Facial Paresis Research Articles

Facial nerve palsy due to a parotid abscess: Two case reports and a review of literature.

Introduction and importanceParotid gland swelling with facial nerve palsy is highly suggestive of a malignancy. Facial nerve palsy is however rarely caused by a parotid abscess. We hereby present two cases, propose treatment and present a review of the literature.Case presentation and clinical discussionOne 75-year-old female and one 81-year-old female presented with a facial nerve paralysis, both caused by a parotid gland abscess. Broad-spectrum antibiotics and incision and drainage was commenced in both cases. Both patients showed good clinical improvement, however, without facial nerve improvement. Magnetic resonance imaging (MRI) scans showed no malignancies at presentation nor during follow-up after one year.ConclusionFacial nerve palsy is rarely caused by a parotid abscess. Incision and drainage in combination with antibiotic treatment is recommended. Chances of facial nerve recovery seem somewhat higher in patients with facial nerve paresis than those with a paralysis.

Facial Paresis and Pulsatile Middle Ear Mass.

Head and neck paragangliomas are uncommon pathologies that present with common symptoms such as pulsatile tinnitus and aural pressure. This article highlights an unusual presentation of a patient with facial paresis who was found to have a jugular paraganglioma. Emphasis is placed on how the otologic examination showed a pulsatile middle ear mass that led to the diagnosis. This case illustrates the importance of maintaining a healthy degree of clinical suspicion when encountering common complaints.

Short- and Long-term Patient Satisfaction and Complications in 650 Endoscopic Forehead Lift Procedures.

The aims are to compare short- versus long-term patient satisfaction and report temporary versus permanent complications in 650 patients with endoscopic forehead lift procedure (EFL). This is a retrospective study on all of the consecutive patients with EFL. Patients with previous trauma and surgery and less than 2 years follow up were excluded. Short- (6 months) and long-term (≥2 years) patient satisfaction (visual analog score [VAS], 0-100) were recorded. Patients' perspectives on temporary versus permanent complications were also documented. Mean age and follow up were 46.4 and 7.1 (2-13) years, respectively. Long-term satisfaction (79.9) was significantly lower than the short term (96.6). The long-term satisfaction decreased in 95.7%, increased in 2.7%, and remained the same in 1.6% of the patients. Intraoperative skin laceration occurred in 3 patients (0.5%). Mean time of forehead numbness recovery was 2.3 months. Temporary complications were itching (13.7%), headache (6.3%), unilateral facial nerve palsy (5.8%), acne (3.2%), and remained staples (1.7%). Permanent complications included undercorrection (7.1%), alopecia (4.2%), forehead irregularities (2.3%), surprised look (2.2%), incision site complications (2%), and glabellar depression (0.9%). Reoperation (1.2%) was performed for undercorrection and alopecia. While short-term satisfaction was significantly lower in patients with temporary facial nerve paresis, long-term satisfaction was lower in patients with undercorrection and reoperation. A high satisfaction scores of 96.6 and 80 were observed in the short- and long-term follow up after the EFL. Frequency of temporary and permanent postoperative complications was 30.3% and 15.8%. Reoperation rate was 1.2%.

Primary non-Hodgkin's lymphoma of the temporal bone

We present a 6-year-old child, hospitalized in MSPI Institute of Mother and Child, Emilian Coţaga Clinic, Pediatric Otorhinolaryngology Department, Chisinau, Republic of Moldova, with primary non-Hodgkin’s lymphoma (NHL) of the temporal bone, with paresis of facial nerve.

