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Greiner RC, Kohlberg GD, Lu GN. Management of facial nerve trauma. Curr Opin Otolaryngol Head Neck Surg 2024; 32:234-238. [PMID: 38695542 DOI: 10.1097/moo.0000000000000976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
Abstract
PURPOSE OF REVIEW To present the current literature on management of facial nerve disorder secondary to trauma, with a focus on the utility of electrodiagnostic testing in this setting. RECENT FINDINGS Patients with facial palsy related to temporal bone fractures should be started on high-dose corticosteroids as early as possible. Recent literature on the benefit of surgical intervention in the setting of temporal bone fracture is mixed. Some studies support early surgical decompression whereas others have found no benefit compared with conservative treatment. SUMMARY The management of facial nerve trauma is based on location and extent of injury. Extratemporal trauma and transected nerve should be treated with surgical exploration and tension-free coaptation ideally within 72 h. There are no guidelines for intratemporal facial nerve trauma. Surgical decompression compared with medical management is debated in the literature without consensus and more large studies are needed.
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Affiliation(s)
| | - Gavriel D Kohlberg
- University of Washington Department of Otolaryngology - Head and Neck Surgery, Seattle, Washington, USA
| | - G Nina Lu
- University of Washington Department of Otolaryngology - Head and Neck Surgery, Seattle, Washington, USA
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Sun P, Wang H, Jiang Z, Li L, Fan Z, Han Y. [Diagnosis and treatment of 68 cases of traumatic facial nerve paralysis]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2024; 38:405-410. [PMID: 38686478 PMCID: PMC11387311 DOI: 10.13201/j.issn.2096-7993.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Indexed: 05/02/2024]
Abstract
Objective:To summarize the clinical characteristics and therapeutic effect of traumatic facial nerve palsy. Methods:Sixty-eight cases of traumatic facial nerve palsy were retrospectively analyzed from January 2015 to May 2023. Results:The median course of disease was 33 days. The facial nerve function of the patients was grade HB-Ⅱin 2 cases, grade HB-Ⅲ in 4 cases, grade HB-Ⅳin 16 cases, grade HB-Ⅴ in 37 cases(38 ears), and grade HB-Ⅵ in 9 cases. 42 cases occurred immediately after injury and 26 cases were delayed. CT examination of temporal bone revealed longitudinal fractures in 51 cases(52 ears) , transverse fractures in 6 cases and mixed fractures in 4 cases. No definite temporal bone fracture was found in the remaining 7 cases. The segments of facial nerve injury in 49 cases(50 ears) were geniculate ganglion and adjacent, in 7 cases were vertical segment, in 7 cases were horizontal segment, in 2 cases were horizontal segment and vertical segment; and the other 3 cases could not be evaluated. Conservative treatment with glucocorticoids was used in 23 ears and surgery was used in 46 ears. Patients were followed up 6-24 months after treatment, including 20 cases of grade HB-Ⅰ, 19 cases of grade HB-Ⅱ, 23 cases(24 ears) of grade HB-Ⅲ, 4 cases of grade HB-Ⅳ, and 1 case of grade HB-Ⅴ.One patient was lost to follow-up. After treatment, the facial nerve function of patients was significantly improved(P<0.05), and there were significant differences between conservative treatment group and surgical treatment group in the course of facial nerve palsy, the ratio of facial palsy immediately after injury, the nerve function before treatment and the nerve function after treatment(P<0.05). There were no significant differences in age, sex, hearing condition, temporal bone fracture, facial nerve injury segment and rate of favorable neurologic outcomes(P>0.05). The comparison of patients with neurodegeneration rate>90% and ≤90% showed that the facial nerve function of patients with neurodegeneration rate>90% before treatment was significantly worse(P<0.05), but there was no significant difference between the facial nerve function after treatment(P>0.05). There was no significant difference in facial nerve function between middle fossa approach group and mastoid approach group(P>0.05). Conclusion:Patients with traumatic facial nerve palsy should be evaluated individually. Patients with mild facial nerve palsy, low neurodegeneration rate and short course of disease can be treated conservatively and followed up closely. Patients with severe facial nerve palsy, high neurodegeneration rate and more than 6 weeks of disease can be actively considered surgery. Good prognosis can be obtained by correct evaluation and treatment.
