Unilateral Paralysis Research Articles

Validation of the Spanish version of the Electronic Facial Palsy Assessment (eFACE)

PurposeThe clinician-graded electronic facial paralysis assessment (eFACE) is a relatively new digital tool for assessing facial palsy. The present study aimed to determine the validity and reliability of the Spanish version of the eFACE.MethodsForward–backward translation from the original English version was performed. Videos and photographs from 65 adult patients with unilateral facial paralysis (any severity, time course, and etiology) were evaluated twice by five otolaryngologists with varying levels of experience in facial palsy evaluation. Internal consistency was measured using Cronbach’s α and the intra- and inter-rater reliability were measured using intraclass correlation coefficient. Concurrent validity was established by calculating Spearman’s rho correlation (ρ) between the eFACE and the House–Brackmann scale (H–B) and Pearson’s correlation (r) between the eFACE and the Sunnybrook Facial Grading System (SFGS).ResultsThe Spanish version of the eFACE showed good internal consistency (Cronbach’s α > 0.8). The intra-rater reliability was nearly perfect for the total score (intraclass correlation coefficient: 0.95–0.99), static score (0.92–0.96), and dynamic score (0.96–0.99) and important-to-excellent for synkinesis score (0.79–0.96). The inter-rater reliability was excellent for the total score (0.85–0.93), static score (0.80–0.90), and dynamic score (0.90–0.95) and moderate-to-important for the synkinesis score (0.55–0.78). The eFACE had a very strong correlation with the H–B (ρ = – 0.88 and – 0.85 for each evaluation, p < 0.001) and the SFGS (r = 0.92 and 0.91 each evaluation, p < 0.001).ConclusionThe Spanish version of the eFACE is a reliable and valid instrument for assessment of facial function in the diagnosis and treatment of patients with facial paralysis.

Improvement in swallowing safety after injection laryngoplasty in patients with unilateral vocal paralysis complicated with aspiration

The benefit of injection laryngoplasty (IL) on voice for unilateral vocal fold paralysis (UVFP) is supported increasingly in literatures, yet less is known for swallowing. Also, prevalence of patient-reported dysphagia is substantially higher than instrumental studies. This prospective study focused on swallowing outcomes, with predetermined flexible endoscopic evaluation of swallowing (FEES) protocol that simulates daily life situation. Adult patients with UVFP and aspiration receiving IL were recruited. Voice outcome measurements, as well as swallowing outcomes including Eating Assessment Tool (EAT-10) and FEES, which challenged patients with different fluid volumes: 10mL, 20mL, and 90mL cup sipping were evaluated. Significant improvements were demonstrated in all voice outcomes. Significant changes were also presented inEAT-10 (P<0.01). Pre-operatively, penetration-aspiration scale (PAS) was 1.5±1.3, 1.9±1.7 and 2.3±1.8 for 10mL, 20mL and 90mL serial sipping, and improved to 1.1±0.3, 1.1±0.4 and 1.4±0.7 post-operatively (P<0.01). Safe swallowing (PAS ≤ 2) was achieved in all, except for one patient, who presented with a post-injection PAS of 4 (material enters the airway, contacts the vocal folds, and is ejected from the airway) on 90mL cup sipping, whose pre-injection PAS was 7 (residue in trachea). Maintaining swallowing function suitable for social environment is important. Our results demonstrated the feasibility of the predetermined FEES protocol, and positive effects of IL on both voice and swallowing outcomes.

Uncommon cause of unilateral paralysis of the hypoglossal nerve

Uncommon cause of unilateral paralysis of the hypoglossal nerve

The Intervention of Physiotherapy in the improvement of facial mimicry in a Peripheral Facial Palsy associated with a Preg-nancy: A Case Report

Peripheral Facial Palsy is a peripheral paralysis of the facial nerve that results in muscle weakness on one side of the face. Patients develop unilateral facial paralysis within one to three days with involvement of the facial musculature associated or not with neurological alterations, the best-known being Bell's Palsy. Symptoms usually peak in the first week and then gradually subside over three weeks to three months. In this context, a female patient with the clinical Diagnosis of Peripheral Facial Paralysis, was subjected to an intervention plan in Physiotherapy lasting 4 months (sessions of 45 minutes at a frequency of 3 times a week), with the particularity of be 28 weeks pregnant at the start of the sessions. After the end of the sessions, there was a considerable improvement in facial movements, translating into considerable functional changes. The patient acquired greater motor recruitment in flaccid muscles, greater facial symmetry, and consequently greater autonomy in eating, chewing, containing liquids and intraoral sensibility.

