Unilateral Facial Nerve Research Articles

Mucormycosis Presented with Painful Facial Nerve Palsy: A Case Report

Mucormycosis is a rare fungal infection with high morbidity and mortality which can present as rhino-cerebral, pulmonary, cutaneous, gastro-intestinal, orbital, and disseminated disease. We are presenting a case of maxillary mucormycosis with unilateral facial nerve palsy as a rare presentation. Clinico-anatomical basis of facial nerve involvement has not yet been completely discovered. We highlight the importance of understanding regional anatomical relationships along with the clinical suspicion which helps to uncover the unusual presentations of mucormycosis.

Clinical and electrophysiological prognostic factors in predicting poor outcomes in patients with idiopathic facial nerve paralysis

ObjectiveThis study was designed to verify whether one or more clinical and neurophysiological parameters could predict a poor prognosis in idiopathic facial paralysis. MethodsSeventy-three outpatients with unilateral idiopathic facial nerve paralysis who visited our hospital within 7 days of onset. All patients received treatment according to a standard therapy protocol and ocular care. Patients’ baseline characteristics were assessed before initiating treatment, including demographic characteristics, facial nerve function assessment and previous medical history. House-Brackmann (H-B) grading system was performed at baseline and six months after the onset. Electroneurography (ENoG) and blink reflex tests were conducted 7–10 days after the onset of paralysis. Sunnybrook Facial Grading System (SFGS) was conducted at baseline, days 7–10 post-onset when the electrophysiological tests were performed, and one month after the onset. ResultsAccording to the H-B grade at 6 months following the onset, 58 patients (79.5 %) had a good prognosis, while 15 patients (20.5 %) had a poor prognosis. The CMAP amplitudes in three facial muscles (frontalis, orbicularis oculi, and orbicularis oris) were decreased, and ENoG values were increased in the poor prognosis group compared with the good prognosis group (all p < 0.01). The results of the blink reflex study showed that the group with a poor prognosis had a longer R1 latency compared to the group with a good prognosis. Additionally, the group with a poor prognosis exhibited a higher rate of R1 absence on the affected side (both p < 0.01). The findings of conditional logistic regression indicated that the absence of R1 on the affected side, frontalis ENoG, orbicularis oculi ENoG, and orbicularis oris ENoG were predictive factors of a poor prognosis for facial nerve palsy. The receiver operating characteristic (ROC) curves showed that the SFGS at 1 month after onset of 55 is considered a critical cutoff value for poor prognosis, with a sensitivity of 86.7 % and specificity of 91.4 %. ConclusionElectroneurography (ENoG) and blink reflex tests acquired within 7–10 days after the onset of paralysis are significant and highly valuable for predicting the prognosis of idiopathic facial nerve paralysis. Higher ENoG values of the muscles innervated by the facial nerve and the absence of R1 on the affected side of the blink reflex are predictive factors for a poor prognosis. The SFGS is a clinical tool that plays an important role in evaluating the prognosis of idiopathic facial paralysis, particularly one month after onset.

Elevated TRPV2 expression in the facial nerve of rats by cold stimulation: Implications for Bell's palsy

ObjectiveBell's palsy, also referred to as clinical manifestations of unilateral facial nerve palsy, encompasses downward angling of the corners of the mouth, the absence of forehead creases, and unilateral incomplete eyelid closure. The incidence of Bell's palsy has increased progressively in recent years, but the underlying mechanism of its occurrence remains unknown; therefore, it is essential to investigate both the cause and treatment of Bell's palsy. Member 2 of the Subfamily V Transient Receptor Potential Cation Channel is a mechanically and thermally sensitive ion channel that plays a crucial role in neural growth and development. Using a novel modeling technique, we endeavored to develop an animal model of Bell's palsy and determine whether TRPV2 expression is altered throughout the course of a facial nerve injury. Materials and methodsThe rats were categorized into 3 groups, and their facial nerve function was assessed using RT-qPCR, WB, and pathologic testing, respectively, after undergoing unilateral cold air stimulation for 1, 3, and 7 days. TRPV2 expression was identified using these techniques. ResultsIn response to cold stimulation, rats exhibited facial nerve paralysis symptoms, demyelinating lesions in the facial nerve, and increased TRPV2 expression. ConclusionsExtended cold stimulation of the facial nerve in rats may lead to an imbalance in facial nerve homeostasis and increased TRPV2 expression. These findings will contribute to the understanding of the potential mechanism by which cold stimulation affects the facial nerve. Moreover, this finding implies that TRPV2 could possibly function as an additional diagnostic marker or therapeutic target in the context of Bell's palsy.

