Bilateral Facial Palsy Research Articles

Creation and Validation of the Facial Diplegia Scale for Assessment of Bilateral Facial Palsy.

Objectives: House-Brackmann (HB) classification and the Sunnybrook Facial Grading System (SFGS), both reference tools for the assessment of facial palsy, are not suitable for bilateral facial palsy. The aim of this study was to develop, standardize, and validate the Facial Diplegia Scale (FDS). Methods: The FDS was standardized in a healthy population (n = 111) and validated in 40 patients with diplegia. Correlations with the SFGS were sought to prove its criterion validity. The comparison between healthy subjects and patients with diplegia was used to test the construct validity. The diagnostic performance of the FDS was verified using an ROC curve based on the HB classification. Internal and external consistency were investigated. Results: The FDS and the SFGS were significantly correlated for the right hemiface [F(39) = 51.51, p < 0.0001, R2 = 0.575] as well as for the left one [F(39) = 95.10, p < 0.0001, R2 = 0.714]. A significant difference between control subjects and patients with diplegia was found [t(149) = -9.95, p < 0.0001]. Good specificity and sensitivity were confirmed. Finally, internal consistency, inter-rater reliability, and test-retest reliability were largely proven. Conclusions: The FDS has been standardized and validated for the subjective assessment of facial diplegia in adults to improve comprehensive assessment.

Overview of Unilateral and Bilateral Pediatric Facial Paralysis: Workup, Treatment, and Frontiers.

Pediatric facial nerve paralysis can present significant challenges based on its various etiologies, unique approach to treatment options, and overall outcomes. It can impact both the child and parent when regarding function, appearance, and psychosocial implications. The etiology of facial nerve palsy can include congenital, traumatic, iatrogenic, and idiopathic causes. In some, the paralysis is transient while others have permanent loss of function. A thorough evaluation and differential diagnosis are essential to guide treatment planning. The purpose of this paper is to review facial paralysis in children with a focus on surgical management.

Bilateral facial nerve palsy complicating Kawasaki disease: A case report and literature review.

Kawasaki disease (KD) manifests as an acute, self-limited vasculitis disease that constitutes the primary cause of acquired heart disease in children under 5 years of age. Facial nerve palsy (FNP) is a rare complication associated with coronary artery lesions (CALs) in patients with KD. Patients with KD and FNP usually present atypically, leading to a delayed diagnosis and treatment of KD. A 4-month-old boy with fever, left FNP and bilateral conjunctival injection with spontaneous resolution, was admitted to the hospital, received a short course of intravenous dexamethasone, and experienced rapid FNP recovery on the first admission. The patient experienced a resurgence of fever, bilateral conjunctival injection, and right FNP, which led to readmission. Physical examination revealed redness at the site of Bacillus Calmette-Guérin inoculation, reddening of lips, and desquamation of the distal extremities. Echocardiography revealed right-sided CALs. The patient initially missed KD on the first admission, and was later diagnosed with complete KD with FNP on the second admission. After a short course of intravenous dexamethasone, the left FNP resolved quickly. However, right FNP recurred after corticosteroids withdrawal. Meanwhile, more typical symptoms were observed, and KD was diagnosed. Treatment ensued with intravenous immunoglobulin (IVIG), aspirin, and dexamethasone. The patient achieved rapid remission, without recurrence. Echocardiography continued to show normal findings during 1-year follow-up after discharge. The clinical symptoms of FNP complicating KD in children are atypical and can easily lead to delayed diagnosis and treatment. FNP in patients with KD may serve as a risk factor for CALs, which are more challenging to resolve than the FNP itself. Adding corticosteroids to IVIG may be recommended to reduce IVIG resistance, decrease the risk of developing CALs, and alleviate CALs.

