Development Of Facial Palsy Research Articles

Microvascular decompression for hemifacial spasm: Complications after 292 procedures without neurophysiological monitoring.

Hemifacial spasm (HFS) is characterized by involuntary, progressive, and intermittent spasms in the upper and lower facial muscles. Due to the high success rate, microvascular decompression (MVD) is the treatment of choice, and intraoperative neuromonitoring (INM) is considered useful for achieving safe surgery. Still, most centers do not have this technology. We analyzed 294 patients with HFS treated with MVD without INM. We only included patients with a neurovascular etiology while excluding other causes, such as tumors. As part of the postoperative evaluation, we assessed preoperative magnetic resonance imaging and pure-tone audiometry. The main complication was peripheral facial paralysis in 50 patients, followed by hypoacusis in 22 patients and deafness in 17 patients, associated with a failed surgical outcome (P = 0.0002). The anterior inferior cerebellar artery (AICA) was an offending vessel, and the involvement of more than one vessel was significantly associated with the development of facial nerve palsy (P = 0.01). AICA was also associated with hearing impairment (P = 0.04). Over 90% of immediate complications improve in the follow-up (6 months), and one patient did not show a cure for initial HFS. MVD is the method with the highest long-term cure rates for treating HFS; however, we must inquire into the multiple factors of the patient and the surgeon to predict surgical outcomes. INM is not a must during MVD for HFS. We recommend its use depending on the availability and mainly on the surgeon's skills, for surgeons.

Development of facial palsy following COVID-19 vaccination: A systematic review.

ObjectiveReports of facial palsy occurring after the receipt of COVID-19 vaccines have raised concerns but are rare. The purpose of this study is to systematically assess the association between COVID-19 vaccination and facial palsy.MethodsOur systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist and compiled all the reported cases of facial palsy post-COVID-19 vaccination. We discussed the probable pathophysiology behind facial palsy as a consequence of COVID-19 vaccination and measures to be taken for future reference. Furthermore, we conducted a detailed assessment of characteristics, clinical courses, treatment, and recovery of patients with facial palsy after receiving a COVID-19 vaccine.ResultsWe included 37 studies providing data on 58 individuals in our review. Over half (51.72%) of the patients complained of facial paralysis following the Oxford-AstraZeneca vaccination. Out of 51 cases, most (88.24%) occurred after the 1st dose. The majority (53.45%) of cases had bilateral facial palsy. Intravenous immunoglobin (IVIg), corticosteroids, and plasmapheresis were the first line of treatment with 75.93% of patients partially recovered, including those undergoing treatment or a lack of follow-up till the end while 22.22% had complete symptomatic recovery.ConclusionsOur review shows that Bell's palsy can be a plausible non-serious adverse effect of COVID-19 vaccination. However, the association observed between COVID-19 vaccination and Bell's palsy is less threatening than the COVID-19 infection. Hence, vaccination should be encouraged because facial palsy, if it occurs, has shown favourable outcomes with treatment.

Post-operative Complications of Patients Underwent Mastoidectomy at Tertiary Care Hospital

Aim: To analyze the post mastoidectomy complications in patients presenting at tertiary care hospital. Methods: This case series study was conducted at Department of ENT, DG Khan Hospital, DG Khan from March 2020 to September 2020 over the period of 6 months. Total 65 patients came for open cavity mastoidectomy either male or female having age between 20-60 years were selected for this study. Results: In present study 65 patients had undergone open cavity mastoidectomy. Mean age of the patients was 39.95 ± 12.57 years. Out of 65 patients, cavity complications was found in 20 (31%) patients. Among the 20 patients who had cavity problems, the most common problem was prolonged discharge found in 19 (95%) patients followed by accumulation of wax in the cavity was found in 5 (25%) patients, Vertigo persisting beyond the immediate postoperative period was found in 3 (15%) patients, perichondritis of pinna was seen in 1 (5%) patients, development of facial palsy was found in 5 (50%) patients, recurrent cholesteatoma was found in 3 (15%) patients and wound infection was found in 2 (10%) patients. Conclusion: Results of present study showed higher rate of post operative complications after mastoidectomy. Sclerotic mastoid was most common. Higher rate of complications was seen after 40th decade of life. Most of the patients were male as compared to female. Prolonged discharge was the most common problem. Keywords: Mastoidectomy, Cavity, Meatoplasty, Pneumatisation, Cholesteatoma

Retromandibular transparotid approach for subcondylar mandibular fracture: A retrospective study.

