House-Brackmann Facial Grading Research Articles

Clinical Outcomes of Salvage Microsurgical Resection after Radiation Therapy for Sporadic Vestibular Schwannomas

Abstract Background The purpose of this study was to evaluate clinical outcomes after salvage microsurgery for vestibular schwannoma (VS) treated initially with modern radiotherapy techniques as compared to those treated with primary microsurgical resection. Methods Patients who underwent microsurgical resection of sporadic VS undergoing a translabyrinthine approach at a single academic skull base tertiary referral center were included. Baseline and postoperative dynamic gait index, functional gait assessment, House–Brackmann facial nerve grading, and completeness of resection were prospectively recorded. Results Of the 265 patients reviewed, 21 (7.9%) patients underwent prior radiation. Median age of the cohort was 55 years (interquartile range: 51–63). The likelihood of achieving a gross total resection was significantly lower for radiated as compared to nonradiated patients (odds ratio: 0.18, 95% confidence interval: 0.05–0.53, p = 0.004) when controlling for tumor size. Radiated patients had better postoperative facial nerve function on the first postoperative day, but this difference was not significant at long-term follow-up. Radiated patients had lower preoperative postural stability scores than nonradiated patients on FGA (26 vs. 23, p = 0.035). Postoperatively, radiated patients had comparable outcomes compared to nonradiated patients when controlling for age and tumor size. Conclusions Compared to patients with VS treated with surgery alone, previously radiated patients are less likely to achieve gross total resection in the salvage setting. Radiated patients scored better on facial nerve outcomes compared to nonradiated patients in the initial postoperative period but demonstrated similar long-term outcomes.

Monocyte to high-density lipoprotein ratio as a novel-potential biomarker for predicting prognosis of Bell's palsy.

In several disorders, the monocyte to high-density lipoprotein ratio (MHR) has been considered a biomarker of systemic inflammation and oxidative stress. However, its role in Bell's palsy (BP) remains unclear. This study investigates the relationship between elevated MHR and poor recovery in BP patients. The clinical data of 729 BP patients were analyzed retrospectively. The House-Brackmann Facial Nerve Grading System (H-B) was utilized to assess the severity of facial motor dysfunction during admission and the follow-up period after discharge. According to the 6months follow-up data, H-B grades 1-2 were classified as recovered (n = 557), and H-B grades 3-6 as unrecovered (n = 172). The patients were split into MHR ≤ 0.26 (n = 361) and MHR > 0.26 (n = 368) groups based on the median MHR to further analyze the connection between different MHRs and prognosis. The level of MHR was substantially greater in the unrecovered group of BP patients than in the restored group (medians[interquartile range], 0.32[0.20, 0.49] vs 0.24[0.11, 0.39], P < 0.001). MHR was an independent risk factor for BP prognosis as indicated by the multivariate logistic regression analysis (OR = 4.467, 95% CI = 1.875-10.646, P = 0.001). The area under the curve (AUC) was 0.615 (95% CI = 0.566-0.664, P < 0.001). The initial H-B score did not differ significantly between MHR ≤ 0.26 (n = 361) and MHR > 0.26 (n = 368) groups. However, after 6months of follow-up, the high-MHR group's H-B score was considerably greater than the low-MHR group's. MHR is expected to be an accessible and effective biomarker of BP. In BP patients, elevated MHR is related to an increased chance of poor recovery.

Reliability and Validity of Emotrics in the Assessment of Facial Palsy.

The globally accepted evaluation method for facial palsy is the House-Brackmann facial grading system; however, it does not reflect minute changes. Several methods have been attempted, but there is no universally accepted evaluation method that is non-time-consuming and quantitative. Recently, Emotrics, a two-dimensional analysis that incorporates machine-learning techniques, has been used in various clinical fields. However, its reliability and validity have not yet been determined. Therefore, this study aimed to examine and establish the reliability and validity of Emotrics. All patients had previously received speech therapy for facial palsy at our hospital between January and November 2022. In speech therapy at our hospital, Emotrics was routinely used to measure the state of the patient's facial palsy. A frame was created to standardize and overcome the limitation of the two-dimensional analysis. Interrater, intrarater, and intrasubject reliability were evaluated with intraclass correlation coefficients (ICC) by measuring the indicators that reflect eye and mouth functions. Validity was evaluated using Spearman's correlation for each Emotrics parameter and the House-Brackmann facial grading system. A total of 23 patients were included in this study. For all parameters, there was significant interrater and intrarater reliability (ICC, 0.61 to 0.99). Intrasubject reliability showed significant reliability in most parameters (ICC, 0.68 to 0.88). Validity showed a significant correlation in two parameters (p-value < 0.001). This single-center study suggests that Emotrics could be a quantitative and efficient facial-palsy evaluation method with good reliability. Therefore, Emotrics is expected to play a key role in assessing facial palsy and in monitoring treatment effects more accurately and precisely.