Through their eyes: Navigating life with limited eyelid closure in patients with Moebius syndrome

Moebius syndrome (MoS), a rare congenital condition caused by the underdevelopment of the sixth and seventh cranial nerves, presents with uni- or bilateral facial paralysis and lateral gaze palsy. Those with MoS often have incomplete eyelid closure (lagophthalmos). This study aimed to investigate the experiences of individuals living with incomplete eyelid closure due to MoS. Participants shared their experiences in semi-structured open-ended focus groups during the 2023 MoS Foundation Conference. Data were analyzed thematically using Nvivo. The Terzis and Bruno scoring system was used to grade participant eyelid closure (range: 1 being no eyelid closure with full scleral show to 5 being complete eyelid closure with no scleral show) and blink (from 1 being no blink to 5 being synchronous and complete blink present). Marginal reflex distances 1 and 2 (MRD1 and MRD2) were measured to grade for ptosis and lid retraction, respectively. Fifteen participants participated in two focus groups, comprising adults (n=12) and adolescents (n=3). All participants had lagophthalmos with some scleral show, ptosis, and lid retraction. The median eyelid closure score was 3 (incomplete eye closure with 1/3 scleral showing). Five key themes were identified: social stigma and misunderstanding, daily life impacts, seasonal exacerbations, different attitudes toward surgical intervention between adults and adolescents, and a prevailing sense of self-acceptance regarding their condition. Incomplete eyelid closure poses significant social challenges for individuals with MoS, especially around social encounters. Our findings show the importance of developing tailored communication tools to support those living with this facial difference.

A case report of fifteen-and-a-half syndrome

BackgroundFifteen-and-a-Half Syndrome is an uncommon clinical presentation characterized by the coexistence of one-and-a-half syndrome and bilateral facial palsy. In this study, we provide a comprehensive description of symptom evolution and imaging changes in a patient with Fifteen-and-a-Half Syndrome.Case presentationA 54-year-old male presented with sudden onset of one-and-a-half syndrome, which gradually progressed to fifteen-and-a-half syndrome. The final diagnosis was confirmed to be pontine infarction which occurred at the midline of the pontine tegmentum.ConclusionThis case highlights the diverse and progressive early clinical manifestations associated with Fifteen-and-a-half Syndrome. Currently, all reported cases of this syndrome are linked to brainstem infarction; however, early differential diagnosis is crucial to ensure prompt initiation of appropriate treatment for affected patients.

A clinical case of acute polyneuropathy, with the onset of bilateral facial nerve palsy in an early childhood

BACKGROUND: The differential diagnosis of peripheral nervous system damage depends on a thorough collection of history, comprehensive assessment of clinical manifestations, and dynamic examination of the patient. This article describes a clinical case of acute polyneuropathy in a young child, which began with gastrointestinal symptoms and bilateral facial neuropathy. CLINICAL CASE DESCRIPTION: The article presents a case of a child with an atypical course of acute polyneuropathy, which began with bilateral facial neuropathy combined with gastrointestinal complaints and pain syndrome. Features of the clinical presentation of the disease required extended laboratory and instrumental testing. Protocols for instrumental verification of diagnosis included nerve conduction studies examining neural conduction and axonal excitability of the affected facial nerve and the healthy side. Additionally, the functional status of the peripheral nerves in the upper and lower limbs was assessed. Polyneuropathic alterations revealed through nerve conduction studies confirmed diagnostic lumbar puncture to determine the presence of neuroinfectious processes. Magnetic resonance imaging of the brain, brachial, and lumbosacral plexuses using intravenous contrast showed the nature and prevalence of a lesion. Based on the overall clinical, laboratory, and instrumental examination data of the patient, “acute inflammatory demyelinating polyneuropathy” was diagnosed; timely etiopathogenetic treatment was initiated. CONCLUSION: In children, the course of a neuroinfection may be atypical. Sometimes, when dissociating the clinical manifestations of the disease from the results of a standard laboratory and instrumental test, expert diagnostic techniques should be used for differential diagnosis purposes.

