Bilateral peripheral facial palsy secondary to Waldenström's macroglobulinemia. A case report and literature review

Contralateral orbicularis oculi muscle transposition in facial paralysis: functional, aesthetic and electromyographic outcomes. A case report and literature update

Purpose: Many surgical approaches have been described for achieving satisfactory functionality in patients with facial paralysis, to ensure the protection of the cornea and the highest degree of physiological blinking. Out of all those available, dynamic techniques are indicated when motion recovery and synchrony are the goals pursued. Orbicularis oculi transposition (OOT) allows a genuine restoration of blinking by means of contralateral reinnervation, with minimal insult for the donor site.Methods: We present the case of a 64-year-old man with unilateral facial paralysis. A physical examination revealed a lagophthalmos of more than 5 mm. A neurophysiological study showed a mild-to-moderate axonal injury of the left facial nerve. Contralateral OOT was indicated as the first therapy option since it can restore involuntary blinking. The orbicularis muscle flap was not divided into branches, as described previously by other authors; the whole flap was transposed to the paralysed upper eyelid to achieve the highest level of potential reinnervation.Results: Lagophthalmos was fully corrected after the surgery. The patient reported subjective improvement of symptoms, less frequent instillation of artificial tear drops and, especially, synchronous blinking with significant improvement in involuntarity. These improvements were maintained after 1 year of follow-up. Postoperative electromyographic studies confirmed the improvement in neural function.Conclusions: OOT can be a safe and effective option for the treatment of patients with peripheral facial paralysis, as it achieves a good restoration of blinking function with minimal morbidity in the healthy donor eye.

A rare neurological complication of Waldenstrom's Macroglobulinemia

Bilateral and simultaneous facial nerve palsy (FNP) is a rare clinical condition occurring in 0.3-2.0% of facial palsy cases and is typically a manifestation of an underlying systemic disease. We here describe a case of a 67-year-old Hispanic man with a known history of Waldenstrom's Macroglobulinemia (WM) who presented to the clinic with a sub-acute onset of bilateral facial weakness. No alternate etiology for the facial weakness was identified after a thorough diagnostic approach. WM is a rare hematological condition due to low-grade B cell lymphoma, where lymphoplasmacytoid cells infiltrate different tissues and secrete monoclonal IgM. Peripheral neuropathy develops in 15-30% of the cases, being usually a chronic, progressive, symmetric, predominantly distal polyneuropathy. Facial nerve impairment is unusual; however, it could be caused by anoxic damage as a result of an increased blood viscosity from IgM monoclonal gammopathy, direct nerve infiltration of tumorous cells and an antibody (anti-MAG) mediated demyelinating process. Treatment is directed to the established mechanism for neural injury. This report highlights a rare condition (WM) with a rare complication (bilateral facial nerve palsy) and illustrates the broad differential comprised by this presenting complaint.