Unilateral Facial Paralysis Research Articles

Neonatal facial palsy without forceps use: report of two cases and review

<p class="abstract">Neonatal facial palsy is a very rare diagnosis with only a few previously published cases of newborns, it can have varying etiologies apart from traumatic causes. The congenital, infectious, inflammatory, neoplastic causes must be eliminated before making the definitive diagnosis of traumatic facial paralysis. A multidisciplinary approach is recommended to differentiate various causes and initiate treatment in a timely manner. Corticosteroids have been used to minimize nerve damage and hasten recovery in the most of studies. We report in this work two cases at 2 and 3 days old of congenital unilateral facial palsy in newborns without history of obstetrical trauma with a good prognosis after corticosteroids with complete resolution.</p>

New evidence of photobiomodulation and ozone therapy combined in the treatment of Bell's palsy

Bell's palsy is the most common cause of unilateral facial palsy reported in the literature. This condition consists of causing rapid onset and unilateral peripheral paresis/paraesthesia of the seventh cranial nerve. Despite being well documented, its etiology is still uncertain, imposing difficulty in immediate treatment. The combination of laser therapy and ozone therapy was proposed as a new treatment method for Bell's palsy, as it combines the efficacy and response of a therapy with the benefits of a minimally invasive approach. In the present study, we describe the first treatment protocol combining laser therapy and ozone therapy in Brazil, as well as details of the technique for the treatment of Bell's palsy. Case Report: A 59-year-old female with paralysis and paresthesia in the right hemiface, diagnosed for Bell's palsy, underwent a combined treatment of laser therapy and ozone therapy (VK OzonTherapy). After the fourth treatment session, a great clinical response was observed, and another session of the VK OzonTherapy protocol was performed. The patient evolved with significant improvement in the sequelae of right hemifacial paralysis, oro-ocular and eye closure, with rapid recovery of muscle tone and correction of asymmetries. Conclusions: This Report shows that the VK OzonTherapy protocol is an adjunct tool for clinical practice capable of improving the aesthetic-functional quality of life in patients with recent unilateral facial palsy.

800 A Rare Cause of Unilateral Facial Palsy in an Adult Presenting to a Tertiary ENT Centre

Abstract Introduction Sinonasal inverted papilloma are benign tumors usually appearing in 5th decade of life. They are characterised by their recurrent nature with extensive local destruction and malignant potential. Case Report A 54-year-old male was referred to our tertiary centre for further management of recurring Inverted papillomas. On review in clinic, he was found to have right facial palsy- House Brackman (HB) grade V with extensive disease in nasal passages and external auditory canal (EAC) bilaterally. This was associated with reduced visual acuity (VA)- 6/12 and proptosis of the right eye. CT Head was suggestive of a lesion involving the right mastoid, external and middle ear, extending into the right middle cranial fossa is likely to account for the right facial nerve palsy. The MRI scan showed multiple enhancing massess in the nasal cavity, the right mastoid and tympanic cavity, the left tympanic cavity with further possible disease in the oropharynx and nasopharynx. He was admitted to hospital from clinic for surgical management and underwent Endoscopic debulking of nasal tumour + Biopsy of bilateral external auditory canals + biopsy of pharynx. The patient was discharged a day after undergoing the procedure and remained well on ENT follow-up visit. He was further referred to Oncology team once histology results were available which showed Nonkeratinising sinonasal carcinoma and is due to receive his first dose of chemotherapy shortly. Conclusion The study showcases the need for awareness in such conditions and potential complications that can arise due to disease progression.

Facial Nerve Paralysis and COVID-19: A Systematic Review.