Unmasking Ataxic Guillain–Barre Syndrome: A Rare Presentation

Abstract A 68-year-old right-handed male with a history of hypertension presented with unsteadiness while walking for 5 days preceded by a vague pain in the left shoulder and both thighs and paresthesias in all extremities. It rapidly progressed to severe gait ataxia, bilateral facial palsy, and speech difficulties. On examination, he had bilateral lower motor neuron type of facial palsy, a wide-based stance, gait ataxia, left-sided hypotonia, cerebellar signs, and generalized areflexia. He had left-sided hypotonia and normal power of all four limbs. Sensory system examination was normal, and Rhomberg’s sign was negative. He had no ophthalmoplegia. While initial considerations pointed toward a cerebrovascular accident, normal magnetic resonance imaging results prompted us to do a lumbar puncture and cerebrospinal fluid analysis, which revealed albuminocytological dissociation indicative of Guillain–Barré Syndrome (GBS). Nerve conduction studies then confirmed our diagnosis. Given these results and a preceding respiratory infection, the patient was diagnosed with a rare ataxic variant of GBS. The patient was treated with plasmapheresis following which he showed dramatic clinical improvement. He was subsequently able to walk without support and perform the majority of his day-to-day activities on his own. He was discharged in a hemodynamically stable condition. This case report, thus, highlights a rare ataxic variant of GBS presenting with acute onset ataxia, areflexia, and facial diplegia. Thus, understanding the GBS and its variants is crucial to managing rare presentations swiftly and avoiding severe complications. It has tremendous scope for further research to understand the pathophysiological dynamics completely and find more targeted therapeutic approaches. We, thus, present a rare case of an ataxic variant of GBS with acute onset ataxia, areflexia, and facial diplegia.

A Case Report of Miller Fisher Syndrome with Bilateral Facial Palsy Using Complex Korean Medicine Treatment Including Facial Chuna Manual Therapy

A Case Report of Miller Fisher Syndrome with Bilateral Facial Palsy Using Complex Korean Medicine Treatment Including Facial Chuna Manual Therapy

Multidisciplinary Care for Moebius Syndrome and Related Disorders: Building a Management Protocol.

Moebius syndrome is a collection of orofacial anomalies with highly variable features affecting many different systems but characterised by bilateral facial palsy and absent eye abduction. We largely regard Moebius syndrome as a diagnosis of exclusion. Lack of awareness and knowledge means that children often fall between services, leading to treatment delays and difficulty interfacing with social care and schools, with long-term impact on physical health and psychosocial development. We developed a multidisciplinary team comprising core clinicians (lead physician, geneticist, speech and language therapist, psychologist and specialist nurse) and an expanded group to encompass the other affected systems. The interactions between our specialties lead to the development of a treatment protocol, which we present. The protocol harnesses the aspects of care of children with a range of other rare diseases at a specialised paediatric centre and synthesises them into a holistic approach for MBS and related conditions. Management is sequenced on an "ABC-style" basis, with airway, feeding, vision and speech taking priority in the early years. We define management priorities as airway stabilisation with swallow assessment, ocular surface protection and maintenance of nutritional support. Management principles for issues such as speech, reflux, drooling and sleep issues are outlined. In later years, psychological support has a prominent role geared towards monitoring and interventions for low mood, self-esteem and bullying.

