House-Brackmann Grade Research Articles

Functional sparing surgery policy for giant vestibular schwannomas.

The objective of this study was to compare the tumour control and facial nerve outcome according to the therapeutic strategy, that is extent of resection and post-operative radiotherapy. Retrospective study of patients with a giant vestibular schwannoma surgically treated from 4 academic skull base centres. Extent of resection, neurological complications, facial nerve function, MRI follow-up and occurrence of complementary treatment were reviewed. Sixty patients were included from 2000 to 2018. Primary end points were comparison the tumour control rate and the post-operative House-Brackmann grade at last follow-up according to the extent of tumour removal (ie total or subtotal removal). Secondary end points were assessment risk factors of poor facial nerve function and comparison complication rate according to extent of tumour removal. Sixty patients had initial surgery at diagnosis. A total resection was realised in 21 cases and a subtotal resection in 39 cases. Thirteen patients needed further treatment. One patient had a recurrence and needed a second surgery 108months after the initial total resection surgery. Twelve patients underwent post-operative radiotherapy, for an evolutive residual tumour. Tumour control was more successful in the total resection group (log-rank test, P=.015). There was no tumour recurrence after post-operative radiotherapy. The facial nerve outcome was significantly better in the subtotal resection group (Mean House-Brackmann grade at last follow-up: 2.2±1.9) than in the total resection group (House-Brackmann grade: 3.5±2.2) (P=.033). Vestibular schwannoma with a cystic component had better facial nerve outcome (P=.0082). Other than facial paralysis, neurological complications were observed in six patients (10% of patients): lower cranial nerves dysfunction in five cases and hemiparesis in one case. Subtotal resection of giant vestibular schwannomas leads to favourable tumour control and facial nerve function and therefore seems to be a valuable strategy.

Effectiveness comparisons of acupuncture treatments for Bell palsy in adults: A protocol for systematic review and Bayesian network meta-analysis.

Background:Bell palsy (BP) is a simple peripheral facial paralysis. A variety of acupuncture treatments have been reported effective for the recovery of BP. However, the relative effectiveness of these acupuncture treatments is still unclear. Therefore, we plan to summarize the evidence and determine the most effective acupuncture treatment for BP.Methods:We will search the following database, including The Cochrane Library, PubMed, Web of Science, EMBASE, China BioMedical Literature (CBM),China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP), and Wanfang database, from their inceptions to April 30, 2020, in order to collect randomized controlled trials (RCTs) on acupuncture in the treatment of BP. We will use Stata16.0 and WinBUGS software for statistical analysis and draw surface under the cumulative ranking curve (SUCRA) graph for each outcome indicator to predict the order of curative effect of treatment measures.Results:This study will compare and rank the effectiveness of different acupuncture methods in the treatment of BP, and the outcome indicators will include House-Brackmann Grading Scale, sequelae, Facial Disability Index score, Sunnybrook facial grading system, Portmann score, and adverse events.Conclusion:Our study will provide supports for clinical practice.INPLASY registration number: INPLASY202040019.

The Efficacy of Electro-Acupuncture Added to Standard Therapy in the Management of Bell Palsy.