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Affiliation(s)
- Pengcheng Sun
- Department of Otolaryngology-Head and Neck Surgery,Shandong Provincial ENT Hospital,Shandong University,Jinan,250022,China
| | - Haibo Wang
- Department of Otolaryngology-Head and Neck Surgery,Shandong Provincial ENT Hospital,Shandong University,Jinan,250022,China
| | - Zhen Jiang
- Department of Otolaryngology-Head and Neck Surgery,Shandong Provincial ENT Hospital,Shandong University,Jinan,250022,China
| | - Li Li
- Department of Otolaryngology-Head and Neck Surgery,Shandong Provincial ENT Hospital,Shandong University,Jinan,250022,China
| | - Zhaomin Fan
- Department of Otolaryngology-Head and Neck Surgery,Shandong Provincial ENT Hospital,Shandong University,Jinan,250022,China
| | - Yuechen Han
- Department of Otolaryngology-Head and Neck Surgery,Shandong Provincial ENT Hospital,Shandong University,Jinan,250022,China
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McCoul ED, Megwalu UC, Joe S, Gray R, O'Brien DC, Ference EH, Lee VS, Patel PS, Figueroa-Morales MA, Shin JJ, Brenner MJ. Systemic Steroids for Otolaryngology-Head and Neck Surgery Disorders: An Evidence-Based Primer for Clinicians. Otolaryngol Head Neck Surg 2023; 168:643-657. [PMID: 35349383 DOI: 10.1177/01945998221087664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/26/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To offer pragmatic, evidence-informed guidance on the use of systemic corticosteroids (SCS) for common otolaryngologic disorders. DATA SOURCES PubMed, Cochrane Library, and American Academy of Otolaryngology-Head and Neck Surgery Foundation clinical practice guidelines. REVIEW METHODS A comprehensive search of published literature through November 2021 was conducted on the efficacy of SCS, alone or in combination with other treatments, for managing disorders in otolaryngology and the subdisciplines. Clinical practice guidelines, systematic reviews, and randomized controlled trials, when available, were preferentially retrieved. Interventions and outcomes of SCS use were compiled to generate summary tables and narrative synthesis of findings. CONCLUSIONS Evidence on the effectiveness of SCS varies widely across otolaryngology disorders. High-level evidence supports SCS use for Bell's palsy, sinonasal polyposis, and lower airway disease. Conversely, evidence is weak or absent for upper respiratory tract infection, eustachian tube dysfunction, benign paroxysmal positional vertigo, adenotonsillar hypertrophy, or nonallergic rhinitis. Evidence is indeterminate for acute laryngitis, acute pharyngitis, acute sinusitis, angioedema, chronic rhinosinusitis without polyps, Ménière's disease, postviral olfactory loss, postoperative nerve paresis/paralysis, facial pain, and sudden sensorineural hearing loss. IMPLICATIONS FOR PRACTICE Clinicians should bring an evidence-informed lens to SCS prescribing to best counsel patients regarding the risks, anticipated benefits, and limited data on long-term effects. Alternate routes of corticosteroid administration-such as sprays, drops, inhalers, and intralesional injections-may be preferable for many disorders, particularly those that are self-limited or require a prolonged duration of therapy. Prudent use of SCS reduces the risk of medication-related adverse effects. Clinicians who are conversant with high-level evidence can achieve optimal outcomes and stewardship when prescribing SCS.
