi, Satoshi; Murotani, Kenta; Ogawa, Takaki; Ueda, Hiromi

2017-05-01

The aim of this study was to investigate the association between RDW values and the prognosis of patients with Bell palsy in an effort to find a prognostic biomarker that predicts recovery from Bell palsy. We measured RDW and evaluated facial movement in 61 patients with Bell palsy aged 50 years and less. All patients were treated with a steroid plus an antiviral agent. Seven patients underwent surgery for facial nerve decompression. During the post-treatment period, patients with a Yanagihara grading score of 36 or more were regarded as having a satisfactory recovery. Patients were divided into two groups (recovered and unrecovered) according to their response to treatment, and several parameters, including the RDW, were measured for further analysis. RDW values were significantly higher in the unrecovered group than in the recovered group (13.5 ± 1.7 vs. 12.7 ± 0.7%, p = 0.046). In the multiple logistic regression model, RDW was the only factor associated with recovery from Bell palsy (odds ratio 1.93, 95% confidence interval 1.02-4.65, p = 0.042). Our preliminary study provides the first evidence that the red cell distribution width (RDW) can predict recovery from Bell palsy in patients aged 50 years and less. Further studies are necessary to elucidate the potential pathophysiological mechanisms for our findings.

Acute Isolated Central Facial Palsy as Manifestation of Middle Cerebral Artery Ischemia.

PubMed

Sands, Kara A; Shahripour, Reza Bavarsad; Kumar, Gyanendra; Barlinn, Kristian; Lyerly, Michael J; Haršány, Michal; Cure, Joel; Yakov, Yuri L; Alexandrov, Anne W; Alexandrov, Andrei V

2016-09-01

Isolated central facial palsy (I-CFP) is attributed to a lacunar syndrome affecting the corona radiata region or pons. We examined our acute stroke registry for patients presenting with I-CFP and localized their symptoms to a vascular lesion. Our database of consecutive patients with symptoms of acute cerebral ischemia admitted from January 2008 to December 2012 was reviewed for NIH Stroke Scale (NIHSS) scores and subcomponents. All patients with I-CFP ± dysarthria (total NIHSS ≤ 3) had contrast-enhanced MR-angiography and transcranial Doppler as standard of care. All ischemic lesions were localized by MRI within 72 hours from symptom onset. Of 2,202 patients with acute cerebral ischemia, 879 patients (35%) had NIHSS score ≤ 3 points (mean age 63 + 15 years, 46 % women). Nine patients (.4%) presented with I-CFP ± dysarthria. Of these, only 1 had a lesion in the corona radiata and patent MCA, 1 had a pontine lesion without proximal vessel occlusion (2/9, or 22%). Remaining 7 patients (78%) had flow-limiting thromboembolic mid-to-distal M1/proximal M2 MCA disease. Of these, 6 (86%) patients had a prominent early anterior temporal artery on MRA and nonlacunar ischemic lesions on MRI. Contrary to current teaching of lesion localization for an I-CFP, our study revealed the majority of acute patients presenting with this symptom had evidence of flow-limiting thromboembolic MCA disease rather than a lacunar lesion. Our findings underscore the essential role of comprehensive vascular imaging in patients presenting with I-CFP, which is commonly associated with acute flow-limiting thromboembolic MCA disease. Copyright © 2016 by the American Society of Neuroimaging.

Efficient quantitative assessment of facial paralysis using iris segmentation and active contour-based key points detection with hybrid classifier.

PubMed

Barbosa, Jocelyn; Lee, Kyubum; Lee, Sunwon; Lodhi, Bilal; Cho, Jae-Gu; Seo, Woo-Keun; Kang, Jaewoo

2016-03-12

Facial palsy or paralysis (FP) is a symptom that loses voluntary muscles movement in one side of the human face, which could be very devastating in the part of the patients. Traditional methods are solely dependent to clinician's judgment and therefore time consuming and subjective in nature. Hence, a quantitative assessment system becomes apparently invaluable for physicians to begin the rehabilitation process; and to produce a reliable and robust method is challenging and still underway. We introduce a novel approach for a quantitative assessment of facial paralysis that tackles classification problem for FP type and degree of severity. Specifically, a novel method of quantitative assessment is presented: an algorithm that extracts the human iris and detects facial landmarks; and a hybrid approach combining the rule-based and machine learning algorithm to analyze and prognosticate facial paralysis using the captured images. A method combining the optimized Daugman's algorithm and Localized Active Contour (LAC) model is proposed to efficiently extract the iris and facial landmark or key points. To improve the performance of LAC, appropriate parameters of initial evolving curve for facial features' segmentation are automatically selected. The symmetry score is measured by the ratio between features extracted from the two sides of the face. Hybrid classifiers (i.e. rule-based with regularized logistic regression) were employed for discriminating healthy and unhealthy subjects, FP type classification, and for facial paralysis grading based on House-Brackmann (H-B) scale. Quantitative analysis was performed to evaluate the performance of the proposed approach. Experiments show that the proposed method demonstrates its efficiency. Facial movement feature extraction on facial images based on iris segmentation and LAC-based key point detection along with a hybrid classifier provides a more efficient way of addressing classification problem on facial palsy type and degree

Efficacy of early physical therapy in severe Bell's palsy: a randomized controlled trial.

PubMed

Nicastri, Maria; Mancini, Patrizia; De Seta, Daniele; Bertoli, Gianantonio; Prosperini, Luca; Toni, Danilo; Inghilleri, Maurizio; Filipo, Roberto

2013-01-01

Bell's palsy (BP) is the most frequent form of peripheral palsy of the facial nerve. Prognosis for recovery is good for most patients; in the remaining cases, different grades of residual impairment persist. Physical therapy, in association with drug administration, aims to improve outcomes. To assess the efficacy of early physical therapy in association with standard drug administration versus pharmacological therapy only, in terms of time to maximum gains and grade of recovery of function, and to examine who will most benefit from rehabilitation. From June 2008 to May 2010, 232 individuals were evaluated. The 87 patients meeting the eligibility criteria were randomly assigned to the experimental group (prednisone and valacyclovir plus physical therapy, n = 39) or the control group (pharmacological therapy, n = 48) within 10 days of onset. Intention-to-treat analyses were done. The physical therapy had a significant effect on grade (P = .038) and time (P = .044) to recovery only in patients presenting with severe facial palsy (House-Brackmann [HB] grade V/VI). No significant differences were found between the study and control groups for outcome of synkinesis. Physical therapy appears to be effective only in the more severe BP (baseline HB grade V/VI), whereas less severe BP (baseline HB grade IV) results in complete spontaneous recovery, regardless of physical therapy.

Surgical treatment of Bell's palsy: current attitudes.

PubMed

Smouha, Eric; Toh, Elizabeth; Schaitkin, Barry M

2011-09-01

To learn the current management of Bell's palsy among practicing otologists and neurotologists and to better define the role of surgical decompression of the facial nerve in the treatment of Bell's palsy. Survey questionnaire. We conducted a survey of members of the American Otological Society and the American Neurotology Society to learn their current practices in the treatment of Bell's palsy. Eighty-six neurotologists responded out of 334 surveys (26%). The majority of respondents obtain magnetic resonance imaging and electrical testing for new patients and treat with a combination of steroids and antiviral agents. More than two thirds of respondents would recommend surgery to patients who met the established electrophysiologic criteria (electroneuronography <10% normal, no spontaneous motor unit action potentials on electromyography within 10 days of onset of complete paralysis). However, only half believe that surgical decompression should be the standard of care, and only half would use a standard middle fossa approach. Lack of evidence was the most commonly cited reason for not recommending surgery. Several respondents wrote that they would leave the option of surgery to the patient. Most important, one third of neurotologists have not performed a surgical decompression for Bell's palsy in the last 10 years, and 95% perform less than one procedure per year. Disagreement persists among practicing otologists about the role of surgical decompression for Bell's palsy. More convincing clinical evidence will be needed before there is widespread consensus regarding the surgical treatment of this condition. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

Bell's Palsy in Children (BellPIC): protocol for a multicentre, placebo-controlled randomized trial.