Chronic inflammatory demyelinating polyneuropathy with hypoglossal nerve involvement and inverted Beevor\u2019s sign: case report

BackgroundCranial nerve involvement is not commonly encountered in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP); this is especially true for involvement of the hypoglossal nerve. Neither Beevor's sign nor its inverted form has previously been described in CIDP.Case presentationA 28-year-old man presented with distal-predominant limb weakness and numbness at the age of 18. A diagnosis of CIDP was made, which was confirmed by electrodiagnostic evidence of demyelination. He responded well to intravenous immunoglobulin and glucocorticoid treatment and achieved remission for 5 years. However, the same symptoms relapsed at the age of 28 and lasted for 10 months. On examination, in addition to limb sensory impairment and muscle weakness, mild bilateral facial paresis, tongue atrophy and fasciculations, and inverted Beevor's sign were also observed. A brief literature review of cranial nerve involvements in CIDP and Beevor's sign or its inverted form were also performed.ConclusionsCranial nerves may be affected in patients with CIDP. Facial palsy is most frequently present, while hypoglossal nerve involvement is rare. Inverted Beevor's sign can appear in CIDP patients.

Two-handed endoscopic ear surgery: Feasibility for stapes surgery

ObjectiveEndoscopic ear surgery is becoming an increasingly popular approach. Our aim in this study is to evaluate the feasibility of the two-handed endoscopic technique for stapes surgery, which has its own unique steps. MethodsPatients who underwent two-handed endoscopic stapes surgery between September 2017 and February 2018 were included in this study. Preoperative and postoperative pure tone averages and air bone gaps, intraoperative complications were recorded. All procedures were performed under hypotensive general anesthesia by the same surgeon using 0° rigid endoscopes of 2.7-mm diameter, 14-cm length with an endoscope holder. ResultsSeven endoscopic two-handed stapes surgery were performed between September 2017 and February 2018. Of these, six patients were operated entirely endoscopically because one patient was found to has perilymph gusher and converted to microscopic surgery. There were no intraoperative tympanic membrane injuries, facial nerve paresis or sensorineural hearing losses. The average preoperative ABG of patients who underwent fully endoscopic surgery was 31.3 dB, and the postoperative ABG closed up to 9.6 dB. ConclusionsAdoption of the two-handed technique during endoscopic stapes surgery ensures the surgeon benefits from the advantages of endoscopy while overcoming the disadvantages of the one-handed technique.

Complications of facial cosmetic botulinum toxin A injection: analysis of the UK Medicines & Healthcare Products Regulatory Agency registry and literature review

Botulinum toxin A (BoNT-A) injection is one of the most frequently undertaken procedures in aesthetic medicine. The Medicines & Healthcare products Regulatory Agency (MHRA) is the government body in the United Kingdom (UK) mandated to ensure that the provision and administration of medicines is safe. We analyzed adverse events of facial cosmetic BoNT-A injections reported to the MHRA and assessed whether the incidence of reported adverse events in this government registry is comparable to published retrospective and prospective studies. A freedom of information (FOI) request was submitted to the MHRA to obtain recorded complications of BoNT- A. Complications reported to the MHRA between 1991 and 2020 were analyzed. Only cases with BoNT-A where the indication was specified as for facial cosmetics were included in the analysis. Additionally, the literature was reviewed on adverse events of facial cosmetic BoNT- A injections, and a statistical meta-analysis of complication rates was carried out. A total of 188 adverse events of aesthetic BoNT-A injections were reported to the MHRA. The literature search resulted in 30 studies and a total of 17,352 injection sessions, where the complication rate was 16% (95% CI=8% to 25%). Frequent adverse events included localized skin reactions such as bruising with an incidence of 5% (95% CI=3% to 7%), headache in 3% (95% CI=from 1% to 5% ), and facial paresis in 2% (95% CI=1% to 3%) of injection sessions. This is the first paper to obtain and evaluate data on adverse events of BoNT-A from the MHRA. An estimate of the likely complication rate of aesthetic BoNT-A in the UK, according to the MHRA database, is significantly lower than the rate recorded from our meta-analysis of the international literature. This suggests that the MHRA may be underestimating the adverse events of aesthetic BoNT-A treatment, which would have implications for patient safety and informed consent. Therefore, legislative changes may be required to ensure more robust reporting of aesthetic BoNT-A in the UK.

