Onset Of Facial Palsy Research Articles

Delayed Surgical Treatment for Long Onset Facial Paralysis

Objectives: Present qualitative evidence that supports surgical intervention to those patients with long onset facial paralysis. Methods: Retrospective study of clinical and surgical records of patients operated from July 2006 to September 2012. Twenty-two patients with long onset facial paralysis were operated at a specialized center. Patients underwent surgical facial nerve decompression. Preoperatory and outcomes were recorded with the House-Brackmann facial function score (HBs). Intraoperative stimulation response was obtained as indicator prognostic outcome for facial nerve function. Results: Patients who undergo surgical decompression obtain reduction in the HBs when intraoperative stimulation is obtained. Conclusions: Surgical decompression of the facial nerve is an option for subjects with long onset facial nerve paralysis with improvement of facial function through time.

Surgical experience of intratemporal facial nerve neurofibromas

Conclusions: The first presentation of intratemporal facial neurofibromas was variable, with facial palsy most common. The tumors often involve two or more segments of facial nerve. Outcomes of the tumors were closely related to nerve integrity, preoperative facial nerve function level, and follow-up period. Objective: The aim of this study was to present surgical experience of 11 cases with intratemporal facial neurofibroma. Methods: Clinical data of the 11 cases with the tumors was retrospectively collected and analyzed. They were followed up for 37.9 ± 1.7 months, range 13–59 months, except for one case that was only followed up for 5 months and was excluded from the analysis of outcomes. Results: Facial palsy was the first presentation in 10 cases, with repetitive facial palsy and vertigo in 1 case; 6 cases (54.5%) were insidious and 5 (45.5%) were sudden in terms of onset. Ear pain around the onset of facial palsy was found in four cases (36.4%). The tumor involved more than one segment in six cases. Among the non-grafted cases one patient with grade V facial nerve function recovered to grade III and another patient with grade VI facial nerve function recovered to grade IV, whereas only one case with grade VI recovered to grade IV among the grafted cases.

難聴を合併したMPO-ANCA関連血管炎患者の3D-FLAIR MR画像評価

Patients with MPO-ANCA related angitis sometimes experience the onset of sonsorineural hearing loss and facial palsy. The main aim of this study was to investigate the relationship between the inflammation in the inner ear and sensorineural hearing loss, or between the inflammation of the facial nerve and facial nerve palsy in patients with MPO-ANCA related angitis. From 2007 to 2011, the inner ear was evaluated in 16 ears from 8 patients with MPO-ANCA related angitis with 3D-FLAIR MRI. In 12 ears of the 16 ears the onset of sensorineural hearing loss was noted, and the signal intensity ratio (SIR) in the cochlea was 0.62 +/- 0.15 on pre-enhancement 3D-FLAIR MRI, and 0.97 +/- 0.5 on post-enhancement. These SIR values were significantly higher than the SIR of non-sensorineural hearing loss patients. The onset of facial palsy was noted in 9 of 16 sides and the facial nerve SIR was 0.83 +/- 0.23 on post-contrast 3D-FLAIR MRI. The SIR in the facial nerve of facial nerve palsy patients was higher than non-facial palsy patients. The conclusion is that sensorineural hearing loss and facial palsy in patients with MPO-ANCA related angitis occurred due to strong inflammation in the cochlea or facial nerve. 3D-FLAIR MRI made this pathology clear.

Post-traumatic Immediate onset Facial Palsy-delayed Exploration with Complete Recovery

ABSTRACTPost-traumatic immediate onset facial palsy is well-documented clinical entity. However, it is usually described in transverse fracture of temporal bone requiring early surgical intervention. Here we report a case of immediate onset facial palsy following longitudinal fracture of temporal bone in a 50-year-old male patient who presented to us 6 months after the closed head trauma. Electroneurography and electromyography showed complete nerve degeneration. Facial palsy was completely recovered after delayed reconstruction almost 7 months after the onset. Here longitudinal fracture of temporal bone caused pressure over the incus which in turn had pressed over the dehiscent facial nerve in its tympanic segment up to the second genu thereby resulted in immediate onset facial palsy.How to cite this articleKulkarni AS, Karnik P, Nataraj U. Post-traumatic Immediate onset Facial Palsy-delayed Exploration with Complete Recovery. Int J Head Neck Surg 2013;4(3):148-151.