Indications of and Efficacy of Facial Nerve Decompression Through Endoscopic Transcanal Approach for Patients with Traumatic Facial Paralysis.

The aim of this study is to evaluate the indications and efficacy of facial nerve decompression through an endoscopic transcanal approach for patients with traumatic facial paralysis. This single-center retrospective study included 11 patients with traumatic facial paralysis from February 2018 to April 2019. We compared the facial nerve and auditory function before and after operation so as to reveal the feasibility and effect of the surgical approach. All 11 patients have successfully received facial nerve decompression through endoscopic transcanal approach. Facial nerve function was objectively evaluated by electroneurography test and House-Brackmann facial nerve grading system. All patients were graded HB-VI with electroneurography ≥ 95% before surgery. The recovery of facial nerve function was good (HB-I or II) (90.9%) a year after surgery with only one case (9.1%) for HB-III. Preoperative high-resolution computed tomography showed that 1 patient had ossicular chain interruption, which was confirmed during operation. Meanwhile, 2 patients with air-bone gap >35 dBHL and whose computed tomography failed to diagnose were found with ossicular chain interruption during operation. The air-bone gap of patients with normal ossicular chain connection was all <30 dBHL. The average air-bone gap was reduced from 27.5 ± 10.1 dBHL to 7.8 ± 3.3 dBHL after operation. Preoperative high-resolution computed tomography combined with localization test can accurately estimate the location of facial nerve injury. Facial nerve decompression through endoscopic transcanal approach can decompress the geniculate ganglion to pyramidal segment of facial nerve, which is suitable for patients with traumatic facial paralysis of this segment. In addition, air-bone gap >35 dBHL may indicate the ossicular chain interruption when it is difficult to be completely judged by high-resolution computed tomography.

Application of anatomy unit resection surgery for lateral basicranial surgical approach in oral squamous carcinoma

BackgroundThe basicranial region lacks definite boundaries and includes various anatomical units. We developed a novel concept of the posterior oral anatomical complex (POAC) to identify these anatomical units in the basicranial region. OSCC with POAC involvement is termed posterior oral squamous cell carcinoma (POSCC) with poor prognosis. The principal aim of this study was to evaluate the effect of anatomy unit resection surgery (AUSR) on patients with POSCC.MethodsA total of 120 POSCC patients who underwent radical surgical treatment were recruited for this study. These POSCC patients were treated with conventional surgery or AUSR. According to the extent of primary tumor resection in the AUSR group, the lateral basicranial surgical approach can be subdivided into four types: face-lateral approach I, face-lateral approach II, face-median approach or face-median and face-lateral combined approach. Facial nerve function was evaluated according to the House-Brackmann Facial Nerve Grading System.ResultsThe overall survival rate was 62.5% and 37.5% in the AURS group and conventional group (hazard ratio: 0.59; p < 0.0001), respectively. The disease-free survival rate was 62.5% and 34.3% in the AURS group and conventional group (hazard ratio: 0.43; p = 0.0008), respectively. The local disease control rate in the AURS group (71.4%) was significantly better than that in the conventional group (34.4%) in present study (p < 0.0001). Compared to the conventional group, all the patients undergoing AURS were classified as T4 stage and presented with more lymph node metastasis (71.4%). A total of 20 patients (face-lateral approach I and face-lateral combined approach) were temporarily disconnected from the temporofacial branch of the facial nerve. Fifteen patients exhibited slight paresis, and five patients presented with moderate or severe paresis. The survival rate of zygomatic arch disconnection was 94.6% (54 of 56 patients).ConclusionThis lateral basicranial surgical approach based on AUSR improves the survival rate and enhances the local control rate while also preserving a good prognosis without damaging the nerve and zygomatic bone. This surgical approach based on AUSR provides a novel and effective surgical treatment to address POSCC with better prognosis, especially for patients without metastatic lymph nodes.

