Lower Motor Neuron Facial Palsy Research Articles

Endoscopic transcanal facial nerve decompression in traumatic facial nerve palsy: A case series

Abstract Temporal bone fractures contribute to 7%–10% of patients suffering from facial nerve (FN) palsy.Traumatic facial paralysis is the most common cause of lower motor neuron facial paralysis, accounting for about 17% of its incidence. Temporal bone fractures contribute to 7%–10% of patients suffering from facial nerve (FN) palsy. The proximal tympanic segment of FN is most commonly affected in such cases. The classical microscopic surgeries for pathologies involving the FN, such as transmastoid approach, middle cranial fossa approach, and translabyrinthine approach, are associated with several disadvantages. The endoscopic transcanal approach is a minimally invasive surgery that can be used mostly for a lesion limited to the tympanic segment of the FN. It provides sufficient exposure for nerve decompression as compared to other approaches. Clear endoscopic vision of the tympanic cavity is also achieved, which is beneficial to ossicular chain reconstruction. Moreover, it causes minimal surgical trauma. Operating time and postoperative hospital stay are also reduced. This technique is cosmetically more acceptable to the patient. In this article, we report three cases of posttraumatic FN palsy where we performed endoscopic transcanal nerve decompression. It resulted in dramatic improvement of the facial palsy from House–Brackmann Grade IV or Grade V to Grade II immediately following surgery. The outcome of FN decompression through this approach was found to be comparable to conventional approach.

Neurosarcoidosis-Induced Winging Scapula: Efficacy of Infliximab Treatment in Addressing Multifaceted Challenges.

Sarcoidosis, a systemic granulomatous disease primarily affecting the respiratory and lymphatic systems, can rarely manifest as neurosarcoidosis either in isolation or alongside other systemic symptoms. Here, we describe the case of a 45-year-old male with a history of recurrent sinusitis refractory to antibiotics, who presented to the emergency department with sinus congestion and dysphagia. Clinical examination revealed left lower motor neuron facial palsy and enlarged submandibular salivary glands. Despite obtaining negative results from various antibody panels, the patient exhibited elevated Angiotensin Converting Enzyme levels of 83 nmol/kg/min. Additionally, computed tomography chest scans revealed bilateral hilar and mediastinal lymph node enlargement, findings consistent with sarcoidosis. Otorhinolaryngology evaluation for dysphagia confirmed left vocal cord palsy. Following a negative infectious disease workup, submandibular salivary gland biopsy confirmed sarcoidosis. Treatment with mycophenolate mofetil and oral steroids led to gradual improvement in salivary gland swelling, dysphagia, and facial palsy. However, worsening left shoulder pain prompted further investigation, revealing winging of the left scapula on repeat examination. Magnetic resonance imaging (MRI) of the cervical spine revealed a six mm hyperintensity in the left dorsal cord at the C5 level, suggesting possible neurosarcoidosis vs. demyelinating disease. Subsequently, the patient was prescribed anti-tumor necrosis factor alpha inhibitor infliximab. Subsequent MRI of the cervical spine, conducted six months after initiating Infliximab therapy, indicated resolution of the lesions. This positive outcome was supported by the patient's report of symptom improvement, notably reduced shoulder pain and improvement in left scapular winging. This case underscores the unusual co-occurrence of Bell's palsy and vocal cord palsy in the same patient, along with the potential contribution of neurosarcoidosis to the winged scapula. Additionally, it sheds light on the positive response of neurosarcoidosis to Infliximab therapy.