A Case Study of &lt;i&gt;Suttigai&lt;/i&gt; (Thermal Cauterization) in the Management of &lt;i&gt;Mugavatham&lt;/i&gt; (Bell’s Palsy)

Bell’s palsy (Mugavatham) is a unilateral lower motor neuron facial paralysis of acute onset. Suttigai (Thermal cauterization) provides prompt relief. This study aims to establish the efficacy of Suttigai therapy in the management of Mugavatham. A 35-year-old male patient diagnosed with right-sided facial paralysis was treated with Suttigai therapy. The “House and Breckmann” assessment scale was used to evaluate the case. After the Suttigai therapy, the scale rating improved from grade IV to grade I. The asymmetry of the face and the motor functions significantly improved as a result. The efficacy of Suttigai treatment for the management of Mugavatham is successful with immediate relief. Hence more and more efforts are needed to optimize the treatment and utilization of Suttigai therapy in the management of Mugavatham.

AYURVEDIC APPROACH TO TREAT CHRONIC RESIDUAL BELL’S PALSY IN CHILDREN: A CASE REPORT

Introduction: Bell’s palsy is the most common type of unilateral facial paralysis (60%-75%). The etiopathogenesis of Bell’s palsy is uncertain. The clinical features include acute onset of unilateral facial paralysis, poor eyelid closure, posterior auricular pain, numbness of cheeks, and deviation of the angle of the mouth towards the unaffected side. Bell’s palsy can be understood as Ardita in Ayurveda. Acharya Sushruta has included bala as a susceptible group while describing the vishesha nidanas of Ardita. Aims and Ideas: To study the effect of a framed Ayurvedic treatment protocol in managing chronic residual Bell’s palsy in children. Methods: The present case was a chronic right-sided residual Bell’s palsy with a history of 12 years and was approached through the line of management of Ardita mentioned in Bruhattrayees and Yogamrutam for 12 days. The treatment was started with takra dhara to give mrdu rookshana. Takra dhara mukha abhyanga and ksheera dhoomam were administered, followed by marsha nasyam. Two specific treatments mentioned in Yogamrutam was adopted in this case, i.e., panasa patra swedam and navaneeta shiro talam. The treatment was ended with shashtika shala pinda swedana to mukha. Results and Discussions: The facial asymmetry was reduced by 60% at the end of the treatment. Watering of the right was subsided entirely, and there was complete effortless closure of the right year after treatment. Pain, twitching and numbness on the right half of the face were utterly absent. The House and Brackmann grade was reduced from Grade III to Grade II after 12 days of treatment.

Unilateral hypoglossal nerve palsy after mild COVID-19: a case report

Post-acute coronavirus disease (COVID-19) syndrome is defined as persistent symptoms or delayed complications after COVID-19. Several cases of cranial nerve invasion related to COVID-19 have been reported. However, to our knowledge, no cases of solitary unilateral hypoglossal nerve paralysis after mild COVID-19 without intubation have been reported to date. Herein, we report the case of a 64-year-old man with unilateral hypoglossal nerve palsy as a complication of COVID-19. He complained of dysarthria and tongue discomfort 2 weeks after COVID-19 onset. Brain and neck computed tomography, magnetic resonance imaging, ultrasonography, and blood tests ruled out other possible causes. The patient’s nerve palsy was rapidly diagnosed and improved with early rehabilitation. Understanding of the pathology of COVID-19 is still limited. Physicians should focus on patients’ symptoms and their relationship to COVID-19, and investigate complications immediately. This case highlights the importance of early detection and rehabilitation of post-acute COVID-19 syndrome.

