Incidence Of Facial Paralysis Research Articles

Efficacy analysis of Gamma knife for the treatment of different types of acoustic neuroma

Objective To analyze the efficacy of Gamma knife for the treatment of different types of acoustic neuroma. Methods From April 1997 to June 2013, 123 patients with acoustic neuroma (<3 cm) treated with Gamma knife in Xiangya Hospital, Central South University were enrolled retrospectively. Hasegawa classification: type A 5 cases, type B 38 cases, type C 47 cases, and typed D 33 cases. Different types of tumor growth and complications after treatment were analyzed and the related factors of influencing the effective tumor control rate were investigated. Results The follow-up time of 123 patients ranged from 6 to 135 months (median, 41 months). The 5-year effective tumor control rate was 92.1%. The tumor control rate of type D was lower than A+ B+ C types (74.1% and 96.1% respectively; P<0.01). Multivariate Cox model analysis showed that the tumor type was an independent factor for affecting tumor control rate (RR, 12.172, 95% CI 2.584-57.348; P=0.002). In the 123 patients, the incidence of radiation-induced brain edema was 12.2% (n=15), and the type A, B, C, and D were 0%, 2.6% (n=1), 10.6% (n=5), and 27.3% (n=9), respectively. The incidences of type C and D were higher than those of type A and B (P=0.014). The incidence of hydrocephalus was 2.4% (n=3, all type D). Of the patients with complete assessment data, the incidence of facial palsy was 10.8% (n=8), and the type A, B, C, and D were 1/4 (n=1), 8.0% (2/25), 4.2% (1/24), and 19.0% (4/21), respectively. The incidence of rigeminal nerve dysfunction was 29.7% (n=22), and type A, B, C, and D were 0%, 4% (1/25), 37.5% (9/24), and 57.1% (12/21), respectively. The incidences of type C and D were higher than those of type A and B (P=0.001). Conclusions The effective control rate of Gamma knife for the treatment of <3 mm acoustic neuroma and the neurological retention rate were closely associated with the tumor typing. The prognoses of type A and B were better, and those of type C and D were poor. Key words: Neuroma, acoustic; Gamma knife; Tumors categories; Complications

Evaluation and Treatment Options of Post Traumatic Facial Nerve Palsy

Facial nerve paralysis by trauma is common cause after idiopathic. Facial palsy as a result of intra cranial, intra temporal and extra temporal blunt injury or fracture and both. Sudden and immediate facial nerve palsy needs early surgical intervention for better outcome. Facial nerve decompression and terminoterminal anastmosis surgical intervention had done in present study. It is a prospective study was done between 2004 to 2006 in Department of Otolaryngology and Head & Neck Surgery in Gandhi Medical College and Associate Hamidia Hospital, Bhopal, (M.P.). The complete clinic examination, otoscopic, audio logical, topodiagnostic, and radiological evaluation were done in all the patients. The outcome of these patients was done on the HouseBrackmann nerve grading system. All patients have infra nuclear type of facial nerve palsy. The maximum incidence of facial nerve paralysis found in the age group between 21 to 30 years. The most common mode of injury was motor vehicle accident in ten patients (60%) and thirteen (76%) patients show complete facial nerve palsy, three (18%) patients were temporal bone fracture and two patients were suffered head injury. Out of 17 patients, 13 patients were normal hearing. Suprachordal (47%) involvement is the most common site of lesion in traumatic facial nerve paralysis. Sudden and immediate onset facial nerve paralysis needs early surgical intervention for better outcome. Facial nerve decompression was better outcome comparing to termino terminal anastmosis. The facial nerve paralysis prognosis depends upon degree of paralysis, duration of paralysis, site of injury and patients’ factors.

