Recurrent Facial Palsy Research Articles

Melkersson-Rosenthal Syndrome Associated to Behçet Disease

Melkersson-Rosenthal syndrome (MRS) is an extremely rare disorder whose complete and typical form associates the triad: recurrent nonpitting orofacial edema, facial paralysis, and lingua plicata (fissured dorsal tongue). The exact pathogenesis of this disease is not yet fully understood. Its association with several other autoimmune disorders and the granulomatous nature of this syndrome suggest a dysimmune origin. The association with systemic vasculitis remains unusual with only two cases previously reported. We report the original case of MRS associated with Behcet disease in a 36-year-old Tunisian woman with favorable outcome under colchicine. Our observation is, to our knowledge, the first to report this association.

Melkersson\u2013Rosenthal syndrome misdiagnosed as recurrent Bell\u2019s palsy: a case report and review of literature

BackgroundMelkersson–Rosenthal syndrome (MRS) is a rare neuro-mucocutaneous disorder of unknown cause, clinically characterized by a triad of recurrent facial palsy, orofacial swelling, and fissured tongue. It is frequently seen in females in their second and third decades of life. MRS is diagnosed based on clinical features and it is rarely possible to observe all the classical triad symptoms at the same time. The disorder may cause recurring peripheral facial palsy that is wrongly diagnosed as recurrent Bell’s palsyCase presentationA 25-year-old female patient was presented to the neurology clinic of Tikur Anbessa Specialized Hospital in Addis Ababa complaining of recurrent left-side peripheral facial weakness, facial swelling and fissured tongue of 5 days duration. Her past medical history was positive for similar symptoms, for which she was diagnosed with Bell’s palsy and received oral corticosteroid treatment. On examination left side lower facial swelling with flat naso-labial fold and fissured tongue were identified. After excluding other mimickers, she was diagnosed with Melkersson–Rosenthal syndrome and completely recovered with high dose of corticosteroid treatment.ConclusionMelkersson–Rosenthal syndrome may present with the classic triads of symptoms, but mostly it shows an incomplete clinical pattern. Therefore, when clinicians including allergists encountered patients with facial swelling and facial palsy, they should have to consider MRS in their differential diagnosis and specifically assess for recurrent facial palsy and fissured tongue. Unlike true angioedema, the facial swelling in MRS often develops gradually and it might cause permanent swelling with cosmetic disfigurement from multiple relapses, which can be prevented by early detection and timely initiation of treatment.

A Case of Recurrent Facial Palsy Associated with Anti-GM2: is it anyway Guillain-barré syndrome?

Objective: A rare case of possible hereditary predisposition to autoimmune neuropathy Background: This case report is of a patient who presented two episodes of Facial paresis in her live without ascertained apparent causes. Bell’s palsy is commonly known as peripheral idiopathic facial nerve palsy, because in the most cases the triggers remain unknown (1). Case Report: I want to present a case of a 34 year old woman who we will call A.B. and who came to us to evaluate the severity of the sequelae of a Bell´s palsy and any eventual need for cosmetic measure. But she had another Bell´s Palsy 9 years ago, so I started to investigate the most common and treatable causes of Facial paresis. I found a significate increase of anti-bodies against ganglioside GM2. When I explained to her that these anti-bodies is commonly related with several neurological diseases, she started to investigate her family history and she found that his father’s brother died of GuillainBarré syndrome about 40 years ago.

Recurrent transient facial nerve palsy on commercial air flights

IntroductionFacial baroparesis is a rare event, usually associated with a favourable outcome. It is related to atmospheric pressure changes that are responsible for neuropraxia. Most cases of facial baroparesis have been reported in the context of underwater diving, but very few cases have been reported during commercial flights. Case reportWe report the case of a patient who experienced several episodes of spontaneously resolving left facial palsy during long-haul flights. The work-up revealed bilateral facial nerve canal dehiscence visible on CT scan and clinical features of bilateral otitis media with effusion associated with hearing loss. DiscussionThe pathogenesis of this disease involves the combination of these two elements inducing ischaemia of the exposed facial nerve submitted to pressure variations. In most cases, ischaemia is rapidly reversible with complete recovery after landing or in response to Valsalva manoeuvres. It is therefore important not to miss this entity to avoid delayed or inappropriate management.

