Cases Of Facial Paralysis Research Articles

Preliminary outcomes of endoscopic middle-ear surgery in 103 cases: a UK experience.

Totally endoscopic ear surgery and endoscope-assisted microsurgery are still new concepts, with relatively few centres in the UK performing them. Advantages include better visualisation of difficult to reach areas, such as the sinus tympani, and limited external incisions. This paper reports our short-term outcomes for endoscopic middle-ear surgery. A prospective review was conducted of the first 103 consecutive patients undergoing totally endoscopic ear surgery or endoscope-assisted microsurgery in 1 centre performed by 1 operator. The outcomes assessed were: tympanic membrane healing, audiological data and complications. Twenty-five patients underwent endoscope-assisted microsurgery, while 78 had totally endoscopic ear surgery. There were no reported cases of dead ear or permanent facial nerve palsy. The average air-bone gap following stapedectomy was 7.38 dB. The tympanic membrane healing rate was 89 per cent. Our results confirm that endoscopic middle-ear surgery is safe, and the short-term outcomes are comparable with conventional surgery.

Endoscope-assisted retrosigmoid approach in hemifacial spasm: our experience

IntroductionThe use of surgical decompression of facial hemispasm due to the loop in the internal auditory canal is not always accepted due to the risk related to the surgical procedure. Currently a new surgical technique allows surgeons to work in safer conditions. ObjectiveTo report the results with endoscope-assisted retrosigmoid approach for facial nerve microvascular decompression in hemifacial spasm due to neurovascular conflict. The surgical technique is described. MethodsWe carried out a prospective study in a tertiary referral center observing 12 (5 male, 7 female) patients, mean age 57.5 years (range 49–71) affected by hemifacial spasm, that underwent to an endoscope assisted retrosigmoid approach for microvascular decompression. We evaluated intra-operative findings, postoperative HFS resolution and complication rates. ResultsHemifacial spasm resolution was noticed in 9/12 (75%) cases within 24h after surgery and in 12/12 (100%) subjects within 45 days. A significant (p<0.001) correlation between preoperative historical duration of hemifacial spasm and postoperative recovery timing was recorded. Only 1 patient had a complication (meningitis), which resolved after intravenous antibiotics with no sequelae. No cases of cerebrospinal fluid leak, facial palsy or hearing impairment were recorded. Hemifacial spasm recurrence was noticed in the only subject where the neurovascular conflict was due to a vein within the internal auditory canal. ConclusionsThe endoscope assisted retrosigmoid approach technique offers an optimal visualization of the neurovascular conflict thorough a minimally invasive approach, thus allowing an accurate decompression of the facial nerve with low complication rates. Due to the less invasive nature, the procedure should be considered in functional surgery of the cerebellar pontine angle as hemifacial spasm treatment, specially when the procedure is performed by an otolaryngologist.

A case of facial nerve palsy after sagittal split ramus osteotomy for mandibular advancement

A case of facial nerve palsy after sagittal split ramus osteotomy for mandibular advancement

A case of facial nerve paralysis associated with the isolated styloid process fracture

A case of facial nerve paralysis associated with the isolated styloid process fracture

Facial nerve paralysis as first sign of metastatic breast cancer to the temporal bone

Introduction. Facial nerve paralysis originates from various factors, although in most cases etiology is idiopathic. Temporal bone metastases are quite rare, but should still be suspected in cases when congenital disorders, inflammatory disease, infection or trauma are excluded as cause of facial palsy. We present an unusual case of facial nerve paralysis as the initial sign of temporal bone metastasis of breast carcinoma and discuss diagnostic pitfalls. Case outline. A 70-year-old patient presented with facial nerve palsy, severe otalgia, hearing loss and vertigo. Patient underwent steroid treatment 6 months earlier due to peripheral facial palsy with complete neurological resolution. CT scan revealed osteolytic lesion of the right temporal bone with extension into the parietal bone and soft-tissue. Additional examination confirmed ductal breast carcinoma and osteolysis of the ribs and vertebrae. After four months, the patient with metastatic breast carcinoma to the temporal bone died despite chemotherapy. Conclusion. Temporal bone metastasis of breast cancer is very rare condition with poor prognosis. Late diagnosis and inadequate management of breast cancer are factors that contribute to the temporal bone metastasis formation. Temporal bone metastasis should be excluded in elderly patients, both with and without any history of malignancy, especially in cases of peripheral facial palsy refractory to treatment.

