Evidence based management of Bell's palsy

Recurrent Bell's Palsy: A Comprehensive Analysis of Associated Factors and Outcomes

Background: Bell's palsy is a common peripheral facial nerve disorder that manifests as sudden unilateral facial paralysis. The condition, believed to be caused by viral infections and ischemic processes, affects a significant portion of the population and is associated with various systemic comorbidities. This study aimed to analyze the clinical characteristics, risk factors, and prognosis in primary and recurrent Bell's palsy to identify factors associated with recurrence and outcomes. Methods: A retrospective study was conducted on patients diagnosed with Bell's palsy at tertiary hospital between 2018 and 2024. Data collected included demographic information, comorbid conditions, clinical features, and recovery outcomes. Statistical analyses were performed to determine the significance of various factors in the recurrence of Bell's palsy. Results: The study included 254 patients. Recurrence was observed in 20.9% of cases. Significant risk factors for recurrence included diabetes (33.3%), hypertension (41.0%), hypothyroidism (56.1%), autoimmune disorders (54.2%), and a family history of Bell's palsy (48.6%). The severity of initial paralysis also influenced recurrence rates. Complete recovery from the initial episode was achieved by 66.9% of patients, whereas prolonged recovery times were noted in recurrent cases. Conclusion: The study highlights the significant role of systemic comorbidities and the severity of initial presentation in the recurrence of Bell's palsy.

Artificial Intelligence-Based Facial Palsy Evaluation: A Survey

Facial palsy evaluation (FPE) aims to assess facial palsy severity of patients, which plays a vital role in facial functional treatment and rehabilitation. The traditional manners of FPE are based on subjective judgment by clinicians, which may ultimately depend on individual experience. Compared with subjective and manual evaluation, objective and automated evaluation using artificial intelligence (AI) has shown great promise in improving traditional manners and recently received significant attention. The motivation of this survey paper is mainly to provide a systemic review that would guide researchers in conducting their future research work and thus make automatic FPE applicable in real-life situations. In this survey, we comprehensively review the state-of-the-art development of AI-based FPE. First, we summarize the general pipeline of FPE systems with the related background introduction. Following this pipeline, we introduce the existing public databases and give the widely used objective evaluation metrics of FPE. In addition, the preprocessing methods in FPE are described. Then, we provide an overview of selected key publications from 2008 and summarize the state-of-the-art methods of FPE that are designed based on AI techniques. Finally, we extensively discuss the current research challenges faced by FPE and provide insights about potential future directions for advancing state-of-the-art research in this field.

Effectiveness of novel facial stretching with structured exercise versus conventional exercise for Bell's palsy: a single-blinded randomized clinical trial

The purpose of the study was to assess the effects of a novel technique involving facial stretching of the unaffected side along with a structured exercise for the affected side on facial symmetry and facial functions as compared to conventional exercise. A hospital-based parallel-group randomized trial was completed among patients with acute Bell's palsy in Mangalore, India. Participants were randomized to receive facial stretching and a structured exercise program (experimental group) or the conventional exercise regimen (conventional group). Primary outcomes were facial symmetry and voluntary movement; assessed by the Sunnybrook Facial Grading System (SFGS). Both regimens were given for 3 weeks, with baseline, 10th day, and 20th day assessments. Out of 31 participants screened, 24 were eligible and 12 participants each were assigned to experimental and conventional groups. Change scores revealed greater improvement in the SFGS score (p = 0.002) for the experimental group participants. Facial stretching and structured exercise program exhibited promising results in enhancing facial symmetry and function in acute Bell's palsy when compared to conventional exercise regimen.

Facial Nerve Palsy in a Five-Month-Old Infant

Facial nerve palsy is a common neurological disorder, and the etiology is categorized as either congenital or acquired. Even after extensive workup, a vast majority of cases are deemed idiopathic. Treatment of acquired facial nerve palsy in pediatrics is essential to prevent long-term aesthetic and functional complications. The prognosis is favorable in pediatric patients and those treated with corticosteroids.

A Ready-to-Use Grading Tool for Facial Palsy Examiners-Automated Grading System in Facial Palsy Patients Made Easy

BACKGROUND

The grading process in facial palsy (FP) patients is crucial for time- and cost-effective therapy decision-making. The House-Brackmann scale (HBS) represents the most commonly used classification system in FP diagnostics. This study investigated the benefits of linking machine learning (ML) techniques with the HBS.

