Peripheral Facial Palsy Research Articles

급성 특발성 안면신경마비로 오인된 측두골 선양낭성암종 1예

Adenoid cystic carcinoma (AdCC) constitutes approximately 1% of head and neck tumors. The external auditory canal is the most prevalent site in the otologic area but AdCC developed in a mastoid is extremely rare and seems to be misdiagnosed as benign inflammatory lesion. Because of its neurotropism, it may involve adjacent nerve early and facial nerve paralysis can develop in the early stage. But its diagnosis, especially in the early stage, is often challenging. Our case report describes a case of a patient with advanced unresectable AdCC in right mastoid with persistent peripheral facial paralysis, which was initially diagnosed as idiopathic Bell’s palsy. Clinicians should be vigilant when treating patients with persistent facial paralysis, especially when imaging studies reveals a lesion around facial nerve in the mastoid, because this may indicate AdCC. This case highlights the diagnostic basis, treatment, and outcomes for this case to improve the understanding of AdCC in the mastoid.

A case of peripheral‐type facial palsy with dysgeusia due to pontine infarction: A case report

AbstractWe describe an 83‐year‐old woman who presented with an acute onset of hemifacial droop. The patient's neurological examination showed peripheral‐type facial palsy with dysgeusia of the right anterior two‐thirds of her tongue. However, MRI revealed an anterior inferior cerebellar artery lesion, diagnosed as brain stem infarction. Peripheral‐type facial palsy has been reported in some stroke cases, with these cases not presenting with dysgeusia. Thus, this finding usually helps differentiate facial nerve palsy from peripheral‐type facial palsy caused by brain stem lesions. Despite the cerebral infarction, our patient presented with peripheral facial nerve palsy with taste disorder. This is because the lesion not only involved the pons but also the middle cerebellar peduncle. Therefore, patients with multiple vascular risk factors need to be carefully diagnosed.

Electroacupuncture combined with Qianzhengsan decoction for the treatment of peripheral facial paralysis: A retrospective study.

This study retrospectively explored the effectiveness of electroacupuncture (EA) combined with Qianzhengsan decoction (QZSD) for the treatment of peripheral facial paralysis (PFP). This retrospective study included patients with PFP admitted to a single hospital between July 2018 and June 2020. Ninety patients were included and divided into treatment (n = 45) and control (n = 45) groups. All the patients in both groups received oral prednisone tablets and mecobalamin. In addition, patients in the treatment group received EA and QZSD. The outcomes were the overall response rate, facial nerve function, facial nerve electromyography, and adverse events. All outcome data were analyzed before and after treatment. Patients in the treatment group achieved better outcomes than those in the control group in improving overall response rate (P = .04), facial nerve function (P < .01), and facial nerve electromyography (P < .01). Patients in both groups reported adverse events. The results of this study showed that patients with PFP and QZSD received better outcomes than those who did not. Further studies are required to confirm these results.

Synkinesis developed after peripheral facial paralysis: An electrophysiological study

Synkinesis developed after peripheral facial paralysis: An electrophysiological study

Translation, cross-cultural adaptation, and validation of the Italian version of the Synkinesis Assessment Questionnaire in individuals with peripheral facial palsy.

After peripheral facial palsy, the onset of facial synkinesis results in aesthetic disfigurement and local muscle tension or pain, with possible deterioration of patient's well-being and social participation. The availability of valid instruments to evaluate patient-reported severity of facial synkinesis is important to capture the subjective perception of facial impairment. To generate and validate an Italian version of the Synkinesis Assessment Questionnaire, a patient-reported outcome measure to assess patient-perceived severity of facial synkinesis after peripheral facial palsy. Observational study. Outpatient clinic of a Rehabilitation Unit. Seventy-five patients with peripheral facial palsy. Through a process of translation and cross-cultural adaptation, we generated the Italian version of the questionnaire (SAQ-IT) and administered it twice to patients with peripheral facial palsy. We evaluated the clinical severity with the Sunnybrook Facial Grading System (SFGS) and the physical and social/well-being function with the two subscales of the Facial Disability Index (FDI-PHY and FDI-SWB, respectively). Cronbach's alpha was 0.87. Item-total correlations ranged from 0.30 to 0.70, while inter-item correlations ranged from 0.15 to 0.82, with an average value of 0.48. Test-retest reliability showed an Intraclass Correlation Coefficient of 0.946 (95% confidence interval: 0.916-0.966). The minimum detectable change (with a 95% confidence level, MDC<inf>95</inf>) was 13.14 points. The correlation between SAQ-IT and the SFGS synkinesis subscore was rho=0.74, while that with the SFGS composite score was rho=0.25, with the FDI-PHY rho=-0.11 and with the FDI-SWB rho=-0.13. Our study validates the SAQ-IT in Italian-speaking individuals with peripheral facial palsy, confirming its acceptable psychometric properties, and providing the MDC<inf>95</inf>. The availability of a valid instrument for the evaluation of patient-perceived severity of facial synkinesis plays an important role in the definition of tailored rehabilitative interventions after peripheral facial palsy.

