Cases Of Facial Paralysis Research Articles

Intraoperative Muscle Electrical Stimulation for Accurate Positioning of the Temporalis Muscle Tendon during Dynamic, One-Stage Lengthening Temporalis Myoplasty for Facial and Lip Reanimation

Facial paralysis is a significant functional and aesthetic handicap. Facial reanimation is performed either by two-stage microsurgical methods or by regional one-stage muscle pedicle flaps. Labbé has modified and improved the regional muscle pedicle transfer flaps for facial reanimation (i.e., the lengthening temporalis myoplasty procedure). This true myoplasty technique is capable of producing a coordinated, spontaneous, and symmetrical smile. An intraoperative electrical stimulation of the temporal muscle is proposed to simulate the smile of the paralyzed side on the surgical table. The intraoperative electrical stimulation of the temporalis muscle, employing direct percutaneous electrode needles or transcutaneous electrical stimulation electrodes, was utilized in 11 primary and four secondary cases with complete facial palsy. The duration of the facial paralysis was up to 12 years. Postoperative follow-up ranged from 3 to 12 months. The insertion points of the temporalis muscle tendon to the nasolabial fold, upper lip, and oral commissure had been changed according to the intraoperative muscle stimulation in six patients of the 11 primary cases (55 percent) and in all four secondary (revisional) cases. A coordinated, spontaneous, and symmetrical smile was achieved in all patients by 3 months after surgery by employing speech therapy and biofeedback. This adjunct intraoperative refinement provides crucial feedback for the surgeon in both primary and secondary facial palsy cases regarding the vector of action of the temporalis muscle and the accuracy of the anchoring points of its tendon, thus enhancing a more coordinated and symmetrical smile.

Post-Traumatic Bilateral Abducens Nerve Palsy and Unilateral Facial Nerve Palsy: A Case Report

Abducens nerve palsy is an unusual sequela of maxillofacial trauma. Unilateral palsy of the abducens has been reported to occur in 1% to 2.7% of all head trauma causes. 1-3 Bilateral abducens nerve palsy is rare and is often associated with intracranial or cervical spine injury. Palsy of the facial nerve in the maxillofacial trauma patient is often seen in association with temporal bone fracture or crush injuries. 4 We describe a case of bilateral abducens nerve palsy and unilateral facial nerve palsy in a maxillofacial trauma patient with a concomitant basilar skull fracture and multiple facial fractures.

Parotidectomy in children: indications and complications

Parotidectomy in children is uncommon, and surgeons face specific challenges not encountered in adult practice. Retrospective review of parotidectomies performed in our paediatric hospital over a 10-year period (1999-2008). Twenty-one children underwent 22 parotidectomies, of which six were total. The following pathology was encountered: atypical mycobacterial infection (8.38 per cent), pleomorphic adenoma (4.19 per cent), lymphatic malformation (2.10 per cent), haemangioma (2 per cent), first branchial cleft anomaly (2 per cent), follicular non-Hodgkin's lymphoma (2 per cent) and lipoblastoma (1.5 per cent). No cases of permanent facial nerve palsy occurred. Mild transient facial nerve palsy occurred in five patients (23 per cent), gustatory sweating in four (19 per cent) and hypertrophic scarring in three (14 per cent). We discuss the range of parotid pathology found in children, the approach to investigation, the surgical difficulties encountered, and ways to reduce the apparently higher rate of complications encountered. Parotid surgery in children should be concentrated in the hands of a small number of surgeons with a particular interest in this area.

Facial nerve decompression via posterior tympanotomy approach in traumatic facial nerve palsy

We managed two cases of facial palsy following trauma, who were decompressed via posterior tympanotomy approach. Both cases improved following surgery. Investigations, surgery and post op management are discussed. We conclude that posterior tympanotomy approach can be used for facial nerve decompression till first genu.