To investigate the comparative efficacy of electro-acupuncture when added to standard therapy in patients with Bell palsy in terms of clinical and neurophysiologic outcomes. A total of 88 patients with Bell palsy who received standard treatment (ST group; n = 40, mean ± standard deviation age: 39.2 ± 6.6 years, 60.0% were males) or standard treatment plus electro-acupuncture (ST-EA group; n = 48, mean ± standard deviation age: 39.5 ± 6.9 years, 58.3% were males) were included. Data on patient demographics, symptoms, comorbidities, and 3-month outcomes on treatment response assessed via House-Brackmann grading system and facial nerve recovery profile and electromyography were recorded. Application of ST-EA versus ST was associated with a significantly higher rate of normal nerve function on 12th week electromyography (66.7% versus 25.0%, P = 0.020), higher frequency of patients with House-Brackmann grade ≤2 in the 3rd week (79.2% versus 45.0%, P = 0.029), 6th week (87.5% versus 45.0%, P = 0.004), and 12th week (95.8% versus 50.0%, P = 0.001), and those with facial nerve recovery profile scores ≥8 in the 6th week (83.3% versus 45.0%, P = 0.011) and 12th week (87.5% versus 50.0%, P = 0.009) of treatment. In conclusion, our findings in patients with Bell palsy revealed superiority of electro-acupuncture added to standard therapy over standard therapy alone in terms of improvement of nerve dysfunction, decrease in paralysis severity, and better functional recovery. This seems to indicate the likelihood of electro-acupuncture to be a safe and promising adjunct in the achievement of more satisfactory clinical outcomes in the management of Bell palsy when used in combination with standard medical and physiotherapy.

Lateralization of facial emotion processing and facial paresis in Vestibular Schwannoma patients.

ObjectiveThis study investigates whether there exist differences in lateralization of facial emotion processing in patients suffering from Vestibular Schwannoma (VS) based on the presence of a facial paresis and their degree of facial functioning as measured by the House Brackmann Grading scale (HBG).MethodsForty‐four VS patients, half of them with a facial paresis and half of them without a facial paresis, rated how emotive they considered images of faces showing emotion in the left versus right visual field. Stimuli consisted of faces with a neutral half and an emotional (happy or angry) half. The study had a mixed design with emotional expression (happy vs. angry) and emotional half (left vs. right visual field) of the faces as repeated measures, and facial paresis (present vs. absent) and HBG as between subjects’ factors. The visual field bias was the main dependent variable.ResultsIn line with typical findings in the normal population, a left visual field bias showed in the current sample: patients judged emotional expressions shown in the left visual field as more emotive than those shown in the right visual field. No differences in visual field bias showed based on the presence of a facial paresis nor based on patients’ HBG.ConclusionVS patients show a left visual field bias when processing facial emotion. No differences in lateralization showed based on the presence of a facial paresis or on patients’ HBG. Based on this study, facial paresis thus does not affect the lateralization of facial emotion processing in patients with VS.

Clinical effectiveness of thread-embedding acupuncture in the treatment of Bell's palsy sequelae: A randomized, patient-assessor-blinded, controlled, clinical trial

IntroductionThe sequelae of Bell’s palsy may mean that it persists for up to six months because of incomplete recovery from paralysis. This randomized controlled trial aimed to investigate the clinical effectiveness of thread-embedding acupuncture (TEA) compared with a sham control in the treatment of patients who had Bell’s palsy for longer than 3 months. MethodsA randomized, parallel-controlled, patient-assessor blinded clinical trial was conducted. In addition to concurrent acupuncture treatment delivered twice a week for eight weeks, the intervention group also received TEA, and the control group was given sham TEA once a week for eight weeks. The primary outcome was change in the Facial Disability Index (FDI) from baseline to eight weeks. The secondary outcome was change in FDI from baseline to four weeks, changes in House-Brackmann grade, Facial Nerve Grading System 2.0, Sunnybrook Facial Grading System, facial stiffness, lip mobility, and satisfaction score. ResultsOf the 61 patients enrolled in the study, 56 were included and randomized. There was a significant difference in the FDI physical score in the TEA group compared with that in the STEA group at eight weeks (p = 0.048). Lip length index in the TEA group was significantly better than that in the STEA group at four weeks (p = 0.014). There was no significant difference for other outcome measurements. ConclusionsThe results showed that the addition of TEA to standard acupuncture treatment was not statistical significant in terms of total FDI. Despite partial clinical improvement, further research is needed for the effectiveness of TEA. Trial registrationThis clinical trial was registered at the clinical research information service of the Republic of Korea (Registration Number: KCT0002557)

Predictive Values of Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Other Prognostic Factors in Pediatric Patients With Bell's Palsy.