WITHDRAWN: Comparison of the effect of total conservative parotidectomy versus superficial parotidectomy in management of benign parotid gland tumor: A systematic review

Since of the 1940s, there has been wide controversy about the most effective surgical treatment for the primary benign parotid tumor. This review investigates the effectiveness and associated complications of superficial parotidectomy versus total conservative parotidectomy in the management of primary benign parotid tumors. An electronic search with restricted dates (1920-2014) and restricted language was performed in August 2014. Thirteen studies were included. In total, 2477 patients were enrolled in the 13 studies, with 1317 patients undergoing superficial parotidectomy and 391 patients undergoing total conservative parotidectomy; 769 patients treated with other surgical techniques were excluded. The maximum follow-up period varied between 2 and 24 years (mean 2.8 years). The incidence of recurrence in the superficial parotidectomy patients ranged from 0% to 15% (mean 5.7%), whereas, in the total conservative parotidectomy patients it ranged from 0% to 16% (mean 3.03%). The incidence of the facial nerve paresis according to collected data in the superficial parotidectomy group ranged from 0% to 23% (mean 6.75%), whereas in the total conservative parotidectomy group it was 0%-45% (mean 15%). The incidence of facial nerve paralysis in the superficial parotidectomy group ranged from 0% to 3% (mean 0.8%), whereas in the total conservative parotidectomy group it was 0%-17 % (mean 4.4%). The results of this review suggest that superficial parotidectomy is superior to total conservative parotidectomy in the management of primary benign tumor in superficial lobes. In addition, superficial parotidectomy showed a minimal recurrence rate for benign tumor in superficial lobes.

Cervical branch of the facial nerve approach for retrograde parotidectomy compared with anterograde parotidectomy

Conclusion: The cervical branch of the facial nerve approach for parotidectomy is an excellent surgical technique that can reduce the incidence of facial nerve paralysis, surgical time, and surgical blood loss. Objective: To develop and evaluate a surgical technique for parotidectomy that can reduce the incidence of facial nerve paralysis. Methods: Retrograde parotidectomy following identification of the cervical branch of the facial nerve in 90 subjects was compared with standard anterograde parotidectomy in 100 subjects. Results: Retrograde parotidectomy with a cervical branch approach was associated with significant decreases in the incidence of facial nerve paralysis, surgical time, and surgical blood loss, compared with anterograde parotidectomy.

Evolution and changing trends in surgery for benign Parotid tumors

The ideal extent of surgical intervention for benign parotid tumors remains a matter of controversy. The aim of the study was to trace the development of surgical therapy in a large cohort, explore its changes in a single institution specializing in salivary gland pathologies over the last 12 years, and determine the extent to which a possible shift in the surgical therapy of parotid benign tumors toward less radical methods was correlated with a change in the incidence of facial palsy and Frey's syndrome. Retrospective clinical study. A retrospective evaluation of the records for all patients treated for benign parotid tumors between 2000 and 2012 at a tertiary referral center was carried out. Surgical methods were classified into four groups: extracapsular dissection, partial superficial parotidectomy, superficial parotidectomy, and complete parotidectomy. A total of 1,624 patients were included in the study. Our analysis demonstrated an increase in the total number of parotidectomies for benign lesions from 71 (2000) to 184 (2012), mostly due to the increase in extracapsular dissections (from 9 to 123). Increased performance of less radical surgery was associated with a significantly decreased incidence of temporary and permanent facial palsies (from 22.8% to 9% and 9.8% to 5.9%, respectively) and Frey's syndrome (from 11.3% to 1.6%). One of the most controversial issues in the treatment of benign parotid tumors is the best therapeutic approach to be taken in such patients. Our study showed that increased performance of less radical surgery was associated with better functional outcomes.

Retrosigmoid removal of small acoustic neuroma: curative tumor removal with preservation of function.