두부 외상 후 발생한 안면마비 및 침골의 유양동내로 전위 1예

두부 외상 후 발생한 안면마비 및 침골의 유양동내로 전위 1예

Herpes zoster oticus: A rare clinical entity

Herpes zoster oticus also known as Ramsay Hunt syndrome is a rare complication of herpes zoster in which reactivation of latent varicella zoster virus infection in the geniculate ganglion causes otalgia, auricular vesicles, and peripheral facial paralysis. Ramsay Hunt syndrome is rare in children and affects both sexes equally. Incidence and clinical severity increases when host immunity is compromised. Because these symptoms do not always present at the onset, this syndrome can be misdiagnosed. Although secondary to Bell's palsy in terms of the cause of acute atraumatic peripheral facial paralysis, Ramsay Hunt syndrome, with incidence ranged from 0.3 to 18%, has a worse prognosis. Herpes zoster oticus accounts for about 12% cases of facial palsy, which is usually unilateral and complete and full recovery occurs in only about 20% of untreated patients. The most advisable method to treat Ramsay Hunt syndrome is the combination therapy with acyclovir and prednisone but still not promising, and several prerequisites are required for better results. We present a case of 32-year-old man suffering from Ramsay Hunt syndrome with grade V facial palsy treated effectively with rehabilitation program, after the termination of the combination therapy of acyclovir and prednisone.

ブロー液耳浴後の顔面神経麻痺例

ブロー液耳浴後の顔面神経麻痺例

Sequelae of peripheral facial palsy

Introduction and objectivesOur purpose was to study functional sequelae after peripheral facial palsy (PFP) and to analyse its impact and relationship with the degree of facial nerve dysfunction, from the neurophysiological point of view. Material and methodsWe present a retrospective study that covers a total of 150 cases of peripheral facial palsy. All patients underwent electroneurography and electromyography to establish the degree of axonal damage and to evaluate the existence of signs of reinnervation in the muscles explored or possible innervation errors. ResultsOf the patients studied, 31.9% (46) had sequelae; 67.4% (31) were women, a statistically significant result (P=.031). Of all the sequelae, the most frequent was myokymia, which appeared in 24% (36) of the cases. Patients with left side involvement presented a higher number of sequelae (40.3%, 27 cases) with a statistically significant difference (P=.05). The average rate of axonal injury on first visit by patients who subsequently developed sequelae was 75.26%; worse results on electroneurography were statistically associated with the onset of sequelae (P=.007). Electromyography of patients with sequelae shows that a greater degree of denervation could be considered a risk factor for the occurrence of sequelae (P=.039). Discussion/conclusionsIn our study, we found that sequelae are more frequent after facial palsy when there is significant axonal loss. This study shows other risk factors not mentioned in the literature as yet, such as female gender and left-side involvement

Secuelas de las parálisis faciales periféricas

Introduction and objectivesThe purpose of this work is to study the functional sequelae after peripheral facial palsy (PFP) to analyze its impact and relationship with the degree of facial nerve dysfunction, from the neurophysiological point of view. MethodsWe present a retrospective study which includes a total of 150 cases of peripheral facial palsy. All patients underwent electroneurography and electromyography to see the degree of axonal damage and to evaluate the existence of signs of reinervation in the muscles explored or possible innervation errors. ResultsOf the patients studied, 31.9% (46) had sequelae; 67.4% (31) were women, a statistically significant result (P=.031).Of all the sequelae, the most frequent was miochymia which appeared in 24% of cases (36).Patients with left side involvement presented a higher number of sequelae (40.3%, 27 cases) with a statistically significant difference (P=.05).The average rate of axonal injury on first visit by patients who subsequently developed sequelae was 75.26%; worse results on electroneurography were statistically associated with the onset of sequelae (P=.007).Electromyography of patients with sequelae shows that a greater degree of denervation could be considered a risk factor for the occurrence of sequelae (P=.039). Discussion/conclusionsIn our study we found that sequelae are more frequent after facial palsy when there is significant axonal loss.This work shows other risk factors so far not mentioned in the literature, such as female gender and left-side involvement.

Facial nerve decompression for idiopathic Bell's palsy: report of 13 cases and literature review

The prognosis for cases of idiopathic facial palsy is usually good. However, some cases develop disabling sequelae, such as synkinesis or severe facial hemispasm, despite targeted medical treatment. The authors try to achieve that electromyography is useful to identify patients with severe palsy and an unfavourable prognosis. These patients would probably benefit from facial nerve decompression. The otolaryngology-head and neck surgery department of Pitié-Salpêtrière Hospital, Paris, a tertiary referral centre. Thirteen cases undergoing surgery between January 1997 and March 2007. We describe the electromyographic findings that led to surgery. All patients underwent surgery via a subpetrous approach, within four months of the onset of palsy. Decompression involved the first and second portions of the nerve and the geniculate ganglion. Recovery to House-Brackmann grade III was obtained in all cases at one year follow up. These results compared favourably with previous reports. A new therapeutic procedure may allow improved results.