Rare Presentation of Lower Motor Neuron Facial Palsy in Cerebral Venous Thrombosis – A Case Report

Rare Presentation of Lower Motor Neuron Facial Palsy in Cerebral Venous Thrombosis – A Case Report

Tuberculosis manifesting as bilateral acute parotid swelling with unilateral lower motor neuron facial palsy: an unusual presentation

A 41-year-old female presented to the otorhinolaryngology department with a history of painful swelling over the bilateral parotid region, low-grade fever for the past one month and progressively worsening left-side facial weakness for the last 15 days. She had received multiple courses of antibiotics elsewhere, which did not result in any improvement except pain. She had no past history of any comorbidities or any previous history of tuberculosis. Examination revealed that she had a non-tender, circumscribed, solitary, 3×3 cm size, firm swelling over the bilateral parotid region. Clinical signs of grade V facial nerve palsy (House and Brackmann classification) were noted. There was a severe grade left lower motor neuron facial nerve palsy (left side) seen. There was no cervical lymphadenopathy. The rest of the head and neck examination was unremarkable. Fine needle aspiration cytology (FNAC) from the most prominent part of the swelling was suggestive of granulomatous inflammation. The patient was initially treated with intravenous antibiotics, supportive care and started on antitubercular drugs (once the diagnosis was established) under the National Tuberculosis Eradication Program (NTEP) to which she responded well and after three months of therapy, her swelling and facial weakness improved significantly. In addition to reporting a completely rare kind of presentation, this paper reviews relevant literature and stresses the need for a high degree of suspicion for tuberculous parotitis in a patient with bilateral parotid swelling. The use of fine needle aspiration is important so that this curable condition can be diagnosed early and medically treated. In this way, surgical intervention can be avoided and further complications can be prevented.

A Case Study of <i>Suttigai</i> (Thermal Cauterization) in the Management of <i>Mugavatham</i> (Bell’s Palsy)

Bell’s palsy (Mugavatham) is a unilateral lower motor neuron facial paralysis of acute onset. Suttigai (Thermal cauterization) provides prompt relief. This study aims to establish the efficacy of Suttigai therapy in the management of Mugavatham. A 35-year-old male patient diagnosed with right-sided facial paralysis was treated with Suttigai therapy. The “House and Breckmann” assessment scale was used to evaluate the case. After the Suttigai therapy, the scale rating improved from grade IV to grade I. The asymmetry of the face and the motor functions significantly improved as a result. The efficacy of Suttigai treatment for the management of Mugavatham is successful with immediate relief. Hence more and more efforts are needed to optimize the treatment and utilization of Suttigai therapy in the management of Mugavatham.

Investigation of functional connectivity in Bell's palsy using functional magnetic resonance imaging: prospective cross-sectional study.

The most common cause of lower motor neuron facial palsy is Bell's palsy (BP). BP results in partial or complete inability to automatically move the facial muscles on the affected side and, in some cases, to close the eyelids, which can cause permanent eye damage. This study investigated changes in brain function and connectivity abnormalities in patients with BP. This study included 46 patients with unilateral BP and 34 healthy controls (HCs). Resting-state brain functional magnetic resonance imaging (fMRI) images were acquired, and Toronto Facial Grading System (TFGS) scores were obtained for all participants. The fractional amplitude of low-frequency fluctuation (fALFF) was estimated, and the relationship between the TFGS and fALFF was determined using correlation analysis for brain regions with changes in fALFF in those with BP versus HCs. Brain regions associated with TFGS were used as seeds for further functional connectivity (FC) analysis; relationships between FC values of abnormal areas and TFGS scores were also analyzed. Activation of the right precuneus, right angular gyrus, left supramarginal gyrus, and left middle occipital gyrus was significantly decreased in the BP group. fALFF was significantly higher in the right thalamus, vermis, and cerebellum of the BP group compared with that in the HC group (P<0.05). The FC between the left middle occipital gyrus and right angular gyrus, left precuneus, and right middle frontal gyrus increased sharply, but decreased in the left angular gyrus, left posterior cingulate gyrus, left middle frontal gyrus, inferior cerebellum, and left middle temporal gyrus. Furthermore, the fALFF in the left middle occipital gyrus was negatively correlated with TFGS score (R=0.144; P=0.008). The pathogenesis of BP is closely related to functional reorganization of the cerebral cortex. Patients with BP have altered fALFF activity in cortical regions associated with facial motion feedback monitoring.

