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Čelakovská J, Boudková P, Wertzova V, Čáková L. Ramsay Hunt syndrome in atopic dermatitis patient treated with dupilumab. Int Immunopharmacol 2024; 136:112345. [PMID: 38820959 DOI: 10.1016/j.intimp.2024.112345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/17/2024] [Accepted: 05/23/2024] [Indexed: 06/02/2024]
Abstract
The Ramsay-Hunt syndrome results from reactivation of the varicella-zoster virus at the geniculate ganglion level. The syndrome is characterized by a combination of symptoms such as ipsilateral facial paralysis, otalgia, and vesicles near the ear and auditory canal. The gold standard in the treatment of Ramsay-Hunt syndrome remains the combination of antiviral therapy with corticosteroids and adequate analgesic therapy. We present a case of a 45-year-old patient with severe form of atopic dermatitis, who developed this syndrome during treatment with dupilumab. The risks and benefits of dupilumab treatment in this patient were considered. Because both bronchial asthma and atopic dermatitis worsened when dupilumab was discontinued, it was indicated to continue this therapy with low-dose of acyclovir.
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Affiliation(s)
- Jarmila Čelakovská
- Department of Dermatology and Venereology, Faculty Hospital and Medical Faculty of Charles University, Hradec Králové 50002, Czech Republic.
| | - Petra Boudková
- Department of Clinical Immunology and Allergy, Faculty Hospital and Medical Faculty of Charles University, Hradec Králové 50002, Czech Republic
| | - Veronika Wertzova
- Department of Dermatology and Venereology, Faculty Hospital and Medical Faculty of Charles University, Hradec Králové 50002, Czech Republic
| | - Lenka Čáková
- Department of Dermatology and Venereology, Faculty Hospital and Medical Faculty of Charles University, Hradec Králové 50002, Czech Republic
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Cheng L, Lin Y, Yang J, Wang Q, Hu R, Li X, Wang H, Xu W. Clinical Characteristics and Prognosis of Herpes Zoster Laryngitis With Vocal Fold Immobility. J Voice 2024:S0892-1997(24)00172-3. [PMID: 38906743 DOI: 10.1016/j.jvoice.2024.05.020] [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: 03/17/2024] [Revised: 05/30/2024] [Accepted: 05/30/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVE To investigate the clinical characteristics and prognosis of herpes zoster laryngitis with vocal fold immobility. STUDY DESIGN Retrospective study. METHODS Clinical characteristics, laryngeal signs on strobolaryngoscopy, imaging examination findings, and outcomes of patients were analyzed retrospectively. RESULTS This study included 17 patients (11 males [64.7%] and six females [35.3%]), with a mean age of 63.3 ± 6.7 years. The primary symptoms were hoarseness (94.1%), dysphagia (76.5%), pharyngalgia on one side (76.5%), and aspiration (70.6%). No patient had skin herpes of the head and neck. The duration of symptoms was 5-30 days (median: 10 days). Twelve patients (70.6%) were in an immunocompromised state before the disease. Strobolaryngoscopy showed congestion and swelling of the mucosa on one side of the larynx, with whitish eruptions on the supraglottic mucosa and ipsilateral vocal fold immobility. Five patients (29.4%) exhibited signs of ipsilateral accessory nerve injury. The imaging examination showed supraglottic inflammatory changes in 12 patients (70.6%). Among the 14 patients whose treatment could be clearly described, only one patient received antiviral treatment, whereas others received neurotrophic and symptomatic treatment. Notably, all patients demonstrated good outcomes because their symptoms eventually returned to normal. CONCLUSION Herpes zoster laryngitis is caused by varicella-zoster virus infection of the vagus nerve. It is characterized by laryngeal herpetic changes on one side and unilateral vocal fold immobility. The inducement of the disease tends to be associated with the abnormal immune state of patients. It can be easily misdiagnosed because of the absence of skin herpetic changes. Regardless of antiviral therapy, patients generally exhibit a favorable outcome.