METHODS

Image datasets of 51 patients seen at the Department of Plastic, Hand, and Reconstructive Surgery at the University Hospital Regensburg, Germany, between June 2020 and May 2021, were used to build the neural network. A total of nine facial poses per patient were used to automatically determine the HBS.

RESULTS

The algorithm had an accuracy of 98%. The algorithm processed the real patient image series (i.e., nine images per patient) in 112 ms. For optimized accuracy, we found 30 training runs to be the most effective training length.

CONCLUSION

We have developed an easy-to-use, time- and cost-efficient algorithm that provides highly accurate automated grading of FP patient images. In combination with our application, the algorithm may facilitate the FP surgeon's clinical workflow.

The Provision of Dental Care to Post COVID-19 Survivors. A Concise Review

Aims

It has been reported that there are a certain percentage of COVID-19 patients who recover but suffer from devastating permanent organ damage or failure. Others suffer from long Covid syndrome, with prolonged symptoms that persist more than 12 weeks. However, there is scarcity of literature regarding the provision of dental treatment for these two groups of patients. This manuscript reviews the impact of multi-system involvement on the provision of dental care to these patients.

Materials and methods

A search of literature was done in PubMed-Medline and Scopus databases to review the available literature on COVID-19 impacts on pulmonary, cardiovascular, haematologic, renal, gastrointestinal, endocrine, and neurologic systems and respective management in dental clinical settings.

Results

The literature search from PubMed-Medline and Scopus databases resulted in 74 salient articles that contributed to the concise review on COVID-19 effects on pulmonary, cardiovascular, haematologic, renal, gastrointestinal, endocrine, and neurologic systems and/or its respective dental management recommendations.

Conclusions

This concise review covers the management of post COVID-19 patients with pulmonary, cardiovascular, haematologic, renal, gastrointestinal, endocrine, or neurologic system complications.

Acute Facial Nerve Palsy in Children: Gold Standard Management

Facial nerve palsy (FNP) is a common illness in the paediatric emergency department. Missed or delayed diagnosis can have a serious impact on a patient’s quality of life. The aim of this article is to give a recent overview of this pathology in terms of the causes, diagnosis, red flag symptoms, complementary examinations, treatments and follow-up in the child population. In cases of acquired, acute onset and isolated FNP, Bell’s palsy can be assumed, and no further investigation is required. In any other scenario, complementary examinations are required. Treatment depends on the aetiology. Corticosteroids, in addition to antiviral medication, are recommended to treat Bell’s palsy whenever a viral infection is suspected. However, the lack of randomised control trials in the paediatric population does not allow us to comment on the effectiveness of these treatments. In all cases, treated or not, children have a very good recovery rate. This review emphasises the necessity of randomised control trials concerning this frequent neurological pathology in order to better treat these children.

Role of Biomarkers as Prognostic Factors in Acute Peripheral Facial Palsy

Acute peripheral facial palsy (APFP), including Bell's palsy and Ramsay Hunt syndrome, is a disease that affects daily life through facial motor dysfunction, causing psychological problems. Various tests to evaluate prognosis have been studied; however, there are no validated predictive biomarkers to guide clinical decision making. Therefore, specific biomarkers that respond to treatment are required to understand prognostic outcomes. In this review, we discuss existing literature regarding the role of APFP biomarkers in prognosis and recovery. We searched the PubMed, EMBASE, and Cochrane Library databases for relevant papers. Our screening identified relevant studies and biomarkers correlating with the identification of predictive biomarkers. Only studies published between January 2000 and October 2021 were included. Our search identified 5835 abstracts, of which 35 were selected. All biomarker samples were obtained from blood and were used in the evaluation of disease severity and prognosis associated with recovery. These biomarkers have been effective prognostic or predictive factors under various conditions. Finally, we classified them into five categories. There is no consensus in the literature on the correlation between outcomes and prognostic factors for APFP. Furthermore, the correlation between hematologic laboratory values and APFP prognosis remains unclear. However, it is important to identify new methods for improving the accuracy of facial paralysis prognosis prediction. Therefore, we systematically evaluated prognostic and potentially predictive APFP biomarkers. Unfortunately, a predictive biomarker validating APFP prognosis remains unknown. More prospective studies are required to reveal and identify promising biomarkers providing accurate prognosis.