Facial neuritis following after COVID-19 vaccination : Case report and Literature review

INTRODUCTION: Facial neuritis is a disease of the nervous system, characterized by shallowing or disappearing wrinkles of the frontalis muscle, incomplete eyelid closure, shallowing nasolabial groove, skewing mouth angle, showing teeth to the healthy side, and skewing mouth angle to the affected side when relaxing. CASE REPORT: In this article, it is reported that a 27-year-old male patient was diagnosed as facial neuritis, and the patient appeared after injection of the COVID-19 vaccine (Modena mRNA-1273) on May 17, 2022. After inspection, no obvious abnormality was found on the MRI plain scan of brain. Electromyography: the left and right facial nerve conduction were normal, and the amplitude of evoked potential on the left side was significantly lower than that on the right side. House-Brackmann Facial Nerve grade IV, the patient's condition improved 14 days after hormone treatment. CONCLUSION: The causal relationship between vaccination and the development of Facial neuritis uncertain. The temporal relationship to the vaccination should encourage health care professionals to be vigilant toward people developing Bell’s palsy after SARS-CoV-2 vaccination with mRNA vaccine. Diagnosis and treatment should be swift and decisive.

Evaluating the results of the surgery of benign parotid tumors

Background: Benign tumors account for 80% of parotid salivary gland tumors, early diagnosis and effective treatment will contribute to reducing complications of surgery. Objective: To evalutate surgical results of benign parotid tumors on facial paralysis and other complications. Research Methodology: including 51 patients with benign parotid salivary gland tumors at Hue University of Medicine and Pharmacy Hospital from June 2019 to October 2021 were operated on and monitored for facial paralysis after 1 week, 1 month, 3 months, and 6 months according to the House-Brackmann facial nerve grading system and noted other complications. Results: Pleomorphic adenoma and Warthin tumors are the two most common types of benign tumors. The rate of facial paralysis at the time points after 1 week, 1 month, 3 months, and 6 months gradually decreased by 56.9%, 35.3%, 19.6%, 0%, respectively. Most temporary facial paralysis grade II (mild) and grade III (moderate) (classification of House - Brackmann). The surgical method was significantly related to facial paralysis (p &lt; 0.05). Other complications such as numbness around the ear, hemorrhage, sialocele, salivary fistula, depression of facial contour, bad scars. Nevertheless, no cases of tumor recurrence and Frey’s syndrome were recorded after 6 months. Conclusion: Surgery is an effective and safe treatment for benign parotid salivary gland tumors. Facial paralysis accounts for a high incidence after surgery, but it will fully recover after 6 months. Choosing the appropriate treatment method helps to minimize complications and recurrence after surgery of parotid salivary gland tumors. Key words: benign parotid tumors, facial paralysis, parotidectomy.

Efficacy of steroid treatment and identification of prognostic factors in idiopathic peripheral facial nerve palsy in children

Purpose: The aim of the study is intended to investigate the etiology and clinical features of children with idiopathic peripheral facial palsy (IPFP) and to identify probable prognostic factors. It is also intended to investigate corticosteroid therapy and compare its efficacy.&#x0D; Materials and Methods: A total of 80 patients with newly diagnosed IPFP were included in the study. Demographic, clinical features and laboratory findings including age, gender, House Brackmann Facial Nerve Grading System (HBGS) grade at admission and follow-up, and the dosage and onset of steroid treatment were reviewed. We assigned our patients to 3 groups: Group 1: Patients given 1 mg/kg oral steroid treatment (1 mg/kg/day oral prednisolone). Group 2: Patients given 2 mg/kg oral steroid treatment (2 mg/kg/day oral prednisolone), and Group 3: Patients who did not receive oral steroid treatment. &#x0D; Results: A total of 80 children (41 girls and 39 boys) with a median age of 11 years were included in the study. The complete recovery was detected in %78,8(n:63) with IPFP. Of all patients, 78.8% (n=63) showed complete recovery. Admission after more than 24 hours was found to reduce the likelihood of ER by 10 times (1/0.10), while patients with HBGS grade of 5 were found to be 33.3 times (1/0.03) less likely to achieve ER than patients with HBGS grades of 2 to 3. Finally, steroid treatment at 2 mg/kg/d increased the probability of early recovery by 8.38 times.&#x0D; Conclusion: The prognosis of IPFP in children was very good. The prognostic factors affecting the early recovery were being HBGS grade 2 or 3 on the 21th day and receiving steroid treatment in the first 24 hours and 2 mg/kg/d dose.