Facial Nerve Palsy after Botulinum Toxin Therapy for Hemifacial Spasm: A Case Report

We herein report a case of left hemifacial spasm (HFS) developed ipsilateral facial nerve palsy 5 days after botulinum toxin type A (BTX-A) injection. Multiple facial muscles presented weakness regardless of BTX-A injection and electrophysiological study revealed left facial nerve palsy. Facial nerve palsy improved completely after 24 weeks. Facial nerve palsy is a common disease and could occur as a coincidence. On the other hand, BTX-A might cause neuropathy in some previously reported cases and our case. Although the pathogenesis of neuropathy following BTX-A injection has not been elucidated, this is the first case of ipsilateral facial nerve palsy following BTXA injection for HFS. Thorough neurological examination and electrophysiological study were useful for distinguishing facial nerve palsy from facial muscles weakness related with botulinum toxin.

Clinical experience in managing temporomandibular joint ankylosis: five-year appraisal in a Nigerian subpopulation.

ObjectivesTemporomandibular joint ankylosis (TMJA) is a joint pathology caused by bony and/or fibrous adhesion of the joint apparatus, resulting in partial or total loss of function.Materials and MethodsThis is a retrospective study conducted between 2012 and 2016 in the northwest region of Nigeria. The data retrieved includes gender, age, etiology of ankylosis, duration of ankylosis, laterality of ankylosis, type of imaging technique, type of airway management, types of incision, surgical procedure, mouth opening, interpositional materials used, and complications. Results were presented as simple frequencies and descriptive statistics.ResultsThirty-six patients with TMJA were evaluated during the study period. There were 21 males (58.3%) and 15 females (41.7%), yielding a male:female ratio of 1.4:1. The patients' age ranged from 5 to 33 years with mean±standard deviation (13.8±6.6 years). Thirty-five cases (97.2%) were determined to be true/bony ankylosis, while only 1 case (2.8%) was false/fibrous ankylosis. Most of the TMJA cases (16 cases, 44.4%) were secondary to a fall. In our series, the most commonly utilized incision was the Bramley-Al-Kayat (15 cases, 41.7%). The mostly commonly performed procedures were condylectomies and upper ramus ostectomies (12 cases each, 33.3%), while the most commonly used interpositional material was temporalis fascia (14 cases, 38.9%). The complications that developed included 4 cases (11.1%) of severe hemorrhage, 1 case (2.8%) of facial nerve palsy, and 1 case (2.8%) of re-ankylosis.ConclusionPlain radiographs, with their shortcomings, still have significant roles in investigating TMJA. Aggressive postoperative physiotherapy for a minimum of 6 months is paramount for successful treatment.

Simultaneous Bilateral Facial Nerve Palsy- Case Series and Review of Literature

Simultaneous bilateral facial paralysis is a rare condition comprising of 0.3-2% of cases of facial palsy and is defined as palsy affecting both sides of the face over a period no longer than 30 days. Usual causes of simultaneous bilateral facial paralysis include Head injuries, Bell’s palsy, Lyme disease, Guillain-Barré syndrome, Sarcoidosis, and Meningitis. A Retrospective case review of patients presenting with simultaneous bilateral facial nerve palsy was carried out over a period of 2 years (May 2010-May 2012). In total, four cases which met the inclusion criteria were selected for evaluation. Of these, two cases were associated with Road traffic accidents; one was diagnosed with Bell’s palsy and one with Sarcoidosis.