Efficacy evaluation and mechanism study of electroacupuncture intervention in acute phase of IFP: study protocol for a randomized controlled trial

Background

Previous studies had already reported the efficacy of electroacupuncture treatment for idiopathic facial nerve palsy (IFP) in a recovery phase; however, the initial use of electroacupuncture in the acute phase remains controversial. Hence, in the present study, we will add electroacupuncture intervention based on oral prednisone tablets in the acute phase of IFP and compare the clinical effects with simple oral prednisone tablets. Besides, the prognosis and safety will be evaluated. The present study aims to evaluate the clinical efficacy, prognosis, and safety of electroacupuncture combined with oral prednisone tablets in the acute phase of IFP, using surface electromyography (sEMG) to objectively observe the recovery of facial expression muscle function. In addition, the morphological changes of the facial nerve were observed dynamically by magnetic resonance imaging (MRI) in the acute phase to reveal the effect mechanism of this therapy.

Methods

Randomized controlled trials will be conducted in the first teaching hospital of Tianjin University of Traditional Chinese Medicine in China from September 2020 to April 2021. The treatment will be carried out in two phases, including the acute phase and the recovery phase. Eighty IFP patients will be recruited and randomized into two groups with a 1:1 ratio. Subjects in the acute phases of the control group will be given oral prednisone tablets, based on the control group, and subjects of the experimental group will be given electroacupuncture therapy simultaneously in the acute phase. Both groups will be stopped taking prednisone tablets and turn to electroacupuncture therapy in a recovery phase. Patients in the experimental group will receive treatment at least 6 times in the acute phase and both groups will receive treatment 9 times in the recovery phase, and there will be a follow-up period of 15 days after the treatment. The primary outcome is supposed to be related to the changes observed in the Sunnybrook (Toronto) Facial Grading System (SFGS) on the baseline and day 30 after the onset. Secondary outcome measures will include House-Brackmann Facial Nerve Grading System (H-B), measurement of Numerical Rating Scale (NRS), Facial Disability Index scale (FDI, including physical function subscore, FDIP, and social functioning and well-being subscore, FDIS), surface electromyogram (sEMG), and magnetic resonance imaging (MRI). Adverse events will be recorded for safety assessment.

Discussion

The results of this trial will allow the present study to compare the difference in efficacy and prognosis between the strategy of combined electroacupuncture in the acute phase and only oral prednisone tablets. The findings from this trial will be published in peer-reviewed journals.

Trial registration

CHICTR ChiCTR2000038472. Registered on 23 September 2020

Influence of Mirror Therapy (Specular Face Software) on Electromyographic Behavior of the Facial Muscles for Facial Palsy

Introduction: Facial paralysis (FP) is a neuromuscular disorder caused by facial nerve injury. There are two main types of FP (which can be either primary or secondary): central and peripheral; Procedure of cases: This case series presents five patients with facial paralysis with different etiologies. In all cases, we assessed the facial disability index and a clinical test registering the electromyographic activity, with and without biofeedback generated by Specular Face, a new software program; Discussion: After performing the appropriate tests, we checked the patients' ability to change certain expressions when the Specular Face program was added. We can confirm that the mirror visual feedback therapy changes the behavior of synkinesis and the muscle function in these patients; Conclusion: The use of mirror therapy using a computerized treatment system of facial images yields promising results in modulating the muscle activity of patients with FP.

Efficacy of electrotherapy in Bell's palsy treatment: A systematic review

BACKGROUND

Up to now there is not enough evidence that supports the use of electrotherapy in the treatment of Bell's palsy.

OBJECTIVE

Through a systematic review, we aimed to verify whether the use of electrotherapy is effective for treating Bell's palsy or peripheral paralysis.

METHODS

Publications were searched in PubMed, EBSCO and Web of Science. The present systematic review included studies that analyzed the electrotherapy as a therapeutic method for treating individuals with Bell's palsy, in order to recover the function of facial muscles.

RESULTS

Seven studies involving a total of 131 cases and 113 controls were included in this systematic review. In the studies analyzed, patients received electrotherapy combined with other treatments such as hot-wet facial napkins, massages and muscle reeducation. Although the effect of electrotherapy alone was not evaluated, the use of electrotherapy combined with other treatments produced a significant improvement in the individuals evaluated.

