Acute Facial Nerve Research Articles

Mastoid effusion on temporal bone MRI in patients with Bell\u2019s palsy and Ramsay Hunt syndrome

This study aimed to investigate the incidence of mastoid effusion on temporal bone magnetic resonance imaging (MRI) in patients with Bell’s palsy (BP) and Ramsay Hunt syndrome (RHS), and evaluate the usefulness of mastoid effusion in early differential diagnosis between BP and RHS. The incidence of mastoid effusion on 3.0 T—temporal bone MRI, which was conducted within 10 days after the onset of acute facial nerve palsy, was compared between 131 patients with BP and 33 patients with RHS. Findings of mastoid cavity on temporal bone MRI were classified into three groups as normal mastoid, mastoid effusion, and sclerotic change, and the incidence of ipsilesional mastoid effusion was significantly higher in RHS than BP (P < 0.001). Tympanic membrane was normal in 7 of 14 RHS patients with mastoid effusion, and injected without middle ear effusion in 7 patients. This study highlights significantly higher incidence of ipsilesional mastoid effusion in RHS than BP, and suggests that the presence of mastoid effusion may provide additional information for differential diagnosis between RHS and BP.

An 18-month-old Girl with a Fleshy Mass in the Ear Canal.

1. Yixian Li, MD* 2. Samuel J. Huang, MD* 3. Michael J. McManus, MD* 1. *Department of Pediatrics, Marshfield Clinic Health System, Marshfield, WI 1. Address correspondence to Michael J. McManus, MD, Department of Pediatrics, Marshfield Clinic Health System, 1000 North Oak Ave, Marshfield, WI 54449. E-mail: mcmanus.michael{at}marshfieldclinic.org An 18-month-old previously healthy girl presents to her pediatrician’s office with fever, rhinorrhea and cough for 4 days. Her highest temperature at home was 102.4°F (39.1°C). Parents notice that her right eye is not closing as tightly as her left eye. This is particularly apparent when she cries. Otoscopic examination reveals that her right ear canal is occluded by “hard cerumen.” Removing the cerumen in the office causes minimal bleeding. The right tympanic membrane is partially visualized, appearing injected and bulging with purulent effusion. Examination confirms that the right eye does not close as tightly as the left eye when she cries. However, when the patient is calm, her facial expression appears symmetric. She is diagnosed with right acute otitis media and questionable right facial nerve palsy (Bell’s palsy). Parents are instructed to observe her symptoms of facial nerve palsy at home and return to clinic for evaluation if the symptom does not resolve spontaneously. She is treated with a course of amoxicillin for 10 days with apparent resolution of illness. Two weeks later, the patient is seen by another pediatrician for a well-child visit and is further treated with amoxicillin clavulanate for a persistent right ear infection. And 4 weeks after initial presentation, she is evaluated for intermittent bleeding from her right ear. Parents express concern for a foreign body in the ear canal. No concern for right eye closing is mentioned by parents during those visits, nor do pediatricians notice any facial asymmetry. A fleshy mass is noted in the …

Bell’s palsy: A case report, review and management

Bell's palsy is defined as an idiopathic unilateral facial nerve paralysis, usually self-limiting. Bell's palsy was first described by Charles Bell and is the most common cause of acute facial nerve paralysis (>80%). Immune, infective and ischemic mechanisms are all believed to play a role in the development of Bell’s palsy, but the precise cause remains unclear. From corticosteroids to botulinum injections, wide therapeutic approaches have been employed for treating bell’s palsy. Here, a case management and brief review of bell’s palsy is discussed. Keywords: Palsy, Idiopathic, Ischemic, Botulinum.

Diagnostic value of dynamic contrast-enhanced magnetic resonance imaging in Bell's palsy.