ObjectiveSeveral cases of facial nerve paralysis (FNP) post‐COVID‐19 infection have been reported with varying presentations and management. This study aims to identify FNP clinical characteristics and recovery outcomes among patients acutely infected with COVID‐19. We hypothesize that FNP is a potentially unique sequalae associated with COVID‐19 infections.MethodsA systematic review of PubMed‐Medline, OVID Embase, and Web of Science databases from inception to November 2021 was conducted following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines.ResultsThis search identified 630 studies with 53 meeting inclusion criteria. This resulted in 72 patients, of which 30 (42%) were diagnosed with Guillain‐Barré Syndrome (GBS). Non‐GBS patients were on average younger (36 vs. 53 years) and more likely to present with unilateral FNP (88%) compared to GBS patients who presented predominantly with bilateral FNP (74%). Among non‐GBS patients, majority (70%) of FNP presented a median of 8 [IQR 10] days after the onset of initial COVID‐19 symptom(s). Treatment for non‐GBS patients consisted of steroids (60%), antivirals (29%), antibiotics (21%), and no treatment (21%). Complete FNP recovery in non‐GBS patients was achieved in 67% patients within a median of 11 [IQR 24] days.ConclusionFNP is a possible presentation post COVID‐19 infections, associated with both GBS and non‐GBS patients. Although no causation can be assumed, the clinical course of isolated FNP associated with COVID‐19 raises the possibility of a unique presentation differing from Bell's palsy, seen with higher proportion of patients developing bilateral FNP and a shorter duration to complete recovery. Laryngoscope, 2022

A Case of Congenital Facial Nerve Palsy with Microtia

Congenital facial nerve palsy is defined as the presence of seventh cranial nerve palsy at birth or shortly thereafter. Itoccurs due to paralysis of muscles of facial expressions. It is mostly developmental or due to birth trauma. It is rare to be bornwith unilateral facial nerve palsy with associated ear anomaly, and hence determining the etiology is pivotal in accessing theprognosis and for selecting the right treatment for better outcome. In this case, a child is born with unilateral left -sided lowermotor neuron type facial palsy, along with left sided microtia with no history of birth trauma or any associated congenital anomalies.Therefore, it is of developmental origin and does not fit into any syndromic diagnosis with an magnetic resonance imaging brainshowing normal facial nerve anatomy. Child had little improvement in facial expressions with better eye closure with regularphysiotherapy. Facial reanimation surgeries can be done either in preschool or adolescent period depending on the child’scondition. In this case, the child is being managed conservatively until he is fit enough to perform facial reanimation surgeries.

The Split Hypoglossal Nerve and Cross-Face Nerve Graft for Dual Innervation of the Functional Muscle Transfer in Facial Reanimation.

Facial paralysis is a disabling deformity. The affected individual is seriously affected both esthetically and functionally. Free functional muscle transfer is currently the corner stone in the management of long-standing facial nerve paralysis. Several nerve options are available to supply the free muscle transfer. These nerves can be used alone or in combination. The aim of this work is to study the possibility and results of dually innervating the free functioning muscle transfer. The dual innervation is done using the split hypoglossal nerve and cross-face nerve graft (CFNG) both sutured in an end-to-end manner to the nerve to gracilis. Twenty-nine patients with unilateral long-standing facial nerve paralysis (more than 1y) were treated using free gracilis muscle transfer dually supplied by the split hypoglossal nerve and CFNG, both sutured in an end-to-end manner. The gained excursion after the free gracilis transfer was 9 to 29mm (mean: 17.24mm). A statistically significant increase ( P -value=0.0001) in the distance from where the midline crosses the lower vermilion border to commissure occurred from preoperative (mean: 16.55mm) to postoperative setting (mean: 33.79mm). Spontaneity was achieved in 26 patients (89.6%). In conclusion, dual innervation of the free muscle transfer using both the split hypoglossal nerve and CFNG (both sutured in an end-to-end manner to the nerve to gracilis) is a good possible option to treat long-standing cases of facial nerve paralysis. It yields adequate muscle excursion with acceptable spontaneity.