CONCLUSIONS

Due to the diverse methodologies used and the small number of individuals included in the studies, we could not fully prove the efficacy of electrotherapy for treating Bell's Palsy. Future studies with larger samples and homogenous populations should be performed to obtain conclusive results.

Relationship between Bell's Palsy and Previous Statin Use: A Case/Non-Case Study

We intended to determine the relationship between previous statin use and Bell’s palsy in a large study population receiving statins for the past 2 years. The Korean National Health Insurance Service—Health Screening Cohort data from 2002 to 2015 were collected. Participants with Bell’s palsy (n = 3203) were matched with participants without Bell’s palsy (n = 12,812). The number of days of previous statin use for 2 years before the onset of Bell’s palsy was analyzed using conditional logistic regression. Subgroups of age, sex, obesity, smoking, alcohol consumption, total cholesterol, and blood pressure were analyzed for any association between Bell’s palsy and prior statin use. The Bell’s palsy group reported greater statin use than the non-Bell’s palsy group (84.6 (standard deviation, SD = 201.7) vs. 74.4(SD = 189.4), p = 0.009). Previous statin use was associated with Bell’s palsy in the crude model (95% confidence intervals = 1.03–1.19, p = 0.006). However, this relationship disappeared when the possible covariates were adjusted for in model 2. All subgroups showed no increased odds for Bell’s palsy in previous statin users. We did not find an association between Bell’s palsy and previous statin use in this Korean population aged ≥40 years.

Reliability and Agreement of 3D Anthropometric Measurements in Facial Palsy Patients Using a Low-Cost 4D Imaging System

The reliability (precision) and agreement (accuracy) of anthropometric measurements based on manually placed 3D landmarks using the RealSense D415 were investigated in this paper. Thirty facial palsy patients, with their face in neutral (resting) position, were recorded simultaneously with the RealSense and a professional 3dMD imaging system. First the RealSense depth accuracy was determined. Subsequently, two observers placed 14 facial landmarks on the 3dMD and RealSense image, assessing the distance between landmark placement. The respective intra- and inter-rater Euclidean distance between the landmark placements was 0.84 mm (±0.58) and 1.00 mm (±0.70) for the 3dMD landmarks and 1.32 mm (±1.27) and 1.62 mm (±1.42) for the RealSense landmarks. From these landmarks 14 anthropometric measurements were derived. The intra- and inter-rater measurements had an overall reliability of 0.95 (0.87 - 0.98) and 0.93 (0.85 - 0.97) for the 3dMD measurements, and 0.83 (0.70 - 0.91) and 0.80 (0.64 - 0.89) for the RealSense measurements, respectively, expressed as the intra-class correlation coefficient. Determined by the Bland-Altman analysis, the agreement between the RealSense measurements and 3dMD measurements was on average -0.90 mm (-4.04 - 2.24) and -0.89 mm (-4.65 - 2.86) for intra- and inter-rater agreement, respectively. Based on the reported reliability and agreement of the RealSense measurements, the RealSense D415 can be considered as a viable option to perform objective 3D anthropomorphic measurements on the face in a neutral position, where a low-cost and portable camera is required.

Predictive Values of Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Other Prognostic Factors in Pediatric Patients With Bell's Palsy

BACKGROUND AND OBJECTIVES

Bell's palsy (BP) is the most frequent cause of unilateral facial paralysis, and inflammation is believed to play an important role in pathogenesis. Due to its rarity, however, no consensus has been reached regarding optimum treatment or factors affecting prognosis. In the present study, treatment outcomes and prognostic factors of BP were investigated in pediatric patients who underwent steroid therapy. The goal was to investigate the relationship between BP and inflammation using multiple inflammatory markers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), and red cell distribution width (RDW).

MATERIALS AND METHODS

In all, 54 patients diagnosed with BP and 39 healthy randomly selected controls were enrolled in this retrospective study. Demographic characteristics and complete blood cell count test results were compared. In addition, prognostic factors were sought by dividing the 54 patients with BP into 2 groups according to the House-Brackmann grading system: low grade BP (grades II and III) and high grade BP (grades IV and V). Serum samples were analyzed retrospectively on initial presentation and 6 months after the symptom begins. Meaningful hematological parameters include NLR, PLR, MPV, and RDW.

RESULTS

The NLR values in the BP group were significantly higher than in the control group. The NLR value in the 2 groups of patients with BP differed significantly. The mean PLR value in the BP group was higher than in the control group; however, there were no significant differences between the low-grade and high-grade BP groups nor were there any statically significant differences in the other characteristics.