Management of small acoustic neuromas (ANs) consists of 3 options: observation with imaging follow-up, radiosurgery, and/or tumor removal. The authors report the long-term outcomes and preservation of function after retrosigmoid tumor removal in 44 patients and clarify the management paradigm for small ANs. A total of 44 consecutively enrolled patients with small ANs and preserved hearing underwent retrosigmoid tumor removal in an attempt to preserve hearing and facial function by use of intraoperative auditory monitoring of auditory brainstem responses (ABRs) and cochlear nerve compound action potentials (CNAPs). All patients were younger than 70 years of age, had a small AN (purely intracanalicular/cerebellopontine angle tumor ≤ 15 mm), and had serviceable hearing preoperatively. According to the guidelines of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery Foundation, preoperative hearing levels of the 44 patients were as follows: Class A, 19 patients; Class B, 17; and Class C, 8. The surgical technique for curative tumor removal with preservation of hearing and facial function included sharp dissection and debulking of the tumor, reconstruction of the internal auditory canal, and wide removal of internal auditory canal dura. For all patients, tumors were totally removed without incidence of facial palsy, death, or other complications. Total tumor removal was confirmed by the first postoperative Gd-enhanced MRI performed 12 months after surgery. Postoperative hearing levels were Class A, 5 patients; Class B, 21; Class C, 11; and Class D, 7. Postoperatively, serviceable (Class A, B, or C) and useful (Class A or B) levels of hearing were preserved for 84% and 72% of patients, respectively. Better preoperative hearing resulted in higher rates of postoperative hearing preservation (p = 0.01); preservation rates were 95% among patients with preoperative Class A hearing, 88% among Class B, and 50% among Class C. Reliable monitoring was more frequently provided by CNAPs than by ABRs (66% vs 32%, p < 0.01), and consistently reliable auditory monitoring was significantly associated with better rates of preservation of useful hearing. Long-term follow-up by MRI with Gd administration (81 ± 43 months [range 5-181 months]; median 7 years) showed no tumor recurrence, and although the preserved hearing declined minimally over the long-term postoperative follow-up period (from 39 ± 15 dB to 45 ± 11 dB in 5.1 ± 3.1 years), 80% of useful hearing and 100% of serviceable hearing remained at the same level. As a result of a surgical technique that involved sharp dissection and internal auditory canal reconstruction with intraoperative auditory monitoring, retrosigmoid removal of small ANs can lead to successful curative tumor removal without long-term recurrence and with excellent functional outcome. Thus, the authors suggest that tumor removal should be the first-line management strategy for younger patients with small ANs and preserved hearing.

Stratifying the risk of facial nerve palsy after benign parotid surgery

Post-operative facial palsy is the most important potential complication of parotid surgery for benign lesions. The published prevalence of facial weakness is up to 57 per cent for temporary weakness and up to 7 per cent for permanent weakness. We aimed to identify potential risk factors for post-operative facial palsy. One hundred and fifty patients who had undergone parotid surgery for benign disease were retrospectively reviewed. Tumour factors (size, location and histopathology), patient factors (age and sex) and operative factors (operation, surgeon grade, surgeon specialty and use of intra-operative facial nerve monitoring) were all analysed for significant associations with post-operative facial palsy. The overall incidence of facial palsy was 26.7 per cent for temporary weakness and 2.6 per cent for permanent weakness. The associations between facial palsy and all the above factors were analysed using Pearson's chi-square test and found to be non-significant. These outcomes compare favourably with the literature. No significant risk factors were identified, suggesting that atraumatic, meticulous surgical technique is still the most important factor affecting post-operative facial palsy.

Role of Nitric Oxide in the Onset of Facial Nerve Palsy by HSV-1 Infection

Although herpes simplex virus type 1 (HSV-1) is a causative agent of Bell palsy, the precise mechanism of the paralysis remains unknown. It is necessary to investigate the pathogenesis and treatment of Bell palsy due to HSV-1 infection. This study elucidated the role of nitric oxide (NO) in the incidence of facial nerve paralysis caused by HSV-1 in mice and to evaluate the possible role of edaravone, a free radical scavenger, in preventing the paralysis. Sixty-two mice served as animal models of Bell palsy in this laboratory study conducted at an academic institution. Levels of NO in the facial nerve were measured using high-performance liquid chromatography and absorption photometry. The incidence of facial palsy was assessed following administration of edaravone immediately after HSV-1 inoculation and daily for 11 days thereafter. The ratio of NO (inoculated side to control side) and incidence of facial palsy. RESULTS Before the onset of facial palsy, no substantial difference in the NO level was noted between the HSV-1-inoculated side and the control side. When facial palsy occurred, usually at 7 days after inoculation, the NO level was significantly higher on the inoculated side than on the control side. Following recovery from the palsy, the high NO level of the inoculated side decreased. No increase in the NO level was observed in animals without transient facial palsy. When edaravone was administered, the incidence of facial palsy decreased significantly. These findings suggest that NO produced by inducible NO synthase in the facial nerve plays an important role in the onset of facial palsy caused by HSV-1 infection, which is considered a causative virus of Bell palsy. Hato and colleagues elucidate the role of nitric oxide in HSV-1–related facial nerve paralysis in mice and evaluate the role of edaravone, a free radical scavenger, in preventing the paralysis.