Management of Bell’s Palsy in an Elderly Patient with Dementia using Kinesiology Tape: A Case Report

Bell’s palsy is an idiopathic nerve lesion involving the facial nerve and is the most common cause of lower motor neuron facial palsy. The management of Bell’s palsy involves the administration of corticosteroids and antiviral medications, physiotherapy including the use of kinesiology tape and time. This case report aims to use kinesiology tape as a rehabilitation tool for Bell’s palsy in an elderly patient with dementia. Due to the patient’s cognitive deficits associated with dementia, she had minimal participation in active rehabilitation and subsequently developed secondary impairments of drooling and ectropion. Kinesiology tape was applied to the patients face to improve facial symmetry, provide support and proprioceptive feedback. Following 10 weeks of application, the patient had reduced ectropion and eye irritation, improved facial symmetry and reduced drooling. The use of kinesiology tape in the rehabilitation of Bell’s palsy may be beneficial in those patients who have reduced capacity to participate in active rehabilitation programs.

A Perplexing Case of Borrelia Burgdorferi (P9-10.003)

<h3>Objective:</h3> To expose a potential Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) mimicker and understand the significance of diagnostic tests in a case of Bannwarth syndrome. <h3>Background:</h3> Lyme borreliosis is an infectious disease affecting the skin, nervous system, and joints transmitted by the bite of Ixodes Ricinus. Neurological manifestations occur in 3–15% of the cases. Bannwarth syndrome is reported in 3% of the CDC-verified cases of Lyme disease. It presents early within weeks to a few months of initial infection, mainly characterized by painful polyradiculoneuritis. <h3>Design/Methods:</h3> <h3>Case:</h3> A 67-year-old male presented with progressive bilateral upper extremity weakness, sparing the lower extremities with diffuse areflexia, facial diplegia, dysarthria, dysphagia, and diplopia. <h3>Results:</h3> Initial exam was remarkable for bilateral arm weakness with left-sided lower motor neuron facial palsy and dysarthria. Symptoms quickly worsened to facial diplegia and dysphagia with inability to manage secretions. Magnetic resonance imaging (MRI) brain showed hyperintensity with enhancement of the left cerebellum and cauda equina enhancement on MRI lumbar spine. Cerebrospinal fluid (CSF) analysis was remarkable for elevated protein (448 mg/dl), mild pleocytosis (8/mm³), and albumin cytological dissociation. Monoclonal protein IgG kappa was present in the gamma globulin region. History, exam and initial work-up led to a tentative diagnosis of pharyngeal-cervical-brachial variant of AIDP. He was treated with plasmapheresis with mild improvement. Initial Lyme serum and CSF serology were positive with a positive confirmatory CSF western blot. His inpatient electromyography exposed asymmetric, subacute cervical polyradiculopathy with signs of active axonal denervation and reinnervation changes with no acquired demyelination. The patient was started on intravenous Ceftriaxone and physical therapy with significant improvement. <h3>Conclusions:</h3> Lyme disease is a magnificent chameleon; hence it is crucial to keep it among the differential diagnosis. This case emphasizes the importance of EMG amongst diagnostic tools given it ultimately, in combination with Lyme testing, changed the diagnosis and management for the patient. <b>Disclosure:</b> Dr. Sahni has nothing to disclose. Dr. Samaniego has nothing to disclose. Dr. Gates has nothing to disclose.

Assessment of Nerve Conduction in Patients With Lower Motor Neuron Facial Paralysis.

Introduction Bell's palsy (BP), a lower motor neuron facial paralysis, commonly causes dysfunction of muscles of facial expression. Nerve conduction electrodiagnostic studies differentiate early-stage minor conduction blocks from later-stage Wallerian degeneration. Nerve conduction studies (NCSs) assess facial nerve function by delivering supramaximal electrical stimulus at the stylomastoid foramen. The amplitude loss percentage of the affected side is calculated with reference to the normal side. Aim The study's aim was to characterize the ncs in BP cases and to evaluate the correlation between the Compound Muscle Action Potential (CMAP) of the muscles affected. Materials and methods One hundred and four NCS data of BP cases were retrospectively collected over the period of two years. Statistical analyses of variables were done using the Chi-square test, one-way ANOVA, and Pearson correlation coefficient. Result The greater amplitude loss was seen in the orbicularis oris muscle innervated by buccal and mandibular branches of the facial nerve. The bivariate correlation between the Right Nasalis versus Right Orbicularis Oculi and Left Orbicularis Oculi versus Left Nasalis showed a highly significant moderately Strong Positive Correlation with an R-value of 0.687 and 0.558, respectively. The amplitude drop percentage was statistically significant in the affected left and right sides with P values of 0.008 and 0.007 respectively (P value < 0.05). The amplitude drop between the nasalis, orbicularis oculi and orbicularis oris muscles of both sides was statistically significant with a P value of 0.001. Conclusion NCS should be mandatorily included as an assessment protocol in BP cases for quantification of nerve degeneration and as a prognostic tool during the course of treatment.