CONCLUSION

The NLR and PLR values are readily accessible parameters that may be useful prognostic markers in pediatric patients with BP. Further studies are required to confirm these results and their utility in predicting prognosis and treating pediatric patients with BP.

Bell's Palsy in Pregnancy

Importance

The incidence and severity of Bell's palsy are increased in pregnancy, with most cases arising in the third trimester or postpartum period. It has been indicated that pregnancy-related Bell's palsy has worse long-term outcomes, such as complete facial paralysis, compared with nonpregnant women and males.

Objective

This article outlines the existing literature diagnosis, treatment, and prognosis of Bell's palsy, specifically looking at the implications during pregnancy. The aim is to provide a reference for physicians treating Bell's palsy in pregnant patients.

Evidence Acquisition

Existing literature on neuropathies during pregnancy, clinical presentation, and treatment of Bell's palsy was reviewed through a MEDLINE and PubMed search. Referenced articles were reviewed and used as primary source materials as appropriate.

Results

Multiple clinical tests of motor function are used to establish the diagnosis of Bell's palsy including Wartenberg's lid vibration test, an abnormal eyelash occlusion test, and asymmetry with voluntary and spontaneous smiling. Optimal treatment for Bell's palsy remains controversial. While early treatment with corticosteroids for 10 days is highly recommended, the simultaneous use of antiviral therapy is frequently performed but has less supporting evidence. Pregnancy itself and delay in treatment initiation are associated with persistent nerve palsy, whereas treatment started within 3 days of symptom onset is usually associated with full recovery. Recurrence of Bell's palsy in pregnancy is rare.

Conclusions and Relevance

To date, there is limited literature in the diagnosis and treatment of Bell's palsy during pregnancy. The prognosis of Bell's palsy in pregnancy is worse than in nonpregnant individuals. Early treatment with steroids is recommended, but not without risk.

Immune-related gene expression profiles of hypothermia adipocytes: Implications for Bell's palsy

OBJECTIVE

To identify immune-related gene expression profiles of adipocytes under low temperatures with RNA sequencing as a model for Bell's palsy implications.

METHODS

Adipocytes were harvested from the white adipose tissue of male Sprague-Dawley rats and cultured under different acute-grade cold exposure conditions of 30, 20, and 10°C, and their genomes were sequenced for RNA sequencing analysis. The differentially expressed genes (DEGs) were validated with reverse transcription polymerase chain reaction.

RESULTS

In total, 55 (35 upregulated and 20 downregulated), 121 (76 upregulated and 45 downregulated), and 92 (64 upregulated and 28 downregulated) DEGs were identified under 30, 20, and 10°C compared with the control, respectively. KEGG and GO analysis revealed that the DEGs were considerably enriched in immune-related pathways (leukocyte transendothelial migration and platelet activation) and infection (bacterial invasion of epithelial cells and Salmonella infection). The levels of key inflammatory chemokines (CSF1, CXCL1, CCL2, and CCL7) were enhanced after cold exposure.

CONCLUSION

These findings broaden our understanding of the immune responses to cold exposure in adipocytes. The molecular profiles of adipocyte immune function will help clarify the potential mechanism impacting myelin, which might contribute to the development of strategies to control Bell's palsy.

Comparison of the efficacy of various doses of steroids for acute facial palsy

BACKGROUND

Although steroids are effective for multiple types of acute facial palsies, an appropriate dosage remains to be established.

AIMS/OBJECTIVES

The objective of this study is to compare the efficacy of high, low, and moderate doses of steroids in patients with acute facial palsy.

MATERIALS AND METHODS

We retrospectively reviewed the medical records of 49 patients with Bell palsy, Ramsay Hunt syndrome, or traumatic facial palsy. The patients were divided into 3 groups. We determined the initial House-Brackmann (HB) grade of each patient and the HB grade at the 3-month follow-up to determine whether complete recovery was achieved.

RESULTS

Results of electroneurography showed that the average and maximum rates of degeneration were not statistically different among the groups. Although the HB grade showed improvement after 3 months, the initial score was not significantly different from that at the follow-up. The degree of recovery was not significantly different among the groups.