A rare neurological complication of Waldenstrom’s Macroglobulinemia

Bilateral and simultaneous facial nerve palsy (FNP) is a rare clinical condition occurring in 0.3–2.0% of facial palsy cases and is typically a manifestation of an underlying systemic disease. We here describe a case of a 67-year-old Hispanic man with a known history of Waldenstrom’s Macroglobulinemia (WM) who presented to the clinic with a sub-acute onset of bilateral facial weakness. No alternate etiology for the facial weakness was identified after a thorough diagnostic approach. WM is a rare hematological condition due to low-grade B cell lymphoma, where lymphoplasmacytoid cells infiltrate different tissues and secrete monoclonal IgM. Peripheral neuropathy develops in 15–30% of the cases, being usually a chronic, progressive, symmetric, predominantly distal polyneuropathy. Facial nerve impairment is unusual; however, it could be caused by anoxic damage as a result of an increased blood viscosity from IgM monoclonal gammopathy, direct nerve infiltration of tumorous cells and an antibody (anti-MAG) mediated demyelinating process. Treatment is directed to the established mechanism for neural injury. This report highlights a rare condition (WM) with a rare complication (bilateral facial nerve palsy) and illustrates the broad differential comprised by this presenting complaint.

Profile of facial palsy in Arar, northern Saudi Arabia

BackgroundThe term facial palsy generally refers to weakness of the facial muscles, mainly resulting from temporary or permanent damage to the facial nerve. Common causes of facial paralysis include infection or inflammation of the facial nerve, head trauma, head or neck tumor, stroke.ObjectiveTo outline the incidence of several etiologies and the profile of patients with peripheral facial paralysis attending the outpatient clinic of the neurology department in Hospitals of Arar City, Saudi Arabia.MethodsThis cross-sectional study was carried out in Arar city from October 2016 to May 2017. The study was conducted in the outpatient clinic of the neurology department in hospitals of Arar City. Any ages of both sexes of all newly diagnosed unilateral facial palsy were included in the study. Data were analyzed by SPSS version 15, using descriptive statistics and Chi-square test. P-value was considered significant if <0.05ResultsThe mean age of the facial palsy cases was 33.65 (±11.71) years. Among the studied participants, the total prevalence of facial palsy was 26.3% (61% females and 39% males). The right side of the face was affected in 51.2% and the etiology was exposure to cold air current in 92.7% of cases. The treatment was physiotherapy in 80.5% of the cases, medical in 17.1% and surgical in 2.4%. There was significant relationship between smoking and the occurrence of facial palsy (p<0.05).ConclusionThe study revealed that facial palsy was common in Arar city. The rate is higher among males than females. We also concluded that exposure to cold air current was the main etiology. We recommend health education sittings to bring awareness to the public about the nature, causes, risk factors, prevention and treatment of the disease.

Effect of modified method of skull closing in microvascular decompression

Objective To investigate the effect of modified method of skull closing in microvascular decompression (MVD) on the incidence of postoperative cerebrospinal fluid (CSF) leakage. Methods We retrospectively analyzed the clinical data of 257 patients who underwent MVD from August 2013 to October 2016 at Department of Neurosurgery, the Affiliated Hospital of Southwest Medical University. Among them, traditional method of skull closing was used in 151 cases before July 2015 and 106 cases received modified method of skull closing after July 2015. The modifications involved aspects including suturing of dual matter, skull reconstruction and suturing of skin. To study the effect, the incidences of CSF leakage and other complications were compared between the traditional and modified groups. Results The surgical effective rates for hemifacial spasm in traditional and modified groups were 91.3%(73/80) and 90.2%(55/61), respectively, and the difference was not statistically significant (P=0.825). The effective rates for trigeminal neuralgia in traditional and modified groups were 85.9%(61/71) and 84.4%(38/45), respectively, and the difference was not statistically significant (P=0.827). The incidences of CSF leakage in traditional and modified groups were 6.6%(10/151) and 0(0/106), respectively, and the difference was statistically significant (P=0.018). The incidence of other complications in traditional group was 10.6%(16/151), which included 6 cases of facial numbness, 2 cases of hearing loss, 2 cases of tinnitus, 5 cases of facial paralysis and 1 cases of intracranial infection. The incidence of other complications in modified group was 9.4%, which included 6 cases of facial numbness, 2 cases of hearing loss and 2 cases of facial paralysis. There was no significant difference in incidence of other complications between two groups (P=0.761). All patients were followed up for 2-23 months, and the median follow-up time was 11 months. Conclusion The modified method of skull closing in MVD could help reduce the incidence of postoperative CSF leakage and may be worthy of further promotion. Key words: Microvascular decompression; Hemifacial spasm; Trigeminal neuralgia; Cerebrospinal fluid leakage

