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Ohm R, Stark B, Brännström F, Marsk E. Sequelae Treatment Needs Following Peripheral Facial Palsy: Retrospective Analysis of 525 Patients. Otol Neurotol 2024; 45:e450-e456. [PMID: 38509809 DOI: 10.1097/mao.0000000000004162] [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: 03/22/2024]
Abstract
OBJECTIVE This study uses retrospective longitudinal data from a large unselected cohort of patients with peripheral facial paralysis to determine the prevalence and patient characteristic predictors of sequelae receiving intervention. STUDY DESIGN Retrospective case review. SETTING Karolinska University Hospital in Stockholm Sweden serves as the only tertiary facial palsy center in the region. Here, patients are diagnosed, are followed up, and undergo all major interventions. PATIENTS All adult patients presenting with peripheral facial palsy due to idiopathic, zoster, or Borrelia origin at Karolinska, January 1, 2010 to December 31, 2011 with follow-up until December 2022. INTERVENTIONS Patient charts were studied to identify patient characteristics, etiology, initial treatment, severity of palsy, and treatments targeting sequelae. MAIN OUTCOME MEASURES Types of initial and late treatments were noted. Sunnybrook and/or House-Brackmann scales were used for palsy grading. RESULTS Five hundred twenty-five patients were included. Thirty-three patients (6.3%) received botulinum toxin injections and/or surgical treatment. In this subgroup, 67% received corticosteroids compared to 85% of all patients ( p = 0.005), cardiovascular disease prevalence was higher (23 and 42%, respectively, p = 0.009). For 81 patients (15%), follow-up was discontinued although the last measurement was Sunnybrook less than 70 or House-Brackmann 3 to 6. CONCLUSIONS Of patients with peripheral facial palsy, 6.3% underwent injections and/or surgical treatment within 12 years. However, due to a rather large proportion not presenting for follow-up, this might be an underestimation. Patients receiving late injections and/or surgical treatment had more comorbidities and received corticosteroid treatment to a significantly lower extent in the acute phase of disease.
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Affiliation(s)
- Rebecka Ohm
- Department of Otorhinolaryngology, Karolinska University Hospital, CLINTEC, Karolinska Institute, Stockholm, Sweden
| | - Birgit Stark
- Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | | | - Elin Marsk
- Department of Otorhinolaryngology, Karolinska University Hospital, CLINTEC, Karolinska Institute, Stockholm, Sweden
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Mohammad L, Fousse M, Wenzel G, Flotats Bastardas M, Faßbender K, Dillmann U, Schick B, Zemlin M, Gärtner BC, Sester U, Schub D, Schmidt T, Sester M. Alterations in pathogen-specific cellular and humoral immunity associated with acute peripheral facial palsy of infectious origin. J Neuroinflammation 2023; 20:246. [PMID: 37880696 PMCID: PMC10598953 DOI: 10.1186/s12974-023-02933-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/14/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Peripheral facial palsy (PFP) is a common neurologic symptom which can be triggered by pathogens, autoimmunity, trauma, tumors, cholesteatoma or further local conditions disturbing the peripheral section of the nerve. In general, its cause is often difficult to identify, remaining unknown in over two thirds of cases. As we have previously shown that the quantity and quality of pathogen-specific T cells change during active infections, we hypothesized that such changes may also help to identify the causative pathogen in PFPs of unknown origin. METHODS In this observational study, pathogen-specific T cells were quantified in blood samples of 55 patients with PFP and 23 healthy controls after stimulation with antigens from varicella-zoster virus (VZV), herpes-simplex viruses (HSV) or borrelia. T cells were further characterized by expression of the inhibitory surface molecule CTLA-4, as well as markers for differentiation (CD27) and proliferation (Ki67). Pathogen-specific antibody responses were analyzed using ELISA. Results were compared with conventional diagnostics. RESULTS Patients with PFP were more often HSV-seropositive than controls (p = 0.0003), whereas VZV- and borrelia-specific antibodies did not differ between groups. Although the quantity and general phenotypical characteristics of antigen-specific T cells did not differ either, expression of CTLA-4 and Ki67 was highly increased in VZV-specific T cells of 9 PFP patients, of which 5 showed typical signs of cutaneous zoster. In the remaining 4 patients, a causal relationship with VZV was possible but remained unclear by clinical standard diagnostics. A similar CTLA-4- and Ki67-expression profile of borrelia-specific T cells was also found in a patient with acute neuroborreliosis. DISCUSSION In conclusion, the high prevalence of HSV-seropositivity among PFP-patients may indicate an underestimation of HSV-involvement in PFP, even though HSV-specific T cell characteristics seem insufficient to identify HSV as a causative agent. In contrast, striking alterations in VZV- and borrelia-specific T cell phenotype and function may allow identification of VZV- and borrelia-triggered PFPs. If confirmed in larger studies, antigen-specific immune-phenotyping may have the potential to improve specificity of the clinical diagnosis.