PREGNANCY INDUCED BELLS PALSY: AN IN DEPTH EXAMINATION OF THERAPEUTIC MODALITIES AND ADJUNCTIVE MEASURES

Background: Bells palsy, a unilateral facial nerve paralysis, often presents challenges in diagnosis and management, especially when occurring during pregnancy and associated with preeclampsia. This case report aims to delineate the clinical manifestation, therapeutic interventions and outcome of preeclampsia-induced Bells palsy during pregnancy, emphasizing the importance of multidisciplinary care and post natal follow-up. Case Description: A 29-year-old gravid individual at 40 weeks of gestation presented with right sided facial weakness and hypertension, diagnosed with preeclampsia-induced Bells palsy. Treatment included antihypertensive medications, corticosteroids and close monitoring. Labor induction resulted in a healthy deliver, with satisfactory outcomes for both mother and baby. Conclusion: Early recognition, prompt treatment initiation and multidisciplinary management are essential in optimizing maternal and fetal outcomes in pregnant individuals with Bells palsy. Continued research efforts are needed to refine therapeutic approaches and improve care.This case underscores the importance of interdisciplinary care and vigilance in pregnant individuals with Bells palsy, highlighting the need for further research to optimize management strategies in this unique population.

Successful treatment of unilateral facial nerve palsy in a pediatric patient with syringobulbia and Chiari malformation type I: illustrative case.

Unlike syringomyelia, syringobulbia is not commonly observed in pediatric patients with Chiari malformation type I (CMI). Previous series have reported the incidence of syringobulbia as between 3% and 4% in these patients. Presentation is typically chronic, with the slow onset of neurological symptoms and cranial nerve (CN) palsies resulting from lower brainstem involvement. The authors report the first case of a pediatric patient with simultaneous CMI, syringobulbia, and unilateral CN VII palsy. A 7-year-old male presented with right facial weakness in addition to headaches, ataxia, urinary incontinence, and falls. Magnetic resonance imaging revealed CMI with a syrinx of the cervicothoracic spine and syringobulbia. Posterior fossa decompression with duraplasty was performed without complications, and the patient was discharged home on postoperation day 5. At the 3-week follow-up, the patient's neurological deficits had largely subsided. At the 3-month follow-up, his CN VII palsy and syringobulbia had completely resolved. Pediatric CMI patients with syringomyelia are at risk for developing syringobulbia and brainstem deficits, including unilateral facial palsy. However, craniocervical decompression can prove successful in treating such deficits.

Pattern of Clinical Profile and Outcome of Gillian Barre Syndrome in Sudanese Patients