Clinical Experience of Qianzhengsan Combined with Acupoint Application in the Treatment of Peripheral Facial Paralysis

Clinical Experience of Qianzhengsan Combined with Acupoint Application in the Treatment of Peripheral Facial Paralysis

A case of Miller Fisher syndrome with delayed onset peripheral facial nerve palsy after COVID-19 vaccination: a case report

BackgroundTo prevent the spread of the novel coronavirus disease 2019 (COVID-19) infection, various vaccines have been developed and used in a large number of people worldwide. One of the most commonly used vaccines is the mRNA vaccine developed by Moderna. Although several studies have shown this vaccine to be safe, the full extent of its side effects has not yet been known. Miller-Fisher syndrome (MFS) is a rare condition that manifests ophthalmoplegia, ataxia, and loss of tendon reflexes. It is a subtype of Guillain–Barré syndrome and an immune-mediated disease related to serum IgG anti-GQ1b antibodies. Several vaccines including those for COVID-19 have been reported to induce MFS. However, there have been no reports of MFS following Moderna COVID-19 vaccine administration.Case presentationA 70-year-old man was referred to our hospital due to diplopia that manifested 1 week after receiving the second Moderna vaccine dose. The patient presented with restricted abduction of both eyes, mild ataxia, and loss of tendon reflexes. He was diagnosed with MFS based on his neurological findings and detection of serum anti-GQ1b antibodies. The patient was administered intravenous immunoglobulin, and his symptoms gradually improved. Five days after admission, the patient showed peripheral facial paralysis on the right side. This symptom was suggested to be a delayed onset of peripheral facial nerve palsy following MFS that gradually improved by administration of steroids and antiviral drugs.ConclusionThere have been no previous reports of MFS after Moderna COVID-19 vaccination. This case may provide new information about the possible neurological side effects of COVID-19 vaccines.

Vaccines and Bell's palsy: A narrative review

The association between vaccines and peripheral facial palsy (PFP), an issue that has been the subject of debate for many years, has been raised again following results of clinical trials assessing mRNA based COVID-19 vaccines. To review the available literature on this topic, PubMed was searched from inception until February 25, 2022. Inclusion criteria were case reports with documented rechallenge and comparative epidemiological studies. Cases of COVID-19 vaccine-induced PFP with available data on vaccine rechallenge were also identified from Vigibase until December 31, 2021. Of the 347 articles retrieved, 32 comparative epidemiological studies, 1 meta-analysis and 4 case reports met our criteria, of which 13 involved COVID-19 vaccines. Eight studies found an association between at least one vaccine and the occurrence of PFP, whereas 24 did not. Positive studies involved seasonal or pandemic H1N1 influenza vaccines administered parenterally (4 studies) or intranasally (1 study with a toxin-adjuvanted vaccine), BNT162b2, a mRNA COVID-19 vaccine (1 disproportionality analysis and 1 observed-to-expected analysis) and an inactivated virus COVID-19 vaccine (CoronaVac®) (1 study combining a case-control and an observed-to-expected approach). Strong evidence was found only for the intranasal influenza vaccine while other positive studies detected only a marginal association between PFP and vaccination. Of the four case reports with documented rechallenge, only two were positive and involved an influenza vaccine and tozinameran in one case each. In Vigibase, rechallenge was documented in 49 reports with 29 (59.2%) cases being negative and 20 (40.8%) positive. The available data did not confirm an excess risk of PFP after vaccination in most studies. Moreover, of the eight epidemiological studies suggesting a possible excess risk of PFP after any vaccine, three were disproportionality analyses and two observed-to excepted analyses, suggesting great caution should be taken when interpreting these results.