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Affiliation(s)
- Leyla Mohammad
- Department of Transplant and Infection Immunology, Saarland University, 66421, Homburg, Germany
| | - Mathias Fousse
- Department of Neurology, Saarland University, Homburg, Germany
| | - Gentiana Wenzel
- Department of Otorhinolaryngology, Saarland University, Homburg, Germany
| | | | - Klaus Faßbender
- Department of Neurology, Saarland University, Homburg, Germany
| | - Ulrich Dillmann
- Department of Neurology, Saarland University, Homburg, Germany
| | - Bernhard Schick
- Department of Otorhinolaryngology, Saarland University, Homburg, Germany
| | - Michael Zemlin
- Department of Pediatrics and Neonatology, Saarland University, Homburg, Germany
| | - Barbara C Gärtner
- Department of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
| | | | - David Schub
- Department of Transplant and Infection Immunology, Saarland University, 66421, Homburg, Germany
| | - Tina Schmidt
- Department of Transplant and Infection Immunology, Saarland University, 66421, Homburg, Germany
| | - Martina Sester
- Department of Transplant and Infection Immunology, Saarland University, 66421, Homburg, Germany.
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Mack I, Kohns Vasconcelos M, Ritz N, Zimmermann P. A diagnostic algorithm for children presenting with peripheral facial nerve palsy and inconclusive diagnosis of neuroborreliosis. Acta Paediatr 2023; 112:1644-1647. [PMID: 37424283 DOI: 10.1111/apa.16841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 07/11/2023]
Affiliation(s)
- Ines Mack
- Department of Paediatrics, University Children's Hospital, Regensburg, Germany
- Department for Infectious Diseases and Vaccinology, University of Basel Children's Hospital (UKBB), Basel, Switzerland
| | - Malte Kohns Vasconcelos
- Department for Infectious Diseases and Vaccinology, University of Basel Children's Hospital (UKBB), Basel, Switzerland
| | - Nicole Ritz
- Department for Infectious Diseases and Vaccinology, University of Basel Children's Hospital (UKBB), Basel, Switzerland
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics and Paediatric Infectious Diseases, Children's Hospital, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Petra Zimmermann
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
- Department of Paediatrics, Fribourg Hospital, Fribourg, Switzerland
- Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
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Association of Overweight and Obesity With Bell Palsy in Children. Pediatr Neurol 2023; 139:43-48. [PMID: 36508882 DOI: 10.1016/j.pediatrneurol.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/14/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND In the Division of Pediatric Neurology at the University Medical Center Göttingen we observed that many patients with Bell palsy are overweight or obese. To evaluate whether overweight and obesity are associated with increased risk of Bell palsy in children we conducted this single-centered retrospective study by performing a database search for International Classification of Diseases (ICD)-10 primary and secondary diagnosis of G51.0 (facial nerve palsy) between January 1, 2010, and December 31, 2020. METHODS For risk assessment, patients' body mass indices (BMIs) were compared with BMI data of controls from a nationwide child health survey. RESULTS In total, 202 patients with peripheral facial nerve palsies (pFPs) were included, of which nearly half were classified as Bell palsies; 38% and 24% of the patients with Bell palsy and pFP had a BMI above the 90th percentile, respectively. High BMI was associated with statistically increased odds of Bell palsy in the group of overweight and obese patients (BMI >90th percentile; odds ratio [OR], 2.42; 95% confidence interval [CI], 1.6 to 3.8; P < 0.001) and solely obese patients (BMI >97th percentile; OR, 2.43; 95% CI, 1.4 to 4.3; P = 0.003). CONCLUSIONS We could confirm our observation that overweight and obesity are associated with increased risk of Bell palsy in children.