A case of variant of GBS with positive serum ganglioside GD3 IgG antibody

BackgroundAcute bulbar palsy-plus (ABPp) syndrome is an unusual variant of Guillain-Barré syndrome (GBS). Anti-GT1a and anti-GQ1b antibodies have been reported in patients with ABPp, but without reports related to GD3 antibodies.MethodsClinical data of a patient diagnosed as ABPp syndrome were reviewed clinically. And we summarized the GBS patients with ABP and facial paralysis reported in the literature.ResultsWe reported a 13-year-old girl presented with asymmetric bifacial weakness, bulbar palsy and transient limb numbness, and had positive serum IgG anti-GD3 antibody. Through reviewing the GBS patients with ABP and facial paralysis reported previously, we found that facial palsy could be unilateral or bilateral. The bilateral facial palsy could present successively or simultaneously, and could be symmetrical or asymmetrical. Other common symptoms included ophthalmoplegia, sensory abnormality and ataxia. IgG anti-GT1a and IgG anti-GQ1b antibodies were the most frequent. Most of the patients had full recovery within two weeks to one year of follow-up.ConclusionsWe reported a patient with asymmetric bifacial palsy and bulbar palsy, which seemed to fit the diagnosis of ABPp syndrome. This was the first report of ABPp variant of GBS with positive serum ganglioside GD3 IgG antibody.

Acute Guillain-Barré Syndrome After Sacroiliac Joint Fusion

BACKGROUND: Guillain-Barré syndrome (GBS), also called acute inflammatory demyelinating polyradiculopathy (AIDP), is one of the most common causes of acute, acquired weaknesses. GBS is an acute immune-mediated polyneuropathy that presents with progressive weakness of the arms or legs. GBS presents after infection; however, there are few reports that describe acute GBS after chronic pain procedures. CASE REPORT: A 70-year-old man with a past medical history of spinal stenosis status post anterior cervical discectomy and fusion, sacroiliac joint (SIJ) dysfunction status post SIJ fusion presented with imbalance, weakness, and difficulty walking. The patient underwent SIJ fusion one week prior; his weakness progressively worsened, requiring a walker. He underwent a series of labs and diagnostic tests, which were consistent with AIDP/GBS. He was placed on respiratory and cardiac monitoring and started on intravenous immunoglobulin treatment. He started developing bilateral facial palsies and started on plasmapheresis. His symptoms have improved and he was discharged from our inpatient rehab facility on after 28 days. CONCLUSIONS: This case report aims to highlight a rare, but potentially dangerous, complication of AIDP/GBS following an SIJ fusion. KEY WORDS: Sacroiliac joint fusion, sacroiliac joint pain, Guillain-Barré syndrome, case report

Uncommon Bilateral Idiopathic Facial Nerve Palsy (Bell's Palsy) in an Infant: An Atypical Age and Clinical Challenges Explored: A Case Report.

Our case study explores Bell's palsy, a rare lower motor neuron facial nerve paralysis, particularly rare in newborns. While often idiopathic, it can stem from congenital or developmental factors. Unilateral facial paralysis is more prevalent, with Bell's palsy accounting for more than 50%, while bilateral facial paralysis is exceptionally rare. We present a distinctive case of idiopathic Bell palsy in a 3.5-month-old infant, initially affecting the right side and spontaneously resolved within 30 days, followed by involvement on the left side a month later. Despite comprehensive evaluations and treatment, persistent facial weakness was observed on the left side. The patient initially responded well but faced ongoing challenges during the second attack. Our findings underscore the need for further research to improve the understanding and management of these cases.

Midforehead Lift for Brow Ptosis Caused by Bilateral Facial Nerve Palsy

Midforehead Lift for Brow Ptosis Caused by Bilateral Facial Nerve Palsy

Oral findings and comprehensive dental management of Moebius syndrome: a systematic review