Clinical Outcome of Hypoglossal-Facial Nerve Anastomosis in Severe Facial Nerve Paralysis: An Experience from Khyber Pakhtunkhwa

Objectives: Facial nerve injury is one of the most devastating complications occurring as a result of any chemical, mechanical or ischemic insult. This study aimed to determine the surgical outcomes of limited experience in lower motor neuron facial palsy in the last decade.&#x0D; Materials and Methods: A Prospective case series was done at Neurosurgery Department, Prime Teaching Hospital, MTI Lady Reading Hospital, and Irfan General Hospital Peshawar Khyber Pakhtunkhwa Pakistan. Patients were diagnosed after thorough clinical examination and radiological findings; conduction studies these as severe facial paralysis (House and Brackmann 4 – 6). Surgical treatment is done with end-to-end hypoglossal-facial nerve anastomosis. Outcomes and complications were documented. Entered data into specifically designed proforma.&#x0D; Results: Out of 13 patients, who underwent a surgical procedure, 8 were male (61.5%) and 5 patients were female (38.5%). The mean age of presentation was 46 years. Patients were labeled on House and Brackmann scale. Improvement was defined as ? 1 grade improvement on the H&amp;B scale, after 1 year of follow-up, 11 patients improved (84.6%) while 2 (15.4%) remained static. The complication was observed as hemiatrophy of the tongue without physiological weakness.&#x0D; Conclusion: Hypoglossal-Facial nerve anastomosis is recommended treatment for severe facial paralysis, during the first year of insult.&#x0D; Keywords: Facial Nerve Paralysis, Hypoglossal-facial nerve, House &amp; Brackmann.

AYURVEDIC MANAGEMENT OF BELL’S PALSY: A CASE STUDY

Introduction: Vatavyadhi is considered one of Mahagada. Ardita vata is one among the vatavyadhi, which may be correlated to Bell’s palsy due to the resemblance of signs and symptoms like deviation of angle of the mouth, decreased function of the affected muscle, numbness or pain in the affected side of the face. Bell’s palsy is the most common unilateral lower motor neuron facial palsy that usually develops spontaneously. Bell’s palsy is around 23 per 100,000 people per year, and it affects men and women equally, with a peak incidence between the age group 10-40 years. Ardita can be successfully managed with Ayurvedic treatment, viz. Nasya karma, Murdhni taila, Karnapurana, Snehana Svedana. Materials and method: A 49-year-old male patient complained of deviation of the angle of the mouth towards the left side and was unable to close the right eye for four days was reported to Panchakarma OPD of Alva’s Ayurveda Medical College and hospital, Moodbidri. Snehana, Svedana, Nasya karma and Murdhni taila were selected, along with internal medications and Kinesio taping. The duration and outcome of the treatments were recorded. Result: The patient recovered markedly with the treatment. Conclusion: Ardita can be managed successfully with various Panchakarma measures, internal medications, and the taping technique.

A Study on Otorhinolaryngologist Perspective of Etiology and Outcomes in Lower Motor Neuron Facial Palsy: A Single Centre Experience Over a Year.