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Affiliation(s)
- Liyu Cheng
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yuhong Lin
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jingjing Yang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qingcui Wang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Rong Hu
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xueyan Li
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Haizhou Wang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wen Xu
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
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Rząd M, Kanecki K, Lewtak K, Tyszko P, Gorynski P, Nitsch-Osuch A. Hospitalizations of patients with herpes zoster in Poland during 2012-2021: A population-based study. Vaccine 2024; 42:1928-1933. [PMID: 38368221 DOI: 10.1016/j.vaccine.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/30/2024] [Accepted: 02/06/2024] [Indexed: 02/19/2024]
Abstract
INTRODUCTION The varicella-zoster virus (VZV) is an infectious agent that causes both chickenpox and herpes zoster/shingles (HZ). This infection can take various clinical forms, result in permanent complications, and be a marker of immunosuppression, e.g. in the course of a neoplastic disease. The aim of this study is to analyze epidemiological trends in hospitalization and hospital mortality rate among HZ patients in Poland (2012-2021). METHODS Our study is a population-based, retrospective analysis of hospital discharge records of patients with HZ. Data were obtained from the National Institute of Public Health in Poland, and they covered the period from 2012 to 2021. All hospitalization records with primary or secondary ICD-10 B02 code diagnosis were included in the study. RESULTS We analyzed the total number of 23,432 hospital discharge records of HZ patients in 2012-2021. The study group consisted of 22,169 (94.6 %) hospitalization records of first-time diagnosis of HZ in hospitalized patients: 9,309 males (42 %) and 12,860 females (58 %). In this group, 70.3 % were patients over 60 years old. The mean and median age was 64 and 69 years, respectively. The mean annual first-time hospitalization rate for HZ was estimated to be 5.8 per 100,000 person-years (95 % CI: 4.8-6.7 per 100,000 person-years). The hospitalization rate for HZ was similar during 2012-2019. There was a significant decrease in hospitalizations in 2020-2021 in comparison with the previous years (R2 = 0.42, p < 0.05). Women showed a higher hospitalization rate than men (p < 0.001). Urban residents had a higher hospitalization rate than rural residents (p < 0.001). In the analyzed period, 246 deaths were recorded (1.1 % of all hospitalized HZ patients) -119 males and 127 females. CONCLUSIONS The HZ-related number of hospitalizations and mortality in Poland are relatively low, but HZ is still a significant health problem. Risk factors include female gender, older age and residence in urban areas.
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Affiliation(s)
- Michał Rząd
- Department of Social Medicine and Public Health, Medical University of Warsaw, 02-091Warsaw, 3 Oczki Street, Poland
| | - Krzysztof Kanecki
- Department of Social Medicine and Public Health, Medical University of Warsaw, 02-091Warsaw, 3 Oczki Street, Poland
| | - Katarzyna Lewtak
- Department of Social Medicine and Public Health, Medical University of Warsaw, 02-091Warsaw, 3 Oczki Street, Poland.
| | - Piotr Tyszko
- Department of Social Medicine and Public Health, Medical University of Warsaw, 02-091Warsaw, 3 Oczki Street, Poland; Institute of Rural Health in Lublin, 2 Jaczewskiego Street, 20-090 Lublin, Poland
| | - Paweł Gorynski
- National Institute of Public Health NIH - National Research Institute, 24 Chocimska Street, 00-791 Warsaw, Poland
| | - Aneta Nitsch-Osuch
- Department of Social Medicine and Public Health, Medical University of Warsaw, 02-091Warsaw, 3 Oczki Street, Poland
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Aishwarya N, Samayan K, Kannan S. Audiological Profiling and Importance of Vestibular Rehabilitation for a Patient with Ramsay Hunt Syndrome: Case Report. Indian J Otolaryngol Head Neck Surg 2023; 75:4075-4078. [PMID: 37974719 PMCID: PMC10645691 DOI: 10.1007/s12070-023-04053-0] [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: 05/05/2023] [Accepted: 06/30/2023] [Indexed: 11/19/2023] Open
Abstract
The case report highlights the importance of the rehabilitative approach and the role of audiology in managing patients with Ramsay Hunt Syndrome (RHS). RHS is a rare condition characterized by neuropathies involving multiple cranial nerves. Out of three neurological variants noted in the literature, RHS type II is characterized by hearing loss, tinnitus, and vertigo. The current case report is of a 37-year-old female diagnosed with RHS type II who reported with the complaints of right-sided headache and chronic otalgia. The progression of the disease caused hearing loss and tinnitus on the right side. Subsequently, the patient also developed signs of imbalance, which were not reported till 2 weeks after the onset of other symptoms. Three audiological evaluations were done during the initial visit, treatment phase, and post-treatment. It also helped identify the need for vestibular rehabilitation therapy and medical treatment. A comprehensive team approach and timely intervention aided in the prevention of the long-lasting effects of RHS in this patient. Awareness about the roles of professionals in assessment and management can help significantly improve the quality of life of individuals, especially in syndromes and multiple disabilities.