POST COVID-19 NEUROLOGICAL SYNDROME (PCNS) IN AN 11 YEARS OLD BOY, A CASE REPORT

By now more than 92.6[1] persons have been reported to be infected with COVID-19, of which significant part are children. Although children experience milder symptoms compared with adults at the time of the infection, cases of post-covid-19 complications have been reported (2, 3, 4, and 5). Complications might also include the CNS, in our case with cerebellar ataxia-like and polyneuritislike signs and symptoms. A 13 year old boy was presented in our clinic with signs of ataxia, occasional vomiting, impaired gait, impaired patellar reflexes on the right leg, incomplete Babinski reflex on the right leg, paresis of the left facial nerve and mild hypertension. Based on the clinical appearance and the parameters that showed past COVID-19 infection, a diagnosis of Post-COVID19 Cerebellar Ataxia-like and Polyneuritis-like was made, meaning a Post Covid-19 Neurological Syndrome (PCNS). Treatment was conducted with antibiotics and immunoglobulins resulting in significant improvement in the following days. There are few reported cases about neurological complications caused by COVID-19 in children and adolescents, without any other symptoms of the virus. This is one of the first cases of PostCOVID19 Cerebellar Ataxia and Polyneuritis in a child as a result of COVID-19 and the first case in our country. Keywords: Post-COVID19 complications, Post Covid-19 Neurological Syndrome, cerebellar ataxia, polyneuropathy, children

Facial nerve preservation in stereotactic radiosurgery of tumors of the cerebellopontine cistern

Introduction. Surgery has traditionally remained the main treatment for tumors of the cerebellopontine cistern but is associated with high risks of dysfunction of the cranial nerves. Radiosurgery is usually performed both as an adjuvant treatment and as an independent option.The study objective is to assess the safety of routine use of radiosurgery to preserve facial nerve function in the treatment of tumors of different origins located in the cerebellopontine cistern.Materials and methods. Since March 2018 to March 2020 there were 145 patients with tumors of cerebellopontine cistern (CPC) at the Center for High-Precision Radiology. Vestibilar schwannomas were detected in 116 (80 %) patients, in 37 cases - relapses or remains after surgery. The 22 patients had meningiomas, 6 after open surgery (WHO I). Trigeminal schwannomas - in 3 patients, facial schwannomas - in 2, jugular schwannomas - in 1 and metastasis of prostate cancer - in 1. 31 patients had facial paresis of different degrees after previous surgery. Among non-operated patients, facial paresis before radiosurgery was observed in only 1 patient. Radiosurgery was performed using the Leksell Gamma Knife Perfexion, the mean marginal dose was 12.2 Gy (11-15 Gy), the mean tumor volume was 3.98 cm3 (0.06-17.47 cm3).Results. Follow-up was performed in 85 patients. The mean follow-up was 359.3 days (91-776), the median follow-up was 367 days. Reduction of the tumor volume was detected in 27 patients, stabilization of the process in 15. The average decrease was 23.9 % (95 % CI 16.8-31.0 %). Transient postirradiation increase was observed in 30 patients only in the group of schwannomas and mean tumor volume increase was 53.7 % (95 % CI 38.5-68.9 %). In patients with previous surgery there were not cases of decline or regression facial paresis. Among patients who had not been operated on before radiosurgery, only in 1 case was the development of facial paresis (House-Brackman III) 5 months after irradiation, which amounted to 1.8 %. It should be especially noted that facial nerve function remained unchanged (House-Brackman I) in both patients with facial schwannomas. Also, not a single case of hemifacial spasm was identified.Conclusion. Radiosurgery of CPC tumors with a marginal dose from 12 to 15 Gy has a high degree of safety in relation to the facial nerve. This makes it possible to justify radiosurgery as alternative to traditional neurosurgical interventions.