Tympanoplasty without mastoidectomy for active otitis media

Objective:The study aims to assess the effect of tympanoplasty without mastoidectomy for the middle ear under different infected states.Method:One hundred and thirteen cases (113 ears) with chronic otitis media (COM) received tympanoplasty without mastoidectomy. All the patients were found inflammatory proliferative lesions in the mastoid and tympanic antrum via CT scan before surgery and were followed up over 1 year. The patients were placed into the infected ear group (72 ears) and uninfected ear group (41 ears) according to the infective condition. We used SPSS statistical software to analyze the efficacy.Result:Of 113 cases, 92 ears had dry ear canals in 1/2 to 1 month after surgery, and the negative air pressure in the tympanum gradually disappeared in 3-6 months after surgery. Of the 72 ears in the infected ear group, 69 ears had postoperative dry ears, and a large amount of intraoperative purulent secretion was seen in the tympanum in 4 cases, which all had dry ear canals. Three cases had relapse, for a dry ear canal rate of 95.8%. Three ears showed dry tympanic membrane perforations, and effective ears with air-bone conduction differences smaller than or equal to 20 dB accounted for 51.4% of cases. Of the 41 ears in the uninfected group, 40 ears had postoperative dry ears, 1 case had relapse, for a dry ear canal rate of 97.6%. Two ears showed dry tympanic membrane perforations. Effective ears with air-bone conduction differences smaller than or equal to 20 dB accounted for 48.8% of cases. No case of facial paralysis, dizziness, formation of invaginations of the tympanic membrane and cholesteatoma were seen in the patients included in this study during the follow-up visits.Conclusion:Whether there are inflammatory proliferative lesions in the mastoidor not, tympanoplasty without mastoidectomy is feasible for chronic active otitis media. Moreover, different infection statuses of the middle ear do not cause difference in the postoperative relapse rate and hearing improvement.

Resection of pontine cavernous malformations using anterior transpetrosal approach with a preauricular arc incision

Objective To evaluate the surgical method and resection outcomes of cavernous malformations (CMs) using anterior transpetrosal approach with a preauricular arc incision. Methods From June 2011 to December 2015, 48 patients with pontine CMs underwent resection using anterior transpetrosal approach with a preauricular arc incision at Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, The patients' clinical date and surgical outcomes were retrospectively analyzed. Results Among the 48 patients, gross total resection (GTR) was achieved in 44 cases and subtotal resection was performed in the remaining 4 cases. No death occurred in this series. Two patients were reoperated on due to postoperative rebleeding. 48 patients were followed up for a mean of 28.3±8.2 months.All patients with preoperative facial nerve palsy and ocular dyskinesia recovered post surgery, and no new cases of facial nerve palsy were reported. Neurological deficits were improved in 34 patients after operations. Five patients experienced transient aphasia postoperatively. The symptoms of 11 patients remained unchanged following surgery. Three patients' neurological conditions deteriorated after surgery. Conclusions The anterior transpetrosal approach with a preauricular incision could provide adequate exposure for the surgical removal of pontine CMs. Resection through anterior lateral part of the brainstem might cause no serious neurological deficits and severe complications such as the facial nerve palsy could be avoided. Key words: Pons; Hemangioma, cavernous, central nervous system; Microsurgery; Anterior transpetrosal approach