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Affiliation(s)
- N. Aishwarya
- Department of Audiology and Speech-Language Pathology, SRM Medical College Hospital and Research Centre, SRM Institute of Science and Technology, SRM Nagar, Kattankulathur, Potheri, Chengalpet District, Tamil Nadu 603203 India
| | - Kala Samayan
- Department of Audiology and Speech-Language Pathology, SRM Medical College Hospital and Research Centre, SRM Institute of Science and Technology, SRM Nagar, Kattankulathur, Potheri, Chengalpet District, Tamil Nadu 603203 India
| | - Sneha Kannan
- Department of Audiology and Speech-Language Pathology, SRM Medical College Hospital and Research Centre, SRM Institute of Science and Technology, SRM Nagar, Kattankulathur, Potheri, Chengalpet District, Tamil Nadu 603203 India
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Teggi R, Del Poggio A, Cangiano I, Nobile A, Gatti O, Bussi M. Cochleo-Vestibular Disorders in Herpes Zoster Oticus: A Literature Review and a Case of Bilateral Vestibular Hypofunction in Unilateral HZO. J Clin Med 2023; 12:6206. [PMID: 37834852 PMCID: PMC10573329 DOI: 10.3390/jcm12196206] [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: 07/31/2023] [Revised: 09/12/2023] [Accepted: 09/18/2023] [Indexed: 10/15/2023] Open
Abstract
The varicella-zoster virus (VZV), a member of the Herpesviridae family, causes both the initial varicella infection and subsequent zoster episodes. Disorders of the eighth cranial nerve are common in people with herpes zoster oticus (HZO). We performed a review of the literature on different databases including PubMed and SCOPUS, focusing on cochlear and vestibular symptoms; 38 studies were considered in our review. A high percentage of cases of HZO provokes cochlear and vestibular symptoms, hearing loss and vertigo, whose onset is normally preceded by vesicles on the external ear. It is still under debate if the sites of damage are the inferior/superior vestibular nerves and cochlear nerves or a direct localization of the infection in the inner ear. The involvement of other contiguous cranial nerves has also been reported in a few cases. We report the case of a patient with single-side HZO presenting clinical manifestations of cochleo-vestibular damage without neurological and meningeal signs; after 15 days, the patient developed a new episode of vertigo with clinical findings of acute contralateral vestibular loss. To our knowledge, only three other such cases have been published. An autoimmune etiology may be considered to explain these findings.
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Affiliation(s)
- Roberto Teggi
- Otolaryngology Department, San Raffaele Scientific Institute, 20132 Milan, Italy; (I.C.); (A.N.); (O.G.); (M.B.)
| | - Anna Del Poggio
- Department of Neuroradiology and CERMAC, San Raffaele Hospital, 20132 Milan, Italy;
| | - Iacopo Cangiano
- Otolaryngology Department, San Raffaele Scientific Institute, 20132 Milan, Italy; (I.C.); (A.N.); (O.G.); (M.B.)
| | - Alessandro Nobile
- Otolaryngology Department, San Raffaele Scientific Institute, 20132 Milan, Italy; (I.C.); (A.N.); (O.G.); (M.B.)
| | - Omar Gatti
- Otolaryngology Department, San Raffaele Scientific Institute, 20132 Milan, Italy; (I.C.); (A.N.); (O.G.); (M.B.)
| | - Mario Bussi
- Otolaryngology Department, San Raffaele Scientific Institute, 20132 Milan, Italy; (I.C.); (A.N.); (O.G.); (M.B.)
