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Göksu MR, Gümrükçü Z, Balaban E, Mercantepe T, Gökçe FM. Electrophysiological and histopathological evaluation of the effectiveness of melatonin and glatiramer acetate for traumatic facial nerve injuries. Injury 2024; 55:111719. [PMID: 39003883 DOI: 10.1016/j.injury.2024.111719] [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: 02/16/2024] [Revised: 06/20/2024] [Accepted: 07/04/2024] [Indexed: 07/16/2024]
Abstract
AIM This study aimed to evaluate the effect of systemic/local use of melatonin and glatiramer acetate on regeneration in traumatic nerve injury models. MATERIALS AND METHODS A total of 42 male Wistar albino rats were randomly divided into 6 groups: healthy control (Group 1), injured control (Group 2), local melatonin (Group 3), systemic melatonin (Group 4), local glatiramer acetate (Group 5), and systemic glatiramer acetate (Group 6). In all groups, electromyography recordings of the facial nerve were obtained after surgery and before sacrifice, and the damaged nerve region was histopathologically examined after sacrifice. RESULTS In the electrophysiological evaluation, the control group had the greatest decrease in amplitude and extension in latency time following surgery than the treatment groups. Furthermore, a significant decrease in the degenerative axon count, edematous areas, and fibrotic areas as well as a significant increase in axonal surface areas was observed in all the treatment groups compared with the damage control group. CONCLUSIONS Although both glatiramer acetate and melatonin are beneficial in regeneration in traumatic facial nerve injuries, it can be concluded that systemic use of melatonin can yield more positive results than glatiramer acetate and local use of both two drugs.
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Affiliation(s)
| | - Zeynep Gümrükçü
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry Recep Tayyip Erdoğan University, Rize, Turkey.
| | - Emre Balaban
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry Recep Tayyip Erdoğan University, Rize, Turkey
| | - Tolga Mercantepe
- Department of Histology Embryology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Fatih Mehmet Gökçe
- Department of Physiology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
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2
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Xu L, Guo T, Sheng X, Du H, Tang Y. Predictive Value of the Neutrophil-to-Lymphocyte Ratio and C-Reactive Protein in Patients with Idiopathic Facial Nerve Palsy. Int J Gen Med 2024; 17:2635-2642. [PMID: 38863739 PMCID: PMC11166163 DOI: 10.2147/ijgm.s458808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/01/2024] [Indexed: 06/13/2024] Open
Abstract
Objective This study aims to investigate the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) in patients with idiopathic facial nerve palsy. Methods The clinical data of patients with idiopathic facial nerve palsy were retrospectively analyzed. After three months of follow-up, patients were divided into good prognosis and poor prognosis, and the correlation between NLR, CRP and idiopathic facial nerve palsy was analyzed. Results Negative correlation of NLR with Portmann score in idiopathic facial nerve palsy (r=-0.788, P<0.05); In contrast to the group with poor prognosis, patients in good prognosis group had low levels of body mass index (BMI), NLR, and C-reactive protein (CRP), and high Portmann score (P<0.05); Multivariate logistic regression analysis showed Portmann score (OR=1.268, 95% CI (1.005-1.616)), NLR (OR=0.262, 95% CI (0.128-0.533)) and CRP levels (OR=0.949, 95% CI (0.895-0.989)) were risk factors of poor prognosis for patients with idiopathic facial nerve palsy. The area under the receiver operator characteristic (ROC) curve of NLR and CRP levels in predicting poor facial nerve function was 0.764 and 0.697, the specificity was 85.5% and 75.0%, and the sensitivity was 74. 0% and 76.0%, respectively. The ROC curve of the combined diagnosis was 0.829, the specificity was 80.7%, and the sensitivity was 82.0%. Conclusion Elevated NLR and CRP are associated with a poor prognosis of idiopathic facial nerve palsy and can serve as an indicator for clinical prognosis, and can be widely used in clinical.
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Affiliation(s)
- Longdong Xu
- Department of Neurology, Changshu NO.5 People’s Hospital, Changshu, Jiangsu, 215500, People’s Republic of China
| | - Tingting Guo
- Department of Neurology, Suzhou Ninth People’s Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, Jiangsu, 215200, People’s Republic of China
| | - Xihua Sheng
- Department of Neurology, Suzhou Ninth People’s Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, Jiangsu, 215200, People’s Republic of China
| | - Huaping Du
- Department of Neurology, Suzhou Ninth People’s Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, Jiangsu, 215200, People’s Republic of China
| | - Ying Tang
- Department of Neurology, Suzhou Ninth People’s Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, Jiangsu, 215200, People’s Republic of China
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Tkach AV, Kutia SA, Tkach VV. [Anatomical and clinical characteristics of the chorda tympani]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:113-117. [PMID: 37966449 DOI: 10.17116/jnevro2023123101113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
The article presents information about the applied and clinical anatomy of the chorda tympani. Brief information is given about the history of its discovery, embryonic and postnatal development, features of anatomy, topography and morphology. The clinical aspects of the lesion and methods of studying the function of the chorda tympani are described.