Bell's palsy (BP) is the most frequent cause of unilateral facial paralysis, and inflammation is believed to play an important role in pathogenesis. Due to its rarity, however, no consensus has been reached regarding optimum treatment or factors affecting prognosis. In the present study, treatment outcomes and prognostic factors of BP were investigated in pediatric patients who underwent steroid therapy. The goal was to investigate the relationship between BP and inflammation using multiple inflammatory markers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), and red cell distribution width (RDW). In all, 54 patients diagnosed with BP and 39 healthy randomly selected controls were enrolled in this retrospective study. Demographic characteristics and complete blood cell count test results were compared. In addition, prognostic factors were sought by dividing the 54 patients with BP into 2 groups according to the House-Brackmann grading system: low grade BP (grades II and III) and high grade BP (grades IV and V). Serum samples were analyzed retrospectively on initial presentation and 6 months after the symptom begins. Meaningful hematological parameters include NLR, PLR, MPV, and RDW. The NLR values in the BP group were significantly higher than in the control group. The NLR value in the 2 groups of patients with BP differed significantly. The mean PLR value in the BP group was higher than in the control group; however, there were no significant differences between the low-grade and high-grade BP groups nor were there any statically significant differences in the other characteristics. The NLR and PLR values are readily accessible parameters that may be useful prognostic markers in pediatric patients with BP. Further studies are required to confirm these results and their utility in predicting prognosis and treating pediatric patients with BP.

Middle Fossa Approach for Facial Nerve Schwannoma Aiming for Functional Improvement: 2-Dimensional Operative Video.

The treatment paradigm of skull base surgery has been changed from radical tumor resection to maximal tumor removal while giving priority to functional preservation. Facial nerve schwannoma is one of the representative disorders of this type of paradigm shift.1 This video demonstrates facial nerve schwannoma surgery through the middle fossa approach, aiming for improvement of facial function. A 33-yr-old woman presented with gradually worsening facial palsy (House-Brackmann grade IV), dizziness, and nausea. Neuroimaging revealed a growing tumor involving the geniculate ganglion, and extending to the middle fossa, internal acoustic meatus, and cerebellopontine angle. The nerve-sparing surgery through the left middle fossa approach was performed under detailed neuromonitoring including the evoked facial electromyograms and auditory brainstem response. The facial nerve fibers were involved within the tumor mass and the plane between the tumor and facial nerve could not be identified as seen in most cases of such large facial nerve schwannomas. But sufficient tumor removal with facial nerve preservation was achieved owing to continuous facial monitoring.2 The patient had no new neurological deficits. Her facial palsy has been gradually improving, now at grade III, without any signs of tumor regrowth during the 10 mo of follow up after the operation. Careful follow up is being continued to survey the possible tumor recurrence. The video was reproduced after informed consent of the patient.

Endoscopic facial nerve decompression in post-traumatic facial palsies: pilot clinical experience.

Post-traumatic facial nerve (FN) paralysis might need surgical decompression in selected patients. Different microscope-based surgical techniques are described in the literature such as the transmastoid, the middle cranial fossa and the translabyrinthine approach. The effectiveness of the transcanal endoscopic approach (TEA) in managing such condition has never been described and its possible indications has to be defined. Retrospective multi-centric case series of patients with post-traumatic FN paralysis surgically treated with TEA. From July 2013 to July 2017, 6 patients underwent TEA for post-traumatic FN paralysis with involvement of the second genu and/or the tympanic segment of the nerve. The surgical technique is described step by step, with focus on anatomic landmarks. Post-operative outcomes are specified in terms of FN postoperative function and audiologic results. The TEA showed to recover a House-Brackmann grade I-II FN function in 83.2% of the patient. Post-operative air-bone gap significantly improved; whereas, the pure-tone average bone conduction did not differ significantly. TEA represents a viable option for the treatment of post-traumatic facial palsy in patients with radiologic evidence of tympanic segment and/or perigeniculate region involvement with no involvement of the mastoid segment of the FN. Transcanal endoscopic facial nerve decompression is a safe and effective approach in highly selected cases. 4.