Potential association between recurrent facial nerve palsy and migraines.

This study aimed to investigate the possible association between recurrent facial nerve palsy and migraines. This study was a prospective case series with a two-year follow-up at an academic, tertiary referral centre and included patients with at least four episodes of recurrent lower motor neuron facial nerve palsy. All patients underwent standardised diagnostic tests. Four patients fulfilled the inclusion criteria. The patients were all female with an average age at presentation of 40.75 years (range, 33-60 years) and an average age at the initial episode of 14 years (range, 12-16 years). The number of episodes varied between six and nine. All patients had at least one episode of facial nerve palsy on the contralateral side. Two patients were diagnosed and treated for migraine with aura remaining asymptomatic following prophylactic medication for migraines. The results raise the possibility of an association between recurrent facial nerve palsy and migraines. Prospective studies in patients with even fewer episodes of facial nerve palsy could shed more light on this association.

Tuberculous otitis media: rare cause of recurrent facial nerve palsy

<p class="abstract">Tuberculous otitis media (TOM) is a rare form of tuberculosis, due to tubercular otitis media, thick caseous material and granulation tissue gets deposited in middle ear cleft causing bone erosion, sequestration, ossicular destruction, heading loss which can be conductive or mixed and rarely facial paralysis. In this case report we discuss tubercular otitis media as a cause of recurrent facial nerve paralysis. 54 year old male patient with no known previous comorbidities presented to ENT OPD on 12 October 19 with complaints of scanty, mucopurulent foul smelling occasionally blood stained continuous otorrhoea (R)×02 years, painless progressive and persistent hearing loss ×1 year and recurrent (R) sided facial nerve palsy, 03 episodes in last 2 years which were spontaneous and sudden in onset, showed gradual recovery with oral medication. Tubercular otitis media is not a very common diagnosis with which an otolaryngologist comes across. It generally presents with otorrhea and hearing loss which mimics more commoner ear disease. Typical findings of multiple tympanic membrane perforations are not necessarily seen. There can be involvement of facial nerve and presence of refractory otorrhoea with atypical features may be considered indicative of tubercular pathology. A clinician should have high index of suspicion whenever there are signs which outlies symptoms in form of severity. This case highlights the diagnostic challenge and high index of clinical suspicion required for diagnosis. Combination of appropriate diagnostic modality along with good clinical vigilance will aid in early diagnosis and start of early medication which reduces chances of any subsequent complications.</p><p class="abstract"> </p>

Total facial nerve decompression in severe idiopathic recurrent facial palsy: its long-term follow-up results

Background: The long-term outcomes of total facial nerve decompression (TFND) in severe idiopathic recurrent facial palsy (IRFP) are still unknown.Aims/objectives: To explore the long-term follow-up results of TFND in IRFP.Materials and methods: Twenty-eight patients suffering from severe IRFP were enrolled. Patients were offered conventional therapy or TFND and were categorized into control or operation group. The follow-up lasted for at least 6 years. Comparison was made in terms of relapse of facial palsy as well as outcomes of facial nerve.Results: There were 16 participants in operation group, whose follow-up lasted for 10.4 ± 1.3 years. In contrast, there were 12 participants in control group, who were followed up lasted for 11.2 ± 1.2 years. No participants suffered relapse in the operation group while seven out of 12 participants (58.3%) encountered relapse with regard to control group (p < .05). In terms of facial nerve results, 16 out of 18 participants (88.9%) reached satisfactory outcomes of facial nerve (HB grade I or II) while only four out of 12 participants (33.3%) achieved satisfactory outcomes in control group (p < .05).Conclusions and significance: In terms of severe IRFP, TFND can defend patients from relapse in a long period, and enhance recovery of facial nerve.

Case report: Recurrent peripheral facial paralysis following two influenza vaccinations in 2009 and 2016

A 57-year-old female experienced two successive peripheral facial paralysis (PFP) episodes following influenza immunization in 2009 and 2016 with two different vaccines. The similarity of chronology and semiology between the two events and the absence of alternative etiology plead for intrinsic accountability. Extrinsic accountability relies on previous case reports of PFP related to flu vaccination (26 cases in the French pharmacovigilance database and 4 cases in the medical literature).