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Valjarevic S, Gavric J, Dragovic S, Jovanovic MB. Ramsay Hunt Syndrome with Pharyngolaryngeal Involvement Mimicking Acute Stroke: A Case Report. Indian J Otolaryngol Head Neck Surg 2023; 75:2345-2348. [PMID: 37636782 PMCID: PMC10447816 DOI: 10.1007/s12070-023-03654-z] [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: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 03/17/2023] Open
Abstract
Ramsay Hunt syndrome is a clinical manifestation of the reactivation of latent varicella zoster virus in the geniculate ganglion after acute infection. It is commonly associated with an acute peripheral facial nerve paralysis, auricular vesicular eruption and acute sensorineural hearing loss. However, in some rare cases the involvement of other cranial nerves, especially the glossopharyngeal and vagal is described. We present a 56-year-old male patient who was diagnosed with acute pharyngitis. Two days later, the patient developed dysarthria, hoarseness, and left side facial weakness. Considering a patient's history of cardiovascular events, the acute stroke was suspected. Magnetic resonance imaging ruled out an acute cerebrovascular accident. The patient's otalgia aggravated and he reported hearing loss. Clinical examination revealed facial paralysis affecting the left side of the face, erythematous rash on the left auricle, multiple vesicles present on patient's left tympanic membrane, ulcerous lesion on the left side of the soft palate and ipsilateral velopharyngeal palsy. Indirect laryngoscopy revealed ulcerous lesions in the left side of the epiglottis and left vocal cord paralysis. The patient was diagnosed with Ramsay Hunt syndrome with cranial polyneuropathy. Oral acyclovir and oral prednisolone were administered. Seven months after discharge, facial paralysis improved to lower grade and flexible laryngoscopy showed that the left vocal cord had resumed normal movement. Ramsay Hunt syndrome can be accompanied by involvement of other cranial nerves. Previous history of hypertensive crises and myocardial infarction may influence a diagnosis of Ramsay Hunt syndrome, especially when it has atypical presentation. However, this diagnosis should be considered in patients with unilateral multiple cranial nerve palsies.
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Affiliation(s)
- Svetlana Valjarevic
- Department of Otorhinolaryngology with Maxillofacial Surgery, Clinical Hospital Center “Zemun”, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia
| | - Jelena Gavric
- Department of Otorhinolaryngology with Maxillofacial Surgery, Clinical Hospital Center “Zemun”, Belgrade, Serbia
| | - Sara Dragovic
- Department of Otorhinolaryngology with Maxillofacial Surgery, Clinical Hospital Center “Zemun”, Belgrade, Serbia
| | - Milan B. Jovanovic
- Department of Otorhinolaryngology with Maxillofacial Surgery, Clinical Hospital Center “Zemun”, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia
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Features of Audio-Vestibular Deficit and 3D-FLAIR Temporal Bone MRI in Patients with Herpes Zoster Oticus. Viruses 2022; 14:v14112568. [PMID: 36423176 PMCID: PMC9692383 DOI: 10.3390/v14112568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/20/2022] [Accepted: 11/18/2022] [Indexed: 11/22/2022] Open
Abstract
Herpes zoster oticus (HZO) is characterized by otalgia and erythematous vesicles in the auricle or external auditory canal. Ramsay Hunt syndrome (RHS) can be diagnosed when facial nerve palsy is accompanied by these symptoms of HZO, and in this case, audio-vestibular symptoms such as hearing loss or dizziness often develop. Recently, 3D-fluid-attenuated inversion recovery sequence (3D-FLAIR) magnetic resonance imaging (MRI) has been introduced in order to evaluate the inner ear structure pathology. The purpose of this study was to investigate the audio-vestibular characteristics in correlation with temporal bone MRI findings in HZO patients. From September 2018 to June 2022, 18 patients with HZO participated in the study. Thirteen patients (77%) showed high-signal intensity in the inner ear structures in 4 h post-contrast 3D-FLAIR images. In a bithermal caloric test, the lateral semicircular canal showed high signal intensity in 4 h post-contrast 3D-FLAIR images in 75% of patients with abnormal canal paresis. While the cochlea showed high signal intensity in 4 h post-contrast 3D-FLAIR images in 75% of patients with hearing loss, the vestibulo-cochlear nerve showed enhancement in post-contrast T1-weighted images in only 33% of patients with hearing loss. The present study demonstrates that audio-vestibular deficits are well-correlated with increased signal intensity of the inner ear endorgans in 4 h post contrast 3D-FLAIR MRI.