İki Çocukta Ramsay Hunt Sendromu

Cranial facial nerve palsy is uncommon in childhood. Diagnostic studies in children and adults have provided convincing evidence that reactivation of varicella-zoster virus (VZV) may lead to cranial nerve VII palsy, which is the most common cause of facial palsy in childhood. Careful physical examination especially detailed ear examination is very important when VZV reactivation is suspected. Early treatment with acylovir therapy may improve the recovery rate of facial nerve palsy. In a study of 28 patients for whom treatment with acyclovir and prednisone was initiated within 3 days after the onset of facial paralysis, the recovery from paralysis was complete in 21 (75%), whereas complete recovery was achieved in only 7 out of 23 patients (30%) for whom treatment was initiated more than 7 days after the onset (30%). The difference betwwen the two groups in terms of facial nerve recovery was significant. The aim of this case report is to emphasize the importance of careful examination and early initiation of therapy in suspected cases of Ramsay Hunt syndrome.

Modified Surgical Approach in Facial Palsy: It’s Worth a Try

Objective: To evaluate effectiveness of a modified technique of facial nerve decompression with respect to improvement in facial function and hearing preservation. Method: Retrospective analysis conducted between 2002 and 2005 of 15 cases of posttraumatic facial nerve paralysis. A modified posterior tympanotomy approach was used in these patients. There were 13 males and 2 females aged between 12 and 43 years (mean age, 23.6 years). All the cases were operated by the senior author. Only patients with immediate onset facial paralysis were included in the analysis. These patients had received a full course of corticosteroids as conservative treatment before the surgical exploration. Intervention: Transmastoid facial nerve decompression using the modified technique. Outcome measurement: The clinical, audiometric, and radiologic evaluation was done for all patients. Analysis: Recovery of facial function and hearing status. Results: Eleven out of 15 patients had recovery of facial function to House Brackmann I-II. Two cases had HB III function. Two patients with bilateral paralysis had HB IV function. Only 1 case reported hearing deterioration. The rest of the patients maintained their preoperative hearing status. Conclusion: This technique provides insight into a favorable way of doing facial nerve decompression with an aim to considerably preserve the hearing.

Modified Stennert’s Protocol in Treating Acute Peripheral Facial Nerve Paralysis: Our Experience

The aim of this study was to know the effect of modified Stennert's protocol on Bell's palsy and delayed onset post traumatic facial nerve paralysis. Retrospective study method which included 26 patients was done. Of this 19 patients had Bell's palsy and seven patients had delayed onset post traumatic facial nerve paralysis. All patients started on modified Stennert's protocol. Nineteen patients were observed and had idiopathic facial nerve paralysis. Fifteen patients showed clinical improvement by the 10thday and by the end of 1month, 18 patients showed significant symptomatic improvement. One patient had residual defects at 6months. Of the seven patients with delayed onset post traumatic facial nerve paralysis, three patients had to undergo facial nerve decompression, the remaining four receiving only modified Stennert's protocol. Improvement was seen in three patients by the 10thday. By the end of 1month a total of five patients showed significant symptomatic improvement. Our experience suggests that regardless of the cause, sudden onset facial paralysis responds favorably to administration of modified Stennert's regimen, resulting in faster recovery and lesser sequelae.

Facial muscle contraction in response to mechanical stretch after severe facial nerve injury: Clapham's sign

Following the onset of facial palsy, physiotherapists routinely inspect the inside of the patient's mouth and cheek for complications such as ulceration or trauma. In several patients with complete facial nerve palsy, it was noticed that when the cheek was stretched there was subsequent spasm of the muscles of facial expression. This also occurred in patients whose facial nerve had been transected. We present four patients in whom this response was demonstrated. We consider the mechanism of this response and its relevance in the management of patients with facial paralysis. Following severe or complete denervation, contraction of the facial muscles following mechanical stretch provides evidence of preservation of activity in the facial muscle's excitation-contraction apparatus. Further research will investigate the clinical significance of this sign and whether it can be used as an early predicator of the development of synkinesis, as well as its relevance to facial nerve grafting and repair.