PubMed

Babl, Franz E; Mackay, Mark T; Borland, Meredith L; Herd, David W; Kochar, Amit; Hort, Jason; Rao, Arjun; Cheek, John A; Furyk, Jeremy; Barrow, Lisa; George, Shane; Zhang, Michael; Gardiner, Kaya; Lee, Katherine J; Davidson, Andrew; Berkowitz, Robert; Sullivan, Frank; Porrello, Emily; Dalziel, Kim Marie; Anderson, Vicki; Oakley, Ed; Hopper, Sandy; Williams, Fiona; Wilson, Catherine; Williams, Amanda; Dalziel, Stuart R

2017-02-13

Bell's palsy or acute idiopathic lower motor neurone facial paralysis is characterized by sudden onset paralysis or weakness of the muscles to one side of the face controlled by the facial nerve. While there is high level evidence in adults demonstrating an improvement in the rate of complete recovery of facial nerve function when treated with steroids compared with placebo, similar high level studies on the use of steroids in Bell's palsy in children are not available. The aim of this study is to assess the utility of steroids in Bell's palsy in children in a randomised placebo-controlled trial. We are conducting a randomised, triple-blinded, placebo controlled trial of the use of prednisolone to improve recovery from Bell's palsy at 1 month. Study sites are 10 hospitals within the Australian and New Zealand PREDICT (Paediatric Research in Emergency Departments International Collaborative) research network. 540 participants will be enrolled. To be eligible patients need to be aged 6 months to < 18 years and present within 72 hours of onset of clinician diagnosed Bell's palsy to one of the participating hospital emergency departments. Patients will be excluded in case of current use of or contraindications to steroids or if there is an alternative diagnosis. Participants will receive either prednisolone 1 mg/kg/day to a maximum of 50 mg/day or taste matched placebo for 10 days. The primary outcome is complete recovery by House-Brackmann scale at 1 month. Secondary outcomes include assessment of recovery using the Sunnybrook scale, the emotional and functional wellbeing of the participants using the Pediatric Quality of Life Inventory and Child Health Utility 9D Scale, pain using Faces Pain Scale Revised or visual analogue scales, synkinesis using a synkinesis assessment questionnaire and health utilisation costs at 1, 3 and 6 months. Participants will be tracked to 12 months if not recovered earlier. Data analysis will be by intention to treat with

[Acute palsy of twelfth cranial nerve].

PubMed

Munoz del Castillo, F; Molina Nieto, T; De la Riva Aguilar, A; Triviño Tarradas, F; Bravo-Rodríguez, F; Ramos Jurado, A

2005-01-01

The hypoglossal nerve or Twelfth-nerve palsy is a rare damage with different causes: tumors or metastases in skull base, cervicals tumors, schwannoma, dissection or aneurysm carotid arteries, stroke, trauma, idiopathic cause, radiation, infections (mononucleosis) or multiple cranial neuropathy. Tumors were responsible for nearly half of the cases in different studies. We studied a female with hypoglossal nerve acute palsy. We made a differential diagnostic with others causes and a review of the literature.

Facial nerve paralysis: A case report of rare complication in uncontrolled diabetic patient with mucormycosis

PubMed Central

Shekar, Vandana; Sikander, Jeelani; Rangdhol, Vishwanath; Naidu, Madhulika

2015-01-01

Mucormycosis is a rare opportunistic aggressive and fatal infection caused by mucor fungus. Seven types of mucormycosis are identified based on the extension and involvement of the lesion, of which the rhino orbital mucormycosis is most common in the head and neck region. Although it is widely spread in nature, clinical cases are rare and observed only in immunocompromised patients and patients with uncontrolled diabetes mellitus. Early symptoms include fever, nasal ulceration or necrosis, periorbital edema or facial swelling, paresthesia and reduced vision. Involvement of cranial nerves although not common, facial nerve palsy is a rare finding. The infection may spread through cribriform plate to the brain resulting in extensive cerebellar infarctions. Timely diagnosis and early recognition of the signs and symptoms, correction of underlying medical disorders, and aggressive medical and surgical intervention are necessary for successful therapeutic outcome. PMID:25810669

Acupuncture and vitamin B12 injection for Bell’s palsy: no high-quality evidence exists

PubMed Central

Wang, Li-li; Guan, Ling; Hao, Peng-liang; Du, Jin-long; Zhang, Meng-xue

2015-01-01

OBJECTIVE: To assess the efficacy of acupuncture combined with vitamin B12 acupoint injection versus acupuncture alone to reduce incomplete recovery in patients with Bell’s palsy. DATA RETRIEVAL: A computer-based online retrieval of Medline, Web of Science, CNKI, CBM databases until April 2014 was performed for relevant trials, using the key words “Bell’s palsy or idiopathic facial palsy or facial palsy” and “acupuncture or vitamin B12 or methylcobalamin”. STUDY SELECTION: All randomized controlled trials that compared acupuncture with acupuncture combined with vitamin B12 in patients with Bell’s palsy were included in the meta-analysis. The initial treatment lasted for at least 4 weeks. The outcomes of incomplete facial recovery were monitored. The scoring index varied and the definition of healing was consistent. The combined effect size was calculated by using relative risk (RR) with 95% confidence interval (CI) using the fixed effect model of Review Manager. MAIN OUTCOME MEASURES: Incomplete recovery rates were chosen as the primary outcome. RESULTS: Five studies involving 344 patients were included in the final analysis. Results showed that the incomplete recovery rate of Bell’s palsy patients was 44.50% in the acupuncture combined with vitamin B12 group but 62.57% in the acupuncture alone group. The major acupoints were Taiyang (EX-HN5), Jiache (ST6), Dicang (ST4) and Sibai (ST2). The combined effect size showed that acupuncture combined with vitamin B12 was better than acupuncture alone for the treatment of Bell’s palsy (RR = 0.71, 95%CI: 0.58–0.87; P = 0.001), this result held true when 8 patients lost to follow up in one study were included into the analyses (RR = 0.70, 95%CI: 0.58–0.86; P = 0.0005). In the subgroup analyses, the therapeutic effect in patients of the electroacupuncture subgroup was better than in the non-electroacupuncture subgroup (P = 0.024). There was no significant difference in the incomplete recovery rate by

[Myxoma of the mastoid with destruction of the facial nerve (author's transl)].

PubMed

Neiger, M

1978-10-01

A case of Myxoma of the mastoid with initial facial spasme followed by palsy of the nerve is reported. After removing the tumor the nerve has been reconstructed from the secound knee until the stylomastoid foramen. The probable origine of the tumor is discussed.

[A Bell"s palsy of long standing, and its rehabilitation. An electromyographic documentation. (author's transl)].

PubMed

Kilimov, N

1977-09-01

We examined a 31 year-old female patient who, since her first year of life and following a parotis operation, had suffered from left-sided Bell's palsy. The electromyographical examinations disclosed a complete loss of voluntary muscle control and of the trigemino-facial reflexes, although the direct responses of the facial nerve could be demonstrated with delayed latences. The findings indicated peripheral regeneration of the facial nerve with absence of central programming and reflex pathways. By means of rhythmic muscle stimulation, voluntary control and reflex excitability was re-established, to a limited extent, on the formerly inactive side within a short space of time.

Case study of Bell's palsy applying complementary treatment within an occupational therapy model.

PubMed

Haltiwanger, Emily; Huber, Theresa; Chang, Joe C; Gonzalez-Stuart, Armando; Gonzales-Stuart, Armando

2009-01-01

For 7% of people with Bell's palsy, facial impairment is permanent. The case study patient was a 48-year-old female who had no recovery from paralysis 12 weeks after onset. Goals were to restore facial sensory-motor functions, functional abilities and reduce depression. Facial paralysis was assessed by clinical observations, the Facial Disability Index and Beck Depression Index. Complementary interventions of aromatherapy, reflexology and electro-acupuncture were used with common physical agent modalities in an intensive home activity and exercise programme. The patient had 100% return of function and resolution of depression after 10 days of intervention. The limitation of this study is that it was a retrospective case study and the investigators reconstructed the case from clinical notes. Further research using a prospective approach is recommended to replicate this study. 2009 John Wiley & Sons, Ltd

[Facial diplegia with atypical paresthesia. A variant of Guillain-Barré syndrome].

PubMed

Dal Verme, Agustín; Acosta, Paula; Margan, Mercedes; Pagnini, Cecilia; Dellepiane, Eugenia; Peralta, Christian

2015-01-01

Guillain-Barré syndrome is an acute demyelinating disease which presents in a classic form with muscular weakness and the lack of reflexes. There are multiple variations and atypical forms of the disease, being facial diplegia with paresthesia one of them. Also, the absence of reflexes in this syndrome is typical but not constant, since 10% of patients present reflexes. We describe a case of atypical presentation with bilateral facial palsy, paresthesia, brisk reflexes and weakness in the lower limbs in a 33 year old woman.

Facial fractures caused by less-lethal rubber bullet weapons: case series report and literature review.

PubMed

Amaral, Marcio Bruno Figueiredo; Bueno, Sebastião Cristian; Abdala, Icaro Buchholz; da Silveira, Roger Lanes

2017-09-01

The present study aims to describe three cases of patients inflicted by rubber bullets with severe facial fractures. In addition, a review of English-language literature involving facial fractures by rubber bullets from 1975 to 2016 was performed. This current study demonstrated that the use of the LLRBW is unsafety even when applied by police enforcements exclusively. Management of facial fractures caused by LLRBW is done in a usual manner with closed or open reduction associated with bone mini-plates or reconstruction plates when indicated. Special initial wound care should be done to avoid secondary infection and additional procedures.

Stellate ganglion block promotes recovery of Bell's palsy in patients with diabetes mellitus.

PubMed

Liu, Guo-Dong; He, Chun-Jing

2014-06-01

Stellate ganglion block (SGB) is effective for treatment of Bell's palsy in patients with diabetes mellitus. Corticosteroids are widely used for treatment of Bell's palsy in patients with diabetes mellitus but may induce complications like hyperglycemia, which calls for an alternative therapy. This study aimed to ascertain the effect of SGB on Bell's palsy in patients with diabetes mellitus. This randomized and single-blinded clinical trial involved 96 diabetic patients with Bell's palsy that were randomly divided into a control group (n = 48) and a treatment group (SGB group, n = 48). The House-Brackmann scale and facial disability index (FDI, including FDIP and FDIS) were observed before treatment and at 1 and 3 months after treatment for assessment of the outcome. No statistically significant difference was found between the two groups before treatment as regards the House-Brackmann scale and FDI. There was a statistically significant difference in FDIP score in the two groups after treatment in comparison with before treatment. The FDIS score showed a statistical difference between the two groups after treatment.

Preoperative Identification of Facial Nerve in Vestibular Schwannomas Surgery Using Diffusion Tensor Tractography

PubMed Central

Choi, Kyung-Sik; Kim, Min-Su; Kwon, Hyeok-Gyu; Jang, Sung-Ho

2014-01-01

Objective Facial nerve palsy is a common complication of treatment for vestibular schwannoma (VS), so preserving facial nerve function is important. The preoperative visualization of the course of facial nerve in relation to VS could help prevent injury to the nerve during the surgery. In this study, we evaluate the accuracy of diffusion tensor tractography (DTT) for preoperative identification of facial nerve. Methods We prospectively collected data from 11 patients with VS, who underwent preoperative DTT for facial nerve. Imaging results were correlated with intraoperative findings. Postoperative DTT was performed at postoperative 3 month. Facial nerve function was clinically evaluated according to the House-Brackmann (HB) facial nerve grading system. Results Facial nerve courses on preoperative tractography were entirely correlated with intraoperative findings in all patients. Facial nerve was located on the anterior of the tumor surface in 5 cases, on anteroinferior in 3 cases, on anterosuperior in 2 cases, and on posteroinferior in 1 case. In postoperative facial nerve tractography, preservation of facial nerve was confirmed in all patients. No patient had severe facial paralysis at postoperative one year. Conclusion This study shows that DTT for preoperative identification of facial nerve in VS surgery could be a very accurate and useful radiological method and could help to improve facial nerve preservation. PMID:25289119

[Progressive cerebral infraction initially presenting with pseudo-ulnar nerve palsy in a patient with severe internal carotid artery stenosis].

PubMed

Kakinuma, Kanako; Nakajima, Masashi; Hieda, Soutarou; Ichikawa, Hiroo; Kawamura, Mitsuru

2010-09-01

A 63-year-old man with hypercholesterolemia developed sensory and motor disturbances in the ulnar side of the right hand, and over three days the weakness evolved to entire right arm. Examination on the 6th day after onset showed mild lower facial palsy in addition to the upper limb weakness on the right. The weakness involved entire right arm sparing shoulder girdle muscles, which was worse in the 4th and 5th digits with claw hand deformity of the hand. Magnetic resonance imaging showed multiple small infracts in the centrum semiovale as well as in the medial side of the precentral knob on the left. Magnetic resonance angiography, ultrasonography, and 3D-CT angiography of the neck showed severe stenosis associated with unstable plaque of the left internal carotid artery. Hemodynamic mechanisms including microemboli and hypoperfusion associated with severe internal carotid artery stenosis are likely to cause stroke in evolution after initial presentation of pseudo-ulnar palsy in the present case.

Reconciling the clinical practice guidelines on Bell's palsy from the AAO-HNSF and the AAN.

PubMed

Schwartz, Seth R; Jones, Stephanie L; Getchius, Thomas S D; Gronseth, Gary S

2014-05-01

Bell's palsy, named after the Scottish anatomist, Sir Charles Bell, is the most common acute mononeuropathy, or disorder affecting a single nerve, and is the most common diagnosis associated with facial nerve weakness/paralysis. In the past 2 years, both the American Academy of Neurology (AAN) and the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) have published clinical practice guidelines aimed to improve the quality of care and outcomes for patients diagnosed with Bell's palsy. This commentary aims to address the similarities and differences in the scope and final recommendations made by each guideline development group.

Cross-face nerve grafting for reanimation of incomplete facial paralysis: quantitative outcomes using the FACIAL CLIMA system and patient satisfaction.

PubMed

Hontanilla, Bernardo; Marre, Diego; Cabello, Alvaro

2014-01-01

Although in most cases Bell palsy resolves spontaneously, approximately one-third of patients will present sequela including facial synkinesis and paresis. Currently, the techniques available for reanimation of these patients include hypoglossal nerve transposition, free muscle transfer, and cross-face nerve grafting (CFNG). Between December 2008 and March 2012, eight patients with incomplete unilateral facial paralysis were reanimated with two-stage CFNG. Gender, age at surgery, etiology of paralysis denervation time, donor and recipient nerves, presence of facial synkinesis, and follow-up were registered. Commissural excursion and velocity and patient satisfaction were evaluated with the FACIAL CLIMA and a questionnaire, respectively. Mean age at surgery was 33.8 ± 11.5 years; mean time of denervation was 96.6 ± 109.8 months. No complications requiring surgery were registered. Follow-up period ranged from 7 to 33 months with a mean of 19 ± 9.7 months. FACIAL CLIMA showed improvement of both commissural excursion and velocity greater than 75% in 4 patients, greater than 50% in 2 patients, and less than 50% in the remaining two patients. Qualitative evaluation revealed a high grade of satisfaction in six patients (75%). Two-stage CFNG is a reliable technique for reanimation of incomplete facial paralysis with a high grade of patient satisfaction. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Facial neuropathy with imaging enhancement of the facial nerve: a case report

PubMed Central

Mumtaz, Sehreen; Jensen, Matthew B

2014-01-01

A young women developed unilateral facial neuropathy 2 weeks after a motor vehicle collision involving fractures of the skull and mandible. MRI showed contrast enhancement of the facial nerve. We review the literature describing facial neuropathy after trauma and facial nerve enhancement patterns with different causes of facial neuropathy. PMID:25574155

Role of low-level laser therapy added to facial expression exercises in patients with idiopathic facial (Bell's) palsy.

PubMed

Ordahan, Banu; Karahan, Ali Yavuz

2017-05-01

The aim of the present study was to investigate the efficacy of low-level laser therapy in conjunction with conventional facial exercise treatment on functional outcomes during the early recovery period in patients with facial paralysis. Forty-six patients (mean age 41 ± 9.7 years; 40 women and 6 men) were randomized into two groups. Patients in the first group received low-level laser treatment as well as facial exercise treatment, while patients in the second group participated in facial exercise intervention alone. Laser treatment was administered at a wavelength of 830 nm, output power of 100 Mw, and frequency of 1 KHz using a gallium-aluminum-arsenide (GaAIAs, infrared laser) diode laser. A mean energy density of 10 J/cm 2 was administered to eight points of the affected side of the face three times per week, for a total of 6 weeks. The rate of facial improvement was evaluated using the facial disability index (FDI) before, 3 weeks after, and 6 weeks after treatment. Friedman analysis of variance was performed to compare the data from the parameters repeatedly measured in the inner-group analysis. Bonferroni correction was performed to compare between groups as a post hoc test if the variance analysis test result was significant. To detect the group differences, the Bonferroni Student t test was used. The Mann-Whitney U test was used to compare numeric data between the groups. In the exercise group, although no significant difference in FDI scores was noted between the start of treatment and week 3 (p < 0.05), significant improvement was observed at week 6 (p < 0.001). In the laser group, significant improvement in FDI scores relative to baseline was observed at 3 and 6 weeks (p < 0.001). Improvements in FDI scores were significantly greater at weeks 3 and 6 in the laser group than those in the exercise group (p < 0.05). Our findings indicate that combined treatment with low-level laser therapy (LLLT) and exercise therapy is associated with