The role of facial nerve motor evoked potentials in predicting facial nerve function in vestibular schwannoma surgery

Objective: To analyze the role of facial nerve motor evoked potentials in predicting facial nerve function in vestibular schwannoma surgery. Methods: In a retrospective clinical study of 226 patients with acoustic neuroma, admitted to our hospital from January 2016 to May 2019, were investigated by facial nerve motor evoked potentials (FNMEP) elicited by multi-pulse transcranial electrical motor cortex stimulation from. For recording the same electrode set-up was used as for continuous EMG monitoring of the orbicularis oculi,oris muscles and mentalis. Pre-surgical (opening dural), intraoperative and post-surgical (closing dural) FNMEP amplitudes and latencies were recorded. End (closing dura) to start (opening dura) amplitude ratios were compared to early-term(3 day after surgery) facial nerve function by House-Brackmann(HB) Grading. Results: 201 patients(88.9%) get a total tumor resection, 15 patients (6.6%) were a subtotal resection, 10 patients(4.4%) were a partial resection. 100 percent of patients had a integrated anatomical preservation of facial nerves, there were four (1.8%) death cases in this group. Reliable FNMEPs were obtained in all patients. The ratio of end-operative to start-operative FNMEP-amplitude showed a negative correlation with early facial nerve function. Correlation was especially close with early function: an amplitude preservation rate of 85.3% led to HB Ⅰ or Ⅱ in 190(84.1%) patients, of 45.6% to HB Ⅲ in 17(7.5%) patients, of 23.1% to HB Ⅳ in 13(5.8%) patients and of 6.7% to HB Ⅴor Ⅵ in 6(2.7%) patients. There was a negative correlation between FNMEP amplitude ratio and post-surgical early HB grading(r=-0.895, P=0.000). Conclusion: FNMEP was highly reliable in predicting early postoperative facial function of the resection of vestibular schwannoma, was a valid protection technique of facial nerve.

Postoperative Functional Preservation of Facial Nerve in Cystic Vestibular Schwannoma

To retrospectively analyze clinical and surgical data of a consecutive series of 26 patients with unilateral cystic vestibular schwannomas. Tumors were classified as type A (central cyst) and type B (peripheral cyst) and as small (tumor diameter <3 cm) and large (tumor diameter >3 cm). All patients underwent microsurgical removal via retrosigmoid approach. The course of the facial nerve (FN) was classified as anterior, anterior-inferior, anterior-superior, and dorsal to the tumor's surface. Mean patient age was 53.5 years. Mean tumor size was 3.2 cm. There were 22 cases classified as type A and only 4 as type B. Total or near-total resection (>95%) was achieved in 16 cases (61.5%), subtotal removal (90%-95%) was achieved in 9 cases (34.6%), and partial removal (<90%) was achieved in 1 case (3.9%). Position pattern of FN was anterior-inferior in 10 cases (38.4%), anterior-superior in 10 cases (38.4%), anterior in 23.2% of 6 cases. At hospital discharge, FN function was House-Brackmann grade I-V in 9 (36%), 10 (38%), 3 (12%), 3 (12%), and 1 (4%) patients; at final follow-up, House-Brackmann grades I, II, III, and IV accounted for 18 (72%), 6 (24%), 1, and 1 cases. During follow-up ranging from 6 months to 10 years, reoperation for growing of residue was never necessary. According to the literature and the results of our series, microneurosurgery of cystic vestibular schwannomas is associated with good outcomes in terms of extent of resection and FN function. In particular, long-term FN function is much more satisfactory than short-term function. In most cases, microsurgery represents the treatment of choice of cystic vestibular schwannomas.