The course of facial corticobulbar tract fibers in the dorsolateral medulla oblongata

BackgroundThe course of the corticobulbar tract (CBT) to the facial nucleus has been investigated by some previous studies. However, there are some unclear points of the course of the CBT to the facial nucleus. This study aimed to elucidate the detailed course of the CBT to the facial nucleus through the analysis of lateral medullary infarction (LMI) cases.MethodsThe neurological characteristics and magnetic resonance imaging findings of 33 consecutive patients with LMI were evaluated. The location of the lesions was classified rostro-caudally (upper, middle, or lower) and horizontally. Further, we compared the neurological characteristics between the groups with and without central facial paresis (FP).ResultsEight (24%) patients with central FP ipsilateral to the lesion were identified. Dysphagia and hiccups were more frequently observed in the group with central FP than in the group without central FP. In patients with central FP, middle medullary lesions and those including the ventral part of the dorsolateral medulla were more frequently observed. Contrastingly, patients with lesions restricted to the lateral and dorsal regions of the dorsolateral medulla did not present with central FP.ConclusionThe results of this study indicate that the CBT to the facial nucleus descends with the corticospinal tract at least to the middle portion of the medulla, and then ascends to the facial nucleus through the medial and ventral areas of the dorsolateral medulla after decussation.

English

BACKGROUND Salivary gland diseases are rare but an important group of disorders. Following surgeries involving the parotid gland, facial nerve paresis is a common postoperative complication. The reported worldwide incidence of facial nerve paresis following parotidectomy is approximately 20 - 60 %. We need to determine the incidence of facial nerve paresis in the post-operative period following superficial, adequate, or extra-capsular parotidectomy of benign parotid tumours with the use of intraoperative facial nerve monitoring. METHODS A non-randomised interventional trial was initiated once cleared by the institutional review board. With the calculated sample size of 44, the patients underwent nervemonitoring for the identification of the branches of the facial nerve. Clinical grading of the nerve function was done using the House-Brackmann score on the postoperative days 2, 7, and 60. The findings were compared with the historical controls (HC) of 53 patients who underwent similar procedures but with no intraoperative facial nerve monitoring. All patients were recruited in continuity for over two years. RESULTS The incidence of facial nerve paresis was 30 - 40 % and 10 - 20 % in the historical control and nerve monitoring group, respectively (P = 0.07). The duration of surgery in the nerve monitoring group was 83 ± 30 minutes and 95 ± 15 minutes in the HC group. The incidence of nerve paresis was similar among the trainees and consultants suggestive of adequate training. CONCLUSIONS Intraoperative facial nerve monitoring is a useful adjunct to reduce the incidence of early postoperative facial nerve paresis. The technique would not prolong the duration of the procedure. The technique may be utilized safely on a routine basis even during surgical training. KEYWORDS Facial Nerve Monitoring, Parotidectomy, Benign Parotid Tumour, HouseBrackmann Score

Chirurgická léčba benigních nádorů příušní žlázy na ORL oddělení Nemocnice České Budějovice, a.s., v letech 2014–2018

ntroduction: Salivary tumors represent a heterogeneous group of tumors of diverse location, histological structure and bio logical behavior. The purpose of this study was a retrospective evaluation of surgical treatment of a group of patients with newly dia gnosed benign tumors of the parotid salivary gland operated in the years 2014–2018 at the ENT department of Hospital České Budějovice, a.s. Material and methods: A type of surgery, defi nitive histology, postoperative complications and a number of recurrences were monitored. The data were evaluated by descriptive statistical methods. Results: A total of 190 surgeries with benign histological fi ndings in 182 patients were performed. The most common benign result was Warthin‘s tumor (90 cases, 47.4%), followed by pleomorphic adenoma (66 cases, 34.7%). Uncommon histological types of tumors were dia gnosed in 14 patients (7.4%). Non-tumorous fi ndings were found in 20 cases (10.5%). The most frequently performed procedure in 84 cases (44.2%) was extracapsular extirpation. Transient lesion in the area of innervation of the temporofacial and / or cervicofacial branch of the facial nerve was present in 34 (17.9%) patients. Permanent paresis of some of the branches of the facial nerve was reported in 2 (1.1%) patients. In 12 patients, the postoperative course was complicated by the development of salivary fi stula (6.3%). Pleomorphic adenoma relapsed after extracapsular extirpation in 5 cases (20.0%). After partial parotidectomy, one recurrence of pleomorphic adenoma (3.6%) was recorded. Warthin‘s tumor relapsed after simple extirpation in 4 cases (20.0%). Conclusion: Our evaluation results of the surgical treatment of benign parotid gland tumors lead us to make further eff orts improve the care of our patients. We see reserves mainly in the routine use of ultrasonographic examination with performance FNAC and thus planning a safe and suffi ciently radical operational solution. Keywords: parotid gland – pleomorphic adenoma – Warthin‘s tumor – parotidectomy – recurrence – facial nerve paresis – FNAC