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Ki MJ, Woo CJ, Oh YJ, Nam SH, Doo AR. Unusual presentations of thoracic disc herniation treated by thoracic epidural block: Case reports. Medicine (Baltimore) 2022; 101:e29618. [PMID: 35905226 PMCID: PMC9333468 DOI: 10.1097/md.0000000000029618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Herniation of the thoracic intervertebral disc (HTD) is a rare disease that accounts for <1% of all disc herniations. Physicians may make diagnostic errors due to the variable clinical features and limited experience of HTD. In this report, we present 2 unusual cases of HTD. PATIENT CONCERNS A 72-year-old woman (case 1) visited our pain clinic because of chronic abdominal discomfort with visible bulging on the left side. Atrophy of the abdominal wall muscle and quadratus lumborum was observed. The therapeutic effect of interfascial plane block to exclude the possibility of truncal neuropathy following muscular atrophy was temporary. The other patient, a 75-year-old man (case 2) complained of aggravation of previously diagnosed postherpetic neuralgia. An extension of the previously symptomatic area of the forward upper dermatome was observed. Radiofrequency treatment on the symptomatic dorsal root ganglion failed to relieve symptoms. DIAGNOSES Two patients underwent magnetic resonance imaging of the spine for further evaluation. The patients were diagnosed with multilevel HTD and foraminal herniated disc, compatible with their symptoms and without myelopathy. INTERVENTIONS Two patients were conservatively treated with a fluoroscopy-guided transforaminal epidural block. OUTCOMES The 2 patients experienced significant pain reduction up to 50% on a numeric rating scale after repeated treatment. LESSONS Multilevel HTD of the mid- to lower-thoracic spine may present as abdominal bulging with atrophy of the abdominal wall muscles. We also report another case of concomitant symptomatic thoracic radiculopathy from HTD and postherpetic neuralgia at the adjacent level. Thoracic transforaminal epidural block may be considered a conservative therapeutic approach for HTD.
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Affiliation(s)
- Min Jong Ki
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Cheol Jong Woo
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Yu Jin Oh
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School, Jeonju, South Korea
| | - Seon Hwa Nam
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School, Jeonju, South Korea
| | - A Ram Doo
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
- *Correspondence: A Ram Doo, Department of Anesthesiology and Pain Medicine, Medical School, Jeonbuk National University, 20 Geonji-ro, Deokjin-gu, Jeonju, Jeollabuk-do 54907, South Korea (e-mail: )
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Abstract
Symmetry of the face is one of the most important features for the perception of attractiveness. Asymmetry of the face means that the right and left sides of the face are not identical. Subclinical facial asymmetry is very common in the general population. Most people have some slight facial asymmetry, and this is the normal biological situation in humans. Abnormalities from soft tissue, dental, and skeletal elements lead to facial asymmetry. Asymmetry has many causal factors, and its aetiology includes both congenital and acquired conditions. Neurological facial asymmetry is scarcely addressed in the dental literature. In this narrative review, we focus on the most common neurological causes of facial asymmetry. From a neurological point of view, facial asymmetry can result from disturbances of the cranial nerves, developmental disorders, or myopathies. In the broad range of differential diagnostics of facial asymmetry, neurological abnormalities should be taken into consideration. The treatment must be related to the underlying cause. Complete knowledge of the aetiological factors and the character of the asymmetry plays a crucial role in formulating a treatment plan.
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Authors reply to letter to the editor considering “Ramsay Hunt Syndrome with multiple cranial neuropathy: a literature review”. Eur Arch Otorhinolaryngol 2022; 279:2709-2712. [DOI: 10.1007/s00405-022-07346-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 11/25/2022]
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Pupić-Bakrač A, Pupić-Bakrač J. Letter to the Editor considering Ramsay Hunt syndrome with multiple cranial neuropathy: a literature review. Eur Arch Otorhinolaryngol 2021; 279:2707-2708. [PMID: 34767072 DOI: 10.1007/s00405-021-07171-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Ana Pupić-Bakrač
- Department of Ophthalmology and Optometry, General Hospital Zadar, Bože Peričića 5, 23 000, Zadar, Croatia
| | - Jure Pupić-Bakrač
- Department of Otorhinolaryngology and Maxillofacial Surgery, General Hospital Zadar, Bože Peričića 5, 23 000, Zadar, Croatia.
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