Bilateral Facial Palsy Research Articles

Bilateral facial palsy in cerebral venous sinus thrombosis – An uncommon association

Background: Cranial nerve palsy in cerebral venous sinus thrombosis (CVST) is not a very common presentation, its pathophysiology is not well understood. Case Description: We report a 27 year old young man with CVST having protein-S deficiency & hyperhomocystinemia, who during his initial days of hospitalization developed bilateral facial palsy. With conservative treatment of CVST, complete recovery of facial palsy occurred with recanalization of transverse sinus. Conclusions: Facial palsy in this patient was probably caused by transient neurapraxia in the intracranial segment of the nerve. It may be hypothesised that elevated venous transmural pressure in the nerve’s satellite vein, which belongs to the affected drainage territory of the transverse sinus, might have caused venous blood-brain barrier dysfunction in the intrinsic vascular system of the nerve, with leakage of fluids and ions into the endoneurial space and thus an increase in interstitial resistance causing conduction defects.

Guillain-Barré Syndrome Associated with COVID-19: A Neurochallenge!!

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent for Coronavirus disease 2019 (COVID-19), originated in Wuhan, China in the fall of 2019 which has soon become a global pandemic engulfing the entire world, presents with a myriad of symptoms from asymptomatic to severe disease with acute respiratory distress syndrome and multiple organ dysfunction and severe inflammatory response. New associations and clinical problems keep appearing with the new virus and here, we are reporting a case of Guillain-Barré syndrome (GBS) presented to us with complaints of progressive proximal muscle weakness and bilateral facial paralysis. The initial nerve conduction study was normal, but clinical examination showed us a picture of acute inflammatory demyelinating polyradiculoneuropathy and the patient was treated with intravenous immunoglobulin to which the patient responded dramatically. Repeat nerve conduction study showed typical features of GBS. Thus, a differential diagnosis of GBS should be kept in mind by all physicians/neurologists who encounter any neurological symptoms (especially muscle weakness) while treating or post-COVID-19 infection.

Congenital Bilateral Microtia-Anotia: A Clinical Challenge

Microtia- Anotia (M-A) is a rare congenital malformation of the external ear structure commonly associated with atresia or stenosis of the ear canal. Its prevalence is more common in Asians and Hispanics, is generally unilateral and is seen more commonly in males. It can either be an isolated defect or be a part of specific pattern of anomalies involving other organs. It has been documented as a component of either a teratogenic embryopathy (isotretinoin, thalidomide or alcohol) or single gene disorders like Treacher Collins and as a part of a pattern of multiple defects like Goldenhar, Nager and CHARGE syndrome. We report a case of a newborn with bilateral microtia-anotia and facial palsy, who on further evaluation was found to have congenital heart disease also. The triad of anotia, facial paralysis and cardiac anomaly is rare and has been first described by Pearl in 1984.Thus, the obviously visible ear malformation at birth should be evaluated in depth to rule out other underlying malformations.

Heerfordt’s syndrome: an uncommon manifestation of sarcoidosis

Heerfordt’s syndrome – the combination of facial palsy, parotid swelling, anterior uveitis and fever, is a rare manifestation of sarcoidosis. Here, we present case history of a patient with bilateral lower motor neuron facial nerve palsy, who was found to have bilateral parotid gland swelling and bilateral hilar lymphadenopathy. Computed tomography guided fine needle aspiration cytology from hilar lymph node findings were consistent with sarcoidosis. Subsequently, based on clinical features and cytological findings, the case was diagnosed as incomplete Heerfordt’s syndrome.
 Birdem Med J 2021; 11(1): 67-69

Bilateral facial palsy in an adult with chickenpox

<p class="abstract">Chickenpox is a result of primary infection with varicella zoster virus. Isolated facial nerve palsy as a complication is rare, and here we report an extraordinary case of bilateral facial nerve palsy following chickenpox in an adult. A 55-year-old male presented to the emergency department with a day’s history of facial weakness. He had recently contracted chickenpox with an onset 16 days prior. Physical examination noted crusted vesicles all over the body and a bilateral facial palsy. There were no clinical signs of meningitis or cerebrovascular accident. He was managed with a short course of oral aciclovir and prednisolone and recovered fully after a month. Presentations of facial nerve palsy in chickenpox are rare and should be differentiated from Ramsay Hunt syndrome. Prognosis is relatively good with the majority of known cases seeing complete facial nerve recovery within 6 months. </p>

Congenital unilateral absence of facial nerve with hypoplastic abducens nerve: A case report of rare Moebius syndrome

Moebius syndrome is a rare congenital neurological disorder characterized by bilateral facial and abducens nerve paralysis. The syndrome may also include involvement of the other cranial nerves and various other congenital deformities and malformations. A one-month-old male infant presented with facial asymmetry, inability to close eye, and drooling of saliva from one side of the mouth, diagnosed to have Moebius syndrome. Early diagnosis of the cases by experienced clinicians and a supportive multidisciplinary approach can help children with Moebius syndrome and prevent associated complications.