Advanced Statistical Analysis of 3D Kinect Data: A Comparison of the Classification Methods

This paper focuses on the statistical analysis of mimetic muscle rehabilitation after head and neck surgery causing facial paresis in patients after head and neck surgery. Our work deals with an evaluation problem of mimetic muscle rehabilitation that is observed by a Kinect stereo-vision camera. After a specific brain surgery, patients are often affected by face palsy, and rehabilitation to renew mimetic muscle innervation takes several months. It is important to be able to observe the rehabilitation process in an objective way. The most commonly used House–Brackmann (HB) scale is based on the clinician’s subjective opinion. This paper compares different methods of supervised learning classification that should be independent of the clinician’s opinion. We compare a parametric model (based on logistic regression), non-parametric model (based on random forests), and neural networks. The classification problem that we have studied combines a limited dataset (it contains only 122 measurements of 93 patients) of complex observations (each measurement consists of a collection of time curves) with an ordinal response variable. To balance the frequencies of the considered classes in our data set, we reclassified the samples from HB4 to HB3 and HB5 to HB6—it means that only four HB grades are used for classification algorithm. The parametric statistical model was found to be the most suitable thanks to its stability, tractability, and reasonable performance in terms of both accuracy and precision.

Clinical study of active squamosal chronic otitis media

<p class="abstract"><strong>Background:</strong> Cholesteatoma term was coined by Johannes Muller in 1838. Cholesteatomas are the last stage of squamous epithelial retraction comprising either the pars tensa or flaccida that are not self-cleansing, which retain epithelial debris and elicit a secondary, inflammatory reaction. Active squamosal epithelial disease is a retraction pocket which is filled with keratinous debris.</p><p class="abstract"><strong>Methods:</strong> 50 patients were selected presenting with active squamosal chronic otitis media (COM). For all cases a detailed history was taken, otoscopic and otomicroscopic examination along with tuning fork test were performed to know the status of tympanic membrane and status of air and bone conduction of sound waves. Audiological assessment was done by pure tone audiometry. X-ray mastoid and high-resolution computed tomography (HRCT) temporal bone was done for analysis. Pre anaesthetic fitness was taken and patients were posted for tympanomastoid exploration. </p><p class="abstract"><strong>Results:</strong> Most common presentation was of foul smelling otorrhoea in 40 patients, reduced hearing in 40 patients. 8 patients presented with vertigo and 2 presented with facial nerve paresis. Most common otoscopic finding was pf postero-superior retraction pocket in 26 patients. After clinical and radiological assessment 30 patients were posted for canal wall down mastoidectomy.</p><p class="abstract"><strong>Conclusions:</strong> Primary acquired cholesteatomacan affect all age group with significant effect on hearing and quality of life.</p>