BackgroundMoebius syndrome (MS) is a rare, non-progressive, neuromuscular, congenic disease involving the oral maxillofacial region. The present study aimed to describe the oral and extraoral findings in MS patients and their comprehensive dental management.MethodsA digital search was carried out in PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar, restricted to articles in English from Jan 01, 2000, to Apr 02, 2023, following PRISMA guidelines. The methodological quality of the studies was evaluated following the JBI guidelines. Qualitative analysis was carried out on the overall result, extraoral and intraoral manifestations, considering dental management as appropriate.ResultsTwenty-three studies were included, and a total of 124 cases of patients with MS were analyzed. The 82% of patients with MS were younger than 15 years of age. The most frequent extraoral manifestations were blinking and visual problems (78,22%), malformations of the upper and lower limbs (58,22%), bilateral facial paralysis (12,90%), lack of facial expression (12.09%), and unilateral facial paralysis (6,45%). On the other hand, the most frequent oral manifestations were tongue deformities (78,22%), micrognathia (37,90%), labial incompetence (36,29%), cleft palate (22,87%), gothic palate (16,12%), microstomia (15,32%), anterior open bite (15,32%), dental caries (8,87%), and periodontal disease (8,06%). The majority of MS patients were treated by pediatric dentistry (60,86%), using a surgical approach (56,52%), and orthodontic and orthopedic maxillary (43,47%) followed by restorative (39,13%), and periodontal treatments (21,73%).ConclusionsThis systematic review demonstrates that patients with MS present a wide variety of oral and extraoral manifestations, for which dental treatments are planned and tailored to each patient in accordance with oral manifestations. These treatments encompass problem resolution and oral health maintenance, incorporating recent techniques in managing and treating patients with MS.

Pattern of Clinical Profile and Outcome of Gillian Barre Syndrome in Sudanese Patients

Introduction: Guillian Barre'-Syndrome (GBS) is an acute, autoimmune disease affecting spinal roots and peripheral nerves, characterized by a rapidly progressive, ascending weakness of the extremity, trunk and even respiratory and facial muscles and with minor sensory and autonomic dysfunction. As in Sudan there is no enough data regarding the pattern of presentation and outcome of GBS, our research aimed to study clinical profile, electrophysiological variant, and outcome of Sudanese patients diagnosed with (GBS). Methods: A multi centers cross-sectional hospital-based study conducted in Khartoum from March to September 2020, 62 patients enrolled in the study, structured questionnaire consists of personal data, clinical history, examination findings, electrophysiological study result, management and outcome is used to assess the clinical profile and outcome of the disease. Results: The study revealed that males and females are equally represented, 70% patients are between 18 years and 50 years. The onset of the weakness was less than or equal 3 days in 33.9% of patients, from 4 to 7 days in 41.9%, from 8 to 14 days in 11.3% and above 14 days in 12.9%.40.3% patients had Evidence of autonomic dysfunction. The majority of patients presented with weakness that started in the lower limbs (93.5%), in (4.8%) the weakness started in the upper limbs and then descend. In (1.6%) the weakness started in the pharyngeal and respiratory muscles from the start. Sensory complains were observed in 54 patients (87.1%), 3 patients (4.8%) developed urinary bladder incontinence and 36 patients (58.1%) had back pain at the onset of the disease. On clinical examination; (98.4%) of patients had absent reflexes, (35.5%) had bilateral facial nerve palsy and (4.8%) had unilateral facial nerve pals. Based on the electrophysiological studies, (37.09 %) were recorded as acute motor axonal neuropathy (AMAN), (29.03%) as acute inflammatory demyelinating poly neuropathy (AIDP) and (29.03%) as acute motor-sensory axonal neuropathy (AMSAN). Regarding the outcome, 30 patients (48.4%) fully recovered, 25 patients (40.3%) recovered with motor deficit, and 7 patients (11.3%) unfortunately died. Conclusion: This study concluded that Guillian Barre'-Syndrome (GBS) in Sudanese population mainly affects age group from 18 to 50 years with variable maximum onset of weakness, presentation and outcome. Lower limb weakness and absent reflexes were the most presenting features. NCS showed axonal type of GBS found to be in nearly 66% of patients and 40% showed clinical evidence of dysautonomia.