Delayed-Onset Unilateral Facial Paralysis After Mastoidectomy: A Case Report

ABSTRACT&#x0D; Objective: To discuss the case of a 36-year-old man who presented with left unilateral facial paralysis 11 days after mastoidectomy.Methods: Design: Case Report Setting: Tertiary Government Training Hospital Patient: OneResults: A 36-year-old man with recurrent left ear discharge of 30 years duration underwent left canal wall-down mastoidectomy and was discharged well after 3 days. On follow up after 8 more days, he was noted to have House Brackmann IV left facial paralysis. Following 5 days methylprednisolone, neurologic evaluation and physical therapy rehabilitation, facial paralysis improved in the ensuing weeks until House-Brackmann I was achieved at week 12.Conclusion: Delayed-onset Facial Palsy (DFP) following tympanomastoid surgery may be approached conservatively, including steroids, acyclovir, and, if with a history of herpes or varicella infection, immunization can be given. Prognosis for DFP is good especially when the facial nerve is identified intraoperatively during otologic surgeries

Unilateral Diaphragm Paralysis Following COVID-19 Infection: A Case Report

We report a patient case of unilateral diaphragm paralysis following COVID-19 infection. A 55-year-old healthy man was infected with SARS-CoV-2 before the availability of a vaccine. He was intubated and pronated for respiratory failure. He experienced new debilitating dyspnea and orthopnea for 6 months after recovery. Dynamic chest radiography demonstrated a new hemidiaphragm paralysis. After surgical plication of the diaphragm, the patient's symptoms resolved. This patient case demonstrates the importance of thorough evaluation for diaphragm paralysis in patients who have suffered COVID-19 infection when there is persistent dyspnea or orthopnea, as well as the neuroinvasive potential of the virus that has yet to be fully explained.

Morphological Study of Stylomastoid Foramen at the Base of Skull and its Role in Facial Nerve Palsy.

The facial nerve emerges out of skull through the stylomastoid foramen located between styloid process and mastoid process. Unilateral paralysis of facial nerve is known as Bell's palsy and is reported to be caused most frequently by herpes simplex virus. The herpes infection is comparatively common but Bell's palsy is not very common. So, other causes of Bell's palsy like variation in morphological forms of stylomastoid cannot be ruled. There is paucity of literature elucidating morphological shapes of this foramen and correlating these forms of foramen with Bell's palsy. Hence the study was carried out. The aim of this study is to expound varied forms of stylomastoid foramen and to bring out clinical implications. The study was conducted in the department of anatomy using undamaged 70 adult dry human skulls of unknown age and sex. The morphological shapes were observed, interpretated and compared with available literature and their clinical implications were brought out. Most common shapes observed were round and oval followed by square shapes. Round shaped foramina were observed in 40 skulls on right sides constituting 57.1% and in 36 skulls on left side constituting 51.4%. While oval shapes were found in 16 skulls on right side (22.6%) and in 12 skulls on left side (17.1%). Rare variants of the foramen include triangular, serrated and closely applied to styloid process. The rare morphological forms were mostly observed to be unilateral in occurrence. Unilateral Bell's palsy is common, so, the rare morphological forms might be responsible for Bell's palsy.

Unilateral Diaphragmatic Paralysis After Stereotactic Ablative Radiation Therapy to a Lung Tumor Abutting the Course of the Phrenic Nerve

We present the case of a woman with metastatic adenoid cystic carcinoma who received stereotactic ablative radiation therapy with a total dose of 50 Gy in 4 fractions to 2 lung metastases and developed symptomatic left phrenic nerve injury 2 years after radiation. The maximum dose to the approximate location of the phrenic nerve was 57.7 Gy, which corresponds to a biologically effective dose for late effects (using α/β ratio = 3) of 335.14 Gy. Here, we discuss the case, planning considerations by radiation oncologists and medical physicists, and the multidisciplinary medical management of this patient.

Neuromuscular retraining therapy combined with preceding botulinum toxin A injection for chronic facial paralysis

Background Neuromuscular retraining therapy (NMRT) is the central treatment for synkinesis. The efficacy of botulinum toxin type A (BTX-A) may be enhanced with the addition of physical therapy. Objectives To investigate the effects of NMRT combined with preceding BTX-A injection (NMRT-B) on facial synkinesis and asymmetry in chronic facial paralysis. Materials and Methods We recruited 99 patients with unilateral facial paralysis and no recovery for > 6 months who underwent NMRT-B for > 1 year. The patients were scheduled to receive NMRT after 1–2 weeks of BTX-A injection. We used a computer-based numerical scoring system to evaluate the facial functions. Primary, secondary, and final facial movement scores were evaluated before and after 1 year of treatment. Results Patients with chronic facial paralysis who underwent NMRT-B exhibited improved facial movement after 1 year of treatment. NMRT-B provided satisfactory control of synkinesis and improved the primary movements. The mean primary and final facial movement scores were significantly increased after treatment, while the mean secondary facial movement scores were significantly decreased. Conclusions and significance NMRT-B improved the final facial movement in patients with chronic facial paralysis and synkinesis, regardless of the degrees of facial synkinesis and asymmetry before treatment.