Superficial parotidectomy: three-year experience using modified Blair's incision

Background: This study presents a series of parotidectomy for superficial benign parotid tumors.Methods: 18 patients had freely mobile superficial benign parotid lesions of grade zero on House-Brackmann facial nerve grading system underwent parotidectomy through modified Blair incision, with meticulous dissection of the main trunk and branches of facial and the greater auricular nerves with parotid duct sparing. Postoperative (PO) facial nerve functions were assessed and graded after patient was fully conscious, on the 5th PO day, and 6th PO month. Collected data included operative time, intraoperative blood loss, duration of hospital stay, wound drainage and PO complications.Results: Mean operative time was 115 (±20.4) minutes and mean intraoperative blood loss was 250 (±60). PO analgesia was provided as non-steroidal anti-inflammatory drugs injection on patient's request. Mean duration of PO hospital stay was 8 (±1.9) hours and of wound drainage was 3 (±0.7) days. No wound infection nor seroma had developed and stitches were allowed for spontaneous removal. Immediate postoperatively 4 patients (22.2%) had incomplete facial nerve weakness; 3 of grade II and one of grade III, at the 5th day PO, two patients still had grade II nerve affection and at the 6th PO month, one patient (5.5%) still had grade II nerve affection.Conclusions: superficial parotidectomy through modified Blair's incision is feasible, safe and allows nerve, vessels and duct sparing even for cases with recurrent swelling. Incomplete facial weakness was encountered in only one patient at the 6th month PO, but was of grade II.

Improved Iatrogenic Facial Nerve Paralysis Based on House-Brackmann Facial Nerve Grading System by Using Acupuncture Therapy: A Case Report.

Iatrogenic facial nerve paralysis is often caused by surgical procedures on temporomandibular joint due to temporomandibular disorder. It can affect the quality of life of the patient due to the facial nerve's importance in communication and expressions. We hereby report a case of a 22-year-old man with right facial nerve paralysis after he had arthroplasty surgery. He received Mefenamic Acid 3 × 500 mg (if necessary) and Mecobalamin 1 × 500 mg. He was treated with manual acupuncture therapy for 3 times a week with 30 minutes of each session until he has reached the deqi sensation. Acupuncture points used were points on the affected side and several points on both sides. The patient underwent acupuncture treatments for 28 sessions in 4.5 months. On the eighth session, the patient had no visible right lagophthalmos. The patients' jaws could open normally after the 12th session, and at the end of the sessions (28th) the patient could raise and lower his right eyebrow perfectly. We found that patient's facial nerve function was improved to normal based on House-Brackmann facial nerve grading system. The nerve conduction velocity and electromyography test results also improved. Acupuncture should be considered as one of the therapeutic tools for treating iatrogenic facial nerve paralysis.

Does Evoked Electromyography Detect the Injured Facial Nerve Recovery Earlier Than Clinical Assessments?

The key element in managing postoperative facial nerve (FN) injuries is timely diagnosis and intervention as indicated. The purpose of this study was to measure and compare evoked electromyography (EEMG) and clinical assessment in terms of the recovery of the injured FN in operated temporomandibular joint ankylosis (TMJA) cases. The investigators designed a prospective cohort study in the primary operated TMJA patients. The primary predictor variable was the technique used to assess FN function, House-Brackmann Facial Nerve Grading System (HBFNGS) or EEMG. The primary outcome variable was time to FN recovery. The FN recovery was assessed in different time points (1 week, 1 month, 3 months, and 6 months). Age, gender, side (unilateral/bilateral), type of ankylosis (Sawhney's classification), and operating time were kept as covariates. Categorical variables were analyzed using Fisher's exact test. Multilevel survival analysis was performed considering the subject as cluster to perform Kaplan-Meier analysis and compute the hazards ratio using the Cox-regression method with adjustment for covariates. P <0.05 was set as statistically significant. The study sample composed of 43 (69 sides) TMJA cases who underwent surgery developed iatrogenic FN injury in 10 cases (14 sides [9 right; 5 left]). The incidence of FN injury was 20.3% (14/69). Sawhey's type III/type IV ankylosis and the operating time for more than 2 hours showed a statistically significant (p<0.05) increase in FN injury. The mean duration to detect FN recovery by EEMG was 9 days (95% confidence interval, 5 to 12 days), but the HBFNGS took 161 days (95% confidence interval, 141 to 181 days). The chance of early detection by EEMG was 18.6 times more than the chance by the HBFNGS (Cox-hazard ratio, 18.6). To conclude, EEMG is a noninvasive and reliable tool that detects FN recovery much earlier than the HBFNGS in the postoperative TMJA cases.