Petrositis caused by fluconazole-resistant candida: case report and literature review

BackgroundPetrositis is a rare and fatal complication associated with otitis media. It is most likely caused by bacterial infections, but in some cases it is caused by fungal infections.Case studyThe case in this report is associated with fungal petrositis. The clinical symptoms are: ear pain from chronic otitis media, severe headache, peripheral facial palsy and diplopia. The case was finally confirmed through imaging of middle ear, bacterial culture, pathology, and blood Metagenomic next-generation sequencing (mNGS) test. The patient was treated with sensitive antifungal drugs.ConclusionDrug treatment is conservative but efficient method in this case. mNGS can provide pathogenic reference, when antibiotic is not efficient enough for fungal infections or drug-resistant fungal infections cases. This allows we to adjust drug use for the treatment.

Potential Association Between COVID-19 Vaccination and Facial Palsy: Three Cases With Neuroimaging Findings.

Acute onset Facial palsy was reported in four vaccinated participants in the BNT162b2 (Pfizer-BioNTech) vaccine clinical trials published on December 10, 2020. So far, few cases of Facial palsy among the mRNA vaccine groups have been previously documented in the literature. Facial palsy is cited as medically attended adverse event following immunization on April 12, 2021, after the first dose of the approved Pfizer-BioNTech COVID-19 vaccines for preventive immunization for SARS-CoV-2 is administrated to the population in Turkey. This study is aimed to describe clinical and magnetic resonance imaging features of three patients, who developed acute onset peripheral facial paralysis after administration of the BNT162b2 vaccine, without any previous medical condition. The first patient presented with right sided facial palsy within the same day following the vaccine was administrated, while the second patient presented with left sided facial palsy 2 months after vaccination. The third patient, on the other hand, presented with right sided facial palsy and abducens nerve (CN VI) paralysis two days after vaccine was administrated.

Standardized reporting of complications of epilepsy surgery and invasive monitoring: A single-center retrospective study

ObjectiveMonitoring adverse effects related to epilepsy surgery is essential for quality control and for counseling patients prior to the procedure. The aim of this study was to analyze the rates of complications related to epilepsy surgery following invasive monitoring and to classify them according to the recently proposed protocol by the E-pilepsy consortium. MethodsThis is a retrospective study of collected data extracted from our routinely updated epilepsy surgery database which consisted of 173 surgical procedures: 89 surgeries for insertion of subdural grids, strips, and/or depth electrodes, and 84 resective surgeries. According to the protocol, complications were defined as unexpected postoperative adverse events and were stratified into transient (lasting less than 6 months) and permanent deficits (lasting 6 months or longer). In addition, we reported patients with postoperative psychiatric disturbances and calculated the rates of transient and permanent postoperative sequelae which were defined as expected postoperative deficits deemed inherent to the surgical procedure. ResultsSix potentially life-threatening complications requiring acceleration of the planned resective surgery occurred during invasive monitoring. Following resective surgery, 12 transient sequelae (8 motor deficits, three language deficits, and one transient dyscalculia) and 10 permanent sequelae (5 mild memory disturbances, four visual field cuts, and one contralateral dysesthesia) occurred. In addition, 7 patients experienced transient motor complications. Four permanent postoperative neurological complications (4.8%) occurred: motor deficits in three patients and a partial peripheral facial palsy in one. Finally, five patients developed de novo psychiatric disturbances (transient in four and permanent in one). ConclusionsThis is the first study to classify complications of epilepsy surgery according to the E-pilepsy consortium protocol. Our findings demonstrate that epilepsy surgery following invasive monitoring is safe and associated with low morbidity when performed in specialized centers. Monitoring these complications according to a unified definition and using a multidimensional protocol will allow for a direct comparison across epilepsy surgery centers, will provide the epileptologists and surgeons with objective percentages to share with their patients and will help in identifying risk factors and improving the safety of epilepsy surgery.

A Rare Presentation of Anti-Gad Associated Neurological Disorder in A Fifteen-YearOld Girl

Anti-GAD antibodies have been associated with numerous neurological conditions that have a wide variety of presentations. These conditions include limbic encephalitis, stiff person syndrome, opsoclonus-myoclonus-ataxia syndrome, cerebellar ataxia, and status epilepticus. In this paper, we aimed to present a female patient admitted with complaints of acute weakness and right peripheral facial palsy, pancytopenia, hepatosplenomegaly, and anti-glutamate decarboxylase antibody and report the diversity and clinical features of neurological diseases associated with anti-glutamate decarboxylase antibodies. Conclusion Besides the common primary syndromes, other new clinical and neurological manifestations have been associated with anti- anti-glutamate decarboxylase antibodies.