VINCRISTINE INDUCED NEUROTOXICITY: STUDY OF 75 CASES

Objective Concern for side-effects of therapy related to treatment of childhood malignancies is becoming an increasingly important topic. In this study, we evaluated extent of vincristine (VCR) induced neurotoxicity in a group of children who underwent chemotherapy, with VCR being part of the regimen. Materials & Methods In this investigation, for 75 children (54% boys, 46% girls), aged between 1 to 14 (mean 6.5±4.3) years, serial weekly neurological examinations were performed; of the 75, 70 had acute lymphoblastic leukemia and 5 Wilm's tumor. All patients were on a chemotherapy protocol of at least 4 consecutive VCR (1.5mg/m2) injections. Results Decreased deep tendons reflexes were seen in the Achilles reflex in 78%, and the patellar reflex in 53% of patients. Muscle weakness was found in 70% of patients, being mild in 76% of them. Four percent of patients showed severe weakness. Petosis, jaw pain, hoarseness, abdominal pain and constipation were seen in 15%, 6%, 12%, 12% and 12% respectively. Paresthesia was observed in 32 of 52 patients, over 4 years old. No cases of foot drop, urinary retention or facial nerve palsy were seen in this patient group. Conclusion Children on usual doses of vincristine regimen may have neuropathic side effects but most of these side effects are mild and not troublesome.

Clinical study clinical observation on treatment of facial paralysis by mild moxibustion

To observe the clinical effect of mild moxibustion for facial paralysis. One hundred cases of facial paralysis were divided randomly into two groups: 50 cases in the treatment group were treated by mild moxibustion, and 50 cases in the control group were treated by oral administration of Cobamamide Tablets. With ten days as one course of the treatments, two courses of the treatments were given. The therapeutic effects were assessed four weeks after treatments. The total effective rate was 96.0% in the treatment group and 88.0% in the control group, and there was statistical difference in the therapeutic effects between the two groups (P<0.05). The therapeutic effect of mild moxibustion for facial paralysis is better than oral administration of Cobamamide Tablets.

Facial Nerve Palsy in Neonates Secondary to Forceps Use

To characterize the presentation, treatment, and outcome of neonates presenting with facial nerve palsy resulting from forceps use. Retrospective medical chart review. Two tertiary care pediatric hospitals. Neonates with facial nerve palsy caused by forceps use born during the period of April 1, 1989, to April 1, 2005. Resolution of facial nerve palsy. Twenty-eight cases of facial nerve palsy caused by forceps use were identified. The palsy was classified as mild to moderate according to the House-Brackman scale. Except in 1 neonate, no treatment was initiated in any of the patients. All 21 neonates with adequate long-term follow-up recovered fully after an average period of 24 days. Because facial nerve palsy caused by forceps use is generally mild and is associated with a favorable outcome, treatment with corticosteroids or surgery is generally not required.

Treatment of 96 cases of facial paralysis by acupuncture

Treatment of 96 cases of facial paralysis by acupuncture

A Case of Facial Palsy Following Tooth Extraction

Facial palsy following tooth extraction is rare and its mechanism is unclear. Possible mechanisms are direct anesthesia of facial nerve, compression and ischemia of facial nerve during edema, neurotoxicity of local anesthetic solution, viral reactivation and ascending infection. Viral reactivation and ascending infection are most likely mechanisms among them. Therefore, it is important to use an antiviral agent combined with steroid for treatment of dental origin facial palsy. We report our recent experience with one case of facial palsy that followed tooth extraction.

Transient facial nerve palsy after general anesthesia: A case report.