Moebius syndrome: Craniofacial clinical manifestations and their association with prenatal exposure to misoprostol.

BackgroundA growing link between prenatal exposure to misoprostol (PEM) and Moebius syndrome (MS) or sequence has been reported. Our objectives were to describe the craniofacial clinical manifestations associated with MS and to determine the frequency of PEM, comparing cases of exposure and nonexposure.MethodsA descriptive, cross‐sectional study of 140 patients with MS. Clinical evaluations, as well as 140 interviews with mothers residing in 39 cities or districts of Colombia, were carried out between April 2008 and May 2018. Additionally, previous clinical history of each case was reviewed.ResultsThe average age of the patients with MS was 8.4 years (29 days to 48 years). All of them presented facial nerve involvement and abducens, 112 (80.8%) with bilateral facial paralysis. 98.5% presented craniofacial disorders, and there were no significant differences between those exposed and not exposed to misoprostol. Forty‐seven percentage of patients (64 cases) presented PEM, in 98.4% of which abortion had been intended.ConclusionPEM could have an influence in the appearance of new cases of MS by increasing the frequency of bleeding during gestation, without increasing the number of associated craniofacial malformations. We present the biggest series on MS and craniofacial findings in the literature, along with a meaningful reference for its understanding.Level of Evidence3b.

Bilateral Post Traumatic Facial Nerve Palsy Presenting as Dysarthria: A Case Report

Bilateral traumatic facial nerve palsy (FNP) is rare and can present with distressing features. We report a 23-year-old male final year medical student with a 10-day history of speech difficulty following a passenger motorcycle road traffic accident. Physical examination showed a fully conscious young man whose only neurological deficit was bilateral lower motor neuron facial nerve palsy (House and Brackmann grade IV) and difficulty pronouncing plosives. A high-resolution temporal bone CT showed a right longitudinal temporal bone fracture. There was no temporal bone fracture on the left side. Brain MRI was normal. He had complete recovery of facial nerve function on conservative management 6 months after the injury.

A Case Report of Traditional Korean Medicine Treatment for a Patient with Idiopathic Bilateral Facial Nerve Palsy

A Case Report of Traditional Korean Medicine Treatment for a Patient with Idiopathic Bilateral Facial Nerve Palsy

Bilateral Facial Nerve (Bell’s) Palsy in a 24-Year-Old Woman: A Case Report

ABSTRACT
 Objective: To report a case of acute bilateral facial nerve palsy in a 24-year-old woman and to present the differential diagnoses, pathophysiology, management and prognosis
 Methods: 
 Design: Case study
 Setting: Tertiary Private Hospital
 Patient: One (1)
 Result: A 24-year-old woman with fever, joint pains, cough, chest pain, difficulty ambulating and progressive facial muscle weakness was diagnosed with rheumatic fever. Bilateral facial nerve paralysis was noted, and Electromyography-Nerve Conduction Velocity (EMG-NCV) testing with special facial nerve study revealed abnormal facial nerve and blink reflex studies while EMG-NCV of the upper and lower limbs were normal. Audiometry and MRI of the brain and facial nerve were normal while Schirmer’s Test showed decreased tearing in both eyes. The rheumatic fever resolved within 5 days of antibiotics, while Prednisone and physiotherapy resulted in improvement of facial paralysis from House Brackmann V to House Brackmann II-III over a period of 6 months.
 Conclusion: Idiopathic facial paralysis or Bell’s Palsy is the most common cause of acute unilateral facial paralysis while bilateral facial nerve paralysis is a rare condition. Patients with facial palsy should undergo appropriate diagnostics to determine the underlying condition and to facilitate prompt management.
 Keywords: facial paralysis, idiopathic; Bell’s palsy

Bilateral facial palsy in an older person

Lyme disease is an infectious disease caused by the Borrelia burgdorferi spirochetes and other related species that are transmitted through an infected tick bite. We report the case of an older patient presenting with bilateral facial palsy due to Lyme disease. Multiple non-specific clinical signs preceded facial palsy with falls, fatigue and pain of both legs especially during the night. Our case illustrates the difficulty to diagnose this infectious disease, especially in older patients who have rare outdoor activities and a low risk of tick exposure.