Analysis of Associated Symptoms of Bell's Palsy

Background and ObjectivesZZWe aimed to evaluate associated symptoms in patients with Bell’s palsy and prognosis according to associated symptoms. Subjects and MethodZZSeventy-four patients with Bell’s palsy were enrolled in this study. We evaluated the degree of facial palsy with Facial Nerve Grading System 2.0. The grade of facial palsy was determined as initial facial palsy at admission and as final facial palsy at visit after 3 months. Afterwards, we examined symptoms (such as otalgia, facial numbness, taste disturbance, eye problems, hyperacusis, and tinnitus) and co-morbid diseases (such as diabetes mellitus and hypertension) associated with facial palsy. After 3 months of the onset of facial palsy, we examined the changes in the associated symptoms. ResultsZZAt admission, 71.6 percent of all patients had symptoms associated with facial palsy. Of the associated symptoms, facial numbness and taste disturbance were the most common, which were still found in 23% of the patients after 3 months of the onset of facial palsy. Patients with a high initial grade of facial palsy were accompanied by taste disturbance and hyperacusis more than by other symptoms. Also patients who had auricular pain during the recovery period of Bell’s palsy showed poor prognosis. Compared to non-hypertension patients, for patients with hypertension, taste disturbance was more common during the early period whereas eye problems were more common during the recovery period. ConclusionZZPatients with Bell’s palsy had diverse symptoms associated with facial palsy. During the early period of Bell’s palsy, we concluded that there was no correlation between the symptoms and the prognosis. However, patients with pain around the ear during the recovery period showed poor recovery of facial palsy. � Korean J Otorhinolaryngol-Head Neck Surg 2011;54:683-7 Key WordsZZBell’s palsy ㆍPrognosis ㆍAssociated symptoms.

Comprehensive Facial Rehabilitation Improves Function in People With Facial Paralysis: A 5-Year Experience at the Massachusetts Eye and Ear Infirmary

The Facial Grading Scale (FGS) is a quantitative instrument used to evaluate facial function after facial nerve injury. However, quantitative improvements in function after facial rehabilitation in people with chronic facial paralysis have not been shown. The objectives of this study were to use the FGS in a large series of consecutive subjects with facial paralysis to quantitatively evaluate improvements in facial function after facial nerve rehabilitation and to describe the management of chronic facial paralysis. The study was a retrospective review. A total of 303 individuals with facial paralysis were evaluated by 1 physical therapist at a tertiary care facial nerve center during a 5-year period. Facial rehabilitation included education, neuromuscular training, massage, meditation-relaxation, and an individualized home program. After 2 months of home exercises, the participants were re-evaluated, and the home program was tailored as necessary. All participants were evaluated with the FGS before the initiation of facial rehabilitation, and 160 participants were re-evaluated after receiving treatment. All participants underwent the initial evaluation at least 4 months after the onset of facial paralysis; for 49 participants, the evaluation took place more than 3 years after onset. Statistically significant increases in FGS scores were seen after treatment (P<.001, t test). The average initial score was 56 (SD=21, range=13-98), and the average score after treatment was 70 (SD=18, range=25-100). A limitation of this study was that evaluations were performed by only 1 therapist. For 160 patients with facial paralysis, statistically significant improvements after facial rehabilitation were shown; the improvements appeared to be long lasting with continued treatment. The improvements in the FGS scores indicated that patients can successfully manage symptoms with rehabilitation and underscored the importance of specialized therapy in the management of facial paralysis.

Role of Kabat physical rehabilitation in Bell's palsy: A randomized trial

Conclusion: When applied at an early stage, Kabat's rehabilitation was shown to provide a better and faster recovery rate in comparison with non-rehabilitated patients. Objective: To assess the validity of an early rehabilitative approach to Bell's palsy patients. Patients and methods: A randomized study involved 20 consecutive patients (10 males, 10 females; aged 35–42 years) affected by Bell's palsy, classified according to the House-Brackmann (HB) grading system and grouped on the basis of undergoing or not early physical rehabilitation according to Kabat, i.e. a proprioceptive neuromuscular rehabilitation. The evaluation was carried out by measuring the amplitude of the compound motor action potential (CMAP), as well as by observing the initial and final HB grade, at days 4, 7 and 15 after onset of facial palsy. Results: Patients belonging to the rehabilitation group clearly showed an overall improvement of clinical stage at the planned final observation, i.e. 15 days after onset of facial palsy, without presenting greater values of CMAP.

Effect of delayed decompression after early steroid treatment on facial function of patients with facial paralysis

Conclusion: The earlier decompression is carried out, the better the result. However, decompression delayed a few days beyond 2 weeks after onset of facial paralysis can benefit the recovery of facial function in patients when combined with early use of steroids with or without antiviral agents. Objectives: To demonstrate the correlation between the time of decompression after the onset of facial paralysis and the facial function after surgery and elucidate the beneficial effect of decompression delayed a few days beyond the 2 week period on recovery of facial function in patients who had received early steroid treatment. Patients and methods: Between April 1994 and December 2007, 91 patients with complete facial paralysis who had received early treatment with steroid with or without antiviral agents were included in the study. An independent sample t test was used to analyze the recovery of facial function in patients receiving surgical decompression at different times after onset of paralysis and medical treatment only. Results: Functional gain according to the House-Brackman (HB) grade was 4.05±0.96 for early decompression, 3.63±0.58 for delayed decompression, 2.90±0.76 for late decompression, and 2.51±0.85 for medical treatment only. Delayed decompression significantly improved the functional outcome of patients compared with late decompression and medical treatment only (p<0.05).