Paralysie faciale bilatérale au cours d’une infection à virus d’Epstein–Barr

Bilateral facial nerve palsy is a rare and sometimes difficult diagnosis. We describe a case of bilateral simultaneous facial nerve palsy associated with Epstein-Barr virus (EBV) infection in a 3-year-old boy. Several symptoms led to the diagnosis of EBV infection: the clinical situation (fever, stomachache, and throat infection), white blood cell count (5300/mm3 with 70% lymphocyte count), seroconversion with EBV-specific antibodies, lymphocytic meningitis, and a positive blood EBV polymerase chain reaction (9.3×103 copies of EBV-DNA). An MRI brain scan showed bilateral gadolinium enhancement of the facial nerve. A treatment plan with IV antibiotics (ceftriaxone) and corticosteroids was implemented. Antibiotics were stopped after the diagnosis of Lyme disease was ruled out. The patient's facial weakness improved within a few weeks. Bilateral facial nerve palsy is rare and, unlike unilateral facial palsy, it is idiopathic in only 20% of cases. Therefore, it requires further investigation and examination to search for the underlying etiology. Lyme disease is the first infectious disease that should be considered in children, especially in endemic areas. An antibiotic treatment effective against Borrelia burgdorferi should be set up until the diagnosis is negated or confirmed. Further examination should include a blood test (such as immunologic testing, and serologic testing for viruses and bacterium with neurological tropism), a cerebrospinal fluid test, and an MRI brain scan to exclude any serious or curable underlying etiology. Facial bilateral nerve palsy associated with EBV is rarely described in children. Neurological complications have been reported in 7% of all EBV infections. The facial nerve is the most frequently affected of all cranial nerves. Facial palsy described in EBV infections is bilateral in 35% of all cases. The physiopathology is currently unknown. Prognosis is good most of the time.

Bilateral facial nerve palsy: challenges in diagnosis

&lt;p class="abstract"&gt;&lt;span lang="EN-IN"&gt;Bilateral facial palsy is a rare condition accounting for less than 2% of all cases of facial nerve palsy. Most of the patients develop bilateral facial nerve palsy secondary to underlying medical condition, which can be neurologic, infectious, traumatic, neoplastic or metabolic disorder. Clinicians should be careful enough to face the diagnostic dilemma and to rule out wide range of differential diagnosis in these cases, some of which can be potentially fatal. Treatment should be initiated according to the diagnosis. We are reporting a case of 26 year old man who presented to our ENT OPD with bilateral facial nerve palsy. The condition could not be attributed to any particular aetiology hence presented a diagnostic dilemma. We endorse the practice of considering wide range of differential diagnosis in all case of bilateral facial nerve palsy. These patients should undergo prompt laboratory and radiological investigations and gruelling evaluation of underlying cause for further specific management.&lt;/span&gt;&lt;/p&gt;

Facial nerve paralysis due to intra aural tick infestation: a case report

Tick infestation in the ear canal may have variable clinical presentations. We present here a case of facial nerve paralysis in a 73 years old lady due to intra aural tick infestation. The patient presented with left otalgia, vertigo and left sided facial asymmetry. The case could be confused with cerebrovascular accident or transient ischemic attack.IMC J Med Sci 2017; 11(1): 29-31

A rare case of concomitant sicca keratopathy and ipsilateral central facial palsy in Wallenberg's dorsolateral medullary syndrome.