Contribution of the Synkinesis Assessment Questionnaire and the Sunnybrook Facial Grading System to the evaluation of synkinesis after peripheral facial palsy: A STROBE observational study

ObjectivesThe main aim of the study was to determine whether the perception of synkinesis by patients with peripheral facial palsy (PFP) matched their clinician's severity assessment. Secondary objectives comprised: (1) to determine whether objective measurement of synkinesis matched the patient's perception; and (2) is to identify factors influencing patients’ perceptions. MethodsThis retrospective study took place from January to May 2020. Forty patients (8 per PFP grade, I-V/VI; 20 women, 20 men) filled out the Synkinesis Assessment Questionnaire (SAQ) and were assessed on the Sunnybrook Facial Grading System (SFGS). Photographs were analyzed on MEEI-Facegram software. ResultsPerceived synkinesis (total SAQ) matched objective grades (SFGS) (Z=2.89; P=0.004), especially for smiling (Z=3.84; P<0.001) and lip protrusion (Z=3.79; P<0.001). Synkinesis on lip protrusion was a more sensitive indicator of perceived synkinesis than synkinesis on smiling (Z=2.96; P=0.003). Duration (ρ=0.5137; P<0.001) and grade of PFP (Chi2=13.82; P=0.008) heightened the perception of synkinesis. ConclusionPatient-reported outcome measures (PROMs) such as the SAQ are relevant for clinical evaluation.

Electron Microscope Observation of Acupuncture and Nerve Repair in the Treatment of Peripheral Facial Paralysis.

The repair of peripheral facial paralysis is a long-term problem in neurosurgery, and nerve repair is often needed. Due to the high differentiation of nerve tissue and the slow regeneration of peripheral nerve fibers, the repair effect after peripheral nerve injury is not ideal. In recent years, studies have found that the inflammatory response after peripheral nerve injury also has an important impact on the repair of peripheral nerve defects. This study depends on the utilization of traditional needle therapy in the treatment of fringe facial loss of motion, and the clinical adequacy of needle therapy in addition to nerve fix in the intense period of fringe facial loss of motion was seen with an electron magnifying lens. Endeavor to give significant exploration results to the clinical treatment of fringe facial loss of motion gives a straightforward, simple, protected, and successful new treatment innovation for the clinical treatment of the infection and enriches the treatment plan for peripheral facial paralysis. Transmission electron microscopy observations showed that 21 days after the artificial nerve was repaired, the nerve injury showed different degrees of recovery, and the myelin sheath was forming and gradually wrapping the new axons, which was similar to the catheter group (NC) and hydrogel group (HC). In contrast, the myelin layer of the fibroblast group (FHC) is more obvious, and the repair effect is better. In the maintenance of fringe nerve surrenders, irritation is an unavoidable interaction, and moderate needle therapy is useful to advance the maintenance of fringe nerve abandons. Talking about the law of nerve fix reaction in fringe nerve imperfection fix is helpful to the examination of fringe nerve deformity fix. Tests have shown that utilizing needle therapy and moxibustion joined with nerve fixes has accomplished great outcomes in the treatment of fringe facial loss of motion, and the patient's recuperation rate has expanded by over 30%.

Clinical Observation of Moxibustion Combined with Flash Can in the Treatment with Peripheral Facial Paralysis

Clinical Observation of Moxibustion Combined with Flash Can in the Treatment with Peripheral Facial Paralysis

Effectiveness and safety of Korean medicine treatment based on the clinical practice guidelines in patients with acute peripheral facial palsy: A protocol for a multicenter, prospective, observational study.