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Vieira AG, Guzen FP, de Paiva JRL, de Oliveira LC, Jales MCDA, Lucena EEDS, Lucena VRDS, Morais HHAD. Morphofunctional regeneration by mesenchymal stem cell and IGF-1 inoculation in a model of facial nerve crush injury in rats. Braz J Otorhinolaryngol 2022; 89:244-253. [PMID: 35715336 PMCID: PMC10071527 DOI: 10.1016/j.bjorl.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 02/25/2022] [Accepted: 04/06/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To analyze the morphofunctional regeneration process of facial nerve injury in the presence of insulin-like growth factor-1 and mesenchymal stem cells. METHODS Fourteen Wistar rats suffered unilateral facial nerve crushing and were randomly divided into two groups. All received insulin-like growth factor-1 inoculation, but only half of the animals received an additional inoculation of mesenchymal stem cells. The animals were followed for 90 days and facial nerve regeneration was analyzed via spontaneous facial motor function tests and immunohistochemistry in the nerve motor nucleus. RESULTS The group that received the growth factor and stem cells showed a statistically superior mean in vibrissae movements (p < 0.01), touch reflex (p = 0.05) and eye closure (p < 0.01), in addition to better immunohistochemistry reactivity. There was a statistically significant difference in the mean number of cells in the facial nerve nucleus between the experimental groups (p = 0.025), with the group that received the growth factor and stem cells showing the highest mean. CONCLUSION The association between growth factor and stem cells potentiates the morphofunctional regeneration of the facial nerve, occurring faster and more effectively. LEVEL OF EVIDENCE 4, degree of recommendation C.
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Abstract
Salivary gland diseases are rare. In the European Union (EU) a disease is considered to be rare if not more than 5 of 10,000 people are affected by it. According to estimates in Germany are about 4 million people with a rare disease. In the EU are about 30 million people with rare diseases [1]. In the present work most of the described diseases of salivary glands and of the facial nerve fall in this category. They form a very heterogeneous group whose treatment takes place mainly in specialized centers. Still, it is essential for the otolaryngologist to identify and to diagnose these diseases in order to initiate the right therapeutic steps. The work is a compilation of innate andacquired rare salivary gland disorders and of rare facial nerve disorders. The etiologies of inflammatory diseases, autoimmune disorders and tumors are taken into account. For the individual topics, the current literature, if available, was evaluated and turned into summarized facts. In this context the development of new processes, diagnostics, imaging and therapy are considered. Genetic backgrounds of salivary gland tumors and the trends in the treatment of tumorous lesions of the facial nerve are picked up. Furthermore, also rare diseases of the salivary glands in childhood are described. Some of them can occur in adults as well, but differ in frequency and symptoms. Due to the rarity of these diseases, it is recommended to tread these in centers with special expertise for it. Finally, the difficulties of initiation of studies and the problems of establishing disease registries concerning salivary gland disorders are discussed. This is very relevant because these pathologies are comparatively seldom.