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Affiliation(s)
- A V Tkach
- Vernadsky Crimean Federal University, Simferopol, Russia
| | - S A Kutia
- Vernadsky Crimean Federal University, Simferopol, Russia
| | - V V Tkach
- Vernadsky Crimean Federal University, Simferopol, Russia
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Głuszkiewicz E, Sowa P, Zieliński M, Adamczyk-Sowa M, Misiołek M, Ścierski W. Prospective Assessment of Risk Factors Influencing Facial Nerve Paresis in Patients after Surgery for Parotid Gland Tumors. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121726. [PMID: 36556928 PMCID: PMC9781186 DOI: 10.3390/medicina58121726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/03/2022] [Accepted: 11/21/2022] [Indexed: 11/26/2022]
Abstract
Background and objectives: Facial weakness is the most important complication of parotid gland tumor surgery. The aims of this study are as follows: (1) assessment of the prevalence of postparotidectomy facial nerve dysfunction; (2) clinical and electrophysiological assessment of the facial nerve function before parotidectomy and at 1 and 6 months postoperatively; (3) assessment of the association of postoperative facial palsy with selected risk factors; and (4) assessment of the correlation between the results of clinical and neurophysiological assessments of facial nerve function. Materials and Methods: This study comprised 50 patients (aged 24-75 years) who underwent parotidectomy at the Department of Otolaryngology and Laryngological Oncology in Zabrze, Poland between 2015 and 2017. The evaluation included neurological, clinical and electrophysiological assessments of the facial nerve prior to surgery and at 1 and 6 months postoperatively. Results: No facial palsy was found preoperatively or 6 months postoperatively. Facial nerve dysfunction was found in 74% of patients 1 month postoperatively. In most cases (54%), paresis was mild or moderate (House-Brackmann grades II and III). The results of electrophysiological tests before parotidectomy were either normal or showed some mild abnormalities. We found a statistically significant correlation between the clinical assessment of the facial nerve function (based on the House-Brackmann scale) one month postoperatively and the latency of the CMAP response from the orbicularis oculi and orbicularis oris muscles. In all three studies, a statistically significant correlation was found between the amplitude of the compound muscle action potential (CMAP) of the orbicularis oris muscle and the degree of facial nerve weakness. Conclusions: The factors that may influence the risk of postoperative facial nerve paralysis (prolonged surgical time and the size and location of the tumor other than in the superficial lobe only) may indirectly suggest that surgery-related difficulties and/or surgeon experience could be crucial to surgery safety.
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Affiliation(s)
- Ewa Głuszkiewicz
- Department and Clinic of Pediatric Neurology, The Independent Public Clinical Hospital no. 6 of the Medical University of Silesia in Katowice, John Paul II Upper Silesian Child Health Centre, 40-752 Katowice, Poland
| | - Paweł Sowa
- Department of Otorhinolaryngology and Oncological Laryngology in Zabrze, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
| | - Maciej Zieliński
- Department of Otorhinolaryngology and Oncological Laryngology in Zabrze, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
- Correspondence: ; Tel.: +48-323732379
| | - Monika Adamczyk-Sowa
- Department of Neurology in Zabrze, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
| | - Maciej Misiołek
- Department of Otorhinolaryngology and Oncological Laryngology in Zabrze, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
| | - Wojciech Ścierski
- Department of Otorhinolaryngology and Oncological Laryngology in Zabrze, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
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A Ready-to-Use Grading Tool for Facial Palsy Examiners—Automated Grading System in Facial Palsy Patients Made Easy. J Pers Med 2022; 12:jpm12101739. [PMID: 36294878 PMCID: PMC9605133 DOI: 10.3390/jpm12101739] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/15/2022] [Accepted: 10/16/2022] [Indexed: 11/25/2022] Open
Abstract
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.
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Knoedler L, Baecher H, Kauke-Navarro M, Prantl L, Machens HG, Scheuermann P, Palm C, Baumann R, Kehrer A, Panayi AC, Knoedler S. Towards a Reliable and Rapid Automated Grading System in Facial Palsy Patients: Facial Palsy Surgery Meets Computer Science. J Clin Med 2022; 11:jcm11174998. [PMID: 36078928 PMCID: PMC9457271 DOI: 10.3390/jcm11174998] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Reliable, time- and cost-effective, and clinician-friendly diagnostic tools are cornerstones in facial palsy (FP) patient management. Different automated FP grading systems have been developed but revealed persisting downsides such as insufficient accuracy and cost-intensive hardware. We aimed to overcome these barriers and programmed an automated grading system for FP patients utilizing the House and Brackmann scale (HBS). Methods: Image datasets of 86 patients seen at the Department of Plastic, Hand, and Reconstructive Surgery at the University Hospital Regensburg, Germany, between June 2017 and May 2021, were used to train the neural network and evaluate its accuracy. Nine facial poses per patient were analyzed by the algorithm. Results: The algorithm showed an accuracy of 100%. Oversampling did not result in altered outcomes, while the direct form displayed superior accuracy levels when compared to the modular classification form (n = 86; 100% vs. 99%). The Early Fusion technique was linked to improved accuracy outcomes in comparison to the Late Fusion and sequential method (n = 86; 100% vs. 96% vs. 97%). Conclusions: Our automated FP grading system combines high-level accuracy with cost- and time-effectiveness. Our algorithm may accelerate the grading process in FP patients and facilitate the FP surgeon’s workflow.