Introduction: Guillian Barre'-Syndrome (GBS) is an acute, autoimmune disease affecting spinal roots and peripheral nerves, characterized by a rapidly progressive, ascending weakness of the extremity, trunk and even respiratory and facial muscles and with minor sensory and autonomic dysfunction. As in Sudan there is no enough data regarding the pattern of presentation and outcome of GBS, our research aimed to study clinical profile, electrophysiological variant, and outcome of Sudanese patients diagnosed with (GBS). Methods: A multi centers cross-sectional hospital-based study conducted in Khartoum from March to September 2020, 62 patients enrolled in the study, structured questionnaire consists of personal data, clinical history, examination findings, electrophysiological study result, management and outcome is used to assess the clinical profile and outcome of the disease. Results: The study revealed that males and females are equally represented, 70% patients are between 18 years and 50 years. The onset of the weakness was less than or equal 3 days in 33.9% of patients, from 4 to 7 days in 41.9%, from 8 to 14 days in 11.3% and above 14 days in 12.9%.40.3% patients had Evidence of autonomic dysfunction. The majority of patients presented with weakness that started in the lower limbs (93.5%), in (4.8%) the weakness started in the upper limbs and then descend. In (1.6%) the weakness started in the pharyngeal and respiratory muscles from the start. Sensory complains were observed in 54 patients (87.1%), 3 patients (4.8%) developed urinary bladder incontinence and 36 patients (58.1%) had back pain at the onset of the disease. On clinical examination; (98.4%) of patients had absent reflexes, (35.5%) had bilateral facial nerve palsy and (4.8%) had unilateral facial nerve pals. Based on the electrophysiological studies, (37.09 %) were recorded as acute motor axonal neuropathy (AMAN), (29.03%) as acute inflammatory demyelinating poly neuropathy (AIDP) and (29.03%) as acute motor-sensory axonal neuropathy (AMSAN). Regarding the outcome, 30 patients (48.4%) fully recovered, 25 patients (40.3%) recovered with motor deficit, and 7 patients (11.3%) unfortunately died. Conclusion: This study concluded that Guillian Barre'-Syndrome (GBS) in Sudanese population mainly affects age group from 18 to 50 years with variable maximum onset of weakness, presentation and outcome. Lower limb weakness and absent reflexes were the most presenting features. NCS showed axonal type of GBS found to be in nearly 66% of patients and 40% showed clinical evidence of dysautonomia.

Post traumatic unilateral facial nerve palsy: A rare case report

Post traumatic unilateral facial nerve palsy: A rare case report

COVİD-19 Enfeksiyonu Sırasında Gelişen Bell Palsi

COVID-19 is an infectious disease caused by a newly discovered coronavirus (SARS-COV-2) that can cause a broad spectrum of symptoms, from asymptomatic to severe respiratory failure. Although the virus mainly affects the respiratory system, it is also known to affect many other systems. Myalgia, hyposmia, anosmia, and Guillain-Barre Syndrome are the most common manifestations due to the peripheral nervous system being affected by the virus. Bell's palsy is a unilateral and sudden facial nerve paralysis. Viral infections are most frequently blamed for etiopathogenesis. Bell palsy due to COVID-19 infection has been reported in the literature as a rare complication. In this case, we wanted to emphasize that Bell's palsy should be kept in mind among the neurological complications that may develop due to COVID-in in a patient who developed Bell's palsy after being diagnosed with COVID-19.

Abstract 137: Management of cSDH with the Use of 10:1 Glue Hyper‐Dilution in MMA Embolization: Radiographic Follow‐up

Introduction Middle meningeal artery (MMA) embolization for the treatment of chronic subdural hematomas (cSDH) is becoming an alternative to surgical intervention. Recent literature suggests distal embolic penetration beyond visible MMA branches achieves optimal cSDH devascularization. Here, we report the mid‐term radiographic follow‐up of a hyper‐dilution glue technique for enhanced embolization of non‐visible dural vasculature. Methods A prospectively maintained IRB‐approved institutional database of the senior authors was retrospectively reviewed to identify and analyze cSDHs managed with 10:1 glue hyper‐dilution (TRUFILLTM n‐BCA liquid embolic) paradigm. Results Over a 5‐month study period (September 2022 to February 2023), 46 cases of 10:1 glue hyper‐dilution for MMA embolization were identified in 23 patients. 56% of the cases were female with an average age of 70±1.59 years. Average admission cSDH thickness was 9.3±0.8 mm with an average midline shift of 3.5±0.5 mm. Bilateral embolization was performed in 91% (n=21) of patients. Technical success was achieved in all cases without need for periprocedural rescue surgery. One postprocedural complication (2.2%), a unilateral partial facial nerve palsy (House‐Brackmann 2), was identified. All patients were discharged at their mRS baseline. Nine patients (40%) had radiographic follow‐up (mean 42±6.7 days; range 1 to 194 days). Complete resolution of the cSDH was achieved in 67% of those with follow‐up imaging (n=9) cases. In those with residual cSDH, average followup thickness was 7.2±0.8mm. Conclusion Mid‐term radiographic results of 10:1 glue hyper‐dilution for MMA embolization for enhanced non‐visible dural vasculature demonstrates a favorable safety profile compatible with the literature and encouraging resolution of cSDH. Further follow‐up and comparative studies are warranted.