Quantitative analysis of facial symmetry and animation following intraoral orthodromic temporalis transfer in facial paralysis

This study aimed to quantitatively analyze the degree and vector of commissure excursion following intraoral orthodromic temporalis transfer. Patients with unilateral facial paralysis who underwent intraoral temporalis transfer were included. Intra-oral coronoidectomy was followed by submucosa tunneling through two vertical intraoral incisions to fixate the temporalis tendon to the perioral location. Oral commissure excursion, upper lip and commissure height differences, and smile angle were measured.Postoperatively, the symmetry of commissure excursion improved in repose (affected side: 114.6 ± 7.0 mm, non-affected side: 115.2 ± 4.9 mm, p = 0.134), while asymmetry arose in smiling (affected side: 30.7 ± 3.4 mm, non-affected side: 34.5 ± 4.4 mm, p = 0.001). Furthermore, the postoperative smile angle demonstrated insufficient vertical movement on the affected side during smiling (affected side: 115.6 ± 5.8°, non-affected side: 118.4 ± 4.9°, p = 0.002) but no significant difference in repose (p = 0.134). Within the limitations of the study it seems that intraoral orthodromic temporalis transfer yields excellent resting symmetry, but smile asymmetry may occur owing to insufficient oral commissure excursion. Nevertheless, as a minimally invasive surgery, this technique can obviate visible scars and benefit patients wishing for the same and can have excellent resting symmetry.

Diffuse Idiopathic Skeletal Hyperostosis Presenting With Hoarseness-A Case Report.

Unilateral vocal cord paralysis-related voice change is a common presentation in the otorhinolaryngology clinic. The well-known etiology was recurrent laryngeal nerve injury due to surgery, traumatic event, or tumor compression, but there are still other etiologies that could interfere with the route of the recurrence laryngeal nerve and lead to unilateral paralysis of the vocal cord. In this report, we presented a rare case of unilateral vocal cord paralysis resulting in diffuse idiopathic skeletal hyperostosis.

Early Simultaneous Cross Facial Nerve Graft and Masseteric Nerve Transfer for Facial Paralysis after Tumor Resection.

Patients undergoing masseter nerve transfer and CFNG for facial paralysis after skull base tumor resection were consented to participate in video interviews. Facial Clinimetric Evaluation (FaCE) Scale (0-100) patient-reported outcome, eFACE, and Facial Grading Scale scores were compared. Nine patients had unilateral facial paralysis from resection of a schwannoma (56%), acoustic neuroma (33%), or vascular malformation (11%). Five underwent early simultaneous CFNG and masseter nerve transfer (mean 3.6 days after resection), whereas four underwent two-stage reanimation including a babysitter procedure (mean 218 days after resection). Postoperative FaCE scale and Facial Grading Scale scores were similar in both groups (P > 0.05). Postoperative mean eFACE scores were similar for both groups for smile (early: 71.5 versus delayed: 75.5; P = 0.08), static (76.3 versus 82.1; P = 0.32), and dynamic scores (59.7 versus 64.9; P = 0.19); however, synkinesis scores were inferior in the early group (76.4 versus 91.1; P = 0.04). Early simultaneous masseter nerve transfer and CFNG provides reanimated movement sooner and in fewer stages than a staged approach in a delayed timeline. The early technique appears to result in similar clinician- and patient-reported outcomes compared with delayed procedures; however, in this preliminary study, the early approach was associated with greater synkinesis, meriting further investigation.