Miller-Fisher Syndrome (MFS) with Delayed Bilateral Facial Nerve Palsy: Imaging and Electrodiagnostic Findings, Treatment and Outcome (2789)

Miller-Fisher Syndrome (MFS) with Delayed Bilateral Facial Nerve Palsy: Imaging and Electrodiagnostic Findings, Treatment and Outcome (2789)

Bilateral Facial Nerve Palsy following Head Injury: A Report of Two Uncommon Cases

AbstractBilateral facial nerve palsy (FNP) following head injury without any brain parenchymal injury or brain stem injury is quite an uncommon presentation. We came across two baffling cases of head trauma in which the patients developed simultaneous bilateral lower motor FNPs without any significant findings in initial brain scans which would suggest the pathophysiology for such a condition. Both the cases were found to be having longitudinal fractures of the temporal bone leading to injury of the facial nerves bilaterally. After conservative management, both the cases showed appreciable neurological improvement on follow-up. Hence, although bilateral FNP can be a diagnostic dilemma, it is quite possible to precisely localize the site of injury and successfully treat it.

Association of Socioeconomic, Personality, and Mental Health Factors With Health-Related Quality of Life in Patients With Facial Palsy

Knowledge of factors associated with health-related quality of life in patients with facial palsy may aid in better interpreting outcomes of research and treatment. To identify factors associated with health-related quality of life in patients with facial palsy. The inclusion period for participants in this cross-sectional study at the University Medical Center Groningen, a tertiary referral center for facial reanimation surgery, was March 1 to June 1, 2019. Patients aged at least 18 years with facial palsy who had undergone surgery for facial palsy between January 1, 2007, and January 1, 2018, and patients visiting the outpatient clinic of the University of Groningen Department of Plastic Surgery for their facial palsy between March 1 and June 1, 2019, were also asked to participate. Of 276 patients invited, 145 gave informed consent. Twenty patients did not respond after consent, 3 patients withdrew from the study, and 1 patient was wrongly included. Health-related quality of life was measured using the Facial Clinimetric Evaluation Scale and the Facial Disability Index (physical score and social score). Facial function was assessed with the Sunnybrook Facial Grading System. Other variables were investigated using validated questionnaires, including the Duke University Religion Index, Ten-Item Personality Inventory, and Hospital Anxiety and Depression Scale. Multivariable linear regression analyses with stepwise backward selection were performed to identify associations with health-related quality of life. Because 44 Sunnybrook composite scores were missing, a sensitivity analysis was performed that excluded the Sunnybrook composite scores from the multivariable analysis. In total, 121 patients with facial palsy were included; their median age was 62 years (interquartile range, 48-71 years), and 63 (52%) were women. Sunnybrook composite score (β = 0.4; 95% CI, 0.2-0.5), extraversion (β = 2.6; 95% CI, 0.4-4.8), and anxiety (β = -2.4; 95% CI, -4.1 to -0.8) were associated with the Facial Clinimetric Evaluation Scale total score (R2 = 0.380; 95% CI, 0.212-0.548). The Sunnybrook composite score was associated with the Facial Disability Index physical score (β = 0.2; 95% CI, 0.0-0.4) (R2 = 0.084; 95% CI, -0.037 to 0.205). Bilateral facial palsy (β = -21.2; 95% CI, -32.3 to -10.1), extraversion (β = 2.7; 95% CI, 1.3-4.1), conscientiousness (β = 2.7; 95% CI, 0.2-5.2), emotional stability (β = 3.3; 95% CI, 1.7-4.8), and depression (β = -1.3; 95% CI, -2.5 to -0.1) were associated with the Facial Disability Index social score (R2 = 0.400; 95% CI, 0.262-0.538). In the sensitivity analysis, the Sunnybrook composite score was associated with age (Spearman ρ = -0.252). Bilateral facial palsy, age, severity of facial palsy, mental distress, and personality traits should be taken into account in future research and treatment of patients with facial palsy.

Electromyographic evaluation of the facial and motor donor nerves before facial reanimation surgery in Moebius syndrome.

Moebius syndrome is a clinical entity characterized by bilateral facial and abducens nerve palsies; other cranial nerver might be affected as well. So far, no studies have reported the electromyographic responses of the facial musculature in this group of patients. The objective of our study is to describe the electromyographic responses of the facial muscle and the main donor nerves for facial reanimation in patients with Moebius syndrome. We analyzed electromyographies from the facial, hypoglossal, masseterine (trigeminal) and accessory nerves from patients with Moebius syndrome treated between 2010 and 2016. Results are presented as percentages and central tendency measures. 24 patients were included, mean age 11.79 ± 9.39 years. The facial nerve showed complete unilateral recruitment in 4 patients, partial bilaterally in 11, 7 showed no activity bilaterally and two had unilateral inactivity. The masseterine was normal in 14 patients, had partial recruitment bilaterally in 4 and unilaterally in 4 cases. The accessory nerve was normal in 20 patients, showed partial recruitment bilaterally in 3 and unilaterally in 1 patients. The hypoglossal was normal in 22 patients, and altered in 2 cases. Patients with Moebius syndrome show several degrees of alteration in electromyographic evaluation of the facial nerve. Electromyography is a useful tool in evaluating potential motor donor nerves for facial reanimation surgery.