The retromandibular transparotid approach provides the shortest and the most direct access to mandibular sub-condylar fractures. However, this approach is less preferred due to the fear of facial nerve injury. The aim of this study was to evaluate the safety and morbidity of the retromandibular transparotid approach for open reduction and internal fixation of sub-condylar mandibular fractures. A retrospective cohort study of 29 patients with 35 sub-condylar mandibular fractures who underwent open reduction and internal fixation through the retromandibular transparotid approach was conducted. The primary study variable was facial nerve palsy, whereas the secondary variables were infection, sialocele, salivary fistula, stability of the fractured segments, post-operative malocclusion, Frey's syndrome, and unesthetic scar. All patients were followed up for 6months. Predictor variables included age, gender, side, location, displacement, etiology, concomitant maxillofacial fractures, and healing status. Fisher's exact test was calculated to find the association between primary variables and predictor variables. Out of 35 sub-condylar fractures (29 patients; 23 male, 6 female), four (11.42%) developed transient facial nerve palsy. Fractures at the condylar neck level (P=.045) and with displacement (P=.026) were significantly associated with the development of facial nerve palsy. Four patients (13.8%) developed slight malocclusion, two had surgical site infections, two developed sialoceles, and one had a salivary fistula. The retromandibular transparotid approach is safe and effective with rare major complications in the management of sub-condylar fractures of the mandible. Condylar neck fractures and displaced fractured segments are associated with an increased risk of development of facial nerve palsy.

Benign parotid mass and facial palsy: systematic review.

Parotid masses causing facial palsy are highly indicative of malignancy. A significant number of cases describing benign parotid disease causing facial palsy have been reported. We performed a systematic review of the literature to establish the aetiology, clinical features, investigations and management undertaken during these presentations to assess how these factors differed from malignant presentations and to establish an evidence-based algorithm for their management. A total of 85 cases were identified from 78 articles. Cystadenolymphomas were the most common histopathological type (p = 0.034). Mean facial palsy recovery duration in neoplastic aetiology was longer than for infective aetiology (p = 0.033). A significant association existed between uncommon infective organisms and development of facial palsy (p = <0.0001). Uncommon benign aetiologies are associated with facial palsy. Investigations and management should be guided by patients' clinical presentations, avoiding excessive treatment. Complete facial palsy recovery rates are high, although not immediate.

Delayed facial palsy in Miller Fisher syndrome

Miller Fisher syndrome is characterised by the triad of ophthalmoplegia, ataxia and areflexia. However, facial palsy can occur during the course of the illness although development of facial palsy when other cardinal signs of Miller Fisher syndrome have reached nadir or improving, is unusual. This delayed appearance of facial palsy can be easily overlooked by the treating clinician. Here, we report four patients with Miller Fisher syndrome and delayed-onset facial palsy. We discuss the possible underlying reasons behind the delay in facial palsy.

Facial nerve palsy: providing eye comfort and cosmesis.

Development of facial nerve palsy (FNP) may lead to dramatic change in the patient's facial function, expression, and emotions. The ophthalmologist may play an important role in the initial evaluation, and the long-term management of patients with new-onset of FNP. In patients with expected temporary facial weakness, no efforts should be wasted to ensure proper corneal protection. Patients with permanent functional deficit may require combination of surgical procedures tailored to the patient's clinical findings that may require good eye comfort and cosmesis.

HN05 AN ANALYSIS OF COMPLICATIONS FOLLOWING SURGICAL TREATMENT OF BENIGN PAROTID DISEASE

The purpose of this study was to review the incidence of and risk factors for, developing complications following parotidectomy for benign disease. In an 11 year period, 162 parotidectomies were performed for benign disease, the commonest being PSA (43%), Warthin’s (30%) and sialadenitis (22%). There were 71 males/91 females, mean age was 58 years and 79% presented with a painless mass of 26 months. 134 patients underwent a superficial parotidectomy and the mean follow‐up was 23 months. Post‐operatively 40% developed a temporary facial palsy, 11% had Frey’s syndrome and 10% developed a salivary fistula. Sialadenitis was a significant risk factor for the development of facial nerve palsy (p &lt; 0.01) and increased the risk of salivary fistulae. Parotid duct ligation increased the risk of nerve palsy in the distribution of the zygomatic and buccal branches. Operations for Warthin’s tumour were associated with an elevated risk of dysfunction of the cervical branch of the facial nerve. Half of the patients had intra‐operative facial nerve stimulation and this uninfluenced the liklehood of facial paresis. The recovery of facial nerve function showed a biphasic distribution, with 90% of patients having normal function within 12 months, followed by a slower recovery rate for up to two years. In conclusion, the incidence of post‐operative complications was influenced by the pathology, with inflammatory lesions significantly increasing the risk of facial nerve dysfunction and other complications, but also by variations in surgical practice, such as parotid duct ligation. Overall, the incidence of permanent facial palsy was under 2%, but a temporary nerve palsy was common at 40%, with most patients regaining normal function within one year of surgery.