Automatic grading of patients with a unilateral facial paralysis based on the Sunnybrook Facial Grading System - A deep learning study based on a convolutional neural network

PurposeIn order to assess the severity and the progression of a unilateral peripheral facial palsy the Sunnybrook Facial Grading System (SFGS) is a well-established grading system due to its clinical relevance, sensitivity, and robust measuring method. However, training is required in order to achieve a high inter-rater reliability. This study investigated the automated grading of facial palsy patients based on the SFGS using a convolutional neural network. MethodsA total of 116 patients with a unilateral peripheral facial palsy and 9 healthy subjects were recorded performing the Sunnybrook poses. A separate model was trained for each of the 13 elements of the SFGS and then used to calculate the Sunnybrook subscores and composite score. The performance of the automated grading system was compared to three clinicians experienced in the grading of a facial palsy. ResultsThe inter-rater reliability of the convolutional neural network was within the range of human observers, with an average intra-class correlation coefficient of 0.87 for the composite Sunnybrook score, 0.45 for the resting symmetry subscore, 0.89 for the symmetry of voluntary movement subscore, and 0.77 for the synkinesis subscore. ConclusionsThis study showed the potential of the automated SFGS to be implemented in a clinical setting. The automated grading system adhered to the original SFGS, which makes the implementation and interpretation of the automated grading more straightforward. The automated system can be implemented in numerous settings such as online consults in an e-Health environment, since the model used 2D images captured from a video recording.

Phrenic nerve neurorrhaphy with a sural nerve graft in unilateral diaphragmatic paralysis

Unilateral diaphragmatic paralysis can present following damage or impairment to a phrenic nerve. In cases where current treatment methods are not feasible, the use of a double phrenic nerve neurorrhaphy with an autologous sural nerve graft should be investigated. In preserved rats, the feasibility of this technique was explored. The sural nerve was excised from the left thigh. Entering into the thoracic cavity bilaterally through the fifth intercostal spaces, the right and left phrenic nerves were identified. The right phrenic nerve was cut to create a distal nerve stump. The sural nerve was grafted onto the distal stump of the right phrenic nerve and the side of the left phrenic nerve. Using six preserved rat cadavers, the end-to-side graft was successfully explored and performed. It was determined that approximately 2.5–3 cm of the sural nerve will be required to be harvested for the graft. The sural nerve was an appropriate size for grafting onto the phrenic nerves. Four 10–0 Nylon sutures were sufficient for each neurorrhaphy. A double phrenic nerve neurorrhaphy with an autologous sural nerve graft is potentially feasible in rat models.

A West Nile Virus infection expressed as unilateral limb paralysis and complicated by Parsonage–Turner syndrome: a case report

BackgroundWest Nile Virus is a single-stranded Ribonucleic Acid arbovirus of the Flaviviridae family that is transmitted to humans by Culex species mosquitoes. West Nile Virus infection is asymptomatic in the majority of affected people. Of those who develop symptoms, the usual manifestation is a febrile syndrome, while only 1% develop neurological symptoms due to a neuroinvasive form of infection, including encephalitis, meningitis, asymmetrical flaccid paralysis, or a combination of all these features. Parsonage–Turner syndrome is a rare disorder characterized by sudden painful symptoms and subsequent paralysis, involving a shoulder or one of the upper limbs due to post-infective brachial plexopathy. The etiology is unknown, although it can be considered a multifactorial process: a predisposing factor, such as viral infection or strenuous upper-extremity exercise, can trigger an immune-mediated process localized in the brachial plexus.Clinical presentationIn late summer, a 79-year-old male Italian patient was admitted to the emergency department for acute right upper limb weakness and high fever, without any mental status impairment, pain, sensory alterations, or signs of meningeal irritation. Laboratory tests confirmed acute West Nile Virus infection, expressed as a unilateral upper limb flaccid paralysis. After a few days, the patient reported an acute pain in the right upper limb scarcely responsive to nonsteroidal anti-inflammatory drug therapy and a subsequent wider distribution of flaccid paralysis. After multiple examinations, Parsonage–Turner syndrome could be suspected. Patient was treated with steroids and reported an improvement of clinical condition after 2 months, with complete pain remission but partial strength recovery in the affected limb.ConclusionsWest Nile Virus disease has a broad spectrum of neurological manifestations, among which the most common are signs of meningeal irritation or cognitive impairment. We report an unusual presentation of neuroinvasive West Nile Virus infection with arm weakness as expression of unilateral viral neuritis, followed by a post-infective brachial plexopathy consistent with Parsonage–Turner syndrome diagnosis. We diagnosed Parsonage–Turner syndrome after excluding the most common causes of atraumatic acute upper limb pain, through a challenging differential diagnosis in a patient with several comorbidities.

