Brackmann Scale Research Articles

Surgical results for one-stage VII/VIII schwannoma resection and hemihypoglossal-facial neurorrhaphy

BackgroundThis retrospective study evaluated the outcomes of patients undergoing one-stage resection of VII/VIII schwannomas and hemihypoglossal-facial neurorrhaphy via the translabyrinthine approach (TLA). MethodsThe study encompassed ten consecutive patients with unilateral hearing loss (six women, four men, mean age: 49.5 ± 12.1 years) who underwent surgery. The cohort included two patients with vestibular schwannomas (VSs), four with facial nerve schwannomas (FNSs) (two originating from the geniculate ganglion of the facial nerve and two from the cerebellopontine angle), one with VS regrowth, and three with residual VSs. Preoperative facial nerve function, assessed using the House–Brackmann (HB) scale, was Grade V in one and Grade VI in nine patients. The mean preoperative duration of facial paralysis was 7.5 ± 6.9 months. ResultsAll patients underwent gross total resection. Postoperatively, one patient experienced cerebrospinal fluid leaks, which were successfully managed with lumbar drains and surgical revisions. At follow-up, facial nerve function improved in all patients: HB Grade V to III in one, HB Grade VI to III in one, HB Grade VI to IV in seven, and Grade VI to V in one. No tumor recurrence was observed during the follow-up period (mean duration: 16.6 ± 9.3 months), and no patient had hemilingual atrophy. ConclusionThe TLA for one-stage resection of VII/VIII schwannomas and facial nerve reconstruction is effective in treating both regrowth and residual VSs and FNSs in the cerebellopontine angle or petrosal bone in patients with severe preoperative facial palsy. This technique facilitates simultaneous tumor removal and nerve anastomosis, thereby reducing the need for multiple surgical interventions in patients with hearing loss and compromised facial nerve function.

Use of athletic tape in the speech-language-hearing treatment of post-stroke facial paralysis in the acute phase.

To verify the efficacy of using athletic tape associated with myofunctional therapy in the speech-language-hearing treatment of facial palsy after stroke in the acute phase. Randomized controlled clinical study with 88 patients with facial palsy in the acute phase of stroke. The sample was allocated in: Group 1: rehabilitation with orofacial myofunctional therapy and use of athletic tape on the paralyzed zygomaticus major and minor muscles; Group 2: rehabilitation alone with orofacial myofunctional therapy on the paralyzed face; Group 3: no speech-language-hearing intervention for facial paralysis. In the evaluation, facial expression movements were requested, and the degree of impairment was determined according to the House and Brackmann scale. Movement incompetence was obtained from measurements of the face with a digital caliper. After the evaluation, the intervention was carried out as determined for groups 1 and 2. The participants of the three groups were reassessed after 15 days. The statistical analysis used was the generalized equations. The groups were homogeneous in terms of age, measure of disability and functioning, severity of neurological impairment and pre-intervention facial paralysis. Group 1 had a significant improvement in the measure from the lateral canthus to the corner of the mouth, with better results than groups 2 and 3. The athletic tape associated with orofacial myofunctional therapy had better results in the treatment of facial paralysis after stroke in the place where it was applied.

Validation of the Spanish version of the Electronic Facial Palsy Assessment (eFACE)

PurposeThe clinician-graded electronic facial paralysis assessment (eFACE) is a relatively new digital tool for assessing facial palsy. The present study aimed to determine the validity and reliability of the Spanish version of the eFACE.MethodsForward–backward translation from the original English version was performed. Videos and photographs from 65 adult patients with unilateral facial paralysis (any severity, time course, and etiology) were evaluated twice by five otolaryngologists with varying levels of experience in facial palsy evaluation. Internal consistency was measured using Cronbach’s α and the intra- and inter-rater reliability were measured using intraclass correlation coefficient. Concurrent validity was established by calculating Spearman’s rho correlation (ρ) between the eFACE and the House–Brackmann scale (H–B) and Pearson’s correlation (r) between the eFACE and the Sunnybrook Facial Grading System (SFGS).ResultsThe Spanish version of the eFACE showed good internal consistency (Cronbach’s α > 0.8). The intra-rater reliability was nearly perfect for the total score (intraclass correlation coefficient: 0.95–0.99), static score (0.92–0.96), and dynamic score (0.96–0.99) and important-to-excellent for synkinesis score (0.79–0.96). The inter-rater reliability was excellent for the total score (0.85–0.93), static score (0.80–0.90), and dynamic score (0.90–0.95) and moderate-to-important for the synkinesis score (0.55–0.78). The eFACE had a very strong correlation with the H–B (ρ = – 0.88 and – 0.85 for each evaluation, p < 0.001) and the SFGS (r = 0.92 and 0.91 each evaluation, p < 0.001).ConclusionThe Spanish version of the eFACE is a reliable and valid instrument for assessment of facial function in the diagnosis and treatment of patients with facial paralysis.