Functional outcome of the facial nerve paralysis after late surgical decompression in otic capsule-sparing fracture

AbstractTemporal bone fracture (TBF) following head trauma is a well-known cause of facial nerve paralysis (FNP) and almost 22% of all skull fractures are TBF. It has been estimated that 25–70% of TBF are associated with FNP and otic capsule-violating fracture of the petrous portion of the temporal bone is more commonly associated with FNP, although otic capsule-sparing fracture is more common. (a) The incidence of FNP is reported to be 10–25% of otic capsule-sparing fracture. (b) With otic capsule-sparing fractures, FNP is often delayed 2–3 days, and is incomplete and temporary, with good recovery during a period of 6–8 weeks. Most clinicians seldom consider a surgical intervention in delayed FNP; however, surgical exploration may be required for complete recovery. The optimal timing for surgical exploration of traumatic FNP to best preserve facial function is currently controversial. Decompression surgery still has a beneficial effect if performed within 14 days of injury. However, late exploratory surgery is recommended in patients who do not experience recovery of facial nerve function, patients who cannot be operated on early, and who present 1–3 months after TBF with more than 95% denervation on electroneurography. Here, we report a case of delayed-onset FNP of otic capsule-sparing fracture with an excellent outcome after late surgical decompression at 6 months after trauma.

Pattern of facial palsy in a typical Nigerian specialist hospital

Data on incidence of facial palsy is generally lacking in Nigeria. To assess six years' incidence of facial palsy in Murtala Muhammed Specialist Hospital (MMSH), Kano, Nigeria. The records of patients diagnosed as facial problems between January 2000 and December 2005 were scrutinized. Data on diagnosis, age, sex, side affected, occupation and causes were obtained. A total number of 698 patients with facial problems were recorded. Five hundred and ninety four (85%) were diagnosed as facial palsy. Out of the diagnosed facial palsy, males (56.2%) had a higher incidence than females; 20-34 years age group (40.3%) had a greater prevalence; the commonest cause of facial palsy was found out to be Idiopathic (39.1%) and was most common among business men (31.6%). Right sided facial palsy (52.2%) was predominant. Incidence of facial palsy was highest in 2003 (25.3%) and decreased from 2004. It was concluded that the incidence of facial palsy was high and Bell's palsy remains the most common causes of facial (nerve) paralysis.

Diabetic Mice Show an Aggravated Course of Herpes-Simplex Virus–Induced Facial Nerve Paralysis

Bell's palsy is highly associated with diabetes mellitus. The cause of Bell's palsy in diabetes mellitus is not completely understood. Diabetic mononeuropathy or reactivation of herpes simplex virus type 1 (HSV-1) may be responsible for the facial paralysis seen in diabetic patients. We previously reported transient and ipsilateral facial paralysis in mice inoculated with HSV-1. In this study, we examined the neuropathogenesis of HSV-1 in diabetic mice to clarify the relationship between Bell's palsy and diabetes mellitus. We compared the incidence and course of facial paralysis after HSV-1 inoculation in diabetic and nondiabetic mice groups. Diabetic mice were prepared by intraperitoneal streptozotocin injection. Facial nerve damage was assessed by electrophysiologic and histopathologic examinations. Compared with the nondiabetic group, the incidence of facial nerve paralysis was significantly increased in the diabetic mice. Electrophysiologic examinations and histopathologic changes also revealed that the facial nerve damage was more severe in the diabetic group. The aggravated course of HSV-1 infection in diabetes suggests that HSV-1 may be the main causative factor for the increased incidence of facial paralysis in diabetic patients.