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Affiliation(s)
- Leonard Knoedler
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
- Correspondence: ; Tel.: +49-151-448-249-58
| | - Helena Baecher
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Martin Kauke-Navarro
- Department of Surgery, Division of Plastic Surgery, Yale School of Medicine, New Haven, CT 06510, USA
| | - Lukas Prantl
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Hans-Günther Machens
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Philipp Scheuermann
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Christoph Palm
- Regensburg Medical Image Computing Lab, Ostbayrische Technische Hochschule Regensburg, 93053 Regensburg, Germany
| | - Raphael Baumann
- Regensburg Medical Image Computing Lab, Ostbayrische Technische Hochschule Regensburg, 93053 Regensburg, Germany
| | - Andreas Kehrer
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Adriana C. Panayi
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Samuel Knoedler
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
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Afshar ZM, Babazadeh A, Afsharian M, Vaziri S, Ebrahimpour S. Bell's Palsy Associated with COVID-19 Infection: A Case Report. Oman Med J 2021; 36:e313. [PMID: 34733557 PMCID: PMC8557307 DOI: 10.5001/omj.2022.30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 05/23/2021] [Indexed: 11/03/2022] Open
Abstract
The COVID-19 has a wide range of symptoms. This novel infectious disease may also trigger a vast range of neurological involvements. The current report describes a case of COVID-19 complicated with Bell's palsy. A 64-year-old woman with diabetes was admitted due to abrupt left hemifacial weakness. On examination, her left hemifacial expression ability was impaired so that her face seemed asymmetrical during smiling, and numbness around the left nasolabial fold was detected. Furthermore, her ability to wink was impaired, and her eyebrow drooped. A brain computed tomography (CT) scan did not show any abnormalities. A lung CT scan was performed, which demonstrated bilateral ground-glass opacity (GGO), along with RT-PCR results indicative of COVID-19. A diagnosis of Bell's palsy in the setting of COVID-19 infection was made. She received antiviral agents and corticosteroids. At two-week follow-up, her symptoms had improved. During the COVID-19 epidemic, any newly occurred neurological involvement raises the suspicion of COVID-19 infection.
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Affiliation(s)
- Zeinab Mohseni Afshar
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Arefeh Babazadeh
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mandana Afsharian
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Siavash Vaziri
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Soheil Ebrahimpour
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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Jones AJ, Tucker BJ, Novinger LJ, Galer CE, Nelson RF. Metastatic Disease of the Temporal Bone: A Contemporary Review. Laryngoscope 2020; 131:1101-1109. [PMID: 32940937 DOI: 10.1002/lary.29096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/20/2020] [Accepted: 08/22/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To identify the frequency and primary site of metastatic pathologies to the temporal bone and characterize the associated symptomatology. METHODS The MEDLINE, Embase, and Web of Science databases were systematically reviewed according to the PRISMA guidelines to identify all cases of pathologically confirmed distant temporal bone metastases published with English translation until October 2019. Descriptive statistics were performed. RESULTS Out of 576 full-length articles included for review, 109 met final criteria for data extraction providing 255 individual cases of distant temporal bone metastases. There was a male predominance (54.9%) with median age of 59.0 years (range 2-90). The most common locations of primary malignancy included the breasts (19.6%), lungs (16.1%), and prostate (8.6%). Most tumors were carcinomas of epithelial origin (75.3%) and predominantly adenocarcinoma (49.4%). The commonest metastatic sites encountered within the temporal bone were the petrous (72.0%) and mastoid (49.0%) portions. Bilateral temporal bone metastases occurred in 39.8% of patients. Patients were asymptomatic in 32.0% of cases. Symptomatic patients primarily reported hearing loss (44.3%), facial palsy (31.2%), and otalgia (16.6%) for a median duration of 1 month. Petrous lesions were associated with asymptomatic cases (P = .001) while mastoid lesions more often exhibited facial palsy (P = .026), otalgia (P < .001), and otorrhea (P < .001). Non-carcinomatous tumors were associated with petrosal metastasis (P = .025) and asymptomatic cases (P = .109). Carcinomatous metastases more often presented with otalgia (P = .003). CONCLUSIONS Temporal bone metastasis is uncommon but should be considered in patients with subacute otologic symptoms or facial palsy and history of distant malignancy. Laryngoscope, 131:1101-1109, 2021.