Recurrent facial palsy: The prognostic value of electrophysiological tests according to recurrence interval

ObjectiveThe prognostic value of nerve excitability tests (NET) and electroneurography (ENoG) for recurrent peripheral facial palsy is poorly understood. This study aimed to evaluate the association between NET/ENoG results for the current palsy and recovery. MethodsWe extracted data on patients who were referred to our hospital (2005–2017). Adult patients with recurrent peripheral facial palsy who underwent NET and ENoG within 3 weeks of onset were retrospectively analyzed (n = 26). Favorable recovery was defined as the achievement of either House–Brackmann grade I/II or the same level of facial movement as before the current palsy. We evaluated the predictive NET/ENoG results by making comparison between the favorable recovery group and the unfavorable recovery group, which were subdivided based on the length of time after the previous palsy. ResultsIn terms of patients with a >4-year recurrent interval, 8 out of 12 patients achieved favorable recovery. Compared to the favorable recovery group, the unfavorable recovery group had significantly higher NET results (9.03 mA vs. −1.08 mA, p = 0.017). Also, the unfavorable recovery group had significantly higher NET results in patients with a >2-year recurrent interval (9.03 mA vs. 1.06 mA, p = 0.036). However, other test results (NET in ≤4-year recurrent interval/all 26 patients, and ENoG in >4-year recurrent interval/≤4-year recurrent interval/all 26 patients) did not differ significantly between patients with favorable and unfavorable recovery. ConclusionNET might be a useful prediction method in patients with at least a few years interval between the previous and the current palsy.

For Whom the Bell's Toll: Recurrent Facial Nerve Paralysis, A Retrospective Study and Systematic Review of the Literature.

To examine the etiology, clinical course, and management of recurrent peripheral facial nerve paralysis. Retrospective review at a single tertiary academic center and systematic review of the literature. Clinical presentation, laboratory and imaging findings, treatment and outcome for all cases of recurrent ipsilateral, recurrent contralateral, and bilateral simultaneous cases of facial paralysis are reviewed. Between 2000 and 2017, 53 patients [41.5% men, 29 median age of onset (range 2.5 wk-75 yr)] were evaluated for recurrent facial nerve paralysis at the authors' institution. Twenty-two (41.5%) cases presented with ipsilateral recurrences only, while the remaining 31 patients (58.5%) had at least 1 episode of contralateral recurrent paralysis. No cases of bilateral simultaneous facial nerve paralysis were observed. The median number of paretic events for all patients was 3 (range 2-20). The median nadir House-Brackmann score was 4, with a median recovery to House-Brackmann grade 1.5 over a mean recovery time of 61.8 days (range 1-420 d). Diagnostic evaluation confirmed Melkersson-Rosenthal syndrome in four (7.5%) cases, neurosarcoidosis in two (3.7%), traumatic neuroma in one (1.9%), Ramsay Hunt syndrome in one (1.9%), granulomatosis with polyangiitis in one (1.9%), and neoplastic causes in three (5.7%) cases [facial nerve schwannoma (n = 2; 3.7%), metastatic squamous cell carcinoma to the deep lobe of the parotid gland (n = 1; 1.9%)]; ultimately, 77.4% (41) of cases were deemed idiopathic. Facial nerve decompression via a middle cranial fossa approach was performed in three (5.7%) cases without subsequent episodes of paralysis. Recurrent facial nerve paralysis is uncommon and few studies have evaluated this unique population. Recurrent ipsilateral and contralateral episodes are most commonly attributed to idiopathic facial nerve paralysis (i.e., Bell's palsy); however, a subset harbor neoplastic causes or local manifestations of underlying systemic disease. A comprehensive diagnostic evaluation is warranted in patients presenting with recurrent facial nerve paralysis and therapeutic considerations including facial nerve decompression can be considered in select cases.

Surgical Outcomes in Idiopathic Recurrent Facial Nerve Paralysis: A Rare Clinical Entity.