Prospective Study of ‘Otological Injury Secondary to Head Trauma’

The aim of study was to evaluate etiological factors, types of skull fracture and associated hearing loss in 50 cases of head injury. This was prospective study involving 50 cases of head injury. Each patient will be subjected to detailed history, otological and neuro otological examination, radiological study followed by audiological assessment by pure tone audiometry. Road traffic injuries were the most frequent cause of injuries in our patients comprising 64% of the total, personal accidents/domestic falls, assaults and agriculture and related injuries were responsible for 8% of the total injuries each. Other causes of the injuries were sports injuries (6%), industrial accidents (4%) and fire arm injuries (2%). Out of the 9 patients having temporal bone fracture 7 cases (78%) had longitudinal fracture and 2 cases (22%) had transverse fracture. Out of the 21 patients having hearing loss, 5 patients (23.8%) had conductive hearing loss, 9 patients (42.86%) had mixed hearing loss and 7 patients (33.34%) had sensorineural hearing loss. Facial nerve palsy was present in 2 patients (28%) among longitudinal fracture cases and 1 patient (50%) among transverse fracture cases. Motor Vehicular accident (MVA) are still the commonest cause of injuries compared to the other mode of injury. Patients with longitudinal fracture showed conductive and mixed loss and patients with transverse fracture showed sensorineural hearing loss. Incidence of facial nerve paralysis was more with transverse fracture cases than with longitudinal fracture cases.

Malignant peripheral nerve sheath tumor in the parotid gland developed on the basis of neurofibromatosis type 1

Malignant peripheral nerve sheath tumors arising from the parotid gland are very rare. They can develop as sporadic cases, or on the basis neurofibromatosis type 1. Tumors originating from the parotid gland are generally easy to palpate and have a solid characteristic. Even if the tumor is malignant in character, the incidence of facial paralysis at the time of diagnosis is around 15% in various studies. However, a malignant tumor originating from the nerve itself may not be noticed during the physical examination for a long period time although it cases facial paralysis and may be mistaken with other non-neoplastic diseases involved in the etiology of facial paralysis leading to a delay in the diagnosis and treatment. Especially patients with type 1 neurofibromatosis have a great tendency to develop malignant peripheral nerve sheath tumors. In this article a case of malignant peripheral nerve sheath tumor developed on the basis of neurofibromatosis type 1 was reported.

Management of Temporal Bone Trauma

The temporal bones are paired structures located on the lateral aspects of the skull and contribute to the skull base. Trauma is usually the result of blunt head injury and can result in damage to the brain and meninges, the middle and internal ear, and the facial nerve. Complications can include intracranial hemorrhage, cerebral contusion, CSF leak and meningitis, hearing loss, vertigo, and facial paralysis. To prevent these complications, diagnosis followed by appropriate medical and surgical management is critical. Diagnosis relies primarily on physical signs and symptoms as well as radiographic imaging. Emergent intervention is required in situations involving herniation of the brain into the middle ear cavity or hemorrhage of the intratemporal carotid artery. Patients with declining facial nerve function are candidates for early surgical intervention. Conductive hearing loss can be corrected surgically as an elective procedure, while sensorineural hearing loss carries a poor prognosis, regardless of management approach. Children generally recover from temporal bone trauma with fewer complications than adults and experience a markedly lower incidence of facial nerve paralysis.

Clinical comparison of functional parotidectomy and superficial parotidectomy

The objective of this study was to compare functional parotidectomy with conventional superficial parotidectomy for benign superficial parotid tumours. The clinical postoperative complications were analysed. More than 6 months follow-up data of 102 patients with parotidectomy were collected. The detailed surgery methods, the incidence of recurrence, facial paralysis and salivary fistula were reviewed. Saliva flow rate of parotid glands and the feeling and concave of the region of auricular lobule were measured. Clinical Frey's syndrome was evaluated by minor test (starch-iodine test). No significant difference of tumour recurrence was found between the two groups. The incidence of facial paralysis in the functional parotidectomy group was significantly lower than that in the conventional parotidectomy group. Results will be presented and discussed.

A prospective, randomized trial for use of prednisolone in patients with facial nerve paralysis after parotidectomy

Background A high rate of facial nerve paralysis (FNP) develops after parotid surgery, but there have been few clinical trials on treatments to improve recovery times. This study evaluated the efficacy of prednisolone in these patients. Methods A total of 123 patients who underwent parotidectomy without injury to the facial nerve were assessed prospectively for postoperative FNP. These patients were assigned randomly to treatment with prednisolone or placebo for 10 days. FNP was evaluated by House-Brackmann grades. Recovery rates and adverse effects were monitored regularly for 6 months after surgery. Results Of the 123 patients, 45 had postoperative FNP. All FNPs were grades II to IV, mostly on 1 or 2 facial areas. The incidence of FNP was increased significantly with malignant pathology, increased parotidectomy extent, and neck dissection ( P < .01). Of 44 evaluable patients, 43 showed full recovery of FNP after 6 months, whereas 1 patient had permanent FNP. Recovery rates were equal in both groups, and there was no evidence of major adverse effects. Conclusions Prednisolone was ineffective in early recovery from postparotidectomy FNP.