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Affiliation(s)
- Alexander J Jones
- Indiana University School of Medicine, Indianapolis, Indiana, U.S.A.,Department of Otolaryngology-Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Brady J Tucker
- Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Leah J Novinger
- Indiana University School of Medicine, Indianapolis, Indiana, U.S.A.,Department of Otolaryngology-Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Chad E Galer
- Indiana University School of Medicine, Indianapolis, Indiana, U.S.A.,Department of Otolaryngology-Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Rick F Nelson
- Indiana University School of Medicine, Indianapolis, Indiana, U.S.A.,Department of Otolaryngology-Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A.,Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
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Binnetoglu A, Demir B, Akakin D, Kervancioglu Demirci E, Batman C. Bacterial cellulose tubes as a nerve conduit for repairing complete facial nerve transection in a rat model. Eur Arch Otorhinolaryngol 2019; 277:277-283. [PMID: 31595316 DOI: 10.1007/s00405-019-05637-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 09/05/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE Functionality of the facial nerve is cosmetically important. While many techniques have been investigated, early and effective treatment for traumatic facial nerve paralysis remains challenging. Here, we aim to examine bacterial cellulose (BC) as a new tubularization material for improving facial nerve regeneration. METHODS Our study was performed on 40 female Sprague Dawley rats. Rats were randomly divided into four groups, with 10 rats per group. In all rats, the main trunk of the facial nerve was completely cut 8 mm before the branching point. For repairing the facial nerve, in group 1, the nerve was left to recover spontaneously (control group); in group 2, it was repaired by primary suturing (8.0 Ethilon sutures, Ethicon); in group 3, BC tubes alone were used to aid nerve repair; and in group 4, both BC tubes and primary sutures (8.0 Ethilon sutures) were used. After 10 weeks, the facial nerve regeneration was evaluated by the whisker movement test and electrophysiologically (nerve stimulation threshold and compound muscle action potential). Nerve regeneration was assessed by calculating the number of myelinated nerve fibers, and by microscopically evaluating the amount of regeneration and fibrosis. RESULTS No significant difference was observed among the groups in terms of whisker movement and electrophysiological parameters (P > 0.05). We found that the numbers of regenerating myelinated fibers were significantly increased (P < 0.05) when BC tubes were used as a nerve conduit. CONCLUSIONS BC can be easily shaped into a hollow tube that guides nerve axons, resulting in better nerve regeneration after transection.
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Affiliation(s)
- Adem Binnetoglu
- Department of Otorhinolaryngology-Head and Neck Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, 02135, USA.
| | - Berat Demir
- Department of Otorhinolaryngology-Head and Neck Surgery, Pendik Training and Research Hospital, Marmara University Medical Faculty, Istanbul, Turkey
| | - Dilek Akakin
- Department of Histology and Embryology, Marmara University Medical Faculty, Istanbul, Turkey
| | - Elif Kervancioglu Demirci
- Department of Histology and Embryology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Caglar Batman
- Department of Otorhinolaryngology-Head and Neck Surgery, Pendik Training and Research Hospital, Marmara University Medical Faculty, Istanbul, Turkey
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Significance of the Marginal Mandibular Branch in Relation to Facial Palsy Reconstruction: Assessment of Microanatomy and Macroanatomy Including Axonal Load in 96 Facial Halves. Ann Plast Surg 2019; 83:e43-e49. [PMID: 31567417 DOI: 10.1097/sap.0000000000002038] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The marginal mandibular branch (MMB) of the facial nerve provides lower lip symmetry apparent during human smile or crying and is mandatory for vocal phonation. In treating facial palsy patients, so far, little attention is directed at the MMB in facial reanimation surgery. However, isolated paralysis may occur congenital, in Bell's palsy or iatrogenic during surgery, prone to its anatomical course. A variety of therapies address symmetry with either weakening of the functional side or reconstruction of the paralyzed side. To further clarify the histoanatomic basis of facial reanimation procedures using nerve transfers, we conducted a human cadaver study examining macroanatomical and microanatomical features of the MMB including its axonal capacity. METHODS Nerve biopsies of the MMB were available from 96 facial halves. Histological processing, digitalization, nerve morphometry investigation, and semiautomated axonal quantification were performed. Statistical analysis was conducted with P < 0.05 as level of significance. RESULTS The main branch of 96 specimens contained an average of 3.72 fascicles 1 to 12, and the axonal capacity was 1603 ± 849 (398-5110, n = 85). Differences were found for sex (P = 0.018), not for facial sides (P = 0.687). Diameters were measured with 1130 ± 327 μm (643-2139, n = 79). A significant difference was noted between sexes (P = 0.029), not for facial sides (P = 0.512.) One millimeter in diameter corresponded to 1480 ± 630 axons (n = 71). A number of 900 axons was correlated with 0.97 mm (specificity, 90%; sensitivity, 72%). CONCLUSIONS Our morphometric results for the MMB provide basic information for further investigations, among dealing with functional reconstructive procedures such as nerve transfers, nerve grafting for direct neurotization or babysitter procedures, and neurectomies to provide ideal power and authenticity.
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[Delineation of the primary tumour clinical target volumes and neck node levels selection of parotid cancers]. Cancer Radiother 2019; 23:255-263. [PMID: 31101541 DOI: 10.1016/j.canrad.2018.07.141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 07/28/2018] [Indexed: 11/22/2022]
Abstract
Salivary glands tumours are uncommon tumours showing a large diversity of histological types. This article presents a synthesis of patterns and paths of invasion of parotid glands tumours in order to propose an approach of the delineation of primary tumour clinical target volumes and of the selection of lymph nodes target volumes. This article does not discuss treatment indications but defines clinical target volumes to treat if radiotherapy is indicated. Postoperative situation being the most frequent, the delineation of primary tumour clinical target volume is based on an anatomical approach.