Bee sting induced facial nerve palsy

Bee stings are one of the common clinical scenarios in day-to-day clinical practice in Sri Lanka. The spectrum of bee sting-related complications can vary from simple allergic reactions to life-threatening conditions and sometimes death. Anaphylaxis, cardiogenic shock, respiratory arrest, acute renal failure, vasospasm-related ischaemia, and acute pulmonary oedema are some of the life-threatening conditions. Neurological manifestations such as acute cerebral infarction, acute demyelinating polyneuropathy, encephalitis, transverse myelitis, and optic neuritis are also reported. We report a rare presentation of unilateral facial nerve palsy following bee stings in a 63-year-old woman, who fully recovered with treatment. Received 11 December 2022, accepted 05 February 2023.

BELL’S PALSY in a girl child: A rare case report with review of literature

Bell's Palsy is a unilateral acute peripheral facial nerve palsy of sudden onset and unknown aetiology. Bell's Palsy is common in adults but rarely seen in children. Inability to close the unilateral eye, drooping of corner of mouth, with drooling of saliva and unable to smile on affected side are few important clinical features of Bell's Palsy. Management of Bell's Palsy in children is basically symptomatic only. Multivitamins with light physiotherapy are all that are helpful to manage most of the Bell's Palsy cases in children. Overall, Bell's Palsy in children is self-limiting with early and complete recovery.

Fate mapping reveals compartment-specific clonal expansion of mononuclear phagocytes during kidney disease

Fate mapping reveals compartment-specific clonal expansion of mononuclear phagocytes during kidney disease

Transcranial Magnetic Stimulation in the Differential Diagnosis of Unilateral Peripheral Facial Nerve Palsy

(1) Background: This study aims to assess the diagnostic accuracy of parameters based on a combination of transcranial magnetic stimulation (TMS) and electrical stimulation (ES) in the differentiation between idiopathic and secondary facial palsy in a large cohort of patients. (2) Methods: Patients with unilateral facial palsy ≤7 days after symptom onset were included. Compound muscle action potential (CMAP) amplitudes were measured after stimulation of both facial nerves at (A) the internal acoustic meatus using TMS, CMAP-TMS, and (B) at the stylomastoid foramen using electrical stimulation, CMAP-ES. To express the degree of nerve dysfunction in the facial canal specifically, the amplitude reduction of the CMAP-TMS in relation to CMAP-ES was calculated and expressed as a percentage (amplitude reduction over the facial canal, ARFC). Receiver Operating Characteristic (ROC) curves were constructed to assess the diagnostic accuracy of ARFC as a marker to discriminate between patients with idiopathic and secondary facial palsy. (3) Results: Data from 498 patient records were analyzed. Idiopathic facial palsy was diagnosed in 424 patients, and secondary facial palsy in 74 patients. The area under the ROC curve for ARFC was 0.398. (4) Conclusions: The overall diagnostic accuracy of this method to differentiate secondary from idiopathic facial palsy is low.

Morphofunctional regeneration by mesenchymal stem cell and IGF-1 inoculation in a model of facial nerve crush injury in rats.

To analyze the morphofunctional regeneration process of facial nerve injury in the presence of insulin-like growth factor-1 and mesenchymal stem cells. Fourteen Wistar rats suffered unilateral facial nerve crushing and were randomly divided into two groups. All received insulin-like growth factor-1 inoculation, but only half of the animals received an additional inoculation of mesenchymal stem cells. The animals were followed for 90 days and facial nerve regeneration was analyzed via spontaneous facial motor function tests and immunohistochemistry in the nerve motor nucleus. The group that received the growth factor and stem cells showed a statistically superior mean in vibrissae movements (p < 0.01), touch reflex (p = 0.05) and eye closure (p < 0.01), in addition to better immunohistochemistry reactivity. There was a statistically significant difference in the mean number of cells in the facial nerve nucleus between the experimental groups (p = 0.025), with the group that received the growth factor and stem cells showing the highest mean. The association between growth factor and stem cells potentiates the morphofunctional regeneration of the facial nerve, occurring faster and more effectively. 4, degree of recommendation C.