BILATERAL FACIAL NERVE PALSY AFTER SARS COV-2 INFECTION IN PEDIATRIC PATIENT

COVID-19 infection has been associated with several neurologic manifestations including anosmia, acute ischemic stroke, Guillain-Barré syndrome, encephalopathy and cranial nerve involvement. Though multiple cases of unilateral facial nerve palsy have been reported but bilateral facial palsy is very rare. Our case was 12 years old female patient who presented with difficulty in closing mouth, drooling of saliva and change in voice. On examination, there was loss of bilateral nasolabial folds, nasal twang of speech and incomplete eye closure bilaterally. Laboratory reports suggested raised CRP and amylase along with positive Immunoglobulin IgG covid-19 antibodies. Magnetic Resonance Imaging of brain and neck showed no abnormality. The child was managed conservatively with supportive care, subsequent to which she gradually improved over next 4-6 weeks. To the best of our knowledge, this is the first pediatric case where SARS-COV2 infection was found to be associated with bilateral facial nerve palsy as a post covid complication. Therefore, bilateral facial palsy should be considered as one of the associations of COVID especially in the present era. A detailed history and examination should be done as it often gets missed due to bilateral involvement. All differential diagnosis should be ruled out by relevant laboratory & radiological tests. Most children are likely to recover well with supportive treatment.

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 >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).

Effect of demographic factors, anthropometric factors, and comorbid diseases on recovery in the Bell's palsy subjects – A correlation study

OBJECTIVES: Bell's palsy is a condition of unilateral facial paralysis with the recovery rate varying from person to person. Various factors influence the prognosis of Bell's palsy subjects. Hence, the aim of this research was to examine the relationship between recovery of Bell's palsy and demographic, anthropometric, and the presence of comorbid diseases. METHODOlOGY: A correlation study was conducted on a total of 70 (both male and female) subjects. Independent outcome measures were age, gender, side, height, weight, body mass index, presence of diabetes, hypertension, and dyslipidemia. Dependent outcome measure was Sunnybrook Facial Grading System which grades the recovery following Bell's palsy. Outcome measures were taken at baseline, after 20 days, and after 1 month. RESULTS: Statistical analysis indicates that age, weight, diabetes, hypertension, and dyslipidemia have a significant correlation with recovery in Bell's palsy patients. CONCLUSION: The positive correlation between weight and recovery indicated that low weight leads to delayed recovery. A negative correlation of recovery with age, diabetes, hypertension, and dyslipidemia indicates that increased age leads to delayed or incomplete recovery and the presence of comorbid diseases leads to delayed/incomplete recovery.

Analysis and comparison of synovitis in rheumatoid arthritis and osteoarthritis patients

Idiopathic intracranial hypertension (IIH) is a disorder that leads to isolated raised intracranial pressure characterized by classical symptoms and signs such as headache, papilledema, sixth nerve palsy causing diplopia and pulsatile tinnitus.In our case report, we present a 20-year-old primigravida suffering from IIH presenting with unusual clinically elicited signs, including bilateral proptosis, unilateral ophthalmoplegia, and unilateral facial nerve palsy. Fundoscopy revealed bilateral papilledema and visual field examination showed enlarged blind spots in both eyes. Lumbar puncture was done to detect the opening pressure of cerebrospinal fluid which was measured to be 57cm of water. MRI brain + venogram was suggestive of vertical kinking of right optic nerve and tortuosity of bilateral optic nerves along with stenosis in bilateral transverse sinuses. In previous literature, there are only two reported cases of IIH that were associated with proptosis, both presenting unilaterally, and one reported case of IIH presenting with complete unilateral facial palsy. When a patient presents with these unorthodox signs, the diagnosis of IIH cannot be excluded.

Resolution of Longstanding Unilateral Facial Palsy after Receiving BNT-162b2 Vaccine: off Target Beneficial Effect or Reverse Nocebo Phenomenon?

A patient had complete left facial palsy followed by minimal residual left facial palsy for the next nine years. In anticipation of oncoming waves of new SARS-CoV-2 variants, and after due consideration, he took the BNT-162b2 vaccine. To his surprise his residual facial palsy gradually and almost entirely recovered after completing the two-dose vaccination, with no relapse up to six months’ followup. The mechanism and significance of such an off-target beneficial effect is discussed with conceptual projection into the future development.