To evaluate the postoperative facial nerve dysfunction, audiometric outcomes, and long-term quality-of-life outcomes of patients with idiopathic recurrent facial nerve paralysis (RFP) after middle cranial fossa (MCF) microsurgical decompression. Retrospective chart analysis of 11 (mean age 37.0 years, range 5 to 67) patients at an academic tertiary referral center who underwent MCF facial nerve decompression. Data analysis included evaluation of pre- and postoperative House-Brackmann (HB) score, pre- and postoperative pure-tone average (PTA), pre-and postoperative word recognition scores (WRS), and postoperative Facial Clinimetric Evaluation survey. Mean number of preoperative facial paralysis episodes was 3.5 (range 2 to 6), and preoperative HB score was 4.5 (range 1 to 6). Postoperatively, 0 patients had further episodes of facial nerve paralysis at an average of 6.5 years (range 0.1 to 17.6) (P = 0.005), and the average postoperative HB score was 2.1 (range 1 to 3) (P = 0.011). Postoperative audiometry was stably maintained as assessed with PTA and WRS scores. Microsurgical facial nerve decompression for idiopathic RFP may be a reliable therapeutic modality to prophylactically decrease the number of facial nerve paralysis episodes and may also help to improve facial nerve functional status. 4 Laryngoscope, 130:200-205, 2020.

Recurrent Bell's palsy.

Although recurrent facial palsy was first reported in 1871, the aetiology, definitions, classifications, pathogenesis, treatment options and prognosis have not been clearly determined. There have been no systematic reviews and meta-analyses of recurrent Bell's palsy. The purpose of this study was to evaluate the clinical manifestations of recurrent Bell's palsy through a systematic review and meta-analysis. The SCOPUS, PubMed, Cochrane Library and EBSCO databases were searched through 1 May 2018, using the search terms "recurrent Bell's palsy" and "recurrent facial palsy," for studies involving patients with recurrent Bell's palsy. Reference lists of eligible studies were also reviewed. A search of titles and abstracts in these four databases identified 222 studies; of these, 27 studies, involving 1041 patients from 13 countries, were analysed. The mean percentage of patients who experienced recurrence of Bell's palsy ranged from 0.8% to 19.4%. Five studies that included 191 patients were included in the meta-analysis. Among patients previously affected by Bell's palsy, the mean incidence of recurrent Bell's palsy was 6.5%. Sidedness of recurrent disease, relative to the side of the original disease, had no effect on patient prognosis. Of all patients with Bell's palsy, 66.0% recovered completely, with the recovery rate lower in patients with recurrent than with primary Bell's palsy.

Isolated and Recurrent Peripheral Facial Palsy Revealing Primary Sjogren’s Syndrome

Primary Sjogren’s syndrome (PSS) is an autoimmune disease characterized by focal lymphoid infiltration of the exocrine glands, mainly manifested by dry ocular and oral syndrome

Recurrent unilateral peripheral facial palsy in a patient with an enlarged styloid process

Recurrent peripheral facial paresis is a rare symptom that may be caused by multiple pathologic conditions. We report a case of recurrent peripheral facial palsies caused by an ipsilateral enlarged styloid process. A surgical excision of the process was performed. The treatment was well tolerated. Postoperatively, no further recurrent paresis was observed. To the best of our knowledge, this is the first case study of an enlarged styloid process with facial paresis. A detailed workup, including imaging, should be performed in cases with recurrent facial paresis and/or cases with a history of trauma and facial paresis and, of course, to exclude a neoplastic etiology.

A Systematic Review of the Literature of the Three Related Disease Entities Cheilitis Granulomatosa, Orofacial Granulomatosis and Melkersson - Rosenthal Syndrome.

Melkersson Rosenthal syndrome (MRS) is a rare disorder of unknown etiology and comprises the triad: orofacial edema, recurrent facial paralysis and lingua plicata. In the current literature confusing heterogeneity exists, mixing together the historically grown terms cheilitis granulomatosa or granulomatous cheilitis, Melkersson Rosenthal syndrome and the umbrella term Orofacial Granulomatosis (OFG). We provide a systematic review comprising all three disease entities of orofacial granulomatosis using the computerized database "Pubmed Medline" entering the keywords "orofacial granulomatosis" (141 references), "Melkersson-Rosenthal syndrome" (207 references), "granulomatous cheilitis" or "cheilitis granulomatosa" (102 references) back to 1956. Full-text journals and case studies were included, and data synthesis was performed individually. Etiology remains unclear for all three disease entities. Etiological relatedness to chronic inflammatory bowel disease is under discussion and effectiveness was found for different treatments, e.g. local triamcinolone injections, antibiotics, surgical interventions, TNF alpha blockers or exclusive enteral nutrition. No randomized controlled trial concerning the therapy of orofacial granulomatosis was found. As a consequence, the therapeutic conclusion is drawn mainly from small case series, thus limiting the evidence of therapeutic interventions. OFG with the sub-entities MRS and cheilitis granulomatosa is an etiological obscure disease process with various possible therapeutic interventions potentially alleviating the disease course but to broaden treatment knowledge further study in randomized controlled trials is needed.