COVID-19 Vaccine-induced Guillain-Barre Syndrome

Abstract First case of severe acute respiratory syndrome coronavirus-2 was detected in Wuhan province of china. Within a year, the vaccine development process accelerated and emergency approval was rolled out for vaccines. Covishield, an adenovirus vector-based vaccine manufactured by Serum Institute of India, was granted emergency use approval by the subject expert committee under Drug Controller General of India in India in the month of January. Numerous adverse effects are still under study following vaccination. Among them, a very rare complication reported is Guillain-Barre syndrome (GBS). The relation between coronavirus disease 19 (COVID-19) vaccine and GBS is still not clear. Here, we present a case of a 32-year-old female with no comorbidities, presented with complaints of bilateral weakness in lower limbs which gradually progressed to upper limbs along with bilateral facial palsy. She had taken her first shot of Covishield vaccine last month. She has no risk factors for GBS, which suggests that it was caused by the vaccine. She was admitted to intensive care unit for further management. This report might help physicians to be more vigilant in evaluating GBS cases especially in the current COVID-19 pandemic era.

Localized Pachymeningitis - An Uncommon Complication of Chronic Otitis Media and Mastoiditis

We describe the case history of a 55-year-old male presenting with gradual onset of bilateral facial nerve paralysis. A radiological test of CT temporal bone revealed soft tissue thickening in bilateral mastoid air cells and middle ear cavities. Tl weighted contrast-enhanced MRI revealed thickening and early enhancement of the adjacent dura, indicating active pachymeningitis. The past middle ear infection appears to cause the above inflammatory findings in the meninges and worsening on the untreated side. Currently, he is on steroids with some improvement in facial nerve paralysis.

Bilateral facial nerve palsy as a presentation of coexisting neuroborreliosis and post-acute COVID-19 syndrome

Bilateral facial nerve palsy as a presentation of coexisting neuroborreliosis and post-acute COVID-19 syndrome

Bilateral Facial Nerve Palsy Following Antibiotic Treatment for Listeria Monocytogenes Meningitis

Listeria monocytogenes (LM) is an intracellular, facultative, gram-positive bacillus transmitted mainly through contaminated food, particularly dairy products and cold deli meats. It typically affects immunocompromised patients, and a rarely neuroinvasive disease in immunocompetent healthy adults has been described in the literature. Despite the timely intervention, neurologic morbidity has been observed after extended periods of recommended antibiotic regimens. This case study highlights the challenges in diagnosing and managing LM meningitis, especially when atypical symptoms and complications arise. Herein, we describe the case of a 57-year-old healthy man admitted with symptoms of nausea, vomiting, headache, neck pain, and stiffness, who was eventually diagnosed with LM-related meningitis and treated with antibiotics. The patient’s hospital course was complicated by bilateral facial nerve palsy, while other symptoms improved with antibiotic treatment, raising suspicion for parainfectious immunological response, which improved with a short course of steroids. This case contributes to the medical literature by providing insights into the immunological response for treating LM meningitis and managing LM meningitis–associated complications. To our knowledge, this could potentially be the first case of LM meningitis causing the parainfectious immunological response of bilateral facial nerve palsy after antibiotic treatment.

Paralisi periferica bilateale del VII nervo cranico da infezione da virus di Epstein-Barr

Following a primary Epstein-Barr virus infection, a 4- years-old boy develops bilateral peripheral VII cranial nerve palsy. Ruled out the other bilateral facial palsy’s causes (first of all borreliosis), the cause of the paralysis is recognized in the Epstein-Barr virus infection. We start a steroid therapy associated with physiotherapy treatment for functional rehabilitation. Bilateral peripheral facial palsy is a rare condition. Un- like unilateral palsy, which is idiopathic in about half of the cases, bilateral palsy is idiopathic in only 20% of cas- es. Both in the case of unilateral and bilateral involve- ment, Borrelia burgdorferi infection stands out among the recognized causes in first place. Another bilateral facial palsy’s cause is Epstein-Barr virus infection, because of its important neurotropism, which causes palsy with a still unclear mechanism. About 2 months after the onset of neurological symptoms our boy is gradually recovering facial nerve functions.