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Zhang Z, Yin H, Wang Z, Li J, Lv H, Zhao P, Yang Z, Wang Z. Imaging re-evaluation of the tympanic segment of the facial nerve canal using cone-beam computed tomography compared with multi-slice computed tomography. Eur Arch Otorhinolaryngol 2019; 276:1933-1941. [DOI: 10.1007/s00405-019-05419-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 04/07/2019] [Indexed: 01/17/2023]
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Abstract
Bell’s palsy is the most common condition involving a rapid and unilateral onset of peripheral paresis/paralysis of the seventh cranial nerve. It affects 11.5–53.3 per 100,000 individuals a year across different populations. Bell’s palsy is a health issue causing concern and has an extremely negative effect on both patients and their families. Therefore, diagnosis and prompt cause determination are key for early treatment. However, the etiology of Bell’s palsy is unclear, and this affects its treatment. Thus, it is critical to determine the causes of Bell’s palsy so that targeted treatment approaches can be developed and employed. This article reviews the literature on the diagnosis of Bell’s palsy and examines possible etiologies of the disorder. It also suggests that the diagnosis of idiopathic facial palsy is based on exclusion and is most often made based on five factors including anatomical structure, viral infection, ischemia, inflammation, and cold stimulation responsivity.
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Romano N, Federici M, Castaldi A. Imaging of cranial nerves: a pictorial overview. Insights Imaging 2019; 10:33. [PMID: 30877408 PMCID: PMC6420596 DOI: 10.1186/s13244-019-0719-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 02/12/2019] [Indexed: 12/13/2022] Open
Abstract
The human body has 12 pairs of cranial nerves that control motor and sensory functions of the head and neck. The anatomy of cranial nerves is complex and its knowledge is crucial to detect pathological alterations in case of nervous disorders. Therefore, it is necessary to know the most frequent pathologies that may involve cranial nerves and recognize their typical characteristics of imaging. Cranial nerve dysfunctions may be the result of pathological processes of the cranial nerve itself or be related to tumors, inflammation, infectious processes, or traumatic injuries of adjacent structures. Magnetic resonance imaging (MRI) is considered the gold standard in the study of the cranial nerves. Computed tomography (CT) allows, usually, an indirect view of the nerve and is useful to demonstrate the intraosseous segments of cranial nerves, the foramina through which they exit skull base and their pathologic changes. The article is a complete pictorial overview of the imaging of cranial nerves, with anatomic and pathologic descriptions and great attention to illustrative depiction. We believe that it could be a useful guide for radiologists and neuroradiologists to review the anatomy and the most important pathologies that involve cranial nerves and their differential diagnosis.
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Affiliation(s)
- Nicola Romano
- Department of Health Sciences (DISSAL) - Radiology Section, University of Genoa, Genoa, Italy.
| | - Margherita Federici
- Department of Diagnostic and Interventional Neuroradiology, E.O. Ospedali Galliera, Genoa, Italy
| | - Antonio Castaldi
- Department of Diagnostic and Interventional Neuroradiology, E.O. Ospedali Galliera, Genoa, Italy
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Magnetic resonance imaging of developmental facial paresis: a spectrum of complex anomalies. Neuroradiology 2018; 60:1053-1061. [PMID: 30074067 DOI: 10.1007/s00234-018-2063-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 07/05/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Despite its clinical implications, the MRI features of developmental facial paresis (DFP) were described in a few case reports. This study aims to describe MRI features of DFP in relation to the embryological development with a proposed radiological new grading system. METHODS The clinical records and MRI of the brain and internal auditory canal of 11 children with DFP were retrospectively reviewed. The following sequences were analyzed: axial, oblique sagittal SPACE of the internal auditory canal and brainstem; axial T2, T1WI and coronal T2WI of the brain. The severity of the maldevelopment of the seventh nerve was graded from 0 to 4: 0 = no abnormalities, 1 = unilateral facial nerve hypoplasia, 2 = unilateral facial nerve aplasia, 3 = aplasia or hypoplasia involving facial nerves on both sides, and 4 = facial nerve aplasia or hypoplasia associated with other cranial nerve palsy. RESULTS Isolated facial nerve palsy was diagnosed in seven patients. It was of grade 1 in five and grade 3 in two. Hypoplasia of the nerve with interrupted course was encountered in two cases. Other associated cranial nerve abnormalities (grade 4) were seen in four patients; two of them were diagnosed previously as Moebius syndrome. In addition to inner ear anomalies, middle and external ear and parotid gland anomalies were described. CONCLUSION To our knowledge, this is the largest series of patients with DFP that represents a continuum of isolated and combined malformations. Understanding of embryological basis can give insights into the anomalous development of the facial nerve.