De novo point mutations in patients diagnosed with ataxic cerebral palsy

PubMed Central

Parolin Schnekenberg, Ricardo; Perkins, Emma M.; Miller, Jack W.; Davies, Wayne I. L.; D’Adamo, Maria Cristina; Pessia, Mauro; Fawcett, Katherine A.; Sims, David; Gillard, Elodie; Hudspith, Karl; Skehel, Paul; Williams, Jonathan; O’Regan, Mary; Jayawant, Sandeep; Jefferson, Rosalind; Hughes, Sarah; Lustenberger, Andrea; Ragoussis, Jiannis

2015-01-01

Cerebral palsy is a sporadic disorder with multiple likely aetiologies, but frequently considered to be caused by birth asphyxia. Genetic investigations are rarely performed in patients with cerebral palsy and there is little proven evidence of genetic causes. As part of a large project investigating children with ataxia, we identified four patients in our cohort with a diagnosis of ataxic cerebral palsy. They were investigated using either targeted next generation sequencing or trio-based exome sequencing and were found to have mutations in three different genes, KCNC3, ITPR1 and SPTBN2. All the mutations were de novo and associated with increased paternal age. The mutations were shown to be pathogenic using a combination of bioinformatics analysis and in vitro model systems. This work is the first to report that the ataxic subtype of cerebral palsy can be caused by de novo dominant point mutations, which explains the sporadic nature of these cases. We conclude that at least some subtypes of cerebral palsy may be caused by de novo genetic mutations and patients with a clinical diagnosis of cerebral palsy should be genetically investigated before causation is ascribed to perinatal asphyxia or other aetiologies. PMID:25981959

Glutaric aciduria type 1 as a cause of dystonic cerebral palsy

PubMed Central

Mohamed, Sarar; Hamad, Muddathir H.; Hassan, Hamdy H.; Salih, Mustafa A.

2015-01-01

Glutaric aciduria type 1 (GA1) is an inherited inborn error of metabolism caused by a deficiency of the enzyme glutaryl Co-A dehydrogenase (GCDH). Here, we report a 14-month-old Saudi boy with GA1 who presented with severe dystonia and was mis-diagnosed as cerebral palsy (CP). He presented to our institute with encephalopathy following an episode of gastroenteritis. His physical examination showed dystonia and spastic quadriplegia. His investigations revealed elevated both urinary 3-hydroxy glutaric acid, and serum glutarylcarnitine. The DNA analysis confirmed homozygosity for a mutation in the GCDH-coding gene (c.482G>A;p.R161Q). This case alerts pediatricians to consider GA1 as a differential diagnosis of children presenting with dystonic CP. PMID:26593172

Glutaric aciduria type 1 as a cause of dystonic cerebral palsy.

PubMed

Mohamed, Sarar; Hamad, Muddathir H; Hassan, Hamdy H; Salih, Mustafa A

2015-11-01

Glutaric aciduria type 1 (GA1) is an inherited inborn error of metabolism caused by a deficiency of the enzyme glutaryl Co-A dehydrogenase (GCDH). Here, we report a 14-month-old Saudi boy with GA1 who presented with severe dystonia and was mis-diagnosed as cerebral palsy (CP). He presented to our institute with encephalopathy following an episode of gastroenteritis. His physical examination showed dystonia and spastic quadriplegia. His investigations revealed elevated both urinary 3-hydroxy glutaric acid, and serum glutarylcarnitine. The DNA analysis confirmed homozygosity for a mutation in the GCDH-coding gene (c.482G greater than A; p.R161Q). This case alerts pediatricians to consider GA1 as a differential diagnosis of children presenting with dystonic CP.

Physical therapy with drug treatment in Bell palsy: a focused review.

PubMed

Ferreira, Margarida; Marques, Elisa E; Duarte, José A; Santos, Paula C

2015-04-01

The physical therapy (PT) associated with standard drug treatment (SDT) in Bell palsy has never been investigated. Randomized controlled trials or quasirandomized controlled trials have compared facial PT (except treatments such as acupuncture and osteopathic) combined with SDT against a control group with SDT alone. Participants included those older than 15 yrs with a clinical diagnosis of Bell palsy, and the primary outcome measure was motor function recovery by the House-Brackmann scale. The methodologic quality of each study was also independently assessed by two reviewers using the PEDro scale. Four studies met the inclusion criteria. Three trials indicate that PT in association with SDT supports higher motor function recovery than SDT alone between 15 days and 1 yr of follow-up. On the other hand, one trial showed that electrical stimulation added to conventional PT with SDT did not influence treatment outcomes. The present review suggests that the current practice of Bell palsy treatment by PT associated with SDT seems to have a positive effect on grade and time recovery compared with SDT alone. However, there is very little quality evidence from randomized controlled trials, and such evidence is insufficient to decide whether combined treatment is beneficial in the management of Bell palsy.

Divergence Palsy due to Divalproex and Oxcarbazepine.

PubMed

Bouffard, Marc Albert; Caplan, Louis R; Torun, Nurhan

This case series is the first to describe divergence palsy as an adverse effect of antiepileptic drug use. Diplopia is a common adverse effect of antiepileptic drugs, but no explanatory motility deficit has ever been reported. We present 2 patients, 1 on oxcarbazepine and 1 on divalproex, each with a normal examination result between spells and divergency palsy when symptomatic. Discontinuation of the antiepileptic medication led to resolution of the episodes in both cases. Rechallenge with the offending agent after washout in one patient resulted in recurrence of diplopia and divergence palsy, both resolving after subsequent withdrawal of the antiepileptic. Antiepileptic drugs may cause divergence palsy.

Chiropractic care of a patient with vertebral subluxation and Bell's palsy.

PubMed

Alcantara, Joel; Plaugher, Gregory; Van Wyngarden, Darwin L

2003-05-01

To describe the chiropractic care of a patient medically diagnosed with Bell's palsy and discuss issues clinically relevant to this disorder, such as its epidemiology, etiology, diagnosis, care, and prognosis. A 49-year-old woman with a medical diagnosis of Bell's palsy sought chiropractic care. Her symptoms included right facial paralysis, extreme phonophobia, pain in the right temporomandibular joint (TMJ), and neck pain. Signs of cervical vertebral and TMJ subluxations included edema, tenderness, asymmetry of motion and posture, and malalignment detected from plain film radiographs. The patient was cared for with full spine contact-specific, high-velocity, low-amplitude adjustments (Gonstead Technique) to sites of vertebral and occipital subluxations. The patient's left TMJ was also adjusted. The initial symptomatic response to care was positive, and the patient made continued improvements during the 6 months of care. There are indications that patients suffering from Bell's palsy may benefit from a holistic chiropractic approach that not only includes a focus of examination and care of the primary regional areas of complaint (eg, face, TMJ) but also potentially from significant vertebral subluxation concomitants.

Postparalysis Facial Synkinesis: Clinical Classification and Surgical Strategies

PubMed Central

Chang, Tommy Nai-Jen; Lu, Johnny Chuieng-Yi

2015-01-01

Background: Postparalysis facial synkinesis (PPFS) can occur after any cause of facial palsy. Current treatments are still inadequate. Surgical intervention, instead of Botox and rehabilitation only, for different degrees of PPFS was proposed. Methods: Seventy patients (43 females and 27 males) with PPFS were enrolled since 1986. They were divided into 4 patterns based on quality of smile and severity of synkinesis. Data collection for clinically various presentations was made: pattern I (n = 14) with good smile but synkinesis, pattern II (n = 17) with acceptable smile but dominant synkinesis, pattern III (n = 34) unacceptable smile and dominant synkinesis, and pattern IV (n = 5) poor smile and synkinesis. Surgical interventions were based on patterns of PPFS. Selective myectomy and some cosmetic procedures were performed for pattern I and II patients. Extensive myectomy and neurectomy of the involved muscles and nerves followed by functioning free-muscle transplantation for facial reanimation in 1- or 2-stage procedure were performed for pattern III and many pattern II patients. A classic 2-stage procedure for facial reanimation was performed for pattern IV patients. Results: Minor aesthetic procedures provided some help to pattern I patients but did not cure the problem. They all had short follow-up. Most patients in patterns II (14/17, 82%) and III (34/34, 100%) showed a significant improvement of eye and smile appearance and significant decrease in synkinetic movements following the aggressively major surgical intervention. Nearly, all of the patients treated by the authors did not need repeated botulinum toxin A injection nor require a profound rehabilitation program in the follow-up period. Conclusions: Treatment of PPFS remains a challenging problem. Major surgical reconstruction showed more promising and long-lasting results than botulinum toxin A and/or rehabilitation on pattern III and II patients. PMID:25878931

Surgical interventions for the early management of Bell's palsy.