The efficacy and safety of acupoint catgut embedding for peripheral facial paralysis: A protocol for systematic review and meta analysis.

Background:Peripheral facial paralysis (PFP) is a consequence of the peripheral neuronal lesion of the facial nerve. It can be either primary (Bell palsy) or secondary. The incidence of PFP is 11.5 to 40.2 per 100,000 people a year. Nearly 70% of patients with PFP recover completely, but almost 30% of patients leave multiple sequelae which caused impacts on the patient's quality of life, both physically and psychologically. The conventional treatments of PFP are limited for some person because of side-effects. Previous studies have suggested that using acupoint catgut embedding (ACE) alone or combined with other therapeutic methods is effective for PFP. However, whether ACE is effective for PFP is still unknown. The purpose of this systematic review (SR) and meta-analysis will summarize the present evidence of ACE used as an intervention for PFP.Method/Design:Randomized controlled clinical trials that use ACE for PFP will be searched from four international electronic databases (PubMed, Cochrane Library, EMBASE, and Web of Science) and 4 Chinese electronic databases (China National Knowledge Infrastructure, VIP, Wanfang, and China Biology Medicine) to search for relevant literature. We only include studies that were published from the initiation to May 2021. The primary outcomes include effectiveness rate based on House-Brackmann Facial Nerve Grading System. Secondary outcomes will include Sunnybrook facial nerve grading system, Portmann score, facial nerve conduction velocity, Facial Disability Index Scale, adverse events. Two reviewers will perform study selection, data extraction, data synthesis, and quality assessment independently. Assessment of risk of bias and data synthesis will be conducted by using Review Manager 5.3 software. Grade system will be used to evaluate the quality of evidence.Discussion:This systematic review will help establish clinical evidence regarding the efficacy and safety of acupoint catgut embedding for peripheral facial paralysis.Trial registration number:CRD42021243212 (PROSPERO)

Effect of an Intensified Combined Electromyography and Visual Feedback Training on Facial Grading in Patients With Post-paralytic Facial Synkinesis.

Background: There is no current standard for facial synkinesis rehabilitation programs. The benefit and stability of effect of an intensified 10-day facial training combining electromyography and visual biofeedback training was evaluated.Methods: Fifty-four patients (77.8% female; median age: 49.5 years) with post-paralytic facial synkinesis (median time to onset of paralysis: 31.1 months) were included in retrospective longitudinal study between January 2013 and June 2016. Facial function was assesses at baseline (T0), first days of training (T1), last day of training (T2), and follow-up visit (T3) at a median time of 6 months later using the House-Brackmann (HB) facial nerve grading system, Stennert index (SI), Facial Nerve Grading System 2.0 (FNGS 2.0), and Sunnybrook Facial Grading System (SFGS). Pairwise comparisons between the time points with post-hoc Bonferroni correction were performed.Results: No significant changes of the gradings and subscores were seen between T0 and T1 (all p > 0.01). The 10-day combined and intensified feedback training between T1 and T2 improved facial symmetry and decreased synkinetic activity. Facial grading with the FNGS 2.0 or the SFGS were most suited to depict the training effect. FNGS 2.0, regional score, FNGS 2.0, synkinesis score, and FNGS 2.0 total score improved significantly (all p ≤ 0.0001). Both, the FNGS 2.0 and the SFGS showed the strongest improvement in the nasolabial fold/zygomatic and the oral region. Neither the age of the patient (r = 0.168; p = 0.224), the gender (r = 0.126; p = 0.363) nor the length of the interval between onset of the palsy and training start (r = 0.011; p = 0.886) correlated with the changes of the SFGS between T1 and T2. The results remained stable between T2 and T3 without any further significant change.Conclusion: Intensified daily combined electromyography and visual biofeedback training over 10 days was effective in patients with facial synkinesis and benefits were stable 6 months after therapy.