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Affiliation(s)
- Edward D McCoul
- Department of Otorhinolaryngology, Ochsner Clinic, New Orleans, Louisiana, USA
| | - Uchechukwu C Megwalu
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California
| | - Stephanie Joe
- Department of Otolaryngology-Head and Neck Surgery, University of Illinois Chicago, Chicago, Illinois, USA
| | - Raluca Gray
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Daniel C O'Brien
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Canada
| | - Elisabeth H Ference
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Victoria S Lee
- Department of Otolaryngology-Head and Neck Surgery, University of Illinois Chicago, Chicago, Illinois, USA
| | - Prayag S Patel
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Marco A Figueroa-Morales
- Department of Otolaryngology-Head and Neck Surgery, Mexican Social Security Institute, Mexico City, Mexico
| | - Jennifer J Shin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts, USA
| | - Michael J Brenner
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Surgical and nonsurgical treatment outcomes in traumatic facial nerve palsy. Eur Arch Otorhinolaryngol 2023; 280:3203-3208. [PMID: 36708423 DOI: 10.1007/s00405-023-07839-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/11/2023] [Indexed: 01/29/2023]
Abstract
PURPOSE Facial nerve decompression surgery is performed on patients with immediate, complete traumatic facial palsy. However, the clinical advantage of the surgical treatment has weak evidence because of lack of control groups in previous studies. Therefore, this study compared facial function outcomes between the patients who underwent surgery and those who did not. Furthermore, in cases of bilateral traumatic facial palsy, the outcomes of the surgical and nonsurgical sides were also discussed. METHODS A retrospective medical chart review of immediate and severe (House-Brackman [HB] grade V and VI) traumatic facial palsy was conducted. Twenty-five ears from the surgical group and eight ears from the conservative treatment group were enrolled. Among the patients, three with immediate and severe bilateral facial palsy underwent unilateral surgery. RESULTS The average HB grade after 1-year follow-up was 1.7 in the surgical group and 1.5 in the nonsurgical group. Four patients who have definite facial canal disruption in the imaging study have recovered to HB grades I-III without surgical intervention. In patients with bilateral facial palsy, the nonsurgical side showed the same or better facial functions than the surgical side. CONCLUSIONS Compared with nonsurgical conservative treatment, facial nerve decompression surgery did not show superior outcomes in immediate HB grade V-VI traumatic facial palsy. The clinical advantage of facial nerve decompression is questionable and should be re-evaluated in a prospectively designed study.
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Albrecht A, Schipper J. [Traumatology of the lateral skull base]. HNO 2022; 70:743-750. [PMID: 36036809 DOI: 10.1007/s00106-022-01212-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 11/04/2022]
Abstract
The most common cause of lateral skull base fractures are still road traffic accidents, followed by falls. The radiologic classification into otic capsule-sparing or otic capsule-violating fractures correlates well with an increased risk of injury to the sensitive structures of the middle ear with otic capsule-violating fractures. In case of immediate onset complete facial nerve paralysis, decompression surgery is generally recommended if bony impingement can be demonstrated on high-resolution CT of the temporal bone. For many other facials nerve complications, recent publications have achieved good to excellent facial nerve recovery rates with watchful waiting under conservative treatment with prednisolone administration.
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Affiliation(s)
- Angelika Albrecht
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland.
| | - Jörg Schipper
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland
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Traumatic facial nerve injury: A case of facial nerve avulsion at the cerebellopontine angle. Radiol Case Rep 2022; 17:2404-2407. [PMID: 35570877 PMCID: PMC9096457 DOI: 10.1016/j.radcr.2022.03.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 03/30/2022] [Indexed: 11/24/2022] Open
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Chang CWD, McCoul ED, Briggs SE, Guardiani EA, Durand ML, Hadlock TA, Hillel AT, Kattar N, Openshaw PJM, Osazuwa-Peters N, Poetker DM, Shin JJ, Chandrasekhar SS, Bradford CR, Brenner MJ. Corticosteroid Use in Otolaryngology: Current Considerations During the COVID-19 Era. Otolaryngol Head Neck Surg 2021; 167:803-820. [PMID: 34874793 DOI: 10.1177/01945998211064275] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To offer pragmatic, evidence-informed advice on administering corticosteroids in otolaryngology during the coronavirus disease 2019 (COVID-19) pandemic, considering therapeutic efficacy, potential adverse effects, susceptibility to COVID-19, and potential effects on efficacy of vaccination against SARS-CoV-2, which causes COVID-19. DATA SOURCES PubMed, Cochrane Library, EMBASE, CINAHL, and guideline databases. REVIEW METHODS Guideline search strategies, supplemented by database searches on sudden sensorineural hearing loss (SSNHL), idiopathic facial nerve paralysis (Bell's palsy), sinonasal polyposis, laryngotracheal disorders, head and neck oncology, and pediatric otolaryngology, prioritizing systematic reviews, randomized controlled trials, and COVID-19-specific findings. CONCLUSIONS Systemic corticosteroids (SCSs) reduce long-term morbidity in individuals with SSNHL and Bell's palsy, reduce acute laryngotracheal edema, and have benefit in perioperative management for some procedures. Topical or locally injected corticosteroids are preferable for most other otolaryngologic indications. SCSs have not shown long-term benefit for sinonasal disorders. SCSs are not a contraindication to vaccination with COVID-19 vaccines approved by the US Food and Drug Administration. The Centers for Disease Control and Prevention noted that these vaccines are safe for immunocompromised patients. IMPLICATIONS FOR PRACTICE SCS use for SSNHL, Bell's palsy, laryngotracheal edema, and perioperative care should follow prepandemic standards. Local or topical corticosteroids are preferable for most other otolaryngologic indications. Whether SCSs attenuate response to vaccination against COVID-19 or increase susceptibility to SARS-CoV-2 infection is unknown. Immunosuppression may lower vaccine efficacy, so immunocompromised patients should adhere to recommended infection control practices. COVID-19 vaccination with Pfizer-BioNTech, Moderna, or Johnson & Johnson vaccines is safe for immunocompromised patients.
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Affiliation(s)
- C W David Chang
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri, Columbia, Missouri, USA
| | - Edward D McCoul
- Department of Otorhinolaryngology, Ochsner Clinic, New Orleans, Louisiana, USA
| | - Selena E Briggs
- Department of Otolaryngology-Head and Neck Surgery, Georgetown University, Washington, DC, USA
| | - Elizabeth A Guardiani
- Department of Otolaryngology-Head and Neck Surgery, University of Maryland, Baltimore, Maryland, USA
| | - Marlene L Durand
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, and Infectious Disease Service, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts, USA
| | - Tessa A Hadlock
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts, USA
| | - Alexander T Hillel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nrusheel Kattar
- Department of Surgery, Louisiana State University, Shreveport, Louisiana, USA
| | | | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina, USA
| | - David M Poetker
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jennifer J Shin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Michael J Brenner
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Zhu GC, Xiao DJ, Zhu BW, Xiao Y. Repairing whole facial nerve defects with xenogeneic acellular nerve grafts in rhesus monkeys. Neural Regen Res 2021; 17:1131-1137. [PMID: 34558542 PMCID: PMC8552849 DOI: 10.4103/1673-5374.324853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Acellular nerve allografts conducted via chemical extraction have achieved satisfactory results in bridging whole facial nerve defects clinically, both in terms of branching a single trunk and in connecting multiple branches of an extratemporal segment. However, in the clinical treatment of facial nerve defects, allogeneic donors are limited. In this experiment, we exposed the left trunk and multiple branches of the extratemporal segment in six rhesus monkeys and dissected a gap of 25 mm to construct a monkey model of a whole left nerve defect. Six monkeys were randomly assigned to an autograft group or a xenogeneic acellular nerve graft group. In the autograft group, the 25-mm whole facial nerve defect was immediately bridged using an autogenous ipsilateral great auricular nerve, and in the xenogeneic acellular nerve graft group, this was done using a xenogeneic acellular nerve graft with trunk-branches. Examinations of facial symmetry, nerve-muscle electrophysiology, retrograde transport of labeled neuronal tracers, and morphology of the regenerated nerve and target muscle at 8 months postoperatively showed that the faces of the monkey appeared to be symmetrical in the static state and slightly asymmetrical during facial movement, and that they could actively close their eyelids completely. The degree of recovery from facial paralysis reached House-Brackmann grade II in both groups. Compound muscle action potentials were recorded and orbicularis oris muscles responded to electro-stimuli on the surgical side in each monkey. FluoroGold-labeled neurons could be detected in the facial nuclei on the injured side. Immunohistochemical staining showed abundant neurofilament-200-positive axons and soluble protein-100-positive Schwann cells in the regenerated nerves. A large number of mid-graft myelinated axons were observed via methylene blue staining and a transmission electron microscope. Taken together, our data indicate that xenogeneic acellular nerve grafts from minipigs are safe and effective for repairing whole facial nerve defects in rhesus monkeys, with an effect similar to that of autologous nerve transplantation. Thus, a xenogeneic acellular nerve graft may be a suitable choice for bridging a whole facial nerve defect if no other method is available. The study was approved by the Laboratory Animal Management Committee and the Ethics Review Committee of the Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, China (approval No. 2018-D-1) on March 15, 2018.