Intratympanic Steroid Treatment of Bell's Palsy in Patients with Comorbid Disease: A Preliminary Report.

This study evaluated the efficacy of intratympanic steroid injection (ITSI)as initial treatment and therecovery speed for Bell's palsy (BP)inpatients with diabetes mellitus (DM)and/or hypertension (HT). In total,90 patients with comorbid diseases diagnosed with BP received either ITSI (study group, n=61) or systemic steroid treatment (SST) (control group, n=29).The facial nerve function was assessed using the House-Brackmann (HB) grading system for up to 6 months or until complete recovery from BP. To investigate a relationship with the complete recovery time from BP, hematologic and baseline characteristic parameters were analyzed. The complete recovery rate of the ITSI and SST groups was 47.5% and 44.8% at the 1st month, 70.5% and 89.7% at the 3rd month, and 96.7% and 100% at the 6th month of the study, respectively. Lymphocyte and neutrophil values were significantly associated with the complete recovery time from BP. No major adverse events from ITSI itself were noticed during the procedure and during the follow-up of the treatment. Both treatment types have no superiorities over each other in initial treatment for BP in patients with comorbid diseases. ITSI is effective and safe and may avoid the unwanted side effects associated with systemic steroids inthese patients.

Facial Schwannoma Management Outcomes: A Systematic Review of the Literature.

To evaluate facial nerve outcomes of various management strategies for facial schwannomas by assimilating individualized patient data from the literature to address controversies in management. PubMed-National Center for Biotechnology Information and Scopus databases. A systematic review of the literature was performed for studies regarding facial schwannomas. Studies were included if they presented patient-level data, type of intervention, pre- and postintervention House-Brackmann (HB) grades, and tumor location by facial nerve segment. Individualized data from 487 patients were collected from 31 studies. Eighty (16.4%) facial schwannomas were managed with observation, 25 (5.1%) with surgical decompression, 20 (4.1%) with stereotactic radiosurgery, 225 (46.2%) with total resection, and 137 (28.1%) with subtotal resection/stripping surgery. Stripping surgery/subtotal resection with good preoperative facial nerve function maintained HB grade 1 or 2 in 96% of cases. With a total resection of intradural tumors, preoperative HB grade did not significantly affect facial nerve outcome (n = 45, P = .46). However, a lower preoperative HB grade was associated with a better facial nerve outcome with intratemporal tumors (n = 56, P = .009). When stereotactic radiosurgery was performed, 40% of patients had improved, 35% were stable, and 25% had worsened facial function. Facial nerve decompression rarely affected short-term facial nerve status. The data from this study help delineate which treatment strategies are best in which clinical scenarios. The findings can be used to develop a more definitive management algorithm for this complicated pathology.

Iatrogenic injury and regeneration of the facial nerve after parotid gland tumour surgery: a pilot study with clinical and neurophysiological assessment

Introduction. Benign tumour surgery of the parotid gland may cause iatrogenic injury of the facial nerve, with results of postoperative treatment depending on the type of injury. The study aimed to clarify the mechanism of facial nerve injury after benign tumour surgery of parotid gland. Materials and Methods. The effectiveness was verified preoperatively and 1, 3, 6 and 17 months postoperatively. House-Brackmann scales, electroneurography, blink reflex study and needle electromyography were performed. Pharmacological treatment (Galantamine, Cocarboxylase, Dexamethasone, Triamcinolone) and supervised physiotherapeutic procedures (Facial-Oral-Tract-Therapy, Proprioceptive neuromuscular facilitation) were applied for six months. Results. Tumour removal led to the total paralysis of the left facial nerve, IV, III and III House-Brackmann grades were ascertained at the subsequent 3rd–5th periods of observation. In postoperative studies, electroneurography results showed full functional recovery of the frontal branch and incomplete regeneration in the marginal mandibular branch. Blink reflex examination showed proper parameters of evoked potentials only during preoperative and the last observation period. Residual voluntary activity of the frontal muscle and weak voluntary activity of orbicularis oris muscle were recorded in the needle electromyography examination. Contracture of mimic muscles at rest and improvement of their voluntary activity on the left side was observed six months after surgery compared to the early period of observation. Conclusion. Consecutive studies showed the predominant axonal type of injury in the marginal mandibular branch and neuropraxia effect of the facial nerve, allowing the creation of a rehabilitation programme optimal for the functional recovery of the nerve.