Efficacy evaluation and mechanism study of electroacupuncture intervention in acute phase of IFP: study protocol for a randomized controlled trial

BackgroundPrevious studies had already reported the efficacy of electroacupuncture treatment for idiopathic facial nerve palsy (IFP) in a recovery phase; however, the initial use of electroacupuncture in the acute phase remains controversial. Hence, in the present study, we will add electroacupuncture intervention based on oral prednisone tablets in the acute phase of IFP and compare the clinical effects with simple oral prednisone tablets. Besides, the prognosis and safety will be evaluated. The present study aims to evaluate the clinical efficacy, prognosis, and safety of electroacupuncture combined with oral prednisone tablets in the acute phase of IFP, using surface electromyography (sEMG) to objectively observe the recovery of facial expression muscle function. In addition, the morphological changes of the facial nerve were observed dynamically by magnetic resonance imaging (MRI) in the acute phase to reveal the effect mechanism of this therapy.MethodsRandomized controlled trials will be conducted in the first teaching hospital of Tianjin University of Traditional Chinese Medicine in China from September 2020 to April 2021. The treatment will be carried out in two phases, including the acute phase and the recovery phase. Eighty IFP patients will be recruited and randomized into two groups with a 1:1 ratio. Subjects in the acute phases of the control group will be given oral prednisone tablets, based on the control group, and subjects of the experimental group will be given electroacupuncture therapy simultaneously in the acute phase. Both groups will be stopped taking prednisone tablets and turn to electroacupuncture therapy in a recovery phase. Patients in the experimental group will receive treatment at least 6 times in the acute phase and both groups will receive treatment 9 times in the recovery phase, and there will be a follow-up period of 15 days after the treatment. The primary outcome is supposed to be related to the changes observed in the Sunnybrook (Toronto) Facial Grading System (SFGS) on the baseline and day 30 after the onset. Secondary outcome measures will include House-Brackmann Facial Nerve Grading System (H-B), measurement of Numerical Rating Scale (NRS), Facial Disability Index scale (FDI, including physical function subscore, FDIP, and social functioning and well-being subscore, FDIS), surface electromyogram (sEMG), and magnetic resonance imaging (MRI). Adverse events will be recorded for safety assessment.DiscussionThe results of this trial will allow the present study to compare the difference in efficacy and prognosis between the strategy of combined electroacupuncture in the acute phase and only oral prednisone tablets. The findings from this trial will be published in peer-reviewed journals.Trial registrationCHICTR ChiCTR2000038472. Registered on 23 September 2020

Masseteric-Facial Anastomosis: A Report of Three Cases

Abstract Intoduction The pathways of the facial nerve are variable, and knowledge of that is essential. The worst impact caused by facial paralysis is related to quality of life, especially regarding the self-esteem and social acceptance on the part of the patients, leading to social isolation and disruption on their mental health. Case Report A 33-year-old female patient, with a stage-T3 acoustic neurinoma, presented with a moderate dysfunction (grades II to III) according to the House-Brackmann (HB) Facial Nerve Grading System. A 43-year-old male patient, with a stage-T4B trigeminal schwannoma, underwent a resective surgery and presented grade-VI dysfunction according to the HB scale. And a female patient with a stage-T4A acoustic neurinoma presented grade-IV dysfunction according to the HB scale. Discussion We performed a literature review of papers related to surgeries for masseteric-facial nerve anastomosis and compiled the results in table; then, we compared these data with those obtained from our cases. Conclusion The masseteric nerve is the one that shows the best prognosis among all the cranial nerves that could be used, but it is also necessary to perform well the surgical technique to access the facial branch and consequently achieve a better masseteric-facial nerve anastomosis.

Characteristics of and Prognosis for Facial Palsy in Patients With Otitis Media With ANCA-Associated Vasculitis (OMAAV).