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Affiliation(s)
- Guo-Chen Zhu
- Department of Otorhinolaryngology-Head and Neck Surgery, Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University; Department of Otorhinolaryngology-Head and Neck Surgery, Affiliated Wuxi Clinical College of Nantong University, Wuxi, Jiangsu Province, China
| | - Da-Jiang Xiao
- Department of Otorhinolaryngology-Head and Neck Surgery, Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University; Department of Otorhinolaryngology-Head and Neck Surgery, Affiliated Wuxi Clinical College of Nantong University, Wuxi, Jiangsu Province, China
| | - Bi-Wen Zhu
- College of Animal Science & Technology, Zhongkai University of Agriculture and Engineering, Guangzhou, Guangdong Province, China
| | - Yan Xiao
- Department of Pathology, Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, Wuxi, Jiangsu Province, China
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Faramarzi M, Faramarzi A, Hosseinialhashemi M. Is Early Traumatic Facial Nerve Surgery a Priority during the COVID-19 Pandemic? Int Arch Otorhinolaryngol 2021; 25:e177-e178. [PMID: 33968216 PMCID: PMC8096494 DOI: 10.1055/s-0041-1724089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/07/2020] [Indexed: 11/27/2022] Open
Abstract
As otolaryngologists are exposed to high risk of coronavirus disease 2019 (COVID-19) infection, logic and evidence-based prioritization for surgeries is essential to reduce the risk of infection amongst healthcare workers. Several clinical guidelines and surgery prioritizing recommendations have been published during the COVID-19 pandemic. They recommended the surgery in the setting of immediate facial nerve paralysis within 72 hours after trauma, but none of the previous studies in the literature suggests that the optimal timing of operation should be less than 2 weeks from injury.
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Affiliation(s)
- Mohammad Faramarzi
- Department of Otorhinolaryngology-Head and Neck Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
- Otolaryngology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Faramarzi
- Otolaryngology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Milad Hosseinialhashemi
- Department of Otorhinolaryngology-Head and Neck Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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10
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Singh GB, Kumar P, Krishna ARA. A Paradigm Shift in the Management of Post Traumatic Complete Facial Nerve Palsy. Indian J Otolaryngol Head Neck Surg 2020; 72:532-534. [PMID: 33088787 DOI: 10.1007/s12070-020-01894-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/04/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Gautam Bir Singh
- Department of Otorhinolaryngology and Head-Neck Surgery, Lady Hardinge Medical College and Associated Hospitals, Shaheed Bhagat Singh Marg, New Delhi, 110001 India
- Faridabad, Haryana India
| | - Poornima Kumar
- Department of Otorhinolaryngology and Head-Neck Surgery, Lady Hardinge Medical College and Associated Hospitals, Shaheed Bhagat Singh Marg, New Delhi, 110001 India
| | - A R Arun Krishna
- Department of Otorhinolaryngology and Head-Neck Surgery, Lady Hardinge Medical College and Associated Hospitals, Shaheed Bhagat Singh Marg, New Delhi, 110001 India
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Non-idiopathic peripheral facial palsy: prognostic factors for outcome. Eur Arch Otorhinolaryngol 2020; 278:3227-3235. [PMID: 33025045 PMCID: PMC8328849 DOI: 10.1007/s00405-020-06398-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/23/2020] [Indexed: 02/06/2023]
Abstract