A case of Bell’s palsy successfully treated with homoeopathy

Bell’s palsy is an acute unilateral facial palsy of the lower motor neuron type predominantly affecting middle aged men. Although exact aetiology is unknown, but probable causes include entrapment of the nerve at the mental foramen and vasospasm due to external factors. Surgical management along with medical management provides an assuring relief for the Bell’s palsy sufferers, may produce adverse effects such as facial nerve palsy or post-surgical synkinesis. Homoeopathic medicines, when selected based on signs and symptoms, act on the vital force dynamically and gently restore the nerve functioning to normal. Here, we present a case of left-sided Bell’s palsy recovered with homoeopathic medicines prescribed on the basis of causation and side affinity. The recovery was assessed by the House Brackmann scale and the quality of life was assessed using the modified Naranjo criteria.

Analysis of Facial Nerve Functionality and Survival Rates of Patients with Parotid Salivary Gland Carcinoma Submitted to Surgery, Facial Nerve Reconstruction, and Adjuvant Radiotherapy

Background and Objectives: Parotid cancer (PC), when treated surgically, may have associated damage to the functionality of the facial nerve. The role of radiotherapy in the recovery of facial motricity remains controversial. This study aimed to evaluate the impact of radiotherapy (RT) on facial nerve functionality in patients who underwent parotidectomy and facial nerve microsurgical reconstruction. Materials and Methods: Four groups of patients were composed: (a) those who underwent parotidectomy without facial nerve reconstruction and RT; (b) those with nerve reconstruction and without RT; (c) those without nerve reconstruction and RT; and (d) those with nerve reconstruction and RT. Results: 49 patients were male, and 43 were female. A total of 89 underwent parotidectomy, 45 partials, and 44 total. Thus, in nine patients, the sural nerve was used for microsurgical reconstruction. Moreover, 48 patients had a normal facial pattern, 15 with paresthesia, and 29 with permanent paralyses after the House–Brackmann (HB) scale evaluation. Conclusions: The evaluation of nerve functionality after parotidectomy by the House–Brackmann scale is a feasible way to evaluate facial motricity that has already decreased in these patients. Finally, longitudinal studies must be performed to clarify the role of each therapy in the multimodal approach and their clinical impact in facial nerve function.

Ocular factors predicting requirement for corneal protective oculoplastic surgery.

Currently there is no universally agreed schema for predicting ocular morbidity in facial nerve palsy. The House Brackmann Scale has limitations in assessing ocular morbidity from facial nerve palsy. Our aim was to create a scoring system to help quantify ocular morbidity to aid in decision making regarding the need for corneal protective oculoplastic surgery. We conducted a large cohort study observing 606 patients attending the specialist facial palsy clinic in Manchester UK between March 2002 and October 2017. Retrospective multivariate analysis identified clinical predictors for the 316 patients that required oculoplastic surgery. β coefficients generated in the multivariate analysis helped formulate a new facial nerve palsy scoring instrument to predict the need for corneal protective oculoplastic surgery. The House Brackmann Scale, corneal lagophthalmos and loss of corneal sensation proved clinically significant predictors for requiring corneal protective oculoplastic surgery. The scoring system derived from these factors provided an accurate and repeatable prediction tool demonstrated by validation studies on our patient population. The area under the ROC curve for the multivariate prediction model was 0.769 (0.726, 0.811). A score of 5 points out of a possible 8 was the best cut off score to recommend oculoplastic surgery, giving a sensitivity of 0.750 and a specificity of 0.671. This study demonstrates that corneal lagophthalmos, corneal sensation and the House Brackmann Scale are important in predicting the need for corneal protective oculoplastic surgery. Our scoring tool is an important clinical decision tool for ophthalmic and ENT colleagues.