Introduction:Peripheral facial palsy (PFP) results in weakness or paralysis of the affected side of the face. In Korea, there is a high demand for Korean medicine treatment for PFP. The clinical practice guidelines (CPGs) of Korean medicine for facial palsy were developed; however, there remains insufficient evidence to support the effectiveness and safety of Korean medicine treatment. Thus, this study aimed to evaluate the effectiveness and safety of Korean medicine treatment based on the CPGs in patients with acute PFP.Methods:This is a multicenter, prospective, observational study. The participants will be recruited from one Korean medicine hospital and eight Korean medicine clinics. The participants will receive Korean medicine treatments based on the CPGs, fill in survey questionnaires, and undergo electrophysiologic testing. The changes in House-Brackmann (H-B) grade, movement of the lip and eye, symptoms related to or accompanied by facial palsy, Facial Disability Index, EuroQol 5-dimension 5-level (EQ-5D-5L), and EuroQol Visual Analogue Scale (EQ-VAS), and the results of electromyography (EMG), electroneurography (ENoG), and Blink Reflex test will be analyzed. For the safety analysis, adverse events will be recorded, and for the feasibility analysis, the results of the Was It Worth It questionnaire will be assessed.Conclusion:We expect to draw real-world clinical data on the effectiveness and safety of Korean medicine treatment based on the CPGs in patients with acute PFP from this study. It would be the basis for complementing and improving the CPGs and provide the basis of clinical and policy decision-making.Trial registration:This study was approved by the Institutional Review Board of Kyung Hee University Korean Medicine Hospital (2021-06-005-001), and registered with the Korean Clinical Trial Registry (CRIS), Republic of Korea (KCT0006562).

CASE REPORT OF BELL’S PALSY FOLLOWING SECOND DOSE OF COVISHIELD VACCINE

Bell’s palsy, also known as acute peripheral facial palsy of unidentified reason, is caused by the acute onset of problems with the facial nerve’s lower motor neuron. Several case reports and series have described peripheral facial nerve palsy associated with COVID-19. In addition, since the US food and drug administration’s (FDA) emergency use authorization of several COVID-19 vaccines, there have been media reports of Bell’s palsy associated with vaccination. This case concerns a 26-year-old female with Bell’s palsy (confirmed by clinical diagnosis – an acute unilateral facial nerve paresis or paralysis with onset in &gt;72 h) after receiving second dose of Covishield vaccine (ChAdOx1 nCoV-19). She experienced decreased sleep, dizziness, and left side eye watering post-vaccination. Next day after vaccination, she noticed muscle weakness on the left side of the face, preventing her from close left eye, drinking fluids, and facial droop accompanied by reduced mobility. The patient was treated with methylprednisolone and eye drops (lubricants).

Clinical features, diagnosis and treatment for patients presenting with granulation tissue of the external auditory canal

Objective:To explore the clinical characteristics and diagnosis and treatment in the patients presenting with granulation tissue of the external auditory canal. Methods:The data of 71 postoperative patients presenting with granulation tissue of the external auditory canal in the Department of Otolaryngology, the First Affiliated Hospital of the Air Force Military Medical University from January 2015 to June 2020 were analyzed retrospectively, including the chief complaint, physical examination, auxiliary examination and preoperative imaging, biopsy was performed when necessary to confirm the diagnosis. Among the 71 patients, 30 cases were diagnosed as chronic otitis media, 19 cases were external auditory canal cholesteatoma, 5 cases were external auditory canal carcinoma, 6 cases were paraganglioma, 1 case was granulomatous hemangioma, 1 case was first branchial cleft fistula, 4 cases were granuloma of the external auditory canal, 4 cases were hemangioma of the external auditory canal, and 1 case was foreign body of the external auditory canal. Individualized treatment plans are made according to the characteristics and extent of the lesions. Results:Postoperative follow-up was 12 to 74 months, with an average of （44±18.1） months. Seventy patients（98.6%） had no complications such as sensorineural deafness, external auditory stenosis or peripheral facial paralysis after surgery, and one patient with paraganglioma had postoperative neurological function grade Ⅱ, and was treated with nutritional nerves, and the postoperative neural function recovered to grade Ⅰ after 3 months. Conclusion:The patients presenting with granulation tissue of the external auditory canal can be diagnosed as various diseases. It is necessary to analyze the patient's medical history in detail, confirm the diagnosis in combination with imaging examination, and formulate an individualized treatment plan to reduce misdiagnosis and missed diagnosis.

Idiopathic Peripheral Facial Palsy and Preclampsia: A Case Report

During pregnancy, pre-eclampsia can be associated to idiopathic peripheral facial nerve palsy. It can be explained by similar physiopathological mechanisms. Facial palsy usually appears during the third trimester of pregnancy or in the early postpartum period. The prognosis is generally good and is not affected by the pregnancy. The occurrence of peripheral facial palsy during pregnancy should alert the obstetrician to look for a possible pre-eclampsia. We report a case of a patient with pre-eclampsia who developed idiopathic peripheral facial palsy during the third semester of pregnancy. Evolution was favorable, following treatment combining anti-hypertensive medication, corticosteroid therapy and ophthalmologic care.

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

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