Features of Facial Asymmetry Following Incomplete Recovery from Facial Paralysis

PurposeThe purpose of this study is to investigate peculiar patterns of facial asymmetry following incomplete recovery from facial paralysis that require optimal physical therapy for effective facial rehabilitation, and to decrease the incidence of avoidable facial sequelae.Materials and MethodsThis study involved 41 patients who had facial sequelae following the treatment of various facial nerve diseases from March 2000 to March 2007. All patients with a follow-up of at least 1 year after the onset of facial paralysis or hyperactive function of the facial nerve were evaluated with the global and regional House-Brackmann (HB) grading systems. The mean global HB scores and regional HB scores with standard deviations were calculated. Other factors were also analyzed.ResultsFour patterns of facial asymmetry can be observed in patients with incomplete facial recovery. The most frequently deteriorated facial movement is frontal wrinkling, followed by an open mouth, smile, or lip pucker in patients with sequelae following facial nerve injury. The most common type of synkinesis was unintended eye closure with an effort to smile.ConclusionWe described common configurations of facial asymmetry seen in incomplete recovery following facial nerve injury in an attempt to develop an optimal strategy for physical therapy for complete and effective facial recovery, and to decrease the incidence of avoidable sequelae.

Cochlear implant and delayed facial palsy

Delayed facial nerve palsy following cochlear implant surgery is less documented though it poses diagnostic and therapeutic challenges. Apart from the functional, aesthetic and emotional concerns, it can raise important medico legal issues. The objectives of this study were: to report a case of delayed facial palsy following cochlear implant surgery in a patient who had positive viral antibody markers pre operatively; and to review the literature on delayed onset facial paralysis following viral reactivation and its relation to cochlear implant surgery. An extensive literature review was done using internet and medical search engines and library facilities. Important articles on the topic were identified and summarised. Data on delayed facial palsy following cochlear implant surgery were collected, constructed in a coherent way and details discussed. Postulated mechanisms of delayed facial palsy include neural oedema, vasospasm and viral reactivation. Of these, reactivation of previous herpes simplex virus infection has special significance, as many of these patients are positive for viral antibody markers. Manipulation of sensory branches of the facial nerve and chorda tympani can be a mechanism in such cases. Correlation of clinical presentation and pre operative positive viral antibody markers with positive polymerase chain reaction can be strongly suggestive of viral reactivation. It is concluded that patients with positive viral antibody markers are more susceptible to facial palsy from viral reactivation. Corticosteroids, antiviral agents and physiotherapy can be useful in producing a quicker and complete recovery. An experienced cochlear implant surgery team and pre operative radiological evaluations are mandatory to decrease the chances of direct facial nerve trauma. Proper irrigation lowers the risk of neural oedema. Copyright © 2009 John Wiley & Sons, Ltd.

Cochlear implant and delayed facial palsy

Delayed facial nerve palsy following cochlear implant surgery is less documented though it poses diagnostic and therapeutic challenges. Apart from the functional, aesthetic and emotional concerns, it can raise important medico legal issues. The objectives of this study were: to report a case of delayed facial palsy following cochlear implant surgery in a patient who had positive viral antibody markers pre operatively; and to review the literature on delayed onset facial paralysis following viral reactivation and its relation to cochlear implant surgery. An extensive literature review was done using internet and medical search engines and library facilities. Important articles on the topic were identified and summarised. Data on delayed facial palsy following cochlear implant surgery were collected, constructed in a coherent way and details discussed. Postulated mechanisms of delayed facial palsy include neural oedema, vasospasm and viral reactivation. Of these, reactivation of previous herpes simplex virus infection has special significance, as many of these patients are positive for viral antibody markers. Manipulation of sensory branches of the facial nerve and chorda tympani can be a mechanism in such cases. Correlation of clinical presentation and pre operative positive viral antibody markers with positive polymerase chain reaction can be strongly suggestive of viral reactivation. It is concluded that patients with positive viral antibody markers are more susceptible to facial palsy from viral reactivation. Corticosteroids, antiviral agents and physiotherapy can be useful in producing a quicker and complete recovery. An experienced cochlear implant surgery team and pre operative radiological evaluations are mandatory to decrease the chances of direct facial nerve trauma. Proper irrigation lowers the risk of neural oedema. Copyright © 2009 John Wiley & Sons, Ltd.