Influence of clinical and neurophysiological parameters on the function outcome of the facial nerve after vestibular schwannoma surgery

Introduction: Vestibular schwannomas are benign neoplasms of the nerve seath, and they represent the third most common endocranial tumour, following the meningioma and the pituitary adenomas. The primary symptoms of vestibular schwannomas are hearing loss, tinnitus as well as a balance disorder. The therapy of vestibular schwannoma consists of observation, surgery and radiosurgery. The majority of patients who are good candidates for surgery are already affected by significant hearing impairment, thus one of the primary goals of the surgery is the preservation of facial nerve function. Aim: To analyze the outcome of facial nerve function one-year post-surgery using clinical and neuropsychological parameters. Material and methods: This study analyzed the patient's clinical status on admission along with the neuroradiological characteristics of tumours and the neurophysiological intraoperative parameters and their effect on the facial nerve function in the early postoperative period as well as one year after the surgery using the House–Brackmann scale. Results: A total of 30 patients who underwent surgery from January 1st 2015 to December 31st 2018 at the Clinical Centre of Serbia, Neurosurgery Clinic for vestibular schwannomas were examined. The median age of the patients was 51 years. Hearing loss was present in all patients. Sensitivity drop in the innervation region of n. trigeminus was present in 7 (23.3%) patients, as was tinnitus. Cerebellar symptomatology (76%) was present in the highest percentage of patients. Conclusion: We can conclude that the most important aspects of the facial nerve function are the preoperative state of the facial nerve and the electrophysiological parameters. Although the radical procedure of surgery led to an immediate postoperative outcome, it was not significant for the ultimate outcome of treatment. Thus, radical surgery may be considered to carry the same risk of definitive impairment of the facial nerve function, just like a combination treatment with subtotal resection and stereotaxic radiosurgery.

Deep-plane facelift technique for managing extensive hemifacial tumors: A retrospective study

This study aimed to evaluate functional and aesthetic outcomes in patients undergoing deep-plane facelifts for the management of extensive hemifacial tumors. The retrospective study included patients who had been diagnosed with benign tumors with extensive hemifacial involvement. All patients underwent tumor debulking via a dual-plane facelift approach, assisted by an ICG camera to visualize the facial nerve structures. To manage the laxity of the skin envelope, the deep-plane face-lift was performed by suspending the superficial musculoaponeurotic layer, followed by suture fixation to the parotid-masseteric fascia.Clinical outcomes, including complications, House–Brackmann grading for facial paralysis, and tumor recurrence rate were investigated. Quantitative facial nerve examination was carried out using FACE-gram software (Massachusetts Eye and Ear Infirmary, Boston, USA) to measure mouth corner movement at rest and when smiling. Using preoperative and 1-year postoperative 3D photographs, facial symmetry was assessed using comparisons of facial volume and the root-mean-square deviation (RMSD) value to represent the height difference between each hemiface.In total, 25 patients who met the inclusion criteria were recruited to the study. Regarding the types of tumor, 13 of the 25 patients were diagnosed with vascular lesions and the other 12 with neurofibromatosis plexiform. Following surgery, two patients showed temporary palsy of the buccal branches — grade II on the House–Brackmann scale — but neural functioning was eventually restored during the follow-up period. During resting, the mouth corner excursion ratio was significantly improved, from 1.11 ± 0.19 preoperatively to 1.02 ± 0.08 postoperatively (p = 0.022). The facial volume ratio was significantly improved in the lower face, from 1.57 ± 0.66 preoperatively to 1.19 ± 0.18 postoperatively (p = 0.008). The RMSD was significantly decreased, from 4.56 ± 2.35 mm preoperatively to 2.08 ± 0.99 mm postoperatively (p < 0.001), representing a decrease in facial asymmetry. Within the limitations of the study, it seems that the ICG camera-assisted deep-plane facelift technique allows preservation of facial nerve functioning and enhances facial symmetry when managing extensive hemifacial tumors.

Retrospective study of peripheral facial paralysis in a tertiary hospital over 3 years

PurposeTo identify clinical and epidemiological characteristics of patients with peripheral facial palsy (PFP) at a tertiary care hospital. MethodThis is a retrospective observational study of patients with PFP treated at a tertiary medical center. We gathered demographic data, etiology, laterality, recurrence, recovery, clinical ophthalmology, severity according to the House–Brackmann (HB) scale, electrophysiological tests, medical services attended, medical and surgical treatment. ResultsTwo hundred and eighty-three PFP were included, 135 (48%) were men and 148 (52%) were women p = 0.47). All patients had unilateral involvement. The mean age was 54 ± 20 years. The main etiology was idiopathic in 215 (76%) patients. Median recovery time was 7 weeks. Recovery was complete in 190 (67%) patients. One hundred and seventy (84%) patients with idiopathic PFP had complete recovery, versus 30 (16%) patients with non-idiopathic PFP (p < 0.01). The 84% of patients with HB grade II, recovered completely, while with HB grade VI only 17% recovered (p = 0.003). Two hundred and twenty-nine patients (81%) had lagophthalmos. The majority received ocular surface care treatment in 271 (96%) patients and of these 249 (88%) patients received oral corticosteroid therapy. Thirteen patients (5%) required ophthalmologic surgery. ConclusionsPFP affects all age ranges, without predilection for sex and unilateral. Its main cause is idiopathic. Recovery is complete in most cases, being more favorable in mild and idiopathic affections. Most only require medical treatment.

Estudio retrospectivo de parálisis facial periférica en un hospital de tercer nivel a lo largo de 3 años

PurposeTo identify clinical and epidemiological characteristics of patients with peripheral facial palsy (PFP) at a tertiary care hospital. MethodThis is a retrospective observational study of patients with PFP treated at a tertiary medical center. We gathered demographic data, etiology, laterality, recurrence, recovery, clinical ophthalmology, severity according to the House–Brackmann (HB) scale, electrophysiological tests, medical services attended, medical and surgical treatment. ResultsTwo hundred and eighty-three PFP were included, 135 (48%) were men and 148 (52%) were women (P=.47). All patients had unilateral involvement. The mean age was 54±20 years. The main etiology was idiopathic in 215 (76%) patients. Median recovery time was 7 weeks. Recovery was complete in 190 (67%) patients. One hundred and seventy (84%) patients with idiopathic PFP had complete recovery, versus 30 (16%) patients with non-idiopathic PFP (P<.01). The 84% of patients with HB grade II, recovered completely, while with HB grade VI only 17% recovered (P=.003). Two hundred and twenty-nine patients (81%) had lagophthalmos. The majority received ocular surface care treatment in 271 (96%) patients and of these 249 (88%) patients received oral corticosteroid therapy. Thirteen patients (5%) required ophthalmologic surgery. ConclusionsPFP affects all age ranges, without predilection for sex and unilateral. Its main cause is idiopathic. Recovery is complete in most cases, being more favorable in mild and idiopathic affections. Most only require medical treatment.

Assessing the Efficacy of Anastomosis between Ansa Cervicalis and Facial Nerve for Patients with Concomitant Facial Palsy and Peripheral Neuropathy.

Background: For decades, patients with facial asymmetry have experienced social interaction difficulties, leading them to seek treatment in the hope of restoring facial symmetry and quality of life. Researchers evaluated numerous surgical techniques, but achieving results remains a significant hurdle. Specifically, anastomosis between the ansa cervicalis (AC) and facial nerve (FN) can hinder the patient's physical appearance. Objective: Our study goal was to examine the efficiency of anastomosis between AC and FN for facial motor function recovery even in the presence of peripheral neuropathy. Materials and Methods: Four patients diagnosed with facial palsy grade VI on the House & Brackmann Scale (HB) after vestibular schwannoma (VS) resection (Koos grade IV) via the retrosigmoid approach underwent AC and FN anastomosis. Outcomes were related to tumor grade, previous therapy, and the time between postoperative facial palsy and anastomosis. Images and neurophysiological data were evaluated. Results: After vs. resection, all four patients demonstrated HB grade VI facial palsy for an average of 17 months. During the follow-up program, lasting between 6 and 36 months, two patients were evaluated as having HB grade III facial palsy; the other two patients were diagnosed with grade IV HB facial palsy. None of the patients developed tongue atrophy, speech disorder, or masticatordys function. Conclusions: Anastomosis between the AC and FN is a safe and effective treatment for facial paralysis after cerebellopontine tumor resection. Nerve reanimation may be feasible even for patients with peripheral polyneuropathy. This study also offers a new option for patients with a progression-free status.