PubMed

McAllister, Kerrie; Walker, David; Donnan, Peter T; Swan, Iain

2013-10-16

primary outcome was recovery of facial palsy at 12 months. The first study showed that the operated group and the non-operated group (who received oral prednisolone) had comparable facial nerve recovery at nine months. This study did not statistically compare the groups but the scores and size of the groups suggested that statistically significant differences are unlikely. The second study reported no statistically significant differences between the operated and control (no treatment) groups. One operated participant in the first study had 20 dB sensorineural hearing loss and persistent vertigo. We identified no new studies when we updated the searches in October 2012. There is only very low quality evidence from randomised controlled trials and this is insufficient to decide whether surgical intervention is beneficial or harmful in the management of Bell's palsy.Further research into the role of surgical intervention is unlikely to be performed because spontaneous recovery occurs in most cases.

De novo point mutations in patients diagnosed with ataxic cerebral palsy.

PubMed

Parolin Schnekenberg, Ricardo; Perkins, Emma M; Miller, Jack W; Davies, Wayne I L; D'Adamo, Maria Cristina; Pessia, Mauro; Fawcett, Katherine A; Sims, David; Gillard, Elodie; Hudspith, Karl; Skehel, Paul; Williams, Jonathan; O'Regan, Mary; Jayawant, Sandeep; Jefferson, Rosalind; Hughes, Sarah; Lustenberger, Andrea; Ragoussis, Jiannis; Jackson, Mandy; Tucker, Stephen J; Németh, Andrea H

2015-07-01

Cerebral palsy is a sporadic disorder with multiple likely aetiologies, but frequently considered to be caused by birth asphyxia. Genetic investigations are rarely performed in patients with cerebral palsy and there is little proven evidence of genetic causes. As part of a large project investigating children with ataxia, we identified four patients in our cohort with a diagnosis of ataxic cerebral palsy. They were investigated using either targeted next generation sequencing or trio-based exome sequencing and were found to have mutations in three different genes, KCNC3, ITPR1 and SPTBN2. All the mutations were de novo and associated with increased paternal age. The mutations were shown to be pathogenic using a combination of bioinformatics analysis and in vitro model systems. This work is the first to report that the ataxic subtype of cerebral palsy can be caused by de novo dominant point mutations, which explains the sporadic nature of these cases. We conclude that at least some subtypes of cerebral palsy may be caused by de novo genetic mutations and patients with a clinical diagnosis of cerebral palsy should be genetically investigated before causation is ascribed to perinatal asphyxia or other aetiologies. © The Author (2015). Published by Oxford University Press on behalf of the Guarantors of Brain.

[Severe Eyeball and Facial Skeletal Injuries Caused by Firefighting Sport].

PubMed

Rusňák, Š; Maranová, Z; Kasl, Z; Hecová, L; Voigt, E; Raiskup, F

2017-07-01

The aim of this work is to draw attention to possible injuries of the eye and the facial skeleton caused by firefighting sport. There was a group of 9 patients presented who were treated from 2006 to 2015 in the Department of Ophthalmology at the University Hospital in Pilsen and diagnosed with severe eyeball contusion after being hit by a jet of water and/or a water pipe. Three cases are presented in detail. Georg Thieme Verlag KG Stuttgart · New York.

Bilateral Ramsay Hunt syndrome in a diabetic patient.

PubMed

Syal, Rajan; Tyagi, Isha; Goyal, Amit

2004-12-02

BACKGROUND: Herpes zoster oticus accounts for about 10% cases of facial palsy, which is usually unilateral and complete and full recovery occurs in only about 20% of untreated patients. Bilateral herpes zoster oticus can sometime occur in immunocompromised patients, though incidence is very rare. CASE PRESENTATION: Diabetic male, 57 year old presented to us with bilateral facial palsy due to herpes zoster oticus. Patient was having bilateral mild to moderate sensorineural hearing loss. Patient was treated with appropriate metabolic control, anti-inflammatory drugs and intravenous acyclovir. Due to uncontrolled diabetes, glucocorticoids were not used in this patient. Significant improvement in hearing status and facial nerve functions were seen in this patient. CONCLUSIONS: Herpes zoster causes severe infections in diabetic patients and can be a cause of bilateral facial palsy and bilateral Ramsay Hunt syndrome. Herpes zoster in diabetic patients should be treated with appropriate metabolic control, NSAIDS and intravenous acyclovir, which we feel should be started at the earliest. Glucocorticoids should be avoided in diabetic patients.

Efficacy of high and low level laser therapy in the treatment of Bell's palsy: a randomized double blind placebo-controlled trial.

PubMed

Alayat, Mohamed Salaheldien Mohamed; Elsodany, Ahmed Mohamed; El Fiky, Amir Abdel Raouf

2014-01-01

The aim of the present study was to investigate and compare the effects of high intensity laser therapy (HILT) and low level laser therapy (LLLT) on the treatment of patients with Bell's palsy. Forty-eight patients participated in and completed this study. The mean age was 43 ± 9.8 years. They were randomly assigned into three groups: HILT group, LLLT group, and exercise group. All patients were treated with facial massage and exercises, but the HILT and LLLT groups received the respective laser therapy. The grade of facial recovery was assessed by the facial disability scale (FDI) and the House-Brackmann scale (HBS). Evaluation was carried out 3 and 6 weeks after treatment for all patients. Laser treatments included eight points on the affected side of the face three times a week for 6 successive weeks. FDI and HBS were used to assess the grade of recovery. The scores of both FDI and HBS were taken before as well as 3 and 6 weeks after treatment. The Friedman test and Wilcoxon signed ranks test were used to compare the FDI and HBS scores within each group. The result showed that both HILT and LLLT significantly improved the recovery of patients with Bell's palsy. Moreover, HILT was the most effective treatment modality compared to LLLT and massage with exercises. Thus, both HILT and LLLT are effective physical therapy modalities for the recovery of patients with Bell's palsy, with HILT showing a slightly greater improvement than LLLT.

Surgical management of third nerve palsy

PubMed Central

Singh, Anupam; Bahuguna, Chirag; Nagpal, Ritu; Kumar, Barun

2016-01-01

Third nerve paralysis has been known to be associated with a wide spectrum of presentation and other associated factors such as the presence of ptosis, pupillary involvement, amblyopia, aberrant regeneration, poor bell's phenomenon, superior oblique (SO) overaction, and lateral rectus (LR) contracture. Correction of strabismus due to third nerve palsy can be complex as four out of the six extraocular muscles are involved and therefore should be approached differently. Third nerve palsy can be congenital or acquired. The common causes of isolated third nerve palsy in children are congenital (43%), trauma (20%), inflammation (13%), aneurysm (7%), and ophthalmoplegic migraine. Whereas, in adult population, common etiologies are vasculopathic disorders (diabetes mellitus, hypertension), aneurysm, and trauma. Treatment can be both nonsurgical and surgical. As nonsurgical modalities are not of much help, surgery remains the main-stay of treatment. Surgical strategies are different for complete and partial third nerve palsy. Surgery for complete third nerve palsy may involve supra-maximal recession - resection of the recti. This may be combined with SO transposition and augmented by surgery on the other eye. For partial third nerve, palsy surgery is determined according to nature and extent of involvement of extraocular muscles. PMID:27433033

Intra-temporal facial nerve centerline segmentation for navigated temporal bone surgery

NASA Astrophysics Data System (ADS)

Voormolen, Eduard H. J.; van Stralen, Marijn; Woerdeman, Peter A.; Pluim, Josien P. W.; Noordmans, Herke J.; Regli, Luca; Berkelbach van der Sprenkel, Jan W.; Viergever, Max A.

2011-03-01

Approaches through the temporal bone require surgeons to drill away bone to expose a target skull base lesion while evading vital structures contained within it, such as the sigmoid sinus, jugular bulb, and facial nerve. We hypothesize that an augmented neuronavigation system that continuously calculates the distance to these structures and warns if the surgeon drills too close, will aid in making safe surgical approaches. Contemporary image guidance systems are lacking an automated method to segment the inhomogeneous and complexly curved facial nerve. Therefore, we developed a segmentation method to delineate the intra-temporal facial nerve centerline from clinically available temporal bone CT images semi-automatically. Our method requires the user to provide the start- and end-point of the facial nerve in a patient's CT scan, after which it iteratively matches an active appearance model based on the shape and texture of forty facial nerves. Its performance was evaluated on 20 patients by comparison to our gold standard: manually segmented facial nerve centerlines. Our segmentation method delineates facial nerve centerlines with a maximum error along its whole trajectory of 0.40+/-0.20 mm (mean+/-standard deviation). These results demonstrate that our model-based segmentation method can robustly segment facial nerve centerlines. Next, we can investigate whether integration of this automated facial nerve delineation with a distance calculating neuronavigation interface results in a system that can adequately warn surgeons during temporal bone drilling, and effectively diminishes risks of iatrogenic facial nerve palsy.