CONCLUSION AND SIGNIFICANCE

Our findings showed that a high dose of steroids did not achieve outcomes that were more clinically meaningful than did that of a moderate or a low-dose steroid. Therefore, moderate or low doses of steroids may be sufficient for the treatment of acute facial palsy.

Closed Loop Microfabricated Facial Reanimation Device Coupling EMG-Driven Facial Nerve Stimulation with a Chronically Implanted Multichannel Cuff Electrode

Permanent facial paralysis and paresis (FP) results from damage to the facial nerve (FN), and is a debilitating condition with substantial functional and psychological consequences for the patient. Unfortunately, surgeons have few tools with which they can satisfactorily reanimate the face. Current strategies employ static (e.g., implantation of nonmuscular material in the face to aid in function/cosmesis) and dynamic options (e.g., gracilis myoneurovascular free tissue transfer) to partially restore volitional facial function and cosmesis. Here, we propose a novel neuroprosthetic approach for facial reanimation that utilizes electromyographic (EMG) input coupled to a chronically implanted multichannel cuff electrode (MCE) to restore instantaneous, volitional, and selective hemifacial movement in a feline model. To accomplish this goal, we developed a single-channel EMG-drive current source coupled with a chronically implanted MCE via a portable microprocessor board. Our results demonstrated a successful feasibility trial in which human EMG input resulted in FN stimulation with subsequent concentric contraction of discrete regions of a feline face.

Selective Stimulation of Facial Muscles Following Chronic Intraneural Electrode Array Implantation and Facial Nerve Injury in the Feline Model

BACKGROUND

Our group has previously shown that activation of specific facial nerve (FN) fiber populations and selective activation of facial musculature can be achieved through acute intraneural multichannel microelectrode array (MEA) implantation in the feline model.

HYPOTHESIS

Selective stimulation of facial muscles will be maintained in the setting of 1) chronic and 2) acute MEA implantation after FN injury and subsequent recovery.

METHODS

This study included seven cats. In three cats with normal facial function, 4-channel penetrating MEAs were implanted chronically in the FN and tested biweekly for 6 months. Electrical current pulses were delivered to each channel individually, and elicited electromyographic (EMG) voltage outputs were recorded for each of several facial muscles. For FN injury experiments, two cats received a standardized hemostat-crush injury, and two cats received a transection-reapproximation injury to the FN main trunk. These four underwent acute implantation of MEA and EMG recording in terminal experiments 4 months postinjury.

RESULTS

Stimulation through individual channels selectively activated restricted nerve populations, resulting in activation of individual muscles in cats with chronic MEA implantation and after nerve injury. Increasing stimulation current levels resulted in increasing EMG voltage responses in all patients. Nerve histology showed only minor neural tissue reaction to the implant.

CONCLUSION

We have established in the animal model the ability of a chronically implanted MEA to selectively stimulate restricted FN fiber populations and elicit activations in specific facial muscles. Likewise, after FN injury, selective stimulation of restricted FN fiber populations and subsequent activation of discrete facial muscles can be achieved after acute MEA implantation.

Does the Degree of the Mastoid Pneumatization Affect the Side of Bell Palsy?

OBJECTIVE

The aim is to investigate the impact of degree of mastoid pneumatization on the affected side of Bell palsy (BP).

STUDY DESIGN

Retrospective study in tertiary academic hospital.

METHODS

In total, 52 patients who were diagnosed with as BP were included in the study. Each patient was staged using House-Brackmann (HB) staging system. All patients underwent temporal bone computed tomography imaging. House-Brackmann scores, side of the BP, and mastoid pneumatization of all of patients were evaluated in the present study.

RESULTS

Regarding the degree of the mastoid pneumatization, there were no significant differences between the affected side and the unaffected side (P = 0.439). The degree of the mastoid pneumatization of the affected side and the unaffected side did not differ between males and females (P = 0.918 for the affected side, P = 0.765 for the unaffected side, respectively). A negative correlation between the age and mastoid pneumatization of each side was found (P = 0.001, P = 0.025, respectively). There was no significant correlation between HB score and the degree of the mastoid pneumatization of each side (P = 0.789, P = 0.703).

CONCLUSION

As a conclusion, the degree of the mastoid pneumatization is not one of the risk factors for BP. Further randomized studies with larger numbers of patients are needed to confirm these findings.