Clinical Outcome of Hypoglossal-Facial Nerve Anastomosis in Severe Facial Nerve Paralysis: An Experience from Khyber Pakhtunkhwa

Objectives: Facial nerve injury is one of the most devastating complications occurring as a result of any chemical, mechanical or ischemic insult. This study aimed to determine the surgical outcomes of limited experience in lower motor neuron facial palsy in the last decade.&#x0D; Materials and Methods: A Prospective case series was done at Neurosurgery Department, Prime Teaching Hospital, MTI Lady Reading Hospital, and Irfan General Hospital Peshawar Khyber Pakhtunkhwa Pakistan. Patients were diagnosed after thorough clinical examination and radiological findings; conduction studies these as severe facial paralysis (House and Brackmann 4 – 6). Surgical treatment is done with end-to-end hypoglossal-facial nerve anastomosis. Outcomes and complications were documented. Entered data into specifically designed proforma.&#x0D; Results: Out of 13 patients, who underwent a surgical procedure, 8 were male (61.5%) and 5 patients were female (38.5%). The mean age of presentation was 46 years. Patients were labeled on House and Brackmann scale. Improvement was defined as ? 1 grade improvement on the H&amp;B scale, after 1 year of follow-up, 11 patients improved (84.6%) while 2 (15.4%) remained static. The complication was observed as hemiatrophy of the tongue without physiological weakness.&#x0D; Conclusion: Hypoglossal-Facial nerve anastomosis is recommended treatment for severe facial paralysis, during the first year of insult.&#x0D; Keywords: Facial Nerve Paralysis, Hypoglossal-facial nerve, House &amp; Brackmann.

Prospective Assessment of Risk Factors Influencing Facial Nerve Paresis in Patients after Surgery for Parotid Gland Tumors.

Background and objectives: Facial weakness is the most important complication of parotid gland tumor surgery. The aims of this study are as follows: (1) assessment of the prevalence of postparotidectomy facial nerve dysfunction; (2) clinical and electrophysiological assessment of the facial nerve function before parotidectomy and at 1 and 6 months postoperatively; (3) assessment of the association of postoperative facial palsy with selected risk factors; and (4) assessment of the correlation between the results of clinical and neurophysiological assessments of facial nerve function. Materials and Methods: This study comprised 50 patients (aged 24-75 years) who underwent parotidectomy at the Department of Otolaryngology and Laryngological Oncology in Zabrze, Poland between 2015 and 2017. The evaluation included neurological, clinical and electrophysiological assessments of the facial nerve prior to surgery and at 1 and 6 months postoperatively. Results: No facial palsy was found preoperatively or 6 months postoperatively. Facial nerve dysfunction was found in 74% of patients 1 month postoperatively. In most cases (54%), paresis was mild or moderate (House-Brackmann grades II and III). The results of electrophysiological tests before parotidectomy were either normal or showed some mild abnormalities. We found a statistically significant correlation between the clinical assessment of the facial nerve function (based on the House-Brackmann scale) one month postoperatively and the latency of the CMAP response from the orbicularis oculi and orbicularis oris muscles. In all three studies, a statistically significant correlation was found between the amplitude of the compound muscle action potential (CMAP) of the orbicularis oris muscle and the degree of facial nerve weakness. Conclusions: The factors that may influence the risk of postoperative facial nerve paralysis (prolonged surgical time and the size and location of the tumor other than in the superficial lobe only) may indirectly suggest that surgery-related difficulties and/or surgeon experience could be crucial to surgery safety.

Early reinnervation of facial muscles after removal of large and giant vestibular schwannomas

Removal of large and giant vestibular schwannomas is associated with the risk of paresis of facial muscles. The probability of anatomical damage to the facial nerve is 10.3–14.0%. Treatment of mimic muscle paralysis is one of the most difficult problems in reconstructive surgery. In this study, the results of neurotization of the facial nerve by masticatory were evaluated in 4 patients after its damage during the removal of large and giant vestibular schwannomas. Neurotization was carried out 10–14 days after tumor removal. With direct neurotization of the facial nerve by masticatory in all patients, it was possible to achieve the function of mimic muscles, corresponding to grade II–III according to the House–Brackmann scale. The use of an autoinsert from the greater ear nerve led to a worse result (House–Brackmann IV).

Development of an application for mobile phones (App) capable to predict the improvement of the degree House Brackmann scale in patients suffering from iatrogenic facial palsy

Development of an application for mobile phones (App) capable to predict the improvement of the degree House Brackmann scale in patients suffering from iatrogenic facial palsy

Towards a Reliable and Rapid Automated Grading System in Facial Palsy Patients: Facial Palsy Surgery Meets Computer Science.