Objectives There is a lack of data on patients’ and diagnostic factors for prognostication of complete recovery in patients with non-idiopathic peripheral facial palsy (FP). Methods Cohort register-based study of 264 patients with non-idiopathic peripheral FP and uniform diagnostics and standardized treatment in a university hospital from 2007 to 2017 (47% female, median age: 57 years). Clinical data, facial grading, electrodiagnostics, motor function tests, non-motor function tests, and onset of prednisolone therapy were assessed for their impact on the probability of complete recovery using univariable and multivariable statistics. Results The most frequent reason for a non-idiopathic peripheral FP was a reactivation of Varicella Zoster Virus (VZV; 36.4%). Traumatic origin had a higher proportion of complete FP (52.9%). Furthermore, in traumatic FP, the mean interval between onset and start of prednisolone therapy was longer than in other cases (5.6 ± 6.2 days). Patients with reactivation of VZV, Lyme disease or otogenic FP had a significant higher recovery rate (p = 0.002, p < 0.0001, p = 0.018, respectively), whereas patients with post-surgery FP and other reasons had a significant lower recovery rate (p < 0.0001). After multivariate analyses voluntary activity in first EMG, Lyme disease and post-surgery cause were identified as independent diagnostic and prognostic factors on the probability of complete recovery (all p < 0.05). Conclusion Infectious causes for non-idiopathic FP like VZV reactivation and Lyme disease had best probability for complete recovery. Post-surgery FP had a worse prognosis. Level of evidence 2 Electronic supplementary material The online version of this article (10.1007/s00405-020-06398-6) contains supplementary material, which is available to authorized users.
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Lassaletta L, Morales-Puebla JM, Altuna X, Arbizu Á, Arístegui M, Batuecas Á, Cenjor C, Espinosa-Sánchez JM, García-Iza L, García-Raya P, González-Otero T, Mañós M, Martín C, Moraleda S, Roda JM, Santiago S, Benítez J, Cavallé L, Correia V, Estévez JM, Gómez J, González R, Jiménez J, Lacosta JL, Lavilla MJ, Peñarrocha J, Polo R, García-Purriños F, Ramos F, Tomás M, Uzcanga M, Vallejo LÁ, Gavilán J. Facial paralysis: Clinical practice guideline of the Spanish Society of Otolaryngology. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020; 71:99-118. [PMID: 31097197 DOI: 10.1016/j.otorri.2018.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 12/10/2018] [Indexed: 12/28/2022]
Abstract
Bell's palsy is the most common diagnosis associated with facial nerve weakness or paralysis. However, not all patients with facial paresis/paralysis have Bell's palsy. Other common causes include treatment of vestibular schwannoma, head and neck tumours, iatrogenic injuries, Herpes zoster, or trauma. The approach to each of these conditions varies widely. The purpose of this guideline is to provide clinicians with guidance on the treatment and monitoring of patients with different causes of facial paralysis. We intend to draft a practical guideline, focusing on operationalised recommendations deemed to be useful in the daily management of patients. This guideline was promoted by the Spanish Society of Otolaryngology and developed by a group of physicians with an interest in facial nerve disorders, including at least one physician from each Autonomous Community. In a question and answer format, it includes 56 relevant topics related to the facial nerve.
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Affiliation(s)
- Luis Lassaletta
- Servicio de Otorrinolaringología, Hospital Universitario La Paz, Madrid, España; Comisión de Otoneurología de la SEORL, Madrid, España; IdiPAZ, Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III, Madrid, España.