Bell's Palsy: Clinical Analysis of 372 Cases and Review of Related Literature

OBJECTIVE

To analyze some clinical and epidemiologic aspects of Bell's palsy (BP) and to develop relevant correlations between existing data in literature and those obtained in this research.

METHODS

From January 2012 to December 2014, 372 consecutive patients diagnosed with BP were studied retrospectively. We reviewed the patients' data including gender, age, occupation, clinical manifestations, comorbid disease, and the rate of recurrence.

RESULT

The highest incidence was identified in those between 39 and 50 years of age. BP was more frequent in warm seasons (spring and summer) with its incidence reaching a peak value in September. The seasonal incidence of BP was significantly higher in summer (p < 0.05). In addition, diabetes mellitus was the most common accompanying comorbid condition.

CONCLUSION

The peak age when BP showed up was in the fourth decade of life and 55.1% of patients belonged to the male gender. BP has been observed to have the highest incidence during warm seasons (spring and summer). Diabetes mellitus was the most common comorbid condition accompanying BP. In addition, a recurrence was more likely to occur in the first 1.5 years after its first incidence.

Neutrophil to Lymphocyte Ratio, Platelet to Lymphocyte Ratio, Mean Platelet Volume and Red Cell Distribution Width Measures in Bells Palsy

AIM:

The purpose of this study was to investigate the usefulness of the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) Mean Platelet Volume (MPV) and Red Cell Distribution Width (RDW) in the differential diagnosis and follow-up of patients with Bells Palsy.

MATERIAL AND METHODS:

Twenty-eight patients diagnosed with Bells Palsy and 28 control patients were included in the study. Serum samples were analysed retrospectively on the initial presentation and the seventh day of admission.

RESULTS:

On admission, the NLR was 1.7±1.2. The mean absolute neutrophil count was 6100 ± 900/mm^3 in Bells Palsy Group. NLR was 0.9 ± 0.2. The mean absolute neutrophil count was 4400 ± 1100/mm^3 in control group. Statistically, significant changes were not observed in NLR, PLR, MPV and RDW measurements in Bells Palsy group between House-Brackman Staging.

CONCLUSION:

Statistically significant changes in the neutrophil count and NLR were determined in the measurements between Bells Palsy and control group (p = 0.013, p = 0.016 respectively) on admission. A grade of the disease and NLR measurements had no statistically significant connection. RDW value was investigated for the first time in the literature for Bells Palsy patients.

Facial nerve paralysis in children

Facial nerve palsy is a condition with several implications, particularly when occurring in childhood. It represents a serious clinical problem as it causes significant concerns in doctors because of its etiology, its treatment options and its outcome, as well as in little patients and their parents, because of functional and aesthetic outcomes. There are several described causes of facial nerve paralysis in children, as it can be congenital (due to delivery traumas and genetic or malformative diseases) or acquired (due to infective, inflammatory, neoplastic, traumatic or iatrogenic causes). Nonetheless, in approximately 40%-75% of the cases, the cause of unilateral facial paralysis still remains idiopathic. A careful diagnostic workout and differential diagnosis are particularly recommended in case of pediatric facial nerve palsy, in order to establish the most appropriate treatment, as the therapeutic approach differs in relation to the etiology.

Facial reanimations: part I--recent paralyses

Unilateral facial paralysis is a common condition: 1 in every 60 people will experience Bell's palsy during the course of their life, and the residual deficits are particularly problematic for those who do not spontaneously recover the function of the facial nerve. Functionally the most relevant defect is lack of corneal lubrication because of inability to close the eyelid or blink. Morphologically, this presents as obvious ptosis caused by absence of the muscle tone at rest. "Restitutio ad integrum" of a paralysed face by operation is currently impossible, but realistic targets are improvement of facial symmetry and partial recovery of closure of the eyelids and smiling. Movements of the forehead and lower lip tend to be neglected targets for intervention because they are of less functional importance. Recent paralyses are those in which the mimetic musculature may be reactivated by provision of neural input, and the time limit is generally 18-24 months. Electromyography helps to detect it by assessing the presence of muscular fibrillations. If those are not detectable paralyses are considered to be long-standing, and new musculature must be transferred into the face, generally by transplantation of a muscular free flap or of the temporalis muscle in several different ways. When the facial nerve has been severed by trauma or during operation, immediate reconstruction must be considered and the simplest and most efficient is direct neurorrhaphy. If an appreciable part of the nerve is missing and the proximal and distal nerve stumps do not meet, an interpositional nerve graft must be placed to guarantee neural continuity. When reconstruction of the total extracranial branch of the facial nerve is required, the thoracodorsal nerve has proved to be highly effective. In case immediate reconstruction cannot be accomplished and the trunk of the facial nerve is not available as a donor nerve, mimetic musculature may be reactivated by provision of new neural input. Strong inputs from the masseteric or hypoglossus nerves may be mixed with those that arise from branches of the contralateral facial nerve after 2 cross-face nerve grafts have been placed, and good functional recovery is generally obtained. Several ancillary procedures are required to improve the end results in most cases.