Background: Reliable, time- and cost-effective, and clinician-friendly diagnostic tools are cornerstones in facial palsy (FP) patient management. Different automated FP grading systems have been developed but revealed persisting downsides such as insufficient accuracy and cost-intensive hardware. We aimed to overcome these barriers and programmed an automated grading system for FP patients utilizing the House and Brackmann scale (HBS). Methods: Image datasets of 86 patients seen at the Department of Plastic, Hand, and Reconstructive Surgery at the University Hospital Regensburg, Germany, between June 2017 and May 2021, were used to train the neural network and evaluate its accuracy. Nine facial poses per patient were analyzed by the algorithm. Results: The algorithm showed an accuracy of 100%. Oversampling did not result in altered outcomes, while the direct form displayed superior accuracy levels when compared to the modular classification form (n = 86; 100% vs. 99%). The Early Fusion technique was linked to improved accuracy outcomes in comparison to the Late Fusion and sequential method (n = 86; 100% vs. 96% vs. 97%). Conclusions: Our automated FP grading system combines high-level accuracy with cost- and time-effectiveness. Our algorithm may accelerate the grading process in FP patients and facilitate the FP surgeon’s workflow.

Screening diagnostics of emotional distress in patients with facial neuropathy

Patients with facial nerve neuropathy (NLN) are often emotionally labile, inadequately assess the severity of symptoms and prognosis of the disease, have low compliance and motivation for treatment and rehabilitation.The purpose of the study: to develop a screening method for assessing the attitude of a patient with NLN to the disease in order to determine his need for psychological assistance and identify factors affecting compliance and motivation for treatment and rehabilitation.Material and methods: the study included 80 patients with NLN of various genesis who applied during the first 3 months (group 1, n = 37) and 3 months after the onset of symptoms (group 2, n = 43). All patients underwent a neurological examination, an assessment of the severity of NLN on the House–Brackmann scale and were asked to fill out a questionnaire on screening diagnostics of indicators of emotional well-being.Results. In Group 1, the severity of the disease was due to weakness of facial muscles and lagophthalmos, in Group 2 — mainly complications in the form of muscle hypertonia (88.4% of patients) and synkinesias on the affected side (89.2%), while strength partially recovered from 6 [3; 6] to 3 [3; 4] points according to According to the House– Brackmann scale, and the frequency of lagophthalmos decreased by 2 times (from 78.4% to 32.6%). The severity of paresis was not correlated with the severity of emotional disorders (p = 0.607) and the presence of lagophthalmos — 3 [2; 6] versus 4 [2; 8] (p = 0.412). The total score of negative questionnaire responses was higher in patients with complications: muscle hypertonicity — 5 [3; 7] versus 3 [1; 5] (p = 0.033) and synkinesia — 6 [3.5; 7.5] versus 3 [2: 6] (p = 0.010). Moreover, the severity of emotional disorders was associated with the number of complications (p = 0.006). Patients believed that the disease made them less attractive (72.5%), others pay too much attention to the face (46.3%) and changed their attitude (18.8%). Since the acute period of NLN, the mood has changed in 65% of patients. Every second patient believed that the disease divided his life into “before” and “after”, every third answered: “this is the worst thing that happened to me in my life.” In three cases, statements of suicidal thoughts were noted. Patients who sought help in the chronic period of NLN are more dysfunctional in terms of emotional state — the total score of negative responses was 6 [3.5; 3] versus 3 [1; 5] (p = 0.001). A third of the patients were convinced that the main responsibility for recovery lies with doctors, so they are at risk of refusing treatment.Conclusion: in the debut of NLN, every second patient worries about appearance and notes a decrease in mood. Negative thoughts and feelings in patients in the chronic stage of the disease occur in 90% of cases. The developed screening method of psychological assessment of the patient’s attitude to the disease allows to determine the patient’s need for psychological help, to identify indications for consultation with a psychologist or psychiatrist.