| | | | - Xabier Altuna
- Servicio de Otorrinolaringología, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - Álvaro Arbizu
- Servicio de Oftalmología, Hospital Universitario La Paz, Madrid, España
| | - Miguel Arístegui
- Servicio de Otorrinolaringología, Hospital Universitario Gregorio Marañón, Madrid, España
| | - Ángel Batuecas
- Servicio de Otorrinolaringología, Hospital Universitario de Salamanca, Salamanca, España; Comisión de Otoneurología de la SEORL, Madrid, España
| | - Carlos Cenjor
- Servicio de Otorrinolaringología, Fundación Jiménez Díaz, Madrid, España; Comisión de Otoneurología de la SEORL, Madrid, España
| | - Juan Manuel Espinosa-Sánchez
- Servicio de Otorrinolaringología, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitariaibs, Granada, España; Comisión de Otoneurología de la SEORL, Madrid, España
| | - Leire García-Iza
- Servicio de Otorrinolaringología, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - Pilar García-Raya
- Servicio de Neurorradiología, Hospital Universitario La Paz, Madrid, España
| | | | - Manuel Mañós
- Servicio Otorrinolaringología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Carlos Martín
- Servicio de Otorrinolaringología, Hospital Universitario Gregorio Marañón, Madrid, España
| | - Susana Moraleda
- Servicio de Rehabilitación, Hospital Universitario La Paz, Madrid, España
| | - Jose María Roda
- Servicio de Neurocirugía, Hospital Universitario La Paz, Madrid, España
| | - Susana Santiago
- Servicio de Neurofisiología, Hospital Universitario La Paz, Madrid, España
| | - Jesús Benítez
- Servicio de Otorrinolaringología, Hospital Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, España
| | - Laura Cavallé
- Departamento de Otorrinolaringología, Hospital Universitario La Fe, Valencia, España
| | - Victor Correia
- Servicio de Otorrinolaringología, Hospital de CUF de Porto, Porto, Portugal
| | - Jose Manuel Estévez
- Servicio de Otorrinolaringología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, España
| | - Justo Gómez
- Servicio de Otorrinolaringología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Rocío González
- Servicio de Otorrinolaringología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - Jorge Jiménez
- Servicio de Otorrinolaringología, Complejo Hospitalario de Toledo, Toledo, España
| | - Jose Luis Lacosta
- Servicio de Otorrinolaringología, Hospital San Pedro, Logroño, La Rioja, España
| | - María José Lavilla
- Servicio de Otorrinolaringología, Hospital Lozano Blesa, Zaragoza, España
| | - Julio Peñarrocha
- Servicio de Otorrinolaringología, Hospital Universitario La Paz, Madrid, España
| | - Rubén Polo
- Servicio de Otorrinolaringología, Hospital Universitario Ramón y Cajal, Madrid, España
| | | | - Francisco Ramos
- Servicio de Otorrinolaringología, Hospital San Pedro de Alcántara, Cáceres, España
| | - Manuel Tomás
- Servicio de Otorrinolaringología, Hospital Son Espases, Mallorca, Islas Baleares, España
| | - María Uzcanga
- Servicio de Otorrinolaringología, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - Luis Ángel Vallejo
- Servicio de Otorrinolaringología, Hospital Universitario Río Hortega, Valladolid, España
| | - Javier Gavilán
- Servicio de Otorrinolaringología, Hospital Universitario La Paz, Madrid, España
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Lassaletta L, Morales-Puebla JM, Altuna X, Arbizu Á, Arístegui M, Batuecas Á, Cenjor C, Espinosa-Sánchez JM, García-Iza L, García-Raya P, González-Otero T, Mañós M, Martín C, Moraleda S, Roda JM, Santiago S, Benítez J, Cavallé L, Correia V, Estévez JM, Gómez J, González R, Jiménez J, Lacosta JL, Lavilla MJ, Peñarrocha J, Polo R, García-Purriños F, Ramos F, Tomás M, Uzcanga M, Vallejo LÁ, Gavilán J. Facial Paralysis: Clinical Practice Guideline of the Spanish Society of Otolaryngology. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020. [DOI: 10.1016/j.otoeng.2018.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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14
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Guntinas-Lichius O, Silver CE, Thielker J, Bernal-Sprekelsen M, Bradford CR, De Bree R, Kowalski LP, Olsen KD, Quer M, Rinaldo A, Rodrigo JR, Sanabria A, Shaha AR, Takes RP, Vander Poorten V, Zbären P, Ferlito A. Management of the facial nerve in parotid cancer: preservation or resection and reconstruction. Eur Arch Otorhinolaryngol 2018; 275:2615-2626. [PMID: 30267218 DOI: 10.1007/s00405-018-5154-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 09/26/2018] [Indexed: 01/06/2023]
Abstract
PURPOSE Management of the facial nerve is instrumental in the surgical treatment of parotid cancer. METHODS A literature search was conducted using PubMed and ScienceDirect database. A total of 195 articles were finally included into the analysis, based on relevance, scientific evidence and actuality. RESULTS In the majority of cases the facial nerve is not involved by tumor. In these cases, identification and preservation of the nerve, in addition to complete tumor removal, are essential for successful surgery. When the nerve is infiltrated by tumor, the affected portion of the nerve must be resected as part of radical parotidectomy. Primary nerve reconstruction or other reanimation techniques give the best long-term functional and cosmetic results. A comprehensive diagnostic evaluation with current imaging and electrophysiological studies will provide the surgeon with the best knowledge of the relationship of the facial nerve to the tumor. Several standardized methods are helpful in finding, dissecting and preserving the nerve during parotid cancer surgery. When radical parotidectomy is indicated, the initial diagnostic work-up can assist in defining the need for adjuvant postoperative therapy and facial reanimation. The aim of rehabilitation is to restore tone, symmetry, and movement to the paralyzed face. CONCLUSIONS The surgical management of facial paralysis has undergone many improvements in recent years. This review gives an overview of recent advances in the diagnostic work-up, surgical techniques and any necessary rehabilitation of the facial nerve in parotid cancer surgery.