Bell's palsy (BP) is the most common form of acute facial nerve disorder and is characterized by rapid onset peripheral facial palsy of unknown etiology. To explore the diagnostic value of dynamic contrast-enhanced (DCE) magnetic resonance imagine (MRI) in patients with BP particularly in involved segments. A retrospective analysis was performed on the patients with BP who underwent routine MRI examinations and volumetric interpolated breath-hold examination (VIBE) sequence-based DCE-MRI before surgery in our department from January 2015 to July 2020. DCE-MRI data postprocessing was performed on Siemens Workstation Extended MR Work Space 2.6.3.5. Statistical analyses were performed using SPSS®v.19.0. The inter-observer reliability was evaluated with kappa identity test and McNemar's test. Twenty-three patients were included. On conventional contrast-enhanced MRI, the two observers were inconsistent in their diagnosis of lesion segments of facial nerve (Kappa 0.426, P = 0.009). Compared to the results of the surgery, the diagnostic consistency of both observers was general (Kappa 0.476, P < 0.001 and Kappa 0.430, P < 0.001, respectively). The diagnostic results of DCE-MRI for lesion segments of the facial nerve were consistent between the two observers (Kappa 0.929, P < 0.001). Compared to the results of the surgery, the diagnostic consistency of both observers was good (Kappa 0.753, P < 0.001 and Kappa 0.731, P < 0.001, respectively). Compared to conventional MRI, DCE-MRI has good stability and repeatability in the diagnosis of the lesion segments of the facial nerve as well as a good specificity and accuracy.

Bell's Palsy: A Prospective Study.

Background Bell's palsy is an acute idiopathic facial nerve paralysis of sudden onset. It is the most common cause of lower motor neuron facial nerve paralysis with an annual incidence of 15–30 per 100,000 population. The objective of this work is to study the grade of the attack and the associated symptoms of Bell's palsy in a group of Sudanese patients. The study type is an analytical prospective-based study. The study was carried out at Khartoum Teaching Dental Hospital, Khartoum General Teaching Hospital. In this prospective of the study, 48 patients with Bell's palsy were evaluated using the House–Brackman scale in relation to the above mentioned variables. Results The study showed 18 patients (37.5%) were grade II, and 24 patients (50%) had postauricular pain before and during the attack. By the end of the study period, 40 patients recovered completely (83.3%), and 8 (16.7%) patients did not recover completely, 5 (10.4%) patients complained of hearing changes during the attack, and 13 (27.1) patients gave a history of exposure to cold before the attack. Conclusion Based on our prospective study, we conclude that the percentage of complete recovery decreases with increased severity of the attack at onset. We failed to demonstrate any relation between postauricular pain and prognosis of Bell's palsy. The percentage of taste changes in our study is low in comparison with those obtained in the literature. In addition, all the patients showed complete regain of taste sensation. The percentage of patients with hearing changes in our study is high compared with some studies. In literature, we have no explanation for that, and it may be related to severity of the attack. In the present study, we found a strong association between exposure to cold and development of Bell's palsy. As the number of patients in our study is small and there is a limited period of follow-up, the study may not reflect the real situation; therefore, we need a large population-based study.

Phosphatidylcholine PC ae C44:6 in cerebrospinal fluid is a sensitive biomarker for bacterial meningitis