Differentiating Bell's Palsy From Lyme-Related Facial Palsy.

To describe the etiology and clinical course of pediatric acute-onset unilateral peripheral facial palsy (FP), to define factors that distinguish Bell's palsy from Lyme-related FP (LRFP), and to determine if early corticosteroid use impacts facial strength recovery in Bell's palsy or LRFP. Retrospective cohort study of children 1 to 18 years old who received clinical care within our pediatric clinical care network (Lyme-endemic region) between 2013 and 2018 for acute-onset unilateral peripheral FP. The study included 306 children; 82 (27%) had LRFP, 209 (68%) had Bell's palsy, and 15 (5%) had FP of different etiology. Most children with LRFP presented between June and November (93%), and compared with Bell's palsy, more often had a preceding systemic prodrome, including fever, malaise, headache, myalgias, and/or arthralgias (55% vs 6%, P < .001). Neuroimaging and lumbar puncture did not add diagnostic value in isolated FP. Of the 226 children with Bell's palsy or LRFP with documented follow-up, FP was resolved in all but 1. There was no association between ultimate parent/clinician assessment of recovery and early corticosteroid use. Bell's palsy and LRFP were common causes of pediatric FP in our Lyme endemic region. Systemic prodrome and calendar month may help distinguish LRFP from Bell's palsy at FP onset, guiding antibiotic use. Early corticosteroid use did not impact our measures of recovery, although subtle abnormalities may not have been appreciated, and time to recovery could not be assessed. Future prospective studies using standardized assessment tools at regular follow-up intervals are necessary.

EFFECT OF COMPREHENSIVE APPROACH ON FEEDING ABILITY OF INFANT WITH FACIAL NERVE PALSY &amp; MICROTIA GRADE 4: A CASE REPORT

Facial nerve palsy is a condition with several implications, particularly when occurring in childhood. it can be congenital or acquired. The unilateral facial paralysis can be suspected when, in absence of front and nasolabial groove motility, there is also asymmetry of the face with buccal deviation when crying. The custom-made Facial splint of low-temperature thermoplastic material can support the weak muscle &amp; prevent the deviation. The infant was referred to Occupational Therapy with facial palsy grade IV. The aim of our study is evaluating the immediate functional outcome, while using the custom-made splint. The patient was assessed twice (i.e. Baseline &amp; after 6 weeks) on Neonatal Behavioral Assessment scale (NBAS), Neonatal Oral Motor Assessment Scale (NOMAS), Nonnutritive sucking scoring system, Preterm Infant Feeding Readiness Assessment Scale &amp; Parent stress scale was used to track the feeding readiness &amp; parental stress respectively during intervention. On NBAS, Level 3 to level 5. On NNSS, infant scored 2 to 6 scoring system on non-nutritive sucking &amp; on NOMAS baby scored from 19 to 22. Her ability to initiate suck was improved considerably. Improvement in scores of Preterm Infant Feeding Readiness Assessment Scale at baseline &amp; after 6 weeks. Infant scored 65 to 57 on Parent Stress Scale. In this study, Family Centered approach &amp; the need-based intervention, a custom-made facial splint of low-temperature thermoplastic material along with face strap effective to facial palsy patient, along with conventional Occupational Therapy intervention.

Suture Cheek Suspension Augments Periorbital Aesthetic Rehabilitation in Facial Nerve Palsy