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Kehrer A, Engelmann S, Ruewe M, Geis S, Taeger C, Kehrer M, Tamm ER, Bleys RLAW, Prantl L, Mandlik V. Perfusion maintains functional potential in denervated mimic muscles in early persistent facial paralysis which requires early microsurgical treatment - the histoanatomic basis of the extratemporal facial nerve trunk assessing axonal load in the context of possible nerve transfers. Clin Hemorheol Microcirc 2018; 70:1-13. [PMID: 30010114 DOI: 10.3233/ch-189905] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Early persistent facial paralysis is characterized by intact muscles of facial expression through maintained perfusion but lacking nerve supply. In facial reanimation procedures aiming at restoration of facial tone and dynamics, neurotization through a donor nerve is performed. Critical for reanimating target muscles is axonal capacity of both donor and recipient nerves. In cases of complete paralysis, the proximal stump of the extratemporal facial nerve trunk may be selected as a recipient site for coaptation. To further clarify the histological basis of this facial reanimation procedure we conducted a human cadaver study examining macro and micro anatomical features of the facial nerve trunk including its axonal capacity in human cadavers. Axonal loads, morphology and morbidity of different donor nerves are discussed reviewing literature in context of nerve transfers. METHODS From 6/2015 to 9/2016 in a group of 53 fresh frozen cadavers a total of 106 facial halves were dissected. Biopsies of the extratemporal facial nerve trunk (FN) were obtained at 1 cm distal to the stylomastoid foramen. After histological processing and digitalization of 99 specimens available, 97 were selected eligible for fascicle counts and 87 fulfilled quality criteria for a semi-automated computer-based axon quantification software using ImageJ/Fiji. RESULTS An average of 3.82 fascicles (range, 1 to 9) were noted (n = 97). 6684±1884 axons (range, 2655- 12457) were counted for the entire group (n = 87). Right facial halves showed 6364±1904 axons (n = 43). Left facial halves demonstrated 6996±1833 axons (n = 44) with no significant difference (p = 0.73). Female cadavers featured 6247±2230 (n = 22), male showed 6769±1809 axons (n = 40). No statistical difference was seen between genders (p = 0.59). A comparison with different studies in literature is made. The nerve diameter in 82 of our specimens could be measured at 1933±424 μm (range, 975 to 3012). CONCLUSIONS No donor nerve has been described to match axonal load or fascicle number of the extratemporal facial nerve main trunk. However, the masseteric nerve may be coapted for neurotization of facial muscles with a low complication rate and good clinical outcomes. Nerve transfer is indicated from 6 months after onset of facial paralysis if no recovery of facial nerve function is seen.
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Affiliation(s)
- A Kehrer
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital Regensburg, Regensburg, Germany
| | - S Engelmann
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital Regensburg, Regensburg, Germany
| | - M Ruewe
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital Regensburg, Regensburg, Germany
| | - S Geis
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital Regensburg, Regensburg, Germany
| | - C Taeger
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital Regensburg, Regensburg, Germany
| | - M Kehrer
- Department of Trauma Surgery, University Hospital Bonn, Germany
| | - E R Tamm
- Institute of Human Anatomy, University of Regensburg, Germany
| | - R L A W Bleys
- Department of Anatomy, University Medical Center Utrecht, The Netherlands
| | - L Prantl
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital Regensburg, Regensburg, Germany
| | - V Mandlik
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital Regensburg, Regensburg, Germany
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Abstract
Idiopathic peripheral facial palsy, also named Bell's palsy, is the most common cause of peripheral facial palsy in adults. Although it is considered as a benign condition, its social and psychological impact can be dramatic, especially in the case of incomplete recovery. The main pathophysiological hypothesis is the reactivation of HSV 1 virus in the geniculate ganglia, leading to nerve edema and its compression through the petrosal bone. Patients experience an acute (less than 24 hours) motor deficit involving ipsilateral muscles of the upper and lower face and reaching its peak within the first three days. Frequently, symptoms are preceded or accompanied by retro-auricular pain and/or ipsilateral face numbness. Diagnosis is usually clinical but one should look for negative signs to eliminate central facial palsy or peripheral facial palsy secondary to infectious, neoplastic or autoimmune diseases. About 75% of the patients will experience spontaneous full recovery, this rate can be improved with oral corticotherapy when introduced within the first 72 hours. To date, no benefit has been demonstrated by adding an antiviral treatment. Hemifacial spasms (involuntary muscles contractions of the hemiface) or syncinesia (involuntary muscles contractions elicited by voluntary ones, due to aberrant reinnervation) may complicate the disease's course. Electroneuromyography can be useful at different stages: it can first reveal the early conduction bloc, then estimate the axonal loss, then bring evidence of the reinnervation process and, lastly, help for the diagnosis of complications.
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Policeni B, Corey AS, Burns J, Conley DB, Crowley RW, Harvey HB, Hoang J, Hunt CH, Jagadeesan BD, Juliano AF, Kennedy TA, Moonis G, Pannell JS, Patel ND, Perlmutter JS, Rosenow JM, Schroeder JW, Whitehead MT, Cornelius RS. ACR Appropriateness Criteria ® Cranial Neuropathy. J Am Coll Radiol 2017; 14:S406-S420. [DOI: 10.1016/j.jacr.2017.08.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 01/09/2023]
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Prasad SC, Laus M, Dandinarasaiah M, Piccirillo E, Russo A, Taibah A, Sanna M. Surgical Management of Intrinsic Tumors of the Facial Nerve. Neurosurgery 2017; 83:740-752. [DOI: 10.1093/neuros/nyx489] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 09/04/2017] [Indexed: 11/15/2022] Open
Abstract
Abstract
BACKGROUND
Intrinsic tumors of the facial nerve are a rare entity. Dealing with this subset of tumors is challenging both in terms of decision making and surgical intervention.
OBJECTIVE
To review the outcomes of surgical management of facial nerve tumors and cable nerve graft interpositioning.
METHODS
A retrospective analysis was performed at a referral center for skull base pathology. One hundred fifteen patients who were surgically treated for facial nerve tumors were included. In case of nerve interruption during surgery, the cable nerve interpositioning technique was employed wherein the facial nerve palsy lasted for less than 1-yr duration. In cases of facial nerve palsy lasting for greater than 1 yr, the nerve was restituted by a hypoglossal facial coaptation.