A small effect of adding antiviral agents in treating patients with severe Bell palsy.

PubMed

van der Veen, Erwin L; Rovers, Maroeska M; de Ru, J Alexander; van der Heijden, Geert J

2012-03-01

In this evidence-based case report, the authors studied the following clinical question: What is the effect of adding antiviral agents to corticosteroids in the treatment of patients with severe or complete Bell palsy? The search yielded 250 original research articles. The 6 randomized trials of these that could be used all reported low-quality data for answering the clinical question; apart from apparent flaws, they did not primarily include patients with severe or complete Bell palsy. Complete functional facial nerve recovery was seen in 75% of the patients receiving prednisolone only and in 83% with additional antiviral treatment. The pooled risk difference of 7% (95% confidence interval, -1% to 15%) results in a number needed to treat of 14 (ie, slightly favors adding an antiviral agent). The authors conclude that although a strong recommendation for adding antiviral agents to corticosteroids to further improve the recovery of patients with severe Bell palsy is precluded by the lack of robust evidence, it should be discussed with the patient.

Evaluation of Patients with Facial Palsy and Ophthalmic Sequelae: A 23-Year Retrospective Review.

PubMed

Joseph, Shannon S; Joseph, Andrew W; Smith, Jane I; Niziol, Leslie M; Musch, David C; Nelson, Christine C

2017-10-01

Facial palsy (FP) can result in serious ophthalmic sequelae including loss of vision. We describe the clinical characteristics of FP patients presenting for ophthalmologic evaluation and the timing for initiating ophthalmologic care. We performed a retrospective review of 96 consecutive FP patients presenting between 1992 and 2015 at a tertiary eye center. The main outcome measures were time interval from the diagnosis of FP and onset of ocular symptoms to the initial ophthalmologic evaluation (IOE), and the severity of exposure keratopathy and eyelid malposition on IOE. The median time interval from the diagnosis of FP to the IOE was 1.6 years (interquartile range; IQR = 0.5-9.2), and from the onset of ocular symptoms to IOE was 0.8 years (IQR = 0.3-2.3). The most common ocular symptoms were dryness (47.9%; n = 46), irritation (39.6%; n = 38), and tearing (30.2%; n = 29). A total of 26.0% (n = 25) of patients were bothered by the appearance of their eyes. Only 13.5% (n = 13) noted change in vision. On IOE, 81.6% (n = 75) of patients had punctate epithelial erosions (PEE), of which 52.3% (n = 35) had moderate to severe PEE, 3.3% (n = 3) had corneal ulcers and 2.2% (n = 2) had corneal abrasions. The average margin-reflex distance 2 was 6.4 mm (SD = 2.4) with average lagophthalmos of 3.5 mm (SD = 3.1). Among FP patients presenting for ophthalmologic evaluation, exposure keratopathy (as evidenced by PEE and corneal ulcers/abrasions) is highly prevalent and moderately severe on IOE, despite only 13.5% of patients noting decreased vision. These findings underscore the importance of timely and thorough ophthalmologic evaluation of FP patients.

Emergency department visits with facial fractures among children and adolescents: an analysis of profile and predictors of causes of injuries.

PubMed

Allareddy, Veerasathpurush; Itty, Abraham; Maiorini, Elyse; Lee, Min Kyeong; Rampa, Sankeerth; Allareddy, Veerajalandhar; Nalliah, Romesh P

2014-09-01

The objectives of this study were to provide nationally representative estimates of hospital-based emergency department (ED) visits for facial fractures in children and adolescents, examine the burden associated with such visits, identify common types of facial fracture, and examine the role of patient-related demographic factors on the causes of facial fractures. The Nationwide Emergency Department Sample for 2008 to 2010 was used. All ED visits with a diagnosis of facial fractures in those no older than 21 years were selected. Demographic characteristics, types of facial fracture, causes of injuries, and hospital charges were examined. During the study period, 336,124 ED visits were for facial fractures in those no older than 21 years. Late adolescents (18 to 21 yr old) and middle adolescents (15 to 17 yr old) comprised 45.6% and 26.6% of all ED visits, respectively. Male patients comprised 74.7% of ED visits. The most common facial fractures were those of the nasal bones and mandible. Younger children were more likely to have falls, pedal cycle accidents, pedestrian accidents, and transport accidents, whereas older groups were more likely to have firearm injuries, motor vehicle traffic accidents, and assaults (P < .05). Female patients were more likely to have falls, motor vehicle traffic accidents, and transport accidents, whereas male patients were more likely to have firearm injuries, pedal cycle accidents, and assaults (P < .05). Those residing at low annual income household levels were at a high risk for having firearm injuries, motor vehicle traffic accidents, and transport accidents (P < .05). Late adolescents, middle adolescents, and male patients comprise a significant proportion of these ED visits. Age, gender, and household income levels are significantly associated with the causes of facial fracture injuries. Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

A rare cause of lateral facial swelling.

PubMed

Mohanty, Sujata; Gulati, Ujjwal; Vandana; Singh, Sapna

2014-01-01

A case of chronic, recurrent and asymptomatic facial swelling in a young male is presented. Swelling extended from lower midface to upper lateral neck and right commissure to anterior massetric border. History, clinical signs and symptoms and examination pointed towards the benign nature of the swelling. Fine-needle aspiration cytology tapered the diagnostic possibilities to a salivary cyst or pseudocyst. Ultrasonography identified the lesion to contain echogenic fluid with irregular borders. "Tail sign" was absent on contrast magnetic resonance imaging, excluding the involvement of the sublingual gland. Surgical excision of the lesion was done along with submandibular gland as both were in continuity via a bottle-neck tract. Final histopathological diagnosis was that of the submandibular gland extravasation phenomenon. As per the best of our knowledge, it is the first case report of a submandibular gland extravasation causing swelling in a retrograde direction onto the face.

A rare cause of lateral facial swelling

PubMed Central

Mohanty, Sujata; Gulati, Ujjwal; Vandana; Singh, Sapna

2014-01-01

A case of chronic, recurrent and asymptomatic facial swelling in a young male is presented. Swelling extended from lower midface to upper lateral neck and right commissure to anterior massetric border. History, clinical signs and symptoms and examination pointed towards the benign nature of the swelling. Fine-needle aspiration cytology tapered the diagnostic possibilities to a salivary cyst or pseudocyst. Ultrasonography identified the lesion to contain echogenic fluid with irregular borders. “Tail sign” was absent on contrast magnetic resonance imaging, excluding the involvement of the sublingual gland. Surgical excision of the lesion was done along with submandibular gland as both were in continuity via a bottle-neck tract. Final histopathological diagnosis was that of the submandibular gland extravasation phenomenon. As per the best of our knowledge, it is the first case report of a submandibular gland extravasation causing swelling in a retrograde direction onto the face. PMID:25593883

Neutrophil-to-lymphocyte ratio as a novel-potential marker for predicting prognosis of Bell palsy.