A 44-year-old woman underwent a breast cancer operation under general anesthesia. We performed bronchoscope guided intubation along with a jaw thrust maneuver on the patient to achieve a good visual field. The patient complained of left lower lip weakness after the operation. The lower lip of the patient was deviated to the right. The cause might have been a temporary compression of the left facial nerve at the mandibular angle during performance of the jaw thrust maneuver. Fortunately, the patient's palsy recovered completely during the following one month. We report here on a case of transient facial nerve palsy after general anesthesia, and this occurred despite performing a very short duration of jaw thrust.

Facial paralysis after superselective intra-arterial chemotherapy via the middle meningeal artery in maxillary cancer

Previous studies have suggested that the severity of facial paralysis after superselective intra-arterial chemotherapy (SSIAC) is usually mild. Here we present two cases of facial paralysis after SSIAC via the middle meningeal artery (MMA). In case 1, the patient completely recovered from his facial paralysis (to H-B grade I) in 6 months after the onset of paralysis. However, in case 2, his facial movement remained at House-Brackmann (H-B) grade IV with severe synkinesis. We must be careful that SSIAC via the MMA may potentially increase the risk of facial paralysis.

Reliability and Complications of 500 Consecutive Cochlear Implantations

To assess device failures as well as early postoperative, late postoperative, and medical complications occurring after cochlear implantation and to discuss their causes and treatments. Retrospective study of 500 consecutive cochlear implantations. Tertiary referral center. All patients receiving cochlear implants at our institution between 1989 and 2006. All complications and treatments were systematically reviewed with a maximum follow-up of 18 years. The number of reimplantations was calculated according to follow-up duration to determine the cochlear implant survival rate. Specific risks of reimplantation were calculated for groups with differing durations of implantation. The overall rate of complications was 16.0% (79 of 500), with minor complications accounting for 5.6%; major complications, 3.2%; and reimplantations, 7.2%. Reasons for revision surgery were device failure, infection, trauma, and "soft device failure" (failure despite normal results from integrity testing). Revision surgery was performed in 51 of the 500 cases (10.2%), and other complications were managed medically (28 of 500; 5.6%). The rate of hard and soft device failures was 6% (30 of 500). Seventy-two percent of reimplantations occurred within 5 years. The risk of severe infection (eventually requiring explantation) was 1.4% (7 of 500). There was 1 case of transient facial palsy following surgery (0.2%), and the incidence of postsurgical meningitis was 0. Cochlear implantation is a safe technique with a relatively low complication rate; however, certain complications may require specific attention to prevent or correct them.

Microvascular decompression as a surgical management for trigeminal neuralgia: long-term follow-up and review of the literature

This retrospective study summarizes our experience based on treating 62 patients with trigeminal neuralgia treated with microvascular decompression. All patients had typical trigeminal neuralgia symptoms, with 24 of them (38%) having failed to benefit from other previous treatment paradigms. We excluded subjects with atypical and/or secondary forms of trigeminal neuralgia. Follow-up duration ranged from 5 months to 10 years 6 months, with recurrence being identified in three patients (4.8%).We found that the superior cerebellar artery is the leading offending vessel in our cases (33.9%; 21 patients). Interestingly, seven patients (11.3%) underwent an early reoperation 12-48 h later after the first operation was deemed ineffective. This subgroup recovered satisfactorily following isolation of the pathogenic vessels. Overall, no mortality was observed in our patients, and the only permanent morbidity outcome was a case of facial nerve palsy (1.6%). We conclude that microvascular decompression and its reapplicaiton for patients who showed no pain relief immediately after the first decompression are safe and effective treatments for trigeminal neuralgia.

Facial Nerve Palsy Complicating Kawasaki Disease

The diagnosis of Kawasaki disease, the most common cause of pediatric acquired heart disease, is difficult and often delayed for children whose age falls outside the typical range of 6 months to 5 years, especially in those with incomplete Kawasaki disease and atypical features. Delayed diagnosis is associated with an increased incidence of coronary artery pathology. Here we describe 2 cases of lower motor neuron facial nerve palsy complicating Kawasaki disease. In both cases the diagnosis of Kawasaki disease was not made acutely, and both patients developed extensive coronary artery lesions. These cases highlight the importance of considering Kawasaki disease in children with unexplained prolonged fever at any age, particularly those without full diagnostic criteria and with unusual features.