Acupuncture for the sequelae of Bell's palsy: a randomized controlled trial

BACKGROUND

Incomplete recovery from facial palsy results in social and physical disabilities, and the medical options for the sequelae of Bell's palsy are limited. Acupuncture is widely used for Bell's palsy patients in East Asia, but its efficacy is unclear.

METHODS

We performed a randomized controlled trial including participants with the sequelae of Bell's palsy with the following two parallel arms: an acupuncture group (n = 26) and a waiting list group (n = 13). The acupuncture group received acupuncture treatments for 8 weeks, whereas the waiting list group did not receive acupuncture treatments during the 8-week period after randomization. The primary outcome measure was change in the Facial Disability Index (FDI) social and well-being subscale at week 8. We also analyzed changes in the FDI physical function subscale, the House-Brackmann score, the Sunnybrook Facial Nerve Grading system, lip mobility and stiffness at 5 and 8 weeks after randomization. An intention-to-treat analysis was applied.

RESULTS

The acupuncture group exhibited greater improvements in the FDI social score (mean difference, 23.54; 95% confidence interval, 12.99 to 34.08) and better results on the FDI physical function subscale (mean difference, 21.54; 95% confidence interval, 7.62 to 35.46), Sunnybrook Facial Nerve Grading score (mean difference, 14.77; 95% confidence interval, 5.05 to 24.49), and stiffness scale (mean difference, -1.58; 95% confidence interval,-2.26 to -0.89) compared with the waiting list group after 8 weeks. No severe adverse event occurred in either group.

CONCLUSION

Compared with the waiting list group, acupuncture had better therapeutic effects on the social and physical aspects of sequelae of Bell's palsy.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN43104115.

Is There a Relationship Between Bell's Palsy and Internal Auditory Canal?

In the present study, we evaluated the diameter of internal acoustic canal in patients with Bells palsy to investigate the role of anatomical differences of the temporal bone in etiology of Bell's palsy. Sixty-four patients who were diagnosed as Bells Palsy and temporal bone computed tomography imagings of them were included into the study group (Group 1). The control group (Group 2) was consisted of 35 healthy subjects without Bell's Palsy. All patients had temporal bone computed tomography imaging. The internal auditory canal inlet, mid-canal, outlet and canal lengths were measured at the most distinctive cross-section of the seventh and eighth cranial nerves bifurcation. In the study group, Bells palsy was on the right side in 26 patients (40.6 %) and on the left side in 38 patients (59.4 %). Initial House-Brackmann (HB) score was HB-2 in 29 patients (45.3 %), HB-3 in 18 patients (28.1 %), HB-4 in 13 patients (20.3 %) and HB-5 in 4 patients (6.2 %). At 6-month evaluation, HB-score of the patients were HB-1 in 37 patients (57.8 %), HB-2 in 25 patients (39.1 %) and HB-3 in 2 patients (3.1 %). Internal auditory canal (IAC) measurements of the groups showed that there were no significant differences between the measurements of right-mid canal, right canal length; and left canal outlet and left canal length of the study and control groups. Right inlet and outlet; and left inlet and mid-canal values of the study group (Bell's palsy) were significantly lower than those of the control group. In Bell's palsy group, left inlet, outlet and canal length values were significantly higher than those of the right ones. Correlation analysis showed that there were no significant correlation between paralysis side; initial HB stage; and IAC measurement results. In patients with higher initial HB score, their 6-month later HB-score was also higher. In patients with higher 6-month HB score; R canal inlet, R mid-canal, L-canal inlet, and L-mid canal values were lower. Lower IAC inlet and mid-canal values were detected in patients with Bell's palsy. Therefore narrow IAC inlet and mid-canal values may be one of the risk factors for Bell's palsy.