To analyse the aetiology and outcomes of all patients attending otorhinolaryngology department for Lower Motor Neuron type facial palsy over one year. STUDY DESIGN-Retrospective study. SETTING-SRM medical college hospital and research institute, Chennai from Jan 2021 to December 2021. SUBJECTS-23 patients with LMN facial palsy in the ENT department were analysed. METHOD-Details about the onset of facial palsy, history of trauma, surgeries were collected. Facial palsy grading according to House Brackmann was done. Relevant investigations, neurological assessments, appropriate treatment, facial physiotherapy, eye protection and relevant surgical management were carried out.Outcomes were assessed by HB grading. Among 23 patients, mean age of presentation of LMN palsy is 40.39 ± 15.0years. According to House Brackmann staging 21.73% had grade 5 facial palsy, 43.47% had grade 4,30.43% of patients had grade 3 and 4.34% had grade 2 facial palsy. 9 patients (39.13%) had facial palsy due to idiopathic cause, 6 (26.08%) had facial palsy due to otologic cause, 3(13.04%) due to Ramsay hunt syndrome and post traumatic in 8.69% of patients. Parotitis in 4.3% of patients and iatrogenic in 8.69% of patients. 18(78.26%) patients were treated medically alone and 5 (21.73%) patients required surgery.Mean duration of recovery is 28.52 ± 12.6days. In follow up, 21.73% of patient had grade 2 facial palsy and 76 .26% of patients had recovered completely. Facial palsy in our study had very good recovery due to early diagnosis and early start of appropriate treatment.

Clinical Study on the Causes and Outcome of Facial Nerve Palsy at Liaquat University Hospital Hyderabad

Background and Aim: A facial paralysis can be enormously distressing for a person. In order to restore and rehab face symmetry, it is essential to understand the source and type of nerve damage. Lower motor neuron facial paralysis was investigated in the current study to assess its various causes. Patients and Method: This prospective study was carried out on 48 facial nerve palsy (FNP) in the Department of Medicine, Liaquat University Hospital, Hyderabad from January 2021 to August 2022. Patients diagnosed with peripheral facial nerve paralysis of any age and both genders were enrolled. Patient’s details such as time of symptom onset, paralysis duration, rapidity of progression, and paralysis completeness were evaluated. Each individual was interviewed about family history, medical illness such as malignancy, tuberculosis, diabetes, autoimmune disorders, previous episodes, any prior surgery, trauma history, and related symptoms such as neurological, auditory, and vestibular. Lesion site and treatment response was administered by Topo diagnostic tests. Data analysis was carried out in SPSS version 26. Results: Out of 48 FNP patients, 34 (70.8%) were male and female 14 (29.2%) respectively. The overall mean age was 35.8±6.2 years with an age range 5 to 70 years. Patients were distributed into different age groups as follows: 6 (12.5%) in 5-20 years, 19 (39.6%) in 21-35 years, 16 (33.3%) in 36-50 years, and 7 (14.6%) in 51-70 years. The prevalence of left and right side affected patients were 20 (41.7%) and 28 (58.3%) respectively. The most prevalent causes of FNP were idiopathic and external trauma found in 12 (25%) cases followed by infections and tumour found in 8 (16.7%) cases. Severity of paralysis calculated based on H. Brackman grading were as follows: Grade IV, V, and VI paralysis were found in 22 (45.8%), 8 (16.7%), and 2 (4.2%) respectively. Physiotherapy and conservative treatment was given to 26 (54.2%) patients followed by facial nerve surgery in 14 (29.2%) patients. Conclusion: The present study found that External trauma and Bell's palsy are the leading causes of LMN facial nerve paralysis. The right side was more affected than the left side, and male patients predominated. Upon presentation, most lesions were suprageniculate and had House Brackmann severity scores of IV. After a one-year follow-up, most of our peripheral facial paralysis cases had recovered fully or partially. Keywords: Facial nerve palsy, Outcomes, Causes, House Brackmann severity.