PubMed

Bucak, Abdulkadir; Ulu, Sahin; Oruc, Serdar; Yucedag, Fatih; Tekin, Mustafa Said; Karakaya, Fatıma; Aycicek, Abdullah

2014-07-01

Bell palsy can be defined as an idiopathic, acute, facial nerve palsy. Although the pathogenesis of Bell palsy is not fully understood, inflammation seems to play important role. Neutrophil-to-lymphocyte (NLR) ratio was defined as a novel potential marker to determine inflammation and it is routinely measured in peripheral blood. Our goal was to investigate the relationship between Bell palsy and inflammation by using NLR. Retrospective study. The 54 patients who were followed up for Bell palsy for a period of 1 to 3 years, along with 45 age- and sex-matched controls, were included in the study. An automated blood cell counter was used for NLR measurements. All patients were treated with prednisone, 1 mg/kg per day with a progressive dose reduction. Patients were classified according to the House-Brackmann grading system at posttreatment period. Those with House-Brackmann grade I and grade II were regarded as satisfactory recovery; and those with House-Brackmann grade III to grade VI were regarded as nonsatisfactory recovery. The mean NLR and neutrophil values in patients with Bell palsy were significantly higher than in the control group (P=0.001 and P<0.001, respectively). In addition, NLR levels were higher in nonsatisfactory recovered patients compared with satisfactory recovered ones (P<0.001). This is the first study investigating the relationship between NLR levels and Bell palsy and its prognosis. Our result suggest that while evaluating Bell palsy patients, NLR might be taken into account as a novel potential marker to predict the patients' prognosis. 3b. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

The Axillary Approach to Raising the Latissimus Dorsi Free Flap for Facial Re-Animation: A Descriptive Surgical Technique

PubMed Central

Butler, Daniel; Grobbelaar, Adriaan

2015-01-01

The latissimus dorsi flap is popular due to the versatile nature of its applications. When used as a pedicled flap it provides a robust solution when soft tissue coverage is required following breast, thoracic and head and neck surgery. Its utilization as a free flap is extensive due to the muscle's size, constant anatomy, large caliber of the pedicle and the fact it can be used for functional muscle transfers. In facial palsy it provides the surgeon with a long neurovascular pedicle that is invaluable in situations where commonly used facial vessels are not available, in congenital cases or where previous free functional muscle transfers have been attempted, or patients where a one-stage procedure is indicated and a long nerve is required to reach the contra-lateral side. Although some facial palsy surgeons use the trans-axillary approach, an operative guide of raising the flap by this method has not been provided. A clear guide of raising the flap with the patient in the supine position is described in detail and offers the benefits of reducing the risk of potential brachial plexus injury and allows two surgical teams to work synchronously to reduce operative time. PMID:25606493

The axillary approach to raising the latissimus dorsi free flap for facial re-animation: a descriptive surgical technique.

PubMed

Leckenby, Jonathan; Butler, Daniel; Grobbelaar, Adriaan

2015-01-01

The latissimus dorsi flap is popular due to the versatile nature of its applications. When used as a pedicled flap it provides a robust solution when soft tissue coverage is required following breast, thoracic and head and neck surgery. Its utilization as a free flap is extensive due to the muscle's size, constant anatomy, large caliber of the pedicle and the fact it can be used for functional muscle transfers. In facial palsy it provides the surgeon with a long neurovascular pedicle that is invaluable in situations where commonly used facial vessels are not available, in congenital cases or where previous free functional muscle transfers have been attempted, or patients where a one-stage procedure is indicated and a long nerve is required to reach the contra-lateral side. Although some facial palsy surgeons use the trans-axillary approach, an operative guide of raising the flap by this method has not been provided. A clear guide of raising the flap with the patient in the supine position is described in detail and offers the benefits of reducing the risk of potential brachial plexus injury and allows two surgical teams to work synchronously to reduce operative time.

[Herbal acupoint sticking combined with electroacupuncture therapy in the treatment of Bell's palsy: a randomized controlled trial].

PubMed

Qi, Qi-Hua; Ni, Shan-Shan; Wang, You-Lan; Peng, Kai; Qu, He-Nian; Yang, Cai-Hua; Wang, Jin; Xi, Wei

2013-11-01

To observe the clinical efficacy and safety of electroacupuncture (EA) combined with herbal acupoint sticking in the treatment of Bell's palsy and provide optimizations for the clinic. One hundred and two cases of Bell's palsy were randomized into an EA combined with herbal acupoint sticking group (group A, 50 cases) and an EA group (group B, 52 cases), EA at Cuanzhu (BL 2), Yangbai (GB 14), Taiyang (EX-HN 5), Quanliao (SI 18),Xiaguan (ST 7), Yingxiang (LI 20), etc. were applied in both groups and "facial paralys No.I " was applied at Yifeng (TE 17) in group A, once daily and 10 times totally were needed. The score of facial nerve function, clinical efficacy were compared before and after treatment. At 1 and 3 month follow up visit, the quality of life scale( WHOQOL-BREF) and the occurrence of complication were observed. The scores of facial nerve function in group A and group B were all significantly improved compared with those before treatment (48. 2+/- 2. 9 vs 25. 7 +/- 4. 9, 45. 9 +/- 6. 2 vs 25. 8 +/- 5. 5, both P0. 05). The occurrence of complication in group A (1 case) was significantly less than that in group B (8 cases, P 0. 05). Compared with EA, the combination of EA and acupoint sticking therapy for Bell's palsy cannot only improve the clinical efficacy and reduce the occurrence of complication but also reliable without any side effect.

The Effectiveness of Neural Therapy in Patients With Bell’s Palsy

PubMed Central

Yavuz, Ferdi; Kelle, Bayram; Balaban, Birol

2016-01-01

This report describes the case of a 42-y-old man with a type of facial nerve palsy of the lower motor neurons (LMNs) on the right side, who was treated with neural therapy. After exposure to cold weather, the patient had suddenly developed difficulty in closing his right eye and a deviation to the left in the angle of his mouth. He had no previous medical illness and had no history of trauma, smoking, alcohol intake, or blood transfusion. PMID:27547166

Change in mobility function and its causes in adults with cerebral palsy by Gross Motor Function Classification System level: A cross-sectional questionnaire study.

PubMed

Himuro, Nobuaki; Mishima, Reiko; Seshimo, Takashi; Morishima, Toshibumi; Kosaki, Keisuke; Ibe, Shigeharu; Asagai, Yoshimi; Minematsu, Koji; Kurita, Kazuhiro; Okayasu, Tsutomu; Shimura, Tsukasa; Hoshino, Kotaro; Suzuki, Toshiro; Yanagizono, Taiichiro

2018-04-07

The prognosis for mobility function by Gross Motor Function Classification System (GMFCS) level is vital as a guide to rehabilitation for people with cerebral palsy. This study sought to investigate change in mobility function and its causes in adults with cerebral palsy by GMFCS level. We conducted a cross-sectional questionnaire study. A total of 386 participants (26 y 8 m, SD 5 y 10 m) with cerebral palsy were analyzed. Participant numbers by GMFCS level were: I (53), II (139), III (74) and IV (120). The median age of participants with peak mobility function in GMFCS level III was younger than that in the other levels. 48% had experienced a decline in mobility. A Kaplan-Meier plot showed the risk of mobility decline increased in GMFCS level III; the hazard ratio was 1.97 (95% CI, 1.20-3.23) compared with level I. The frequently reported causes of mobility decline were changes in environment, and illness and injury in GMFCS level III, stiffness and deformity in level IV, and reduced physical activity in level II and III. Peak mobility function and mobility decline occurred at a younger age in GMFCS level III, with the cause of mobility decline differing by GMFCS level.

[New developments in spastic unilateral cerebral palsy].

PubMed

Chabrier, S; Roubertie, A; Allard, D; Bonhomme, C; Gautheron, V

2010-01-01

Hemiplegic (or spastic unilateral) cerebral palsy accounts for about 30% of all cases of cerebral palsy. With a population prevalence of 0.6 per 1000 live births, it is the most common type of cerebral palsy among term-born children and the second most common type after diplegia among preterm infants. Many types of prenatal and perinatal brain injury can lead to congenital hemiplegia and brain MRI is the most useful tool to classify them with accuracy and to provide early prognostic information. Perinatal arterial ischemic stroke thus appears as the leading cause in term infants, whereas encephalopathy of prematurity is the most common cause in premature babies. Other causes include brain malformations, neonatal sinovenous thrombosis, parenchymal hemorrhage (for example due to coagulopathy or alloimmune thrombocytopenia) and the more recently described familial forms of porencephaly associated with mutations in the COL4A1 gene. In adjunction with pharmacologic treatment (botulinium neurotoxin injection), new evidence-based rehabilitational interventions, such as constraint-induced movement therapy and mirror therapy, are increasingly being used.

Cerebral Palsy. Fact Sheet = La Paralisis Cerebral. Hojas Informativas Sobre Discapacidades.

ERIC Educational Resources Information Center

National Information Center for Children and Youth with Disabilities, Washington, DC.