R013: Incidence of Facial Palsy after Cochlear Implantation

R013: Incidence of Facial Palsy after Cochlear Implantation

Effects of acyclovir on facial nerve paralysis induced by herpes simplex virus type 1 in mice

Objectives: Bell's palsy has recently been claimed to be caused by herpes simplex virus type 1 (HSV-1) infection. The anti-viral agent acyclovir is a specific inhibitor of herpesvirus replication, and the most effective agent for the treatment herpesvirus infection. The purpose of this experiment was to assess the effect of acyclovir on the facial nerve paralysis included by HSV-1 infection. Methods: We succeeded in producing an animal model of acute and transient facial nerve paralysis induced with HSV-1 neuritis simulating human Bell's palsy. In this study, acyclovir administration was performed before and after facial nerve paralysis, and continued for 5 days. Controls were given phosphate-buffer saline (PBS) instead of acyclovir, and the incidence and duration of facial nerve paralysis was compared in the acyclovir groups and controls. Results: The incidence of facial nerve paralysis was significantly lower in the group given acyclovir before the paralysis than in the controls, and the duration of facial nerve paralysis was shorter. Conclusions: Administration of acyclovir before the paralysis reduced the incidence and duration of facial nerve paralysis. Administration of acyclovir after the paralysis improved the duration of facial nerve paralysis.

耳下腺腫ようの臨床統計

Between 1990 and 2002, 91 cases underwent excision of parotid tumors at St. Marianna University School of Medicine. The most prevalent tumor among benign parotid tumors was pleomorphic adenoma (52.8%), followed by Warthin's tumor (33.3%). Malignant tumors (20.9%) consisted of 4 adenocarcinomas, 3 metastases, 2 carcinomas in pleomorphic adenoma, 2 squamous cell carcinomas, and 2 undifferentiated carcinomas. Tumors that were accompanied by spontaneous pain or facial nerve palsy were frequently malignant. It is important to diagnose parotid tumors by the history, symptoms, and local findings. Ultraysound examination and MRI showed a high accuracy rate (73-80%). The incidence of facial palsy was 4.1% in benign tumors and 10.5% in malignant tumors.

A clinical audit into the success rate of inferior alveolar nerve block analgesia in general dental practice.

The aim of this study was to produce some observational evidence of the success rate of inferior alveolar nerve block (IDB) analgesia that is achieved in general dental practice. The objective was to help provide some measure of expected failure rates and help dental practitioners in their self-appraisal of this crucial basic skill. Up to 100 consecutive IDB analgesia procedures for four dentists were recorded. In a subdivision of this study 200 consecutive IDBs for a fifth dentist were recorded. This dentist had the greatest experience of giving IDB analgesia of the dentists in this study. In this part of the study the dentist made a note if he anticipated that the procedure would fail. The reason for this was that it was felt that experienced dental practitioners could predict when failure was about to occur. The level of facial nerve palsy was also recorded. Overall, 533 of 580 (91.9%) local anaesthetic administrations were deemed to be successful. The only factor that significantly affected the likelihood of success was the practitioner administering the local anaesthetic, and this was only borderline statistically significant. In order to be certain that the other factors did not affect the outcome, the data were re-analysed using the technique of Poisson regression. This technique investigated the effects of each of the factors in turn while controlling for the differences in success that can be attributed to the different practitioners. The regression analyses also did not detect any differences in success that could be attributed to any of the other recorded factors. The incidence of facial palsy was 0.3%. This paper gives an insight into the possible success rates to be encountered by general dental practitioners when they administer IDB analgesia. The only recorded factor that could be shown to affect the chance of a successful local analgesic was the operator. The incidence of facial nerve palsy at 0.3% may be more common than has previously been considered.