662 Bilateral Vocal Cord Paralysis and Cranial Polyneuropathy: A Rare Presentation of Ramsay Hunt Syndrome

Abstract Case Presentation A 61-year-old gentleman with chronic lymphocytic leukaemia presented with right sided disseminated vesicles, otalgia, hearing loss, facial weakness, dysphagia, hoarseness, breathlessness, and stridor. In the preceding 48 hours he had two A&amp;E presentations with only right otalgia, facial weakness, throat tightness and mild breathlessness. Cranial nerve (CN) examination demonstrated right cheek numbness and absent jaw jerk reflex (CNV), right grade 6 lower motor neuron facial palsy (CNVII), impaired hearing (CNVIII), dysphonia, dysphagia, and asymmetric palate elevation (CNIX and X). Fibreoptic nasendoscopy (FNE) demonstrated bilateral vocal cord palsy. He was diagnosed with Ramsay Hunt syndrome (RHS) and disseminated herpes zoster (HZ) requiring intubation and ventilation, intravenous steroids, aciclovir, antibiotics and a prolonged intensive care admission. He was discharged after three months. Eight months later, he has a long-term tracheostomy, gastrostomy, and live-in carer. Discussion This is the only case found in the literature of RHS and associated bilateral vocal cord palsy with cranial polyneuropathy requiring a long-term tracheostomy. It highlights the significant morbidity attached with RHS complications, particularly in a patient with underlying malignancy. Awareness of these rare and potentially life-threatening complications should be raised to avoid investigation and treatment delay. HZ should be considered in patients with CNVII palsy and otalgia, with or without vesicles. Clinicians should perform full CN examination including FNE to assess for cranial polyneuropathy. RHS can present without vesicles, making it indistinguishable from Bell's Palsy. Therefore, we should consider treating Bell's Palsy with aciclovir. Furthermore, multidisciplinary management of disseminated HZ is essential.

168 Asymptomatic dengue illness complicated by Guillain Barre syndrome

Arboviral infection Dengue can cause a spectrum of disease varying from asymptomatic illness to dengue fever to the severe dengue hemorrhagic fever. Neurological complications are rarely reported in the lit- erature (0.5–6%), mostly from dengue-endemic areas in tropics and subtropical regions. We report a case of a 59-year-old man who returned from a recent work-related travel from India. Three weeks following a mild viral prodrome, he developed bilateral lower motor neuron facial palsy with absent deep tendon reflexes. CSF showed albuminocytologic dissociation and electrophysiological studies showed demyeli- nating neuropathy. Routine GBS screen for common etiological viruses was negative and subsequently additional testing based on recent travel was performed which showed positive Dengue IgM and RNA in serum. The patient was treated with plasma exchange for 5 days and his facial weakness improved to a great extent.This case demonstrates the importance of considering arboviral infections such as Dengue in patients with GBS particularly in people living in or travelling from endemic areas. Additionally, like many other viral illnesses, there may not be clear clinical evidence of Dengue fever and the prodrome may go unnoticed and undiagnosed, hence a high index of suspicion is required.s_hasan_s@yahoo.com

Study of aetiology and associated topodiagnostic and electrodiagnostic tests among subjects with lower motor neuron facial palsy

Background : Lower motor neuron (LMN) facial palsy is a very common clinical occurrence with an estimated incidence of 20 to 30 per 100,000 population. LMN facial palsy is commonly encountered by Otorhinolaryngologists, internal medicine practitioners and Neurologists alike. Being a mixed nerve, it’s paralysis can lead to mechanical impairment and emotional, social implications. Objective: To study the topodiagnostic and electrodiagnostic tests associated with Lower Motor Neuron Facial palsy among the study subjects. Methodology : The present cross sectional study conducted by the Department of otorhinolaryngology, neurology, neurosurgery , Pediatric and General Medicine Departments at JSS Medical College and Hospital Mysore from October 2015 to September 2017. A total of 155 study subjects were enrolled for the purpose of the study during the study period who met the inclusion criteria were enrolled for the purpose of the study . Results : Bell’s palsy was the most common etiology identified with 101 cases, 65.2%% of the individuals, followed by Ramsay Hunt syndrome with 12 cases, 7.7%, followed by traumatic and delayed facial palsy. Iatrogenic and delayed facial palsy was seen in 5 individuals, 3.2%.Pregnant and post partum patients were 3, 1.9%.

Post-Varicella Neurological Complications: A Preliminary Observation from a Tertiary Care Centre of Eastern India.