RESULTS
Various degrees of progressive paralysis were seen in 84 (73%) cases. Sixty nine (60%) of the tumors involved multiple segments of the facial nerve. Sixty-two (53.9%) tumors involved the geniculate ganglion. Seventy four (64.3%) of the cases were schwannomas. Hearing preservation surgeries were performed in 60 (52.1%). Ninety one (79.1%) of the nerves that were sectioned in association with tumor removal were restituted primarily by interposition cable grafting. The mean preoperative House-Brackmann grading of the facial nerve was 3.6. The mean immediate postoperative grading was 5.4, which recovered to a mean of 3.4 at the end of 1 yr.
CONCLUSION
In patients with good facial nerve function (House-Brackmann grade I-II), a wait-and-scan approach is recommended. In cases where the facial nerve has been interrupted during surgery, the cable nerve interpositioning technique is a convenient and well-accepted procedure for immediate restitution of the nerve.
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Affiliation(s)
| | - Melissa Laus
- Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy
- Department of ENT-Head & Neck Surgery, University of Chieti, Chieti, Italy
| | - Manjunath Dandinarasaiah
- Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy
- Department of ENT-Head & Neck Surgery, Karnataka Institute of Medical Sciences, Hubli, India
| | - Enrico Piccirillo
- Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy
| | - Alessandra Russo
- Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy
| | - Abdelkader Taibah
- Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy
| | - Mario Sanna
- Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy
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Acute Facial Nerve Palsy With Ipsilateral Soft Palate Ulcers. J Oral Maxillofac Surg 2017; 75:1906-1914. [DOI: 10.1016/j.joms.2017.02.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 02/19/2017] [Accepted: 02/21/2017] [Indexed: 11/20/2022]
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Vestibular Schwannomas Treated with Cyberknife®: Clinical Outcomes. TUMORI JOURNAL 2016; 102:569-573. [DOI: 10.5301/tj.5000561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2016] [Indexed: 11/20/2022]
Abstract
Purpose Fractionated stereotactic radiotherapy (FSR) is a recognized treatment for vestibular schwannomas (VS). This study's aim is to present clinical outcomes and local control (LC) results for patients with VS treated with FSR using the Cyberknife® (CK) in 2 French cancer centers. Methods Patients treated with FSR for VS between 2007 and 2012 were retrospectively analyzed. Local control was determined using follow-up MRI. The hearing preservation (HP) rate was determined by analyzing pretreatment and posttreatment audiograms. Results Forty patients were treated for VS with the CK in both centers. The mean maximal VS dimension was 18.3 mm (range 3–30). The median follow-up was 36 months and the LC was 97% at 3 years of follow-up and 89% after 5 years. The HP rate was 83% and no facial nerve impairment was reported. Conclusions Our results in terms of LC and HP rate are congruent with similar studies that use the CK to treat VS. It appears that the CK is safe and efficient in VS management even for large lesions. Further studies with larger cohorts are warranted.
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Bartella AK, Ghassemi M, Hölzle F, Ghassemi A. Reconstruction of facial soft tissue: comparison between conventional procedures and the facelift technique. Br J Oral Maxillofac Surg 2016; 54:1006-1011. [PMID: 27542312 DOI: 10.1016/j.bjoms.2016.07.018] [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: 01/10/2016] [Accepted: 07/23/2016] [Indexed: 10/21/2022]
Abstract
We compared the result of replacement using a modified facelift technique with those of other commonly used surgical techniques for the treatment of defects of the soft tissue of the infraorbital and cheek region. We made a retrospective observational study of 86 patients who had defects of the facial soft tissue after excision of malignant tumours. Procedures used for reconstructions included non-vascularised skin grafts, local flaps, facelift technique, and microvascular free flaps, and we evaluated morbidity; duration of hospital stay; the need for, and duration of stay in the intensive care unit (ICU); and functional and aesthetic outcomes. We studied 46 men and 40 women (mean (range) age 71 (8-99) years). We found no significant difference between the methods apart from shorter duration of hospital stay and lower incidence of ectropion in the facelift group. The facelift technique also gave the best aesthetic outcome. However, in defects larger than 60cm2, microvascular free tissue transfer was the only choice. The facelift technique is reliable and safe, and gives excellent aesthetic and functional outcomes, but its use is limited to defects smaller than 60cm2.
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Affiliation(s)
- A K Bartella
- University Hospital RWTH-Aachen, Department of Oral and Maxillofacial Surgery, Pauwelsstraße 30, 52074 Aachen Germany.