The aim of the present study was to investigate the characteristics and prognosis of facial palsy in patients with otitis media with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (OMAAV). Retrospective case review. Tertiary referral center. Thirty-seven patients with OMAAV. The patients were divided into the facial palsy group and non-palsy group. The severity of and prognosis for facial palsy were evaluated using the House-Brackmann facial grading system (HB). Characteristics were compared between the facial palsy group and non-palsy group. Facial palsy was observed in eight patients. The last HB grade for all patients was either grade I or II after treatment with a combination of corticosteroids and immunosuppressant therapy. There were no cases in which palsy relapsed. Facial palsy in OMAAV was significantly more common in female patients, and patients with facial palsy demonstrated significantly higher rates of hypertrophic pachymeningitis than did those without facial palsy. Facial palsy in patients with OMAAV was detected in 21.6% and a good prognosis was obtained by use of the appropriate treatment. Facial palsy is one of the most important symptoms by which to diagnose OMAAV. When encountering the patients with intractable otitis media complicated with facial palsy, appropriate examination including ANCA titer should be performed.

EFFECT OF DIABETES AND SYSTEMIC INFLAMMATION PARAMETERS ON THE PROGNOSIS OF BELL’S PALSY

Objective: This study aimed to evaluate the prognostic importance of diabetes mellitus, hematologic and biochemical test findings including neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic inflammation response index and triglyceride-glucose index in patients with Bell’s palsy and to compare these results with healthy subjects.Material and Methods: The study included 75 patients with incomplete Bell’s palsy.and 24 healthy subjects as the control group. Patients were divided into two groups as diabetes mellitus and non- diabetes mellitus patients. Complete blood count, biochemical tests including glucose, liver and renal function tests and blood lipid profile were analyzed from all the subjects and neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic inflammation response index and triglyceride-glucose index values were calculated from these results.Results: Neutrophil-to-lymphocyte ratio and systemic inflammation response index values were higher in patients with Bell’s palsy when compared with the control group. Triglyceride-glucose index was positively correlated with recovery time in all patients and the diabetes mellitus group. It was also positively correlated with prognosis in non- diabetes mellitus patients. High neutrophil-to-lymphocyte ratio was predictive for delayed recovery time only in non- diabetes mellitus patients.Conclusion: Our results indicated that diabetes mellitus didn’t influence severity, recovery time and prognosis of Bell’s palsy. High triglyceride levels and triglyceride-glucose index values were associated with long recovery time in patients with Bell’s palsy. For both diabetes mellitus and non- diabetes mellitus patients, House-Brackmann facial nerve grading scale-initial was the best parameter to predict the prognosis. Neutrophil-to-lymphocyte ratio and systemic inflammation response index values were significantly higher in patients with Bell’s palsy.

COMPLETE MANAGEMENT OF ARDITA (BELL’S PALSY) AS PER AYURVEDA CHIKITSA SUTRA – A CASE REPORT

Bell’s palsy, also known as acute idiopathic lower motor neuron facial paralysis, is characterized by sud-den onset paralysis or weakness of the muscles to one side of the face controlled by the facial nerve. In contemporary science, administration of steroids is the treatment of choice for complete facial palsy. Cer-tain Panchakarma procedures and internal Ayurvedic medicines have been proved to be beneficial in the management of Ardita vata. The present report deals with a case of 62-year-old male patient diagnosed as Ardita vata was treated with various Panchakarma procedures like Nasya, Shirobasti, Kukkutanda Swedana, Dashmoola Ksheer Dhoom, Gandoosh and oral Ayurveda medicines. Criteria of assessment was based on the scoring of House-Brackmann Facial Nerve Grading scale. After completion of Ayurveda treatment, the patient Shown almost complete recovery without any adverse effects. This case is an evi-dence to demonstrate the effectiveness of Ayurveda treatment in case of Ardita vata (Bell’s palsy).