This fact sheet on cerebral palsy is written in both English and Spanish. First, it provides a definition of cerebral palsy and considers various causes (e.g., an insufficient amount of oxygen reaching the fetal or newborn brain). The fact sheet then offers incidence figures and explains characteristics of the three main types of cerebral palsy:…

The neurologist’s dilemma: A comprehensive clinical review of Bell’s palsy, with emphasis on current management trends

PubMed Central

Zandian, Anthony; Osiro, Stephen; Hudson, Ryan; Ali, Irfan M.; Matusz, Petru; Tubbs, Shane R.; Loukas, Marios

2014-01-01

Background Recent advances in Bell’s palsy (BP) were reviewed to assess the current trends in its management and prognosis. Material/Methods We retrieved the literature on BP using the Cochrane Database of Systematic Reviews, PubMed, and Google Scholar. Key words and phrases used during the search included ‘Bell’s palsy’, ‘Bell’s phenomenon’, ‘facial palsy’, and ‘idiopathic facial paralysis’. Emphasis was placed on articles and randomized controlled trails (RCTs) published within the last 5 years. Results BP is currently considered the leading disorder affecting the facial nerve. The literature is replete with theories of its etiology, but the reactivation of herpes simplex virus isoform 1 (HSV-1) and/or herpes zoster virus (HZV) from the geniculate ganglia is now the most strongly suspected cause. Despite the advancements in neuroimaging techniques, the diagnosis of BP remains one of exclusion. In addition, most patients with BP recover spontaneously within 3 weeks. Conclusions Corticosteroids are currently the drug of choice when medical therapy is needed. Antivirals, in contrast, are not superior to placebo according to most reliable studies. At the time of publication, there is no consensus as to the benefit of acupuncture or surgical decompression of the facial nerve. Long-term therapeutic agents and adjuvant medications for BP are necessary due to recurrence and intractable cases. In the future, large RCTs will be required to determine whether BP is associated with an increased risk of stroke. PMID:24441932

Diagnosis of unilateral trapezius muscle palsy: 54 Cases.

PubMed

Seror, Paul; Stojkovic, Tanya; Lefevre-Colau, Marie Martine; Lenglet, Timothée

2017-08-01

We assessed medical and surgical causes of unilateral trapezius muscle (TM) palsy and/or wasting. Clinical and electrodiagnostic data were collected in 54 patients with TM impairment over 21 years. In total, 35 cases had a medical origin: neuralgic amyotrophy (NA, n = 22), idiopathic unilateral TM palsy (n = 5), regional neck radiotherapy for different conditions (n = 2), facioscapulohumeral dystrophy (FSH) (n = 4), abnormal loop of the jugular vein (n = 1), or basilar impression (n = 1). Other etiologies were neck surgery (n = 16), cervicofacial lift (n = 2), or trauma (n = 1). There were 5 main diagnostic findings in unilateral TM palsy: (1) dynamic examination of the scapula provides a new clinical sign; (2) NA is the most frequent medical cause; (3) in medical cases, partial preservation of the upper TM can offer good recovery; (4) FSH must be considered, especially in young patients; and (5) minor neck surgery can lead to severe TM palsy. Muscle Nerve 56: 215-223, 2017. © 2016 Wiley Periodicals, Inc.

Hypoglossal-facial nerve anastomosis and rehabilitation in patients with complete facial palsy: cohort study of 30 patients followed up for three years

PubMed Central

Toffola, Elena Dalla; Pavese, Chiara; Cecini, Miriam; Petrucci, Lucia; Ricotti, Susanna; Bejor, Maurizio; Salimbeni, Grazia; Biglioli, Federico; Klersy, Catherine

2014-01-01

Summary Our study evaluates the grade and timing of recovery in 30 patients with complete facial paralysis (House-Brackmann grade VI) treated with hypoglossal-facial nerve (XII-VII) anastomosis and a long-term rehabilitation program, consisting of exercises in facial muscle activation mediated by tongue movement and synkinesis control with mirror feedback. Reinnervation after XII-VII anastomosis occurred in 29 patients, on average 5.4 months after surgery. Three years after the anastomosis, 23.3% of patients had grade II, 53.3% grade III, 20% grade IV and 3.3% grade VI ratings on the House-Brackmann scale. Time to reinnervation was associated with the final House-Brackmann grade. Our study demonstrates that patients undergoing XII-VII anastomosis and a long-term rehabilitation program display a significant recovery of facial symmetry and movement. The recovery continues for at least three years after the anastomosis, meaning that prolonged follow-up of these patients is advisable. PMID:25473738

Deficient functional recovery after facial nerve crush in rats is associated with restricted rearrangements of synaptic terminals in the facial nucleus.

PubMed

Hundeshagen, G; Szameit, K; Thieme, H; Finkensieper, M; Angelov, D N; Guntinas-Lichius, O; Irintchev, A

2013-09-17

Crush injuries of peripheral nerves typically lead to axonotmesis, axonal damage without disruption of connective tissue sheaths. Generally, human patients and experimental animals recover well after axonotmesis and the favorable outcome has been attributed to precise axonal reinnervation of the original peripheral targets. Here we assessed functionally and morphologically the long-term consequences of facial nerve axonotmesis in rats. Expectedly, we found that 5 months after crush or cryogenic nerve lesion, the numbers of motoneurons with regenerated axons and their projection pattern into the main branches of the facial nerve were similar to those in control animals suggesting precise target reinnervation. Unexpectedly, however, we found that functional recovery, estimated by vibrissal motion analysis, was incomplete at 2 months after injury and did not improve thereafter. The maximum amplitude of whisking remained substantially, by more than 30% lower than control values even 5 months after axonotmesis. Morphological analyses showed that the facial motoneurons ipsilateral to injury were innervated by lower numbers of glutamatergic terminals (-15%) and cholinergic perisomatic boutons (-26%) compared with the contralateral non-injured motoneurons. The structural deficits were correlated with functional performance of individual animals and associated with microgliosis in the facial nucleus but not with polyinnervation of muscle fibers. These results support the idea that restricted CNS plasticity and insufficient afferent inputs to motoneurons may substantially contribute to functional deficits after facial nerve injuries, possibly including pathologic conditions in humans like axonotmesis in idiopathic facial nerve (Bell's) palsy. Copyright © 2013 IBRO. Published by Elsevier Ltd. All rights reserved.

Bilateral Ramsay Hunt syndrome in a diabetic patient

PubMed Central

Syal, Rajan; Tyagi, Isha; Goyal, Amit

2004-01-01

Background Herpes zoster oticus accounts for about 10% cases of facial palsy, which is usually unilateral and complete and full recovery occurs in only about 20% of untreated patients. Bilateral herpes zoster oticus can sometime occur in immunocompromised patients, though incidence is very rare. Case presentation Diabetic male, 57 year old presented to us with bilateral facial palsy due to herpes zoster oticus. Patient was having bilateral mild to moderate sensorineural hearing loss. Patient was treated with appropriate metabolic control, anti-inflammatory drugs and intravenous acyclovir. Due to uncontrolled diabetes, glucocorticoids were not used in this patient. Significant improvement in hearing status and facial nerve functions were seen in this patient. Conclusions Herpes zoster causes severe infections in diabetic patients and can be a cause of bilateral facial palsy and bilateral Ramsay Hunt syndrome. Herpes zoster in diabetic patients should be treated with appropriate metabolic control, NSAIDS and intravenous acyclovir, which we feel should be started at the earliest. Glucocorticoids should be avoided in diabetic patients. PMID:15575957

The Relative Power of an Emotion's Facial Expression, Label, and Behavioral Consequence to Evoke Preschoolers' Knowledge of Its Cause

ERIC Educational Resources Information Center

Widen, Sherri C.; Russell, James A.

2004-01-01

Lay people and scientists alike assume that, especially for young children, facial expressions are a strong cue to another's emotion. We report a study in which children (N=120; 3-4 years) described events that would cause basic emotions (surprise, fear, anger, disgust, sadness) presented as its facial expression, as its label, or as its…

Restoration of Trigeminal Cutaneous Sensation with Cross-Face Sural Nerve Grafts: A Novel Approach to Facial Sensory Rehabilitation.

PubMed

Catapano, Joseph; Scholl, David; Ho, Emily; Zuker, Ronald M; Borschel, Gregory H

2015-09-01

Although treating facial palsy is considered debilitating for patients, trigeminal nerve palsy and sensory deficits of the face are overlooked components of disability. Complete anesthesia leaves patients susceptible to occult injury, and facial sensation is an important component of interaction and activities of daily living. Sensory reconstruction is well established in the restoration of hand sensation; however, only one previous report proposed a surgical strategy for sensory nerve reconstruction of the face with use of nerve transfers. Nerve transfers, when used alone, have limited application because of their restricted arc of rotation in the face; extending their arc by adding nerve grafts greatly expands their utility. The following cases demonstrate the early results after V2 and V3 reconstruction with cross-face nerve grafts in three patients with acquired trigeminal nerve palsy. Cross-face nerve grafts using the sural nerve permit more proximal reconstruction of the infraorbital and mental nerves, which allows reinnervation of their entire cutaneous distribution. All patients demonstrated improved sensation in the reconstructed dermatomes, and no patients reported donor-site abnormalities. Cross-face nerve grafts result in minimal donor-site morbidity and are promising as a surgical strategy to address sensory deficits of the face. Therapeutic, V.