Comparison of static and dynamic symmetry between masseter-innervated and dual-innervated free multivector serratus anterior muscle transfer for complete facial paralysis

In this study, facial symmetry was compared between the masseter-innervated and dual-innervated free multivector serratus anterior muscle transfer (FMSAMT) methods. Eighteen patients with unilateral complete facial paralysis underwent facial reanimation surgery between April 2006 and July 2019. The masseter-innervated FMSAMT group (Group M, n=8) underwent end-to-end coaptation with the ipsilateral masseter nerve in one stage. The dual-innervated FMSAMT group (Group D, n=10) underwent end-to-end coaptation with the masseter nerve and end-to-side coaptation with the contralateral facial nerve via cross-face nerve graft. They were further divided into the one-stage (Group D1, n=5) and two-stage (Group D2, n=5) subgroups. The durations of periods until the first visible muscle contraction with clenching, first spontaneous smile, and the completion of resting tone were evaluated. The possibility of a spontaneous smile and symmetry of the midline and horizontal deviation at rest and during voluntary smiling were compared between each group. Groups M and D differed significantly in the possibility of a spontaneous smile and improvement rate of midline deviation and horizontal deviation at rest (p<0.001, p<0.001, and p=0.001, respectively) but not in the improvement rate of midline and horizontal deviation during voluntary smiling. The duration of the period until the completion of resting tone was significantly shorter in Group D1 than in Group D2 (p=0.048); however, the possibility of a spontaneous smile and the improvement rate of midline and horizontal deviation were not significantly different. Dual-innervated FMSAMT was effective in guaranteeing a symmetrical resting tone, voluntary smiling, and reproducing a spontaneous smile.

INDICATIONS FOR THYROID SURGERYEXPERIENCE OF THE ENT DEPARTMENTOF MOULAY ISMAÏL MILITARY HOSPITAL IN MEKNES (ABOUT 103 CASES)

Introduction: The indications for thyroid surgery are currently well defined and specified in the consensus recommendations for the management of thyroid nodules, which would allow on the one hand to reduce the excessive number of thyroidectomies, and on the other hand would not allow a malignant lesion to evolve. Objectives: Our study aims to evaluate the epidemiological, clinical and paraclinical characteristics of patients who have undergone thyroidectomy and to discuss the different surgical indications. Patients and methods: This is a retrospective study spread over one year, from January to December 2019, involving 103 patients hospitalized for thyroid surgery, in the ENT (ear nose throat) department of Moulay Ismail military hospital in Meknes. Results: The average age of our population was 50.68 years and the sex ratio W/M was 5.86. The time to consultation was more than 2 years in half of the patients. The reason for consultation was cervical swelling in 88 cases, signs of hyperthyroidism in 27 cases and compression in 15 cases. All our patients have benefited preoperatively from a TSH assay and a cervical ultrasound. A cervico-thoracic scan was performed in all patients with plunging and/or compressive goiter. Cytopuncture could only be performed in 10 cases.Surgical indications were retained in case of suspected malignancy (56.31%) hyperthyroidism (26.22%), compressive goiter (14.56%), aesthetic discomfort (1.94%) and recurrent thyroid cyst (0.97%)The surgical procedure consisted of a total thyroidectomy in 81.5% of cases, a lobo isthmectomy in 8.7% of cases and secondary totalization in 9.7% of cases. The pathological study revealed thyroid cancer in 11.65% of cases. Postoperative follow-up was marked by the occurrence of a compressive hematoma in one patient, transient unilateral recurrent paralysis in 2 patients, transient hypoparathyroidism in 6 patients, and tumor recurrence in one case Discussion: Surgical indications have been proposed, primarily in case of suspected thyroid neoplasia, mainly based on clinical and ultrasound criteria. The cancer/benign tumor ratio was 13.2%. It was therefore important to develop the cytopuncture.Autonomous goiters/nodules and compressive and/or plunging goiters were the main other indications for surgery with low morbidity, but at the cost of permanent hypothyroidism. Conclusion: Surgery is the gold standard treatment for symptomatic thyroid goiters/nodules. However, its contribution must be constantly reassessed according to the evolution of new diagnostic procedures and alternative techniques.