Complications of Parotid surgery: A study in 60 cases

Objective: To evaluate the common complications following parotid surgery.
 Material & methods: A retrospective study was done from January 2011 to December 2019 in the Department of ENT & Head Neck Surgery, Enam Medical College & hospital, Savar. Sixty (60) patients with both benign & malignant parotid disease underwent surgical treatment was selected for this study. All cases were diagnosed preoperatively by Fine Needle Aspiration Cytology (FNAC). Patients with preoperative facial nerve palsy were excluded from this study. Patients were followed up for six months and per operative & postoperative complications were evaluated.
 Results: Out of 60 patients, superficial parotidectomy was done in52 (86.67%) patients and total conservative parotidectomy was done in 08 (13.33%) patients. In this study 56 cases were benign and 04 cases were malignant. Among this 41 (68.33%) pleomorphic adenoma, 05 (8.33%) warthin’s tumour, 03 (5%) benign lymphoepithelial cyst, 03(5%) haemangioma, 02(3.33) sialocele, 01(1.67) dermoid and 01 (1.67%) had salivary fistula. All 04(6.67%) malignant cases were diagnosed as mucoepidermoid carcinoma. Majority of pleomorphic adenomas (92.68%) involved the superficial lobe of the gland. Most commonly observed post operative complication was facial nerve paresis (05%), but only 1.67% developed permanent palsy. Others complication includes Hypoesthesia of the greater auricular nerve (05%), Frey’s syndrome (3.33%) & wound infection (3.33%).
 Conclusion: Facial nerve palsy is the frequent complication after parotid surgery in this study. Surgeons have to pay attention to minimize the risk of complication during parotidectomy. However, this operation continues to be a challenge on account of the wide range of tumours encountered and the variations in size and location and the facial nerve preservation.
 Bangladesh J Otorhinolaryngol; April 2021; 27(1): 59-65

Endoscopic intracanalicular vestibular schwannoma excision via middle ear corridors a surgical options

Background With more intracanalicular vestibular schwannoma (ICVS) diagnosed, treatment options are limited either to wait-and-see or surgery. The transpromontorial and infrapromontorial approaches allow direct route to the fundus of internal auditory canal with certain advantages in preserving facial nerve and even cochlear nerve. Objectives To describe the middle ear corridor approach for ICVS excision. Methodology All transpromontorial and infrapromontorial approaches for ICVS excision were recruited. The surgeries were performed at an otologic center by a single experienced otologist. Results Three cases of ICVS Koos Type I were included in this review. Two cases were operated with exclusive endoscopic transcanal transpromontorial approach excision of tumor. One case underwent concurrent transcanal excision of ICVS through infrapromontorial approach with cochlear implantation. Two of them developed facial nerve paresis. The last patient recovered fully with viable cochlear nerve enabling hearing restoration with cochlear implant. Conclusion The potential of surgery in ICVS via middle ear approach is a safe and direct route with promising outcome. This approach offers removal of the ICVS without interrupting facial and cochlear nerves. Hence, the preservation of facial function and hearing are possible.

Deep Lobe Parotid Tumors: A Systematic Review and Meta-analysis.

We performed a systematic review and meta-analysis of deep lobe parotid tumors to evaluate their unique characteristics. PubMed/Medline, Embase, Web of Sciences, and Cochrane Library databases were queried for relevant literature. Studies were individually assessed by 2 independent reviewers. Risk of bias was assessed with the Cochrane bias tool, GRADE criteria, and MINORS criteria. Results were reported according to the PRISMA guidelines. Statistical analysis was performed by comparing rates of malignancy between deep and superficial lobe tumors. In total, 8 studies including 379 deep lobe parotid tumors met inclusion criteria. Mean age at diagnosis was 44.9 years. Computed tomography scan was the most common imaging modality. Preoperative diagnostic fine-needle aspiration was utilized in 39.4% of patients and demonstrated high sensitivity for malignant disease. The most common approach was subtotal parotidectomy with facial nerve preservation (58.9%). The rate of malignancy was 26.6%, which was significantly higher than that of the superficial lobe tumors in this study (risk ratio, 1.25; 95% CI, 1.01-1.56). The rate of temporary postoperative facial nerve weakness between deep and superficial lobe tumors was 32.5% and 11.7%, respectively. Deep lobe parotid tumors had a 26.6% rate of malignancy. On meta-analysis, deep lobe tumors appeared to have higher rates of malignancy than superficial lobe tumors. Surgical excision of deep lobe tumors showed increased rates of temporary facial nerve paresis as compared with superficial lobe tumors. Computed tomography scan was the most common imaging modality. There were limited data regarding the utility of fine-needle aspiration.