Outcomes of Transzygomatic Middle Cranial Fossa Approach for Skull Base Tumors—A Single Institutional Experience

Objective This study aimed to evaluate surgical outcomes after transzygomatic middle cranial fossa (MCF) (TZ-MCF) approach for tumor control in patients with large skull base lesions involving the MCF and adjacent sites. Setting This study was done at the tertiary skull base center. Design This is a retrospective case series. Main Outcome Measures The main outcome measures were tumor control (recurrence), new-onset cranial neuropathies, facial nerve and audiometric outcomes, cerebrospinal fluid (CSF) leak, and wound complications. Results Sixteen patients were identified with a median age of 45 years (range: 20-72). The mean maximum tumor dimension was 5.49 cm (standard deviation [SD]: 1.2, range: 3.1-7.3) and the mean tumor volume was 28.5 cm 3 (SD: 18.8, range: 2.9-63.8). Ten (62.5%) tumors were left sided. The most common pathology encountered was meningioma ( n = 7) followed by chondrosarcoma ( n = 4). Mean follow-up was 36.3 (SD: 26.9) months. Gross total resection or near total resection was achieved in nine (56.2%) and planned subtotal resection was used in seven (43.7%). Postoperative additional new cranial nerve (CN) deficits included CN V ( n = 1), CN III ( n = 2), CN VI ( n = 1), and CN X ( n = 1). Major neurological morbidity (hemiplegia) was encountered in two patients with resolution. There were no cases of CSF leak, meningitis, hemorrhage, seizures, aphasia, or death. There was no recurrence or regrowth of residual tumor. Facial nerve function was preserved in all but one patient (House-Brackmann grade 2). Conclusion Various skull base tumors involving MCF with extension to adjacent sites can be successfully resected using the TZ-MCF approach in a multidisciplinary fashion. This approach yields optimal exposure and permits excellent tumor control with acceptable CN and neurological morbidity.

Proprioceptive Neuromuscular Facilitation in LMN Facial Palsy: A Case Report

Background: LMN facial palsy changes facial expression and leads to functional problems in facial movement and negative psychological effects on patients. Fortunately, some ofLMN facial palsy problems recover completely, but some others remain with some sequelae like asymmetry, muscle contracture, synkinesis, and hyperkinesias that need rehabilitation. Aim of Study:The main purpose of this case report is to analyze the effect of proprioceptive Neuromuscular Facilitation (Rhythmic initiation, repeated stretch, 3 session /week) onLMN Facial palsy. Method: Patient was assessed by HOUSE BRACKMANN GRADING SCALE (HBGS) and then after he was given PNF treatment for a period of one month and once again the patient was reassessed by HOUSE BRACKMANN GRADING SCALE. Result: The finding of the case showed that there was overall improvement in functions of face muscle in LMN Facial palsy patients. Conclusion: The significant result shows the improvement in facial symmetry in bell palsy patients.

Reliability of diffusion tensor tractography of facial nerve in cerebello-pontine angle tumours.