Recovery of Facial Movement and Facial Synkinesis in Bell's Palsy Patients

We examined the relationship between the time course of development of facial synkinesis in patients with Bell's palsy and the severity of facial nerve damage. Retrospective study. Tertiary referral center. Thirty-nine consecutive patients with Bell's palsy who developed synkinesis. Diagnostic. Subjects were divided into groups A (electroneurographic [ENoG] value, <10%; n = 31) and B (ENoG value, > or =10%; n = 8). Development of facial synkinesis was assessed based on the appearance of synkinetic potentials from the orbicularis oris muscle on the blink reflex test. Times to appearance of facial synkinesis in groups A and B were compared. The proportion of patients who developed facial synkinesis after complete recovery of facial movement was also assessed in 14 patients whose facial movement recovered completely. The mean time to maximal recovery of facial movement was significantly longer in group A than in group B (p < 0.001), whereas the duration between the appearance of facial synkinesis and the onset of facial paralysis did not differ significantly between the 2 groups (p = 0.72). The proportion of patients who developed facial synkinesis after complete recovery of facial movement was significantly greater in group B than in group A (p = 0.015). During the course of recovery from Bell's palsy, the patients with an ENoG value of 10% or greater have a higher risk of developing facial synkinesis after complete recovery of facial movement.

Ischemic Stroke in Williams-Beuren Syndrome: A Case Report

A 15-year-old girl was admitted because of an acute onset of facial palsy and right hemiparesis. The patient had a history of moderate mental retardation and developmental delay. On admission, her vital signs were stable, except for high blood pressure. Magnetic resonance imaging demonstrated an infarct involving the left internal capsule and putamen. Because of the patient's young age, an extensive stroke survey was performed. Williams-Beuren syndrome was finally confirmed by fluorescent in situ hybridization. Compared with the previously reported cases, no evidence of cerebral arterial stenosis or cardiac abnormalities was found by noninvasive imaging techniques. Because Williams-Beuren syndrome is a complex, multiple congenital anomaly syndrome with prominent cardiovascular features, regular assessment and antihypertensive treatment are necessary to minimize the lifelong cardiovascular risk in patients with this syndrome.

Correlation between enhanced MRI and surgical findings in herpes zoster oticus

Conclusion: This study demonstrates good correlation between enhanced MRI and surgical findings. Objectives: This study investigated the reliability of enhanced magnetic resonance imaging (MRI) to make a surgical decision on the strategy for facial nerve decompression in herpes zoster oticus, by determining the degree of correlation between contrast enhancement in MRI and the pathologic change in the facial nerve. Subjects and methods: This retrospective study of 13 patients, who underwent facial nerve decompression with herpes zoster oticus, was designed to compare gadolinium-enhanced segment of facial nerve on MRI and the pathologically changed segment confirmed by surgical exploration, grouping them by the timing of operation after onset of facial paralysis. Results: Commonly enhanced segments on MRI were the labyrinthine, intracanalicular, and geniculate ganglion, found in 84%, 69%, and 69% of all patients, respectively. The most common pathologic segment was the labyrinthine segment (92%), followed by the geniculate ganglion (84%).

Mastoid bone fracture presenting as unusual delayed onset of facial nerve palsy

Delayed-onset facial nerve paralysis is a rather uncommon complication of a mastoid bone fracture for children younger than 10 years. We routinely arrange a cranial computed tomography (CT) for patients encountering initial loss of consciousness, severe headache, intractable vomiting, and/or any neurologic deficit arising from trauma to the head. However, minor symptomatic cranial nerve damage may be missed and the presenting symptom diagnosed as being a peripheral nerve problem. Herein, we report a case of a young boy who presented at our emergency department (ED) 3 days subsequent to his accident, complaining of hearing loss in the right ear and paralysis of the ipsilateral face. Unpredictably, we observed his cranial CT scan revealing a linear fracture of the skull over the right temporal bone involving the right mastoid air cells. The patient was treated conservatively and recovered well without any adverse neurologic consequences. We emphasize that ED physicians should arrange a cranial CT scan for a head-injured child with symptomatic facial nerve palsy, even if there are no symptoms such as severe headache, vomiting, Battle sign, and/or initial loss of consciousness.

Non-invasive acoustic neuroma treatment via Gamma Knife stereotactic radiosurgery

Non-invasive acoustic neuroma treatment via Gamma Knife stereotactic radiosurgery