Spinal anesthesia in a patient with grade IV Bell's palsy for caesarean section

Dear Editor, A 25-year-old primigravida with 39-weeks of gestation was referred with complaints of inability to close the right eyelid and deviation of the right side of the mouth for the past one day. There was no history of ear discharge, decreased hearing, hyperacusis, diminished salivation and lacrimation, loss of taste sensation in the anterior two third of the tongue and fever. The patient was diagnosed as right-side grade IV facial nerve palsy. The patient was advised on an antiviral, multivitamins and steroids. Laboratory investigations were normal. The patient was scheduled for an elective caesarean section because of cephalopelvic distortion and tablet Metoclopramide and Ranitidine were administered. On shifting to the operating room, the heart rate was 82 beats·min-1, non-invasive blood pressure was 160/108 mmHg, respiratory rate was 21 breaths·min-1, and SpO2 99% on room air were recorded. Left uterine displacement was applied by a 15° left-tilt of the operation table. In the left lateral position, a subarachnoid block was performed in L3-L4 space with 27G Quincke’s spinal needle, 0.5% heavy Bupivacaine 2 ml (10 mg) was administered. Oxygen was administered via face mask at 6 L/min. A female baby was delivered with Apgar scores of 9 at 1 min and 5 min and 10 at 10 min. Intraoperative fluid administration was 800 mL. Urine output was 200 mL. Oxytocin was administered 1 unit every 30 sec to a total of 5 units. There was no episode of any adverse events intraoperatively. Injection Paracetamol 1 gram intravenously was given after skin closure. TAP block was performed by posterior approach using the Fujifilm sonosite mini-Dock (serial no Q4XK8D, Ref P17000-17) ultrasound machine using linear array transducer probe (6-13 MH z). 0.5% Ropivacaine 15 ml was given on either side. She was shifted to recovery room. She was discharged on seventh postoperative day. Bell’s palsy, named after the Scottish anatomist, Sir Charles Bell, is the most common acute mononeuropathy, with facial nerve weakness/paralysis.[1] Few theories have been postulated but most common are nerve compression syndrome due to the fluid retention during pregnancy and immunosuppression during pregnancy may lead to flaring of a latent viral infection.[2] Although typically self-limited, Bell’s palsy may cause significant temporary oral incompetence and an inability to close the eyelid, leading to potential eye injury and inability to blow out the cheek on the affected side, and the Bell’s phenomenon, an upward and out-ward motion of the eye when the patient attempts to close the eyelid. The treatment modalities include medical therapy with steroids and antivirals, surgical decompression and complementary and alternative therapies such as acupuncture.[3] Following House-Brackmann Facial Nerve Grading System the patient was diagnosed as grade IV Bell’s Palsy which moderately severe dysfunction.[4] Pregnant women are three times more vulnerable than non-pregnant women to develop Bell’s palsy. During the third trimester (71%) and early postpartum period (21%) in majority of cases.[5] Our patient also developed Bell’s palsy in late third trimester. It has been postulated that Bell’s palsy could be a predictor of pre-eclampsia. Our patient too showed signs of sudden onset of pregnancy induced hypertension. Following general anesthesia, the facial nerve injury has been documented to be 0.03-1.4% owing to inappropriate size endotracheal tube, supraglottic airway and tightly holding a mask. The facial nerve has a variable course and may be superficial at times this may make it more prone for injury.[6] We opted for spinal anesthesia, as there is no documentation that Bell’s palsy is associated with meningitis and systemic blood borne viremia. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

The Association of Vestibular Schwannoma Volume With Facial Nerve Outcomes After Surgical Resection.

To explore the relationship between tumor size and facial nerve outcomes following vestibular schwannoma (VS) resection. Single institutional retrospective chart review of all adult patients with untreated sporadic VS who underwent surgical resection from 2008 to 2018 with preoperative magnetic resonance imaging (MRI) and 1 year of follow-up. The primary outcome measure was facial nerve outcome as assessed by the House-Brackmann facial nerve grading system. One hundred sixty-seven patients, 54.5% female, with a median age of 49 years (20-76 years), were identified who underwent VS resection. Surgical resection was performed by translabyrinthine (76.7%), middle cranial fossa (14.4%), retrosigmoid (7.2%), and transpromontorial (1.8%) approaches. The median tumor diameter and volume were 25.3 mm (range: 4.1-47.1 mm) and 3.17 cm3 (range: 0.01-30.6 cm3 ), respectively. The median follow-up was 24.2 months (range: 12-114.2 months). Gross total resection was performed in 79% of cases, with residual tumor identified on MRI in 17% of cases. For patients with tumors <3 cm3 , 92.7% had grade 1 or 2 facial function after at least 1 year follow-up, compared to 81.2% for those with tumors >3 cm3 (univariate logistic regression OR = 2.9, P = .03). Tumor volume >3 cm3 was predictive of facial weakness on multivariate regression analysis (OR = 7.4, P = .02) when controlling for surgical approach, internal auditory canal extension, anterior extension, age, gender, and extent of resection. Tumor volume >3 cm3 is associated with worse facial nerve outcomes 12 months following surgical resection. IV Laryngoscope, 131:E1328-E1334, 2021.