This study aimed to verify the accuracy of preoperative visualisation of the facial nerve (FN) by magnetic resonance-based (MR) diffusion tensor imaging-fibre tracking (DTI-FT) with neuronavigation system integration in patients with cerebello-pontine angle (CPA) tumours. Complete excision with preservation of the FN remains the critical goal of today's vestibular schwannoma (VS) surgery. DTI-FT of the FN with neuronavigation is yet to be fully evaluated, and could make surgery safer. This was a prospective cohort study in which 38 consecutive patients with a CPA tumour (32 VSs, five meningiomas and one epidermoid cyst) were operated on via the retrosigmoid route from 2013 to 2019. The course of the FN was simulated before surgery using StealthViz and the images were transferred to the Medtronic S7 neuronavigation system. The FN location reconstructed by DTI-FT was verified during the surgery. MR acquisition was inappropriate in three patients (7.9%). DTI-FT correctly predicted the course of the FN in 31 of the 38 patients; the discordance rate was 18.4%. The accuracy of DTI-FT was 81.6% (95% CI: 65.67-92.26), sensitivity 88.57% (95% CI: 73.26-96.80) and positive predictive value was 91.18% (95% CI: 90.17-92.09). The reliability of the neuronavigation-integrated visualisation of the FN did not depend on the tumour size (p = 0.85), but the method was more accurate when the nerve was compact in shape (p = 0.03, area under curve (AUC) 0.87, 95% CI: 0.60-1.00) and in females (p = 0.04, AUC 0.78, 95% CI: 0.56-1.00). Following surgery, 86.5% of the patients presented with useful facial function (House-Brackmann grades I-III). Correct simulation of the FN did not prevent postoperative facial palsy (p = 0.35). The accuracy of DTI-FT of the FN integrated with neuronavigation remains unsatisfactory. This method does not provide any clinical benefit over non-integrated DTI-FT in terms of nerve function preservation. Due to the low reliability of the predictions, further technical advances in predicting the course of the FN are awaited by clinicians. However, DTI-FT images in the operating theatre would make tumour excision more comfortable for the surgeon.

Evaluation of VIIth-XIIth cranial nerve anastomosis results by age.

To evaluate VIIth-XIIth cranial nerve (hypoglossal-facial nerve) anastomosis results by age. A total of 34 patients who attended a follow-up visit in 2016, aged 20-63 years, were enrolled. The House-Brackmann facial nerve function grading system and the Facial Clinimetric Evaluation scale were applied. Regarding post-anastomosis facial nerve function, in the group aged 40 years or less, 14 patients (78 per cent) had House-Brackmann grade III and 4 patients (22 per cent) had House-Brackmann grade IV facial nerve function post-anastomosis. In the group aged over 40 years, nine patients (56 per cent) had House-Brackmann grade III and seven patients (44 per cent) had House-Brackmann grade IV facial nerve function post-anastomosis. There was a statistically significant difference between the two groups in mean facial movement domain scores (p = 0.02). Analysis between age and facial movement score in all 34 patients demonstrated a moderate negative correlation (Pearson correlation coefficient: -0.38) and statistical significance (p = 0.02). Facial reanimation yielded better results in younger than in older patients.

Outcome of Bell’s Palsy- An Institutional Study

Background and purpose: Bell’s palsy represents sudden onset of lower motor neuron type of facial palsy in the absence of other cranial nerve involvement. Pathophysiologically, it has been described mostly due to viral infection, and early use of antiviral therapy, steroids and physiotherapy has shown to limit the disease and helps in early recovery from palsy. With the objective to evaluate over all clinical outcome of the patients presented with Bell’s palsy with our treatment strategies this study was performed. &#x0D; Material and method: This is a prospective analytical study with non probability consecutive sampling technique over the duration of 6 months. Continuous variable like age is presented using mean and standard deviation. Categorical data are presented as percentage and analysis of outcome of the treatment is done using Fischer’s exact test. Statistical analysis was done using SPSS -20.&#x0D; Result: Total number of patients enrolled in the study was 19, where mean age was 33.47 (SD 15.71) years. Bell’s palsy was more commonly seen in female patients (58%). House Brackmann grading of facial nerve palsy at the time of presentation was four. There was significant association of early treatment with complete recovery in this study.&#x0D; Conclusion: Early treatment of bells palsy with acyclovir, steroids, and physiotherapy has shown promising result in most of the studies; and this holds true in this study as well, where delaying the treatment was significantly associated with poorer recovery.