| | - M Ghassemi
- University Hospital RWTH-Aachen, Department of Orthodontics, Pauwelsstraße 30, 52074 Aachen Germany
| | - F Hölzle
- University Hospital RWTH-Aachen, Department of Oral and Maxillofacial Surgery, Pauwelsstraße 30, 52074 Aachen Germany
| | - A Ghassemi
- Oral and Maxillofacial Surgery, Academic Hospital of the University of Hanover, Klinikum Lippe, Röntgenstr. 18, 32756 Detmold Germany; Medical Faculty University RWTH, Aachen, Pauwelsstraße 30, 52074 Aachen Germany
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Cavusoglu M, Cılız DS, Duran S, Ozsoy A, Elverici E, Karaoglanoglu R, Sakman B. Temporal bone MRI with 3D-FIESTA in the evaluation of facial and audiovestibular dysfunction. Diagn Interv Imaging 2016; 97:863-9. [PMID: 26725525 DOI: 10.1016/j.diii.2015.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 11/24/2015] [Accepted: 11/25/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the clinical usefulness of magnetic resonance imaging (MRI) of the temporal bone using three-dimensional fast imaging employing steady-state acquisition (3D-FIESTA) sequences in patients with facial and audiovestibular dysfunction. METHODS We retrospectively reviewed the MR images of 1263 patients who presented with hearing loss (n=429), peripheral facial palsy (n=96), tinnitus (n=341) or vertigo (n=397). There were 605 men and 658 women, with a mean age of 46.97±16.95 (SD) years (range: 2-83 years). Positive MRI findings that were responsible for clinical manifestations in individual patients were categorized according to the anatomic sites and etiologies of the lesions. RESULTS Positive MRI findings possibly responsible for clinical manifestations were found in 232/1263 (18.37%) patients, including 86/429 (20.05%) patients with hearing loss, 21/96 (21.88%) patients with facial palsy, 62/341 (18.18%) patients with tinnitus, and 63/397 (15.87%) patients with vertigo. CONCLUSION Although the use of MRI of the temporal bone using 3D-FIESTA shows positive findings in only 18.37% of patients, it provides important information in those with facial and audiovestibular dysfunction. However, for patients with normal MRI of the temporal bone, other etiological factors should be investigated in order to clarify or elucidate the cause of clinical manifestations.
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Affiliation(s)
- M Cavusoglu
- Ankara Numune Education and Research Hospital, Clinic of Radiology, Talatpaşa Bulvarı No. 5, Altındağ, 06100 Ankara, Turkey.
| | - D S Cılız
- Ankara Numune Education and Research Hospital, Clinic of Radiology, Talatpaşa Bulvarı No. 5, Altındağ, 06100 Ankara, Turkey.
| | - S Duran
- Ankara Numune Education and Research Hospital, Clinic of Radiology, Talatpaşa Bulvarı No. 5, Altındağ, 06100 Ankara, Turkey.
| | - A Ozsoy
- Ankara Numune Education and Research Hospital, Clinic of Radiology, Talatpaşa Bulvarı No. 5, Altındağ, 06100 Ankara, Turkey.
| | - E Elverici
- Ankara Numune Education and Research Hospital, Clinic of Radiology, Talatpaşa Bulvarı No. 5, Altındağ, 06100 Ankara, Turkey.
| | - R Karaoglanoglu
- Ankara Numune Education and Research Hospital, Clinic of Radiology, Talatpaşa Bulvarı No. 5, Altındağ, 06100 Ankara, Turkey.
| | - B Sakman
- Ankara Numune Education and Research Hospital, Clinic of Radiology, Talatpaşa Bulvarı No. 5, Altındağ, 06100 Ankara, Turkey.
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Perspectives in the reconstruction of paediatric facial paralysis. Curr Opin Otolaryngol Head Neck Surg 2015; 23:470-9. [DOI: 10.1097/moo.0000000000000211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Portelinha J, Passarinho MP, Costa JM. Neuro-ophthalmological approach to facial nerve palsy. Saudi J Ophthalmol 2014; 29:39-47. [PMID: 25859138 DOI: 10.1016/j.sjopt.2014.09.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 09/09/2014] [Indexed: 10/24/2022] Open
Abstract
Facial nerve palsy is associated with significant morbidity and can have different etiologies. The most common causes are Bell's palsy, Ramsay-Hunt syndrome and trauma, including surgical trauma. Incidence varies between 17 and 35 cases per 100,000. Initial evaluation should include accurate clinical history, followed by a comprehensive investigation of the head and neck, including ophthalmological, otological, oral and neurological examination, to exclude secondary causes. Routine laboratory testing and diagnostic imaging is not indicated in patients with new-onset Bell's palsy, but should be performed in patients with risk factors, atypical cases or in any case without resolution within 4 months. Many factors are involved in determining the appropriate treatment of these patients: the underlying cause, expected duration of nerve dysfunction, anatomical manifestations, severity of symptoms and objective clinical findings. Systemic steroids should be offered to patients with new-onset Bell's palsy to increase the chance of facial nerve recovery and reduce synkinesis. Ophthalmologists play a pivotal role in the multidisciplinary team involved in the evaluation and rehabilitation of these patients. In the acute phase, the main priority should be to ensure adequate corneal protection. Treatment depends on the degree of nerve lesion and on the risk of the corneal damage based on the amount of lagophthalmos, the quality of Bell's phenomenon, the presence or absence of corneal sensitivity and the degree of lid retraction. The main therapy is intensive lubrication. Other treatments include: taping the eyelid overnight, botulinum toxin injection, tarsorrhaphy, eyelid weight implants, scleral contact lenses and palpebral spring. Once the cornea is protected, longer term planning for eyelid and facial rehabilitation may take place. Spontaneous complete recovery of Bell's palsy occurs in up to 70% of cases. Long-term complications include aberrant regeneration with synkinesis. FNP after acoustic neuroma surgery remains the most common indication for FN rehabilitation.
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Affiliation(s)
- Joana Portelinha
- Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | | | - João Marques Costa
- Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
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