Moebius Syndrome: What We Know So Far.

Moebius syndrome (MBS) is a rare congenital cranial nerve disorder characterized by unilateral, bilateral symmetrical, or asymmetrical facial (VII) and abducens (VI) nerve palsies. Genetics and rhombencephalon vascular disturbances from intrauterine environmental exposures have been attributed to its development. It can present with various orofacial abnormalities. Although the diagnosis is purely clinical, certain characteristic features are present in the brain's images. With no cure, it is essential to devise management on a personalized basis. We discuss etiology, presentation, diagnostic approaches, and effective management in the existing literature. This comprehensive review examines the clinic-pathological aspects of Moebius syndrome. The authors employed the PUBMED base index to identify pertinent literature and reference it accordingto research keywords. Findings suggest the most popular etiology is the theory of intrauterine vascular disruption to the brainstem during embryogenesis, followed by the genetic hypothesis. Intrauterine environmental exposures have been implicated as potential risk factors. Facial and abducens nerve palsies are the most common presenting features. However, clinical manifestations of lower cranial nerves (IX, X, XI, XII) may be present with orthopedic anomalies and intellectual deficiencies. The diagnosis is clinical with minimal defined diagnostic criteria. Characteristic radiological manifestations involving the brainstem and cerebellum can be observed in imaging studies. With no definitive treatment options, a multidisciplinary approach is employed to provide supportive care. Despite radiological manifestations, Moebius syndrome is diagnosed clinically. Although incurable, a multidisciplinary approach, with personalized rehabilitative measures, can manage physical and psychological deficits; however, standard guidelines need to be established.

Delayed Onset Facial Palsy After Temporal Bone Fracture: A Case Series

Study Design Retrospective Case Series Objective This study’s objective is to identify gaps in facial trauma care by exploring 4 cases of delayed onset facial nerve palsy after temporal bone fracture. Methods A retrospective chart review was performed on 4 patients who presented to the emergency department with facial palsy after a previous trauma. Relevant physical exam findings, radiological images and follow-up was documented. Results We present a case series of young, previously healthy patients who presented to the emergency department days or weeks after traumatic temporal bone fracture with delayed onset unilateral facial nerve paralysis. None of these patients were warned of this potential complication, connected to an outpatient physician and all received a costly workup. Conclusions Patients presenting with temporal bone fracture and intact facial nerve function can develop delayed-onset facial paralysis several days after their injury. To offset costly and stressful return visits to the emergency department, patients with temporal bone fractures along the course of the facial nerve should receive education regarding the possible delayed development of facial palsy prior to discharge and otolaryngological or primary care follow-up within 2 weeks of the injury.

Clinical characteristics of Lyme neuroborreliosis in Dutch children and adults.

Lyme neuroborreliosis (LNB) is a tick-borne infection caused by Borrelia burgdorferi which can affect the nervous system in adults and children. The clinical course of LNB in adults is often different than in children. Studies comparing these differences are scarce. The aim of this study was to compare the clinical characteristics and outcome of LNB between children and adults. We performed an observational retrospective study among patients with LNB who presented at Gelre Hospital from 2007 to 2020 and had cerebrospinal fluid pleocytosis. Data were collected from electronic medical records. A total of 127 patients with LNB were identified. Included were 58 children (median age 8years) and 69 adults (median age 56years). The incidence of LNB was 3.2 per 100,000 inhabitants per year. The most common neurological manifestation in adults and in children was facial nerve palsy (67%). Unilateral facial nerve palsy was more prevalent in children (85%) than in adults (42%) (P < 0.001). Headache was also more prevalent in children (59%) than in adults (32%) (P = 0.003). (Poly)radiculitis was more prevalent in adults (51%) than in children (3%) (P < 0.001), encephalitis was not reported in children. In children, the time between symptom onset and diagnosis was 10days versus 28days in adults (P < 0.001). Complete recovery was reported significantly more often in children (83%) compared to adults (40%) (P < 0.001). Conclusion: In a Lyme-endemic area in the Netherlands, LNB commonly presents with facial nerve palsy. Facial nerve palsy and headache are more prevalent in children, while radiculitis and encephalitis are mostly reported in adults. What is Known: • The clinical course of Lyme neuroborreliosis in adults is often different from children. . • The aim of this study was to compare the clinical characteristics and outcome of LNB between children and adults. What is New: • Lyme neuroborreliosis in the Netherlands commonly presents with facial nerve palsy. • Facial nerve palsy and headache are more prevalent in children than in adults.Radiculitis and encephalitis are mostly reported in adults.