Purpose: Facial nerve palsy may lead to significant functional facial and ocular morbidity. Soft tissue resuspension may improve both functional and aesthetic defects. We have adapted a minimally invasive midface suspension, which may be easily combined with routine paretic periocular rehabilitation to optimize outcomes. Methods: A retrospective review of patients with unilateral facial nerve palsy who underwent midcheek release and suture suspension simultaneous with periocular surgical rehabilitation at 2 surgical centers was performed. A temporal incision was made and dissection carried along the deep temporalis fascia to the lateral orbital rim. Dissection was continued subperiosteally along the anterior face of the maxilla to the piriform aperture. In severe cases, a second incision via superior buccal sulcus was utilized to maximize cheek soft tissue mobilization. Through 3 separate stab incisions along the nasolabial fold each end of a 0-0 permanent braided suture on a Keith needle was used to engage and elevate cheek soft tissues, secured at the deep temporalis fascia. Results: Seven patients (mean age 69 years) with unilateral facial nerve palsy and symptomatic facial droop underwent midface suture suspension simultaneous to eyelid reconstruction. With an average follow-up of 8.7 months, all patients demonstrated lasting improvement in facial asymmetry and reported satisfaction with their results. There were no significant postoperative complications. Conclusions: Midfacial static soft tissue resuspension is an effective minimally invasive surgical option for static facial rehabilitation in patients with facial nerve paralysis that can be performed at the time of periocular rehabilitation to enhance functional and aesthetic outcomes.

Functional Outcome Comparison of Free Gracilis Muscle Anchoring Methods in Patients with Facial Paralysis: Upper Lip Red Line Incision versus Facelift Incision Approach.

The greatest challenge of a free-muscle transfer in facial reanimation surgery is anchoring muscle to perioral soft tissue. An additional incision provides a better way to anchor the transferred muscle but leaves a visible scar. Herein, we compared the functional and aesthetic outcomes in a conventional facelift incision approach with and without the addition of a red line incision. This study included patients experiencing unilateral facial paralysis who underwent free gracilis transfer between December 2016 and December 2018. Anchoring through facelift incision with extended neck incision was performed in the control group, while a red line incision was added in the red line group by avoiding extended neck incision. Oral commissure excursion, upper lip and commissure height differences, and symmetry were measured. A total of 24 patients met the criteria and were included in this study. Of these, 10 patients were assigned to the red line group and 14 to the control group. The red line and control groups demonstrated a similar symmetry index in both resting (0.96 ± 0.18 and 0.92 ± 0.10, respectively; p = 0.435) and smiling (0.94 ± 0.12 and 0.91 ± 0.10, respectively; p = 0.314). However, the upper lip height difference demonstrated greater postoperative improvement (resting: 2.12 ± 1.13 vs. 3.92 ± 1.41 mm, p = 0.002, and smiling: 1.68 ± 0.88 vs. 3.41 ± 1.69 mm, p = 0.004, respectively). A scar could be easily concealed on the mucocutaneous line of the lip. This novel method for muscle anchoring in facial reanimation surgery allows surgeons to approach perioral muscle more directly. This leads to improved surgical results by securely anchoring the transferred muscles using a fixation point that is more medially located than in other approaches. Our method is effective and offers an improved surgical outcome for the free functional gracilis muscle transfer.

Validation of a New Graphic Facial Nerve Grading System: FAME Scale.

Background and Objective:Most of the existing qualitative facial nerve grading systems are very subjective while the quantitative grading systems are more complex, require longer data input time and specific software. There is a need for having a scoring system with graphic criteria to improve the subjectivity, reliability and convenience. We aimed to develop and validate such a reliable graphic scale for use in Bell's palsy.Methods:Face videos of patients with unilateral facial paralysis were recorded using smartphones and analyzed for six items including five voluntary facial movements apart from complications of facial palsy (synkinesis, hyperkinesis, and contracture). 15 videos were used for pilot study, 75 for the development of scale and 110 for its validation. Each video was rated on two separate occasions by 3 independent raters, a score of 0-4 was assigned to each item using the graphic scoring criteria, and a composite score was obtained (range 0–24). Five disease severity categories: normal (score 0), mild (score 1–6), moderate (score 7-12), severe (score: 13–18) and profound facial weakness (score: 19-24).Results:The proposed scale and its component items had high inter-rater and intra-rater reliability (Kappa >0.7). Good correlation (Pearson co-efficient >0.7) was seen among the voluntary movements. The proposed scale is a valid tool to score motor deficits and complications of facial palsy.Conclusions:The proposed scale is a valid and reliable graphic scale to describe facial motor dysfunction and its secondary defects.