BackgroundThe timely diagnosis of bacterial meningitis is of utmost importance due to the need to institute antibiotic treatment as early as possible. Moreover, the differentiation from other causes of meningitis/encephalitis is critical because of differences in management such as the need for antiviral or immunosuppressive treatments. Considering our previously reported association between free membrane phospholipids in cerebrospinal fluid (CSF) and CNS involvement in neuroinfections we evaluated phosphatidylcholine PC ae C44:6, an integral constituent of cell membranes, as diagnostic biomarker for bacterial meningitis.MethodsWe used tandem mass spectrometry to measure concentrations of PC ae C44:6 in cell-free CSF samples (n = 221) from patients with acute bacterial meningitis, neuroborreliosis, viral meningitis/encephalitis (herpes simplex virus, varicella zoster virus, enteroviruses), autoimmune neuroinflammation (anti-NMDA-receptor autoimmune encephalitis, multiple sclerosis), facial nerve and segmental herpes zoster (shingles), and noninflammatory CNS disorders (Bell’s palsy, Tourette syndrome, normal pressure hydrocephalus).ResultsPC ae C44:6 concentrations were significantly higher in bacterial meningitis than in all other diagnostic groups, and were higher in patients with a classic bacterial meningitis pathogen (e.g. Streptococcus pneumoniae, Neisseria meningitidis, Staphylococcus aureus) than in those with less virulent or opportunistic pathogens as causative agents (P = 0.026). PC ae C44:6 concentrations were only moderately associated with CSF cell count (Spearman’s ρ = 0.45; P = 0.009), indicating that they do not merely reflect neuroinflammation. In receiver operating characteristic curve analysis, PC ae C44:6 equaled CSF cell count in the ability to distinguish bacterial meningitis from viral meningitis/encephalitis and autoimmune CNS disorders (AUC 0.93 both), but had higher sensitivity (91% vs. 41%) and negative predictive value (98% vs. 89%). A diagnostic algorithm comprising cell count, lactate and PC ae C44:6 had a sensitivity of 97% (specificity 87%) and negative predictive value of 99% (positive predictive value 61%) and correctly diagnosed three of four bacterial meningitis samples that were misclassified by cell count and lactate due to low values not suggestive of bacterial meningitis.ConclusionsIncreased CSF PC ae C44:6 concentrations in bacterial meningitis likely reflect ongoing CNS cell membrane stress or damage and have potential as additional, sensitive biomarker to diagnose bacterial meningitis in patients with less pronounced neuroinflammation.

Ramsay hunt syndrome: case report

Ramsay-Hunt Syndrome is an uncommon disease caused by the reactivation of latent Varicella zoster virus in the geniculate ganglion. It is characterized with a herpes zoster oticus associated with an acute peripheral facial nerve paralysis, and possible other cranial nerve lesions. We describe the case of a 27-year-old man who presented with severe ear pain for two days, with vesicular eruptions on the external ear and ipsilateral peripheric facial paralysis. He was treated with the association of intravenous steroids and acyclovir for 7 days. The evolution showed gratifying results. The one-year follow-up showed no relapse of the syndrome. The purpose of this report is to highlight the importance of a thorough clinical examination and early treatment of the Ramsay-Hunt syndrome.

Acute vs late extracranial facial nerve branch(s) repair: A comparative study

Acute vs late extracranial facial nerve branch(s) repair: A comparative study

Hypoglossal Facial Nerve Anastomosis for Post-Operative and Post-Traumatic Complete Facial Nerve Paralysis.

AIM:This study aims to evaluate the outcome of patients with complete facial paralysis following surgery to cerebellopontine angle tumours or following traumatic petrous bone fractures after reanimation by hypoglossal-facial anastomosis as regards clinical improvement of facial asymmetry and facial muscle contractility as well as complications associated with hypoglossal-facial reanimation procedure.METHODS:This thesis included a prospective study to be carried out on 15 patients with unilateral complete lower motor neuron facial paralysis (11 patients after cerebellopontine angle tumour resection and 4 patients after traumatic transverse petrous bone fracture) operated upon by end to end hypoglossal-facial nerve anastomosis in Cairo university hospitals in the period between June 2015 and January 2017.RESULTS:At one year follow up the improvement of facial nerve functions were as follows: Three cases (20%) had improved to House Hrackmann grade II, eleven cases (73.33%) had improved to grade III, and one patient (6.66%) had improved to House Brackmann grade IV.CONCLUSION:Despite the various techniques in facial reanimation following facial nerve paralysis, the end to end hypoglossal-facial nerve anastomosis remains the gold standard procedure with satisfying results in cases of the viable distal facial stump and non-atrophic muscles. Early hypoglossal-facial anastomotic repair after acute facial nerve injury is associated with better long-term facial function outcomes and should be considered in the management algorithm.

Altered Brain Fraction Amplitude of Low Frequency Fluctuation at Resting State in Patients With Early Left and Right Bell’s Palsy: Do They Have Differences?