Expressionless Physiognomy–A Case of Moebius Syndrome

Moebius syndrome (MBS) is a rare neurological disorder which characterized by bilateral or unilateral facial nerve weakness with bilateral abducens nerve palsy. It can affect multiple cranial nerves with an incidence of 2–20 cases per million births. We report a 6 years female child with MBS with morpho-functional deficits and developmental problems.

Magnetic resonance imaging findings of delayed facial palsy after dental procedures suggest viral reactivation as pathogenesis: a retrospective study.

We hypothesize that delayed facial paralysis following dental procedures is also associated with viral reactivation. In this study, the brain magnetic resonance imaging (MRI) findings of patients were analyzed to identify the pathogenesis of facial nerve palsy after dental treatment. We retrospectively reviewed the medical records of patients with unilateral facial nerve palsy and identified those diagnosed with delayed facial nerve palsy within 30days of dental treatment. We assessed the clinical characteristics, electrodiagnostic findings, and imaging findings of these patients and looked for MRI findings that support a viral hypothesis for facial palsy. Among 924 patients with facial palsy, 11 (1.2%) had delayed facial paralysis following dental procedures. Patients developed facial palsy at an average of 3.2days (1-11days) after undergoing a dental procedure. The internal auditory canal MRI revealed abnormal enhancement of affected facial nerve in nine patients. The intensity and pattern of the enhancement were similar to those of Bell's palsy. Facial palsy can develop within the days following dental procedures, and the MRI results suggest that delayed facial palsy after dental treatment is related to viral reactivation-like Bell's palsy.

Surgical treatment for Bell's palsy - review

Introduction: Bell's palsy is a peripheral, unilateral facial nerve palsy of sudden onset and an unknown cause. The diagnosis is primarily based on clinical examination, but in some patients performing electrophysiological tests, i.e. ENoG and EMG, can be recommended for prognostic purposes. Glucocorticoids are the mainstay of treatment in Bell's palsy, whereas surgical treatment remains controversial.&#x0D; Objectives and methods: Review of literature concerning the relevance of facial nerve decompression for Bell's palsy, its techniques and efficacy, as well as patient's eligibility criteria for surgical treatment. Only publications in English were included.&#x0D; Results: In AAO-HNS guidelines there is no recommendation for surgical treatment in Bell's palsy or against it. The assumption that facial nerve in this entity becomes compressed in the narrowest portion of the Fallopian canal, i.e. meatal foramen, can be the rationale for facial nerve decompression in this segment. The optimal surgical exposure of this portion of the facial nerve canal is provided by the middle cranial fossa approach, although the efficacy of facial nerve decompression via the transmastoid approach has also been reported. Most surgeons consider the degeneration of &gt;90% of facial nerve fibers shown in ENoG the eligibility criterion for surgical treatment in Bell's palsy. There is no consensus on when facial nerve decompression after the onset of Bell's palsy should be performed.&#x0D; Conclusions: Observations show that facial nerve decompression should be considered, if a patient fulfills clinical and electrophysiological criteria. As long as high level quality evidence lacks, clinicians' attitude towards surgical treatment for Bell's palsy will remain ambivalent.