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Affiliation(s)
- Claudia Scherl
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie,
Universitätsklinikum Mannheim
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Moniuszko-Malinowska A, Guziejko K, Czarnowska A, Kułakowska A, Zajkowska O, Pancewicz S, Świerzbińska R, Dunaj J, Czupryna P, Róg-Makal M, Zajkowska J. Assessment of anti-HSV antibodies in patients with facial palsy in the course of neuroborreliosis. Int J Clin Pract 2021; 75:e13749. [PMID: 33128311 DOI: 10.1111/ijcp.13749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 09/23/2020] [Indexed: 11/27/2022] Open
Abstract
AIM There are many causes of facial nerve palsy. The most common causes are neuroborreliosis (NB), idiopathic paralysis or Herpes simplex virus (HSV) reactivation. The aim of this study was to characterize patients with facial palsy in the course of NB and to determine whether HSV-1 reactivation takes place during the acute phase of NB. METHODS A retrospective analysis of 66 patients with facial nerve palsy was performed. In 38 patients, facial palsy was caused by Borrelia burgdorferi sl infection. Immunological tests for HSV-1, tick-borne encephalitis virus and B burgdorferi sl in serum and cerebrospinal fluid (CSF) were performed. RESULTS In this analysis, 55.2% of NB patients had right nerve palsy and 21% bilateral palsy; 15.8% of patients had erythema migrans (EM). Lymphocytic meningitis was diagnosed in 92% of patients and Bannwarth's syndrome was diagnosed in 47% of patients. IgM anti-HSV-1 antibodies were detected in four patients with NB and two patients with facial nerve palsy of other origin. IgM anti-HSV-1 antibodies were detected in the CSF of three patients (7.9%) with NB, and one of them had bilateral VII paresis and EM simultaneously. Treatment with ceftriaxone or doxycycline led to complete recovery. CONCLUSIONS Neuroborreliosis should always be considered as a cause of peripheral facial nerve palsy. Peripheral facial nerve palsy is a significant symptom in the course of NB, especially in patients accompanied by meningitis. Pathomechanism of facial nerve paresis has not been well explained so far and may depend on two independent mechanisms in NB, including HSV-1 reactivation.
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Affiliation(s)
- Anna Moniuszko-Malinowska
- Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, Bialystok, Poland
| | - Katarzyna Guziejko
- Department of Lung Diseases and Tuberculosis, Medical University of Bialystok, Bialystok, Poland
| | - Agata Czarnowska
- Department of Neurology, Medical University of Bialystok, Bialystok, Poland
| | - Alina Kułakowska
- Department of Neurology, Medical University of Bialystok, Bialystok, Poland
| | - Olga Zajkowska
- Faculty of Economic Sciences, University of Warsaw, Warsaw, Poland
| | - Sławomir Pancewicz
- Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, Bialystok, Poland
| | - Renata Świerzbińska
- Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, Bialystok, Poland
| | - Justyna Dunaj
- Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, Bialystok, Poland
| | - Piotr Czupryna
- Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, Bialystok, Poland
| | - Magdalena Róg-Makal
- Department of Invasive Cardiology, Medical University in Białystok, Białystok, Poland
| | - Joanna Zajkowska
- Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, Bialystok, Poland
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Abstract
Enteroviruses are one of the leading causes of central nervous system infections, but their causative role in peripheral facial nerve palsy is unresolved. We used data from a large national Enterovirus Surveillance Database to identify cases of facial nerve palsy, showing a rate of 3.8% of patients with facial nerve palsy to have enterovirus infection.
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Corbacho-Zaldívar M, González-Sánchez E. Revisión sistemática sobre la prevalencia de la serología infecciosa en la parálisis facial periférica. REVISTA ORL 2020. [DOI: 10.14201/orl.23480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introducción y objetivos. La parálisis facial periférica es una afección del Nervio Facial que suele cursar con dolor retroauricular, pródromos vitales y parálisis facial. Ante la falta de bibliografía sobre la etiología de dicha parálisis se propuso realizar una revisión sistemática orientada a conocer la prevalencia serológica de la parálisis facial periférica en los diferentes estudios publicados incluyendo el realizado en esta facultad el curso anterior. Materiales y métodos. Revisión sistemática y metanálisis de los estudios publicados sobre la confirmación de una parálisis facial periférica por serología positiva. Resultados. Un total de 628 pacientes fueron analizados, de los cuáles 76 tenían serología positiva (12,10%). El metanálisis muestra heterogeneidad entre los resultados y sesgo de publicación. Conclusiones. No se evidencia que haya una relación significativa entre una parálisis facial periférica y una serología positiva reciente por lo que no se obtendría beneficio con un tratamiento antiviral.
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