Purpose: Bell’s palsy refers to acute idiopathic unilateral facial nerve palsy. It is a common disorder of the main motor pathway to the facial muscles. This study aimed to investigate the abnormal fraction amplitude of low frequency fluctuation (fALFF) of the brain in patients with early left and right Bell’s palsy.Materials and Methods: Sixty-seven patients (left 33, right 34) and 37 age- and sex-matched healthy controls underwent resting-state functional magnetic resonance imaging (R-fMRI) examination. The fALFF values were measured from all subjects and were compared among the left palsy, right palsy, and control groups. Then, correlations between the Toronto Facial Grading System (TFGS) scores of the patients and the fALFF values of abnormal brain regions were analyzed.Results: Significant group differences in fALFF values among the three groups were observed mainly in the cerebral cortical, subcortical, and deep gray matter regions. Compared with the right Bell’s palsy group, the left Bell’s palsy group showed significantly decreased fALFF values in the left temporal pole of the superior temporal gyrus (TPOsup), right supramarginal, left and right middle cingulate cortex (MCC), left superior frontal gyrus (SFG), and left precentral gyrus (PreCG), and increased fALFF values were observed in the right SFG and PreCG. Furthermore, altered fALFF values correlated positively with the TFGS scores in the left superior TPO, bilateral MCC, and right PreCG, and correlated negatively with the TFGS scores in the right SFG of the left Bell’s palsy group. Altered fALFF values correlated positively with the TFGS scores in the bilateral MCC and right PreCG and correlated negatively with the TFGS scores in the left superior TPO and SFG of the right Bell’s palsy group.Conclusion: Regulatory mechanisms seem to differ between patients with left and right early Bell’s palsy. The severity of the disease is associated with these functional alterations.

Prognosis of Bell Palsy: A Clinical, Neurophysiological, and Ultrasound Study.

Bell palsy is the most common cause of acute facial nerve paralysis. Ultrasound has proved its ability in detecting structural lesions along the course of the affected nerves.The current work aimed at studying the accuracy of ultrasound to predict the prognosis of Bell palsy in correlation to the clinical scale and nerve conduction studies. The study included 20 cases of acute Bell palsy treated with prednisolone and physiotherapy. The participants were examined using the House-Brackmann (HB) scale, electrophysiologically and neurosonologically in the affected side and healthy side that served as a control. There was significant correlation between HB outcomes with onset of HB results. There was significant increase in the distal facial nerve diameter on the affected side compared with the normal side (P < 0.001). Although ultrasound at onset did not predict the outcome, nerve conduction studies did predict the outcome. Baseline HB clinical assessment of Bell palsy gives information on the clinical outcome of the disease. In addition to that, initial nerve conduction studies proved to be superior to ultrasound in predicting the outcome.

Effectiveness of electrical stimulation for rehabilitation of facial nerve paralysis

Background: Despite no significant advantage being demonstrated for its use and no standardization of treatment guidelines, electrical stimulation is still applied by therapists to treat facial paralysis. The aim of this investigation was to determine whether electrical stimulation therapy for patients with acute or chronic facial nerve paralysis improves time to, and rates of full recovery and facial function compared with no intervention. Method: A systematic review of randomized and quasi-randomized controlled trials through Scopus, Medline, PEDro, Embase, CINAHL, Pubmed, and Cochrane Library search engines for studies published up until August 2016. Reference lists were reviewed for further studies. Review Manager was used to extract data and review quality of the studies. Studies were assessed for randomization of participants, allocation concealment, blinding of participants, assessors and physiotherapists, presence and reporting of outcome data. Results: Five studies were included for analysis – four during acute recovery and one in chronic facial nerve paralysis. In acute facial nerve paralysis, two studies found no benefit of electrical stimulation and two studies found improvement. A meta-analysis on changes in the House–Brackmann Score after treatment, rates of full recovery and time to full recovery showed no statistically significant difference between intervention and control groups. In chronic facial nerve paralysis, one study found improvements after extensive electrical stimulation on the Facial Paralysis Recovery Profile. Conclusions: There is no evidence to support the use of electrical stimulation during the acute phase of recovery after Bell’s palsy and there is low-level evidence for patients with chronic symptoms. Furthermore, there is no evidence available on the use of electrical stimulation for other causes of facial nerve paralysis.