Objectives:The objective of this study is to analyse detailed clinical presentations, imaging findings, and outcome in a series of 17 cases (n = 17) with neurological complications following acute varicella infection.Methods:It is an observational study on the patients who presented to the neurology outpatient department of our institute with neurological abnormalities following acute varicella infection within the last 3 months.Results:Neuroimaging, either computed tomography or magnetic resonance imaging, cerebrospinal fluid analysis, electroencephalography and nerve conduction studies were performed in all the patients along with other specialized investigations as per clinical context. The age of presentation varied from childhood to middle age (median age was 23 years) and range of clinical spectrum was also wide. Peripheral nervous system involvement was more common in the form of Guillain–Barré syndrome (29.4%) and isolated lower motor neuron facial nerve palsy (23.5%) compared to central nervous system (CNS) involvement. CNS involvement was documented in the form of ataxia (11.76%), myelopathy (17.6%), stroke (5.88%) and encephalitis (5.88%).Conclusion:Chickenpox is a common viral disease and most patients recover without any complication. Although rare, neurological complications following acute varicella infection may have myriad presentations ranging from lower motor neuron facial palsy to life-threatening encephalitis. Compared to other studies, varicella encephalitis and ataxia were not so common in our study group. Response to therapy was uniformly good except in the patients presenting with ataxia. Response was particularly good to central and peripheral demyelinating disorders.

Complete and incomplete lower motor neuron facial palsy in post-COVID-19 mucormycosis

Purpose:To study facial nerve palsy (FNP) in post-COVID-19-mucormycosis patients and its ocular complications, report different presentations of FNP in such patients, and propose its etiopathogenesis based on presentation and clinico-radiologic localization.Methods:A prospective cohort study was carried out in patients of post-COVID-19-mucormycosis who presented at our tertiary center, over a period of 3 months. Motor and sensory examination of the facial nerve was done to diagnose FNP and localize the lesion clinically. Slit-lamp examination was done for grading corneal involvement. MRI brain, orbit, and paranasal sinuses (PNS) with contrast were studied to find involvement along the facial nerve. It was assessed whether this site of lesion corresponded with clinical localization. Data were analyzed using the percentage of total cases and Fisher’s test.Results:A total of 300 patients with post-COVID-19 mucormycosis were examined, of which 30 (10%) patients were found to have FNP. All were lower motor neuron (LMN) type and were associated with corneal complications. The most common site clinically was distal to the chorda tympani (66.66%) and radiologically was infratemporal (IT) fossa (63.4%). The clinical localization significantly correlated with the radiological findings (P = 0.012). Twenty percent of patients showed incomplete involvement of facial musclesConclusion:FNP was found to be of LMN type. The most common site of insult was IT fossa. There was a good clinico-radiological correspondence of lesions. Isolated lesions were also found along the peripheral nerve course, presenting as incomplete facial palsy. Recognition of FNP in post-COVID-19 mucormycosis, in all its variable forms, is important to manage corneal complications.

Cerebral venous sinus thrombosis with lower motor neuron facial palsy

Cerebral venous sinus thrombosis with lower motor neuron facial palsy

Ayurvedic Management of Facial Paralysis -A Single Case Study

Bell's palsy or acute idiopathic lower motor neuron facial palsy are similar to Ardita vatapresenting with palsy on one side of the face. Sudden paralysis or weakness of the muscles on one side of the face controlled by the facial nerve characteristics this condition. Bell's palsy is an idiopathic, immune-mediated condition that is thought to be triggered by an infection. In today's science, steroid medication is the preferred treatment for full facial palsy. A 66-year-old person was diagnosed with Ardita vataas a result of a nor bearing pain in left ear and was treated with Mahamasha taila Nasyaand oral Ayurvedic medicines, as well as two Panchakarmasessions. The treatment lasted four months in total, but significant benefits were shown after just one month, indicating practically complete recovery without the use of any additional drugs.The patient had the identical ailment in the right side of hisface 5 years ago, and he received complete relief after 2 years of allopathic treatment. This instance serves as proof of the efficacy of Ayurvedictreatment in the treatment of Ardita vata(Bell's palsy) and as a proposal for more research on a larger number of patients.