A rare cause of bilateral facial nerve paralysis due to acute otitis media in a 52-year-old man

Facial nerve paralysis is a known complication of middle ear diseases such as chronic otitis media. However, it is rarely seen in acute otitis media (AOM). Bilateral facial nerve paralysis is an extremely rare incidence in AOM in an adult patient. As it is a rare clinical entity, the management of this condition is not very well outlined as per the standard guidelines. Aggressive and appropriate treatment in the earliest period helps patients to recover from facial nerve paralysis. Here, we present a case of bilateral facial nerve paralysis in a 52-year-old male with bilateral AOM. Facial nerve paralysis in both sides recovered to normal with appropriate treatment along with myringotomy.

Bilateral post traumatic facial nerve palsy presenting as Dysarthria: A case report

Bilateral post traumatic facial nerve palsy presenting as Dysarthria: A case report

Post Traumatic Mask Face, Diagnostic Dilemma in Bilateral Traumatic Facial Palsy. Case Report

Traumatic temporal bone fractures, most of the time presents with complications in the form of cerebrospinal fluid leak, facial nerve injury as it enters the petrous part of temporal bone and also sometimes hearing loss due to concomitant vestibulocochlear nerve injury.2,3,4 Second most vulnerable nerve in head injury is facial nerve, with olfactory nerve being the first, and one reason for this is the tortuous bony course in the skull base and temporal bone.8-12 Evaluating facial nerve injury in head injury patient start with an inspection of the temporal bone for any signs of injury, i.e. laceration or visible auditory cartilage or any hematomas or bruises over mastoid, which is called Battle sign.10-12 Functional testing of facial nerve should be recorded in head injury with temporal bone fracture as soon as possible.1, 3- D CT reconstruction of the skull and temporal bone should be carried out when there is suspicion of facial nerve injury.11,12 Complementary electro diagnostic testing should also be performed in order to assess the severity of facial nerve injury.2,3,4 These all helps in early detection and further management of facial nerve injury.5,6,7,11 We presented a case of 18years old male who had road traffic accident on 29.10.2018. This patient suffered with the head injury with bleeding from nose and right ear.

Orofacial motor dysfunction in Moebius syndrome.

To review orofacial disabilities and their consequences in children with Moebius syndrome (MBS). We retrospectively analysed the records of 32 patients (21 males, 11 females) with non-progressive bilateral facial and abducens palsies who had been examined before 6 months of age. All facial muscles were severely involved in 17 patients; in the 15 others, partial movements were found in the lower face. Most patients (n=24) were unable to smile. Patients frequently presented with congenital trismus (n=20) and drooling (n=18). Additional palsies involved cranial nerves IX and X (n=18) and XII (n=25). Sucking was absent or weak in 30 patients; swallowing was impaired in 25. During the first month of life, feeding disorders were graded as severe/moderate in 25. Respiratory complications occurred in 17. Severe feeding disorders were associated with congenital trismus (p=0.01) and with cranial nerve IX and X palsy (p=0.01). Growth failure between 1 and 6 months of age, followed by catch-up growth between 6 and 12 months, was observed in 20 patients. Between 2 and 5 years of age, 25 out of 32 patients attained normal oral diet and 28 out of 29 showed normal growth. Children with MBS frequently require adjusted therapeutic options to prevent failure to thrive. Congenital trismus, cranial nerve IX and X palsy, and laryngeal-tracheal dysfunctions are predictors of severe feeding disorders. Moebius syndrome frequently induces reduced oral intake and early failure to thrive. Normal oral diet and growth parameters are attained at 2 to 5 years of age. Congenital trismus, pharyngeal palsy, and laryngeal disorders predict dysphagia.

Congenital facial palsy

Congenital facial palsy is unilateral or bilateral facial nerve palsy at birth due to genetic or different pathogenic factors. It can be divided into syndromic type and non-syndromic type according to its accompanying symptom. The pathogeny and symptom of each type are different, in part with genetic heterogeneity. Congenital facial palsy cannot recover spontaneously. Different types of congenital facial palsy have different treatment schemes. The treatment is significant to the improvement of life quality and physical and mental development of children with congenital facial palsy.