Objective: To describe a patient with a right-sided supranuclear facial palsy and concomitant sicca keratopathy of the right eye following right-sided dorsolateral medullary infarction. Methods: Our patient underwent a complete ophthalmologic and neurologic examination including biomicroscopy, fundus examination, cranial nerve examination, Shirmer I test, and magnetic resonance imaging of the brain.Results: A 61-year-old woman presented in emergency with a central facial nerve palsy on the right side and truncal ataxia. Neurologic assessment revealed a concurrent dysphagia, dysarthria, hypoesthesia of the right face, and weakness of the right upper limb. Magnetic resonance imaging of the brain showed an old left-sided cerebellar infarction, but a recent ischemic infarction at the level of the right dorsolateral medulla oblongata was the cause of our patient’s current problems. One month after diagnosis of the right-sided dorsolateral medullary syndrome, there were complaints of ocular irritation and a diminished visual acuity in the right eye. Biomicroscopy showed a sicca keratopathy with nearly complete absence of tear secretion on the Shirmer I test, but with normal eye closure and preserved corneal reflexes and sensitivity.Conclusion: A dorsolateral medullary syndrome can have a variable expression in symptomatology. Our case is special because of the combination of an ipsilateral supranuclear facial palsy with normal upper facial muscle function together with an ipsilateral sicca keratopathy as a result of a nearly absent tear secretion. We hypothesized that the mechanism underlying the patient’s sicca keratopathy ipsilateral to the supranuclear facial palsy involved the superior salivatory nucleus, which is situated in the caudal pons inferiorly of the motor facial nucleus and is most probably affected by a superior extension of the infarcted area in the right medulla oblongata.

Pedicled Temporalis Muscle Flap for Craniofacial Reconstruction: A 35-Year Clinical Experience with 366 Flaps.

In the past 130 years, the temporalis muscle flap has been used for a variety of different indications. In this age of microsurgery and perforator flaps, the temporalis muscle flap still has many useful applications for craniofacial reconstruction. Three hundred sixty-six temporalis muscle flaps were performed in a single center between 1978 and 2012. The authors divided the cases into two series-before and after 1994-because, after 1994, they started to perform free flap reconstructions, and indications for reconstruction with a temporalis muscle flap were changed RESULTS:: In the series after 1994, flaps were most commonly used for reconstruction of defects in the maxilla, mandible, and oropharynx, in addition to facial reanimation and filling of orbital defects. Complications included total flap necrosis (1.6 percent) and partial flap necrosis (10.7 percent). The rate of material extrusion at the donor site decreased after porous polyethylene was uniformly used for reconstruction from 17.1 to 7.9 percent. The pedicled temporalis muscle flap continues to have many applications in craniofacial reconstruction. With increasing use of free flaps, the authors' indications for the pedicled temporalis muscle flap are now restricted to (1) orbital filling for congenital or acquired anophthalmia; (2) filling of unilateral maxillectomy defects; and (3) facial reanimation in selected cases of facial nerve palsy. Therapeutic, IV.

Clinical features and radiological evaluation of otic capsule sparing temporal bone fractures.

To evaluate the clinical and radiological aspects of otic capsule sparing temporal bone fractures. Using medical records, 188 temporal bones of 173 patients with otic capsule sparing temporal bone fractures were evaluated. Otoscopic findings and symptoms, facial paralysis, and hearing loss were assessed. Using regional analysis, 7 fractures were classified as type I, 85 as type II, 169 as type III and 114 as type IV. Fourteen of the 17 facial paralysis cases improved to House-Brackmann grade II or lower at an average of 57.6 days after the initial evaluation. Thirty-one patients underwent initial and follow-up pure tone audiometry examinations. The air-bone gap closed significantly from 27.2 dB at an average of 21.8 days post-trauma to 19.6 dB at an average of 79.9 days post-trauma, without the need for surgical intervention. Initial conservative treatment for facial paralysis or conductive hearing loss is possible in otic capsule sparing fracture cases after careful evaluation of the patient.

顔面や頸部に帯状疱疹を伴った顔面神経麻痺の3例

顔面や頸部に帯状疱疹を伴った顔面神経麻痺の3例