Bell's palsy in an adolescent girl - not always a neurologist's territory: A case report and review of literature

Infections, inflammatory, and autoimmune conditions are the well-recognized etiologies of acute facial nerve paralysis in children. Bell's palsy is idiopathic peripheral facial nerve palsy. Cranial neuropathies do occur in children due to the central nervous system involvement by malignancies but uncommon in pediatric acute lymphoblastic leukemias and even rarer in acute myeloid leukemias (AMLs). We report a case of a 13-year-old girl who presented with acute facial nerve palsy, was being treated as Bell's palsy elsewhere and was later diagnosed to have AML.

Facial nerve repair after operative injury: Impact of timing on hypoglossal-facial nerve graft outcomes

PurposeReanimation of facial paralysis is a complex problem with multiple treatment options. One option is hypoglossal-facial nerve grafting, which can be performed in the immediate postoperative period after nerve transection, or in a delayed setting after skull base surgery when the nerve is anatomically intact but function is poor. The purpose of this study is to investigate the effect of timing of hypoglossal-facial grafting on functional outcome. Materials and methodsA retrospective case series from a single tertiary otologic referral center was performed identifying 60 patients with facial nerve injury following cerebellopontine angle tumor extirpation. Patients underwent hypoglossal-facial nerve anastomosis following facial nerve injury. Facial nerve function was measured using the House–Brackmann facial nerve grading system at a median follow-up interval of 18months. Multivariate logistic regression analysis was used determine how time to hypoglossal-facial nerve grafting affected odds of achieving House–Brackmann grade of ≤3. ResultsPatients who underwent acute hypoglossal-facial anastomotic repair (0–14days from injury) were more likely to achieve House–Brackmann grade ≤3 compared to those that had delayed repair (OR 4.97, 95% CI 1.5–16.9, p=0.01). ConclusionsEarly hypoglossal-facial anastomotic repair after acute facial nerve injury is associated with better long-term facial function outcomes and should be considered in the management algorithm.

Metaphysical Energy Therapy in the Treatment of Cranial Nerve Palsies with Special Reference to Bell’s Palsy

Neuropathy, or nerve injury, is a severe and common impediment of diabetes. Studies evaluate that 50% of people with diabetes will develop neuropathy. Diabetic nerve injury is impairment of a single solitary nerve (also named mononeuropathy). Com- monly 2 cranial nerves Viz., cranial nerve VII and cranial nerve VI are involved in facial nerve palsies. The former one is called Bell’s palsy and is acute Lower Motor Neuron facial nerve paralysis (>80%) causing an inability to control facial muscles on the affected side. The later one is sixth nerve palsy, (the abducens nerve), which is responsible for triggering contraction of the lateral rectus muscle to abduct (i.e., turn out) the eye resulting in double vision on the affected side. In recent times, we have found to our amazement, rapid restoration of normalcy within a few hours to a few days, of Cranial Nerve palsies in diabetic subjects at our centre. We are presenting a group of cases having Type2DM over different time periods from 6 to 20 years and those who suddenly suffered facial nerve palsy and they came to VHSDRC for treatment. They were started on the new modality called the Dynamic Acupuncture Mediated Meta-physical Energy Therapy (DAMM Therapy), to recover from the facial palsy. The DAMM therapy is a unique novel way of infusing and transferring healing energy from the therapist to the patient. Within 2 - 7 sittings of DAMM therapy patients showed 75% - 100% improvement in their clinical condition.