Facial emotion detection in Vestibular Schwannoma patients with and without facial paresis

ABSTRACT This study investigates whether there exist differences in facial emotion detection accuracy in patients suffering from Vestibular Schwannoma (VS) due to their facial paresis. Forty-four VS patients, half of them with, and half of them without a facial paresis, had to classify pictures of facial expressions as being emotional or non-emotional. The visual information of images was systematically manipulated by adding different levels of visual noise. The study had a mixed design with emotional expression (happy vs. angry) and visual noise level (10% to 80%) as repeated measures and facial paresis (present vs. absent) and degree of facial dysfunction as between subjects’ factors. Emotion detection accuracy declined when visual information declined, an effect that was stronger for anger than for happy expressions. Overall, emotion detection accuracy for happy and angry faces did not differ between VS patients with or without a facial paresis, although exploratory analyses suggest that the ability to recognize emotions in angry facial expressions was slightly more impaired in patients with facial paresis. The findings are discussed in the context of the effects of facial paresis on emotion detection, and the role of facial mimicry, in particular, as an important mechanism for facial emotion processing and understanding.

Malignant Transformation of Chronic Nonspecific Sialadenitis: A Rare Clinical Presentation

ABSTRACT A 26-year-old man presented with a large, painless, mobile, pedunculated, fluctuant, and nontransilluminant swelling hanging in front of the left ear. He had undergone superficial parotidectomy 9 months ago elsewhere for chronic nonspecific sialadenitis of left parotid gland. The fine needle aspiration was nondiagnostic and revealed turbid dark yellow color fluid. A total parotidectomy was performed to remove the lesion completely as the tumor was involving the deep lobe. Histopathology was consistent with features of low-grade mucoepidermoid carcinoma. Immediate postoperatively the patient had a House and Brackman grade III left facial nerve paresis, which later improved to grade II. This unusual presentation of malignant transformation of chronic nonspecific sialadenitis is one of the rare unique reported cases to our knowledge. How to cite this article: Ashish G, Michael RC. Malignant Transformation of Chronic Nonspecific Sialadenitis: A Rare Clinical Presentation. Int J Head Neck Surg 2021;12(1):31–33.

Young patient`s secondary prevention in ischemic stroke with the percutaneous closure of the patent foramen ovale and postoperative repermeabilisation – case report

Introduction. Cryptogenic stroke represents 25% of all cases. Paradoxical embolism is a common case in people under 45 years old who have patent foramen ovale. Case presentation. 44-years old patient with left motor deficit, dysarthria and dizziness suddenly installed after physical effort. During neurological evaluation, the patient had a central type facial paresis, slight asymmetry of the palatine tonsil, left motor hemiparesis (4/5), dysmetria and dysarthria. Biological examinations showed an association with MTHFR and heterozygous V factor mutation. Computed tomography was made brain with venous sequence where we could see hypoplastic right vertebral artery. MRI revealed a stroke in the territory of the superior cerebellar artery, bilaterally. Transesophageal ultrasound described a patent foramen ovale and an atrial septal defect. RoPE scale was 8 which meant a big risk for paradoxical embolism. Surgical correction was made for secondary prevention of stroke. After 3 months, the patient made a transcranial ultrasound with microbubbles contrast agent which detected a permeable right-to-left shunt. Conclusions. The ischemic stroke and patent foramen ovale with paradoxical embolism mechanism are common in young adults. Postinterventional repermeabilization are rare cases which can raise many questions about prophylaxis and treatment.