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Affiliation(s)
- Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
- Facial Nerve Center, Jena University Hospital, Jena, Germany.
- European Salivary Gland Society, Geneva, Switzerland.
| | - Carl E Silver
- Department of Surgery, University of Arizona College of Medicine, Phoenix, USA
| | - Jovanna Thielker
- Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
- Facial Nerve Center, Jena University Hospital, Jena, Germany
| | | | - Carol R Bradford
- Department of Otolaryngology, University of Michigan, Ann Arbor, USA
| | - Remco De Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Luis P Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Kerry D Olsen
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, USA
| | - Miquel Quer
- European Salivary Gland Society, Geneva, Switzerland
- Department of Otolaryngology, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Juan R Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias and Instituto Universitario de Oncología del Principado de Asturias, CIBERONC, Oviedo, Spain
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Clinica Vida, Universidad de Antioquia, Medellín, Colombia
| | - Ashok R Shaha
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Vincent Vander Poorten
- European Salivary Gland Society, Geneva, Switzerland
- Otorhinolaryngology-Head and Neck Surgery and Department of Oncology, section Head and Neck Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Peter Zbären
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital, Berne, Switzerland
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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15
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Surgery for post-traumatic facial paralysis: are we overdoing it? Eur Arch Otorhinolaryngol 2018; 275:2695-2703. [PMID: 30255202 DOI: 10.1007/s00405-018-5141-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/19/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Early facial nerve decompression is recommended for cases of post-traumatic facial palsy on the basis of ENoG with degeneration > 95%. There is still a dispute in the literature concerning the role and timing of surgery versus conservative treatment in such cases. This study has been planned to evaluate the outcome of conservative management in traumatic facial paralysis with regard to type of trauma, onset, and electrodiagnostic tests. METHODS A prospective cohort study included 39 patients with post-traumatic facial palsy. All patients underwent ENoG, nerve stimulation test, HRCT temporal bone and Schirmer's test. The patients received intravenous methylprednisolone 1 gm/day for 5 days or oral prednisolone 1 mg/kg in tapering doses for 3 weeks. Follow-up was done at 4, 12 and 24 weeks after the treatment. Surgical exploration was limited to patients showing no improvement after 12 weeks. Facial nerve function was evaluated by the HBFNS and FEMA grading systems. RESULTS Among the 39 patients in the study [5 women and 34 men; mean (SD) age, 33.5 (11.37) years], facial nerve recovery with conservative treatment alone was noted in 31 patients. The first signs of clinical recovery were noted in 27 patients by 4 weeks, in 31 patients by 12 weeks. Seven patients required surgical exploration. At 24 weeks, 31 patients recovered to House-Brackmann grade I/III and 1 patient to grade IV. 19 of 26 patients with longitudinal fractures had grade I/III recovery, whereas all 6 patients with transverse fracture recovered on conservative treatment. CONCLUSIONS Patients with incomplete facial palsy are candidates for conservative management. It is justified to try conservative management in patients with complete facial paralysis for up to 3 months even in cases where ENoG and NET suggest poor prognosis. The presence of sensorineural hearing loss or transverse fracture at presentation does not suggest a poor prognosis for improvement.
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