An Unusual Cause of Recurrent Facial Nerve Palsy

An Unusual Cause of Recurrent Facial Nerve Palsy

Facial nerve palsy in children: A retrospective study of 124 cases.

To report the causes and clinical evaluation of children with facial nerve palsy (FNP) admitted to an affiliated university hospital during a 5-year period (2011-2015). A total of 124 children were retrospectively categorised into two groups: idiopathic Bell's palsy (109 patients) and the second group into other FNP aetiologies (15 patients). All children received a standardised work-up and follow-up. Therapy consisted of steroid administration associated with antiviral treatment when a viral infection was suspected. All children of the first group had a full recovery under oral steroids within 2 months of treatment. From the second group, seven children (46%) had a viral infection based on serological findings, two of them were positive for neurotropic herpes viruses, and one had Ramsay Hunt syndrome; six children with infectious FNP had recurrent FNP on the ipsilateral or contralateral side. Five patients had FNP as a complication of acute otitis media; three of them (60%) had partial or full recovery postoperatively. One child developed FNP following temporal bone trauma that had an uneventful recovery with conservative treatment. One child suffered from Melkersson-Rosenthal syndrome, and another child presented with FNP associated with unilateral hemiparesis following an ischaemic cerebral infarct. Facial palsy in children is a manifestation of a heterogeneous group of causes. The most common aetiology of FNP in children in our study was idiopathic (Bell's palsy), followed by infective causes, such as acute otitis media and neurotropic herpes viruses. Therefore, treatment should be adapted to each patient depending on the underlying disease and severity of FNP.

Childhood Sarcoidosis Presenting as Recurrent Facial Palsy

Recurrent facial palsy in a patient merits investigation for underlying etiology. 8-year-old boy with erythematous itchy skin lesion and recurrent facial palsy. He had a past history of aseptic meningitis and nephrocalcinosis. Raised angiotensin converting enzyme levels, interstitial lung disease on CT chest, and non caseating granulomas on skin biopsy clinched the diagnosis of sarcoidosis. Multisystem involvement and recurrent lower motor facial nerve palsy is a clinical clue for sarcoidosis.

Childhood peripheral facial palsy.

The objectives of this study were to evaluate the demographic and clinical characteristics, causes, treatment patterns, outcome, and recurrence of childhood peripheral facial palsy. We performed a retrospective study of 144 peripheral facial palsy patients, under 18years old in a tertiary care pediatric hospital. Medical charts were reviewed to analyze the age, gender, side of facial nerve paralysis, family history, cause, grading by the House-Brackmann Facial Nerve Grading Scale (HBS), results of diagnostic tests, therapies, outcomes, and recurrence. Causes were as follows: 115 idiopathic (Bell's palsy) facial palsy (79.9%), 17 infections (11.8%) (9 otitis media, 4 varicella zoster virus (VZV) infection, 3 tooth abscess, and 1 group A β-hemolytic streptococcus infection), 7 trauma (4.9%), 4 congenital-syndrome (2.8%), and 1 (0.7%) arterial hypertension. There was no difference in age, sex, family history, grading, or outcome between idiopathic and cause-defined facial palsy. At the end of the first year, our recovery rates were 98.3%. No significant difference in recovery outcome was detected between the patients who were treated with and without steroid treatment. Thirteen (9%) patients had recurrent attacks, and no differences in the outcomes of patients with recurrent facial palsy were observed. Recurrence time ranged from 6months to 6years. The results of this study indicate that both Bell's palsy and cause-defined facial palsy in children have a very good prognosis. Medical treatment based on corticosteroids is not certainly effective in improving outcomes in children. Recurrent attacks occurred in 6years from the onset which leads to the conclusion that we should have a long-term follow-up of patients diagnosed with Bell's palsy.

Recurrent Facial Paralysis Secondary to Congenital Cholesteatoma

Recurrent Facial Paralysis Secondary to Congenital Cholesteatoma