Facial nerve function and general outcome of patients operated for cerebellopontine angle tumors in Addis Ababa, Ethiopia, a retrospective study

IntroductionCerebellopontine angle (CPA) tumors consist of 10% of brain tumors. Surgical outcome is measured using functional status and cranial nerve preservation. MethodA hospital based retrospective cross-sectional descriptive study was done between August 31, 2015 and August 31, 2020. Fifty-five patients operated in the study period were enrolled in this study. Our study used House Brackmann Scale and Extended Glasgow Outcome Score. Fisher’s extract test was used to identify factors associated with outcome. P value < 0.05 was considered significant. ResultThe mean age of the study participants was 36.64 years with male predominance (52.7%). Hearing loss (85%) was the commonest presentation. The mean tumor size was 4.4 cms ± 1.02. The tumors were operated through Retro-sigmoid approach without neurophysiologic monitoring. Post-operative CT scan shows GTR in 77.8%. At one year there were 66.7% patients with good facial nerve outcome, 20.8% with acceptable outcome and 12.5% with poor outcome. The post op GOS-E showed GOS-E of 8 in 25.5% and GOS-E of 7 in 23,6% of the patients. The operative mortality was high and predictors of mortality were postoperative infections (P =.003) and pre-operative facial palsy(P <.001) ConclusionOur patients presented with larger tumor sizes. The rate of functional facial nerve preservation was low and the researchers advocate for improved microsurgical techniques and acquiring neuromonitoring to improve outcome. Health facilities evaluating the patients initially should have a systemic approach to diagnose the patients earlier and refer to a capable neurosurgical facility. The overall outcome was acceptable and surgery is a better option for the management of cerebellopontine angle tumors in our set-up.

Advanced Analysis of 3D Kinect Data: Supervised Classification of Facial Nerve Function via Parallel Convolutional Neural Networks

In this paper, we designed a methodology to classify facial nerve function after head and neck surgery. It is important to be able to observe the rehabilitation process objectively after a specific brain surgery, when patients are often affected by face palsy. The dataset that is used for classification problems in this study only contains 236 measurements of 127 patients of complex observations using the most commonly used House–Brackmann (HB) scale, which is based on the subjective opinion of the physician. Although there are several traditional evaluation methods for measuring facial paralysis, they still suffer from ignoring facial movement information. This plays an important role in the analysis of facial paralysis and limits the selection of useful facial features for the evaluation of facial paralysis. In this paper, we present a triple-path convolutional neural network (TPCNN) to evaluate the problem of mimetic muscle rehabilitation, which is observed by a Kinect stereovision camera. A system consisting of three modules for facial landmark measure computation and facial paralysis classification based on a parallel convolutional neural network structure is used to quantitatively assess the classification of facial nerve paralysis by considering facial features based on the region and the temporal variation of facial landmark sequences. The proposed deep network analyzes both the global and local facial movement features of a patient’s face. These extracted high-level representations are then fused for the final evaluation of facial paralysis. The experimental results have verified the better performance of TPCNN compared to state-of-the-art deep learning networks.

P 64 Evaluation of cortical reorganization in patients with facial palsy by navigated transcranial magnetic stimulation (nTMS) and functional MRI

Background: Bell’s palsy develops due to a lesion of the facial nerve and might occur idiopathic, as a result of masses in the cerebello-pontine angle or brainstem or as a result of trauma or surgery. This prospective study aims to evaluate cortical reorganization after facial nerve palsy by means of navigated transcranial magnetic stimulation (nTMS), diffusion tensor imaging (DTI) and resting state functional magnetic resonance imaging (rsfMRI). Methods: The study is based on a prospective patient and healthy subject cohort study. The patient group consist mainly of patients with tumors of the cerebello pontine angle suffering from a postoperative facial nerve palsy. The House & Brackmann scale, and Sunnybrook scale were used to assess the facial nerve function. The cortical excitability of the facial network was determined by navigated transcranial magnetic stimulation (nTMS) with the following parameters: Resting motor threshold (RMT), Recruitment curve (RC), Cortical silent period (CSP) and Motor area. By means of functional and diffusion MRI corticobulbar tract integrity and interhemispheric connectivity were displayed. Results: We present the first results of our ongoing trial. In these two patients we were able to detect a reduced cortical excitability expressed by an increased RMT interhemispheric ration (1,3; 0,6). The facial motor area of the affected hemisphere was reduced in size (218 mm2 vs. 355,1 mm2) and there was a diminished interhemispheric connectivity (pFWE (corr) = 0.03) Conclusion: By better characterization of neuronal recovery, risk groups of patients without clinical improvement can be defined early. This gives this group a better chance to receive early surgical facial nerve reconstruction, therefore resulting in a better functional outcome. Furthermore, evaluation of cortical excitability and representation of the facial motor network after surgery might also display postoperative recovery.