Selective Electrical Surface Stimulation to Support Functional Recovery in the Early Phase After Unilateral Acute Facial Nerve or Vocal Fold Paralysis.

This article addresses the potential clinical value of surface electrical stimulation in the acute phase of denervation after the onset of facial nerve or recurrent laryngeal nerve paralysis. These two nerve lesions are the most frequent head and neck nerve lesions. In this review, we will work out several similarities concerning the pathophysiology features and the clinical scenario between both nerve lesions, which allow to develop some general rules for surface electrical stimulation applicable for both nerve lesions. The focus is on electrical stimulation in the phase between denervation and reinnervation of the target muscles. The aim of electrostimulation in this phase of denervation is to bridge the time until reinnervation is complete and to maintain facial or laryngeal function. In this phase, electrostimulation has to stimulate directly the denervated muscles, i.e. muscle stimulation and not nerve stimulation. There is preliminary data that early electrostimulation might also improve the functional outcome. Because there are still caveats against the use of electrostimulation, the neurophysiology of denervated facial and laryngeal muscles in comparison to innervated muscles is explained in detail. This is necessary to understand why the negative results published in several studies that used stimulation parameters are not suitable for denervated muscle fibers. Juxtaposed are studies using parameters adapted for the stimulation of denervated facial or laryngeal muscles. These studies used standardized outcome measure and show that an effective and tolerable electrostimulation of facial and laryngeal muscles without side effects in the early phase after onset of the lesions is feasible, does not hinder nerve regeneration and might even be able to improve the functional outcome. This has now to be proven in larger controlled trials. In our view, surface electrical stimulation has an unexploited potential to enrich the early therapy concepts for patients with unilateral facial or vocal fold paralysis.

Combined impact of myofascial techniques and gymnastics for the rehabilitation of children with neuropathy of the facial nerve

Facial neuropathy (Bell’s palsy) is a disease characterized by damage to the nerve fibers of the VII cranial nerve with the occurrence of unilateral facial muscle weakness or paralysis. Damage to the facial nerve is the most common type of cranial neuropathy. Delayed treatment onset and/or inadequate therapy of the disease leads to the residual neurological deficit, which may significantly reduce the patient’s quality of life. The best result in the rehabilitation of children with facial nerve neuropathy is provided with an integrated approach using myofascial manual therapy techniques and exercises. This is achieved during the therapy sessions with a myofascial manual techniques complex. After preparing the muscles, fascia and skin, the therapist conducts a set of passive and active exercises with a patient to restore the work of his/her facial muscles. The method was created, tested, and implemented in the Federal State Autonomous Institution “National Medical Research Center of Children’s Health” of the Ministry of Health of the Russian Federation. The essence of the method consists of the process of therapy sessions, providing a gradual recovery of functional relationships between the myofascial structures of the face, and improvement of lymphatic drainage, arterial blood supply, and venous outflow restoration. The alternation of myofascial manual techniques with exercises contributes to the maximum effective restoration of the symmetrical work of the facial muscles. Evaluation of the effectiveness of myofascial manual techniques and corrective exercises was carried out by clinical presentation changes and follow-up data. Comprehensive rehabilitation using myofascial manual techniques and exercises makes it possible to achieve improvement in restoring the function of facial muscles, eliminating asymmetry, and preventing complications. Conclusion. The obtained results demonstrated the effectiveness of myofascial manual techniques and exercises in the rehabilitation of children with facial neuropathy. Based on the results of the study, a positive effect of this method was shown to improve the functions of mimic muscles and facial symmetry in children with Bell’s palsy.

Sudden Onset of Unilateral Facial Paralysis with Ear Pruritus: A Quiz.

Abstract is missing (Quiz)

Advances and future directions in the care of patients with facial paralysis

Advances and future directions in the care of patients with facial paralysis