Evaluation of Factors Associated With Favorable Outcomes in Adults With Bell Palsy

Identification of the factors associated with improved facial nerve function after treatment of Bell palsy is important to provide patients with early and effective treatment. To identify factors that are associated with improved treatment outcomes in patients with Bell palsy. This retrospective cohort study included 1364 patients with Bell palsy treated at the outpatient clinic of the Department of Otolaryngology at the Kyung Hee University Hospital, Seoul, Republic of Korea, between January 1, 2005, and December 31, 2017. The medical records of patients admitted to this hospital for management of acute facial palsy were reviewed by 3 otolaryngologists with more than 20 years' experience in treating facial palsy. Facial function at the initial and final visits were measured using the House-Brackmann (H-B) grading system, which is one of several analysis tools developed to quantify facial function and provide reproducible information. It is a widely accepted system for grading facial function in 6 steps, from normal (H-B grade I) to total paralysis (H-B grade VI). In total, 1364 patients with primary Bell palsy (718 [52.6%] women) and a mean (SD) age of 47.7 (16.7) years were enrolled. The overall rate of favorable outcome, which was defined as an H-B grade of I or II at the 6-month follow-up visit, was 80.6% (1099 of 1364 patients). Of 1099 patients who had a favorable outcome at 6 months, 343 (31.2%) were younger than 40 years. Of 1364 patients, 1053 (77.2%) had moderate facial dysfunction (H-B grade III or IV). No pathological spontaneous fibrillation activity (ie, good electromyography [EMG] results) was detected on EMG in 937 of 1364 patients (68.7%), 492 (36.1%) had controlled hypertension, and 673 (49.3%) were treated with oral corticosteroids alone. Multivariable analysis revealed that the following factors were associated with favorable outcome: age younger than 40 years (odds ratio [OR], 1.56; 95% CI, 1.09-2.22), an initial H-B grade of III or IV (OR, 2.62; 95% CI, 1.93-3.57), good EMG results after 2 weeks of treatment (OR, 3.38; 95% CI, 2.48-4.61), absence of diabetes (OR, 1.43; 95% CI, 1.04-2.36), and control of hypertension (OR, 1.64; 95% CI, 1.16-2.33). Multiple logistic regression analysis in this study suggests that multiple clinical factors are associated with favorable outcomes in patients with Bell palsy.

Concurrent treatment with intratympanic dexamethasone improves facial nerve recovery in Ramsay Hunt syndrome

ObjectiveTo determine whether early intervention with intratympanic steroid injections, known as concurrent intratympanic steroid therapy (ITST), is an effective supplement to systemic steroid therapy for moderately-severe to severe Ramsay Hunt syndrome. MethodsForty-six patients with Ramsay Hunt syndrome (House-Brackmann grade IV or higher) who received either concurrent ITST with standard systemic steroid therapy (ITST group, n = 12) or standard systemic therapy alone (control group, n = 34) with antivirals starting within 7 days of onset. Patients in the concurrent ITST group received the standard systemic dose of prednisolone (410 mg in total) and intratympanic dexamethasone (16.5 mg in total) over 10 consecutive days. Patients in the control group received systemic prednisolone at the standard dose or higher (average dose, 581 ± 25 mg). ResultsThe recovery rate was higher in the concurrent ITST group than in the control group (93% vs 47%, P = .013). The adjusted odds ratio was 22.2 (95% confidence interval 1.32–373.58, P = .031). ConclusionsThe recovery rate was higher after concurrent systemic and intratympanic steroid therapy than after standard systemic steroid therapy, regardless of whether the steroid used had lower or equivalent glucocorticoid potency. This finding suggests that concurrent intratympanic steroid therapy is a beneficial supplement in patients with Ramsay Hunt syndrome.