Atypical cartilaginous tumor/chondrosarcoma, grade 1, of the mastoid in three family members: A new entity

We present a case series of a family with three members having cartilaginous tumors of the mastoid. All patients presented between the ages of 9 to 12 years with acute onset facial nerve paralysis. Histologic analysis of all tumors showed similar features, consistent with atypical cartilaginous tumors/chondrosarcoma, low-grade. Conventional cytogenetic analysis performed on one of the sons' tumor showed no evidence of chromosomal abnormality. High-resolution array comparative genomic hybridization performed on the same patient's blood also showed no unbalanced chromosomal abnormality. This is the first report of family members with this unusual combination of clinical, radiologic, and histologic finding. Laryngoscope, 126:E310-E313, 2016.

A Contemporary Approach to Facial Reanimation.

The management of acute facial nerve insult may entail medical therapy, surgical exploration, decompression, or repair depending on the etiology. When recovery is not complete, facial mimetic function lies on a spectrum ranging from flaccid paralysis to hyperkinesis resulting in facial immobility. Through systematic assessment of the face at rest and with movement, one may tailor the management to the particular pattern of dysfunction. Interventions for long-standing facial palsy include physical therapy, injectables, and surgical reanimation procedures. The goal of the management is to restore facial balance and movement. This article summarizes a contemporary approach to the management of facial nerve insults.

Contemporary solutions for the treatment of facial nerve paralysis.

After reviewing this article, the participant should be able to: 1. Understand the most modern indications and technique for neurotization, including masseter-to-facial nerve transfer (fifth-to-seventh cranial nerve transfer). 2. Contrast the advantages and limitations associated with contiguous muscle transfers and free-muscle transfers for facial reanimation. 3. Understand the indications for a two-stage and one-stage free gracilis muscle transfer for facial reanimation. 4. Apply nonsurgical adjuvant treatments for acute facial nerve paralysis. Facial expression is a complex neuromotor and psychomotor process that is disrupted in patients with facial paralysis breaking the link between emotion and physical expression. Contemporary reconstructive options are being implemented in patients with facial paralysis. While static procedures provide facial symmetry at rest, true 'facial reanimation' requires restoration of facial movement. Contemporary treatment options include neurotization procedures (a new motor nerve is used to restore innervation to a viable muscle), contiguous regional muscle transfer (most commonly temporalis muscle transfer), microsurgical free muscle transfer, and nonsurgical adjuvants used to balance facial symmetry. Each approach has advantages and disadvantages along with ongoing controversies and should be individualized for each patient. Treatments for patients with facial paralysis continue to evolve in order to restore the complex psychomotor process of facial expression.

Post-traumatic acute bilateral facial nerve palsy - a management dilemma

Abstract Acute bilateral facial nerve paralysis is a rare clinical entity, and its management remains very controversial (operative or conservative). Here we are presenting a case of acute onset bilateral facial nerve palsy following head injury with bilateral temporal bone fracture with clinico-radiographic contrary. Patient was managed conservatively with complete recovery. By this article, authors want to stress on combining clinical examination and radiological findings for decision making of this rare entity and tried to evaluate the management.

Gender Differences in Childhood Lyme Neuroborreliosis.

Background. Many neurological diseases show differences between genders. We studied gender differences in childhood Lyme neuroborreliosis (LNB) in an endemic area of Lyme borreliosis in Norway. Methods. In a population based study, all children (<14 years of age) with symptoms suspicious of LNB, including all children with acute facial nerve palsy, were evaluated for LNB by medical history, clinical examination, blood tests, and lumbar puncture. LNB was diagnosed according to international criteria. Results. 142 children were diagnosed with LNB during 2001–2009. Facial nerve palsy was more common in girls (86%) than in boys (62%) (p < 0.001), but headache and/or neck stiffness as the only symptom was more common in boys (30%) than in girls (10%) (p = 0.003). The girls were younger than boys and had a shorter duration of symptoms, but boys had a higher level of pleocytosis than girls. In a multivariate analysis, both gender and having headache and neck stiffness were associated with a higher level of pleocytosis. Conclusion. Girls and boys have different clinical presentations of LNB, and boys have a higher level of inflammation than girls independent of the clinical presentation.