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McGuire B. Updates on Evaluation and Treatment of Common Complaints in Pregnancy. Obstet Gynecol Clin North Am 2023; 50:535-547. [PMID: 37500215 DOI: 10.1016/j.ogc.2023.03.016] [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: 07/29/2023]
Abstract
Patients experience many new and concerning symptoms during pregnancy and it is the role of the obstetric clinician to provide appropriate guidance, recommendations, and treatment options. Often times, these symptoms are related to hormonal and physiologic changes that occur and will resolve in the postpartum period. However, clinicians must be able to recognize more concerning pathologic symptoms that require further evaluation and treatment. This review provides updates on the evaluation and management of some of the common symptoms during pregnancy.
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Affiliation(s)
- Brenna McGuire
- Department of Obstetrics and Gynecology, University of New Mexico Hospital, UNM Obstetrics & Gynecology, MSC10 5580, 1 University of New Mexico, Albuquerque, NM 87131, USA.
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2
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Vozar A, Dugas J, Deskins SJ, Udassi S. Facial Nerve Palsy in a Five-Month-Old Infant. Cureus 2023; 15:e39799. [PMID: 37398712 PMCID: PMC10313389 DOI: 10.7759/cureus.39799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 07/04/2023] Open
Abstract
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.
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Affiliation(s)
- Amber Vozar
- Pediatrics, West Virginia University, Morgantown, USA
| | - John Dugas
- Pediatrics, West Virginia University, Morgantown, USA
| | - Seth J Deskins
- Internal Medicine and Pediatrics, West Virginia University Medicine, Morgantown, USA
| | - Sharda Udassi
- Pediatrics, West Virginia University, Morgantown, USA
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3
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Association of Overweight and Obesity With Bell Palsy in Children. Pediatr Neurol 2023; 139:43-48. [PMID: 36508882 DOI: 10.1016/j.pediatrneurol.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/14/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND In the Division of Pediatric Neurology at the University Medical Center Göttingen we observed that many patients with Bell palsy are overweight or obese. To evaluate whether overweight and obesity are associated with increased risk of Bell palsy in children we conducted this single-centered retrospective study by performing a database search for International Classification of Diseases (ICD)-10 primary and secondary diagnosis of G51.0 (facial nerve palsy) between January 1, 2010, and December 31, 2020. METHODS For risk assessment, patients' body mass indices (BMIs) were compared with BMI data of controls from a nationwide child health survey. RESULTS In total, 202 patients with peripheral facial nerve palsies (pFPs) were included, of which nearly half were classified as Bell palsies; 38% and 24% of the patients with Bell palsy and pFP had a BMI above the 90th percentile, respectively. High BMI was associated with statistically increased odds of Bell palsy in the group of overweight and obese patients (BMI >90th percentile; odds ratio [OR], 2.42; 95% confidence interval [CI], 1.6 to 3.8; P < 0.001) and solely obese patients (BMI >97th percentile; OR, 2.43; 95% CI, 1.4 to 4.3; P = 0.003). CONCLUSIONS We could confirm our observation that overweight and obesity are associated with increased risk of Bell palsy in children.
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KOÇ UÇAR H, SARIGEÇİLİ E. Çocuklarda idiyopatik periferik fasiyal sinir paralizisinde steroid tedavisinin etkinliği ve prognostik faktörlerin belirlenmesi. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1053502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Purpose: The aim of the study is intended to investigate the etiology and clinical features of children with idiopathic peripheral facial palsy (IPFP) and to identify probable prognostic factors. It is also intended to investigate corticosteroid therapy and compare its efficacy.
Materials and Methods: A total of 80 patients with newly diagnosed IPFP were included in the study. Demographic, clinical features and laboratory findings including age, gender, House Brackmann Facial Nerve Grading System (HBGS) grade at admission and follow-up, and the dosage and onset of steroid treatment were reviewed. We assigned our patients to 3 groups: Group 1: Patients given 1 mg/kg oral steroid treatment (1 mg/kg/day oral prednisolone). Group 2: Patients given 2 mg/kg oral steroid treatment (2 mg/kg/day oral prednisolone), and Group 3: Patients who did not receive oral steroid treatment.
Results: A total of 80 children (41 girls and 39 boys) with a median age of 11 years were included in the study. The complete recovery was detected in %78,8(n:63) with IPFP. Of all patients, 78.8% (n=63) showed complete recovery. Admission after more than 24 hours was found to reduce the likelihood of ER by 10 times (1/0.10), while patients with HBGS grade of 5 were found to be 33.3 times (1/0.03) less likely to achieve ER than patients with HBGS grades of 2 to 3. Finally, steroid treatment at 2 mg/kg/d increased the probability of early recovery by 8.38 times.
Conclusion: The prognosis of IPFP in children was very good. The prognostic factors affecting the early recovery were being HBGS grade 2 or 3 on the 21th day and receiving steroid treatment in the first 24 hours and 2 mg/kg/d dose.
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Affiliation(s)
- Habibe KOÇ UÇAR
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, ADANA ŞEHİR SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
| | - Esra SARIGEÇİLİ
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, ADANA ŞEHİR SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
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Ali L, Alhatou M, Adeli G, Elalamy O, Zada Y, Mohammed I, Sharif M, Noor Illahi M, Naeem M, Iqrar A. Lesion Localization and Prognosis Using Electrodiagnostic Studies in Facial Diplegia: A Rare Variant of Guillain-Barre Syndrome. Cureus 2022; 14:e25047. [PMID: 35719795 PMCID: PMC9200109 DOI: 10.7759/cureus.25047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 11/06/2022] Open
Abstract
Background The etiology of facial nerve palsy is diverse and includes herpes zoster virus, Guillain-Barre syndrome (GBS), otitis media, Lyme disease, sarcoidosis, human immunodeficiency virus, etc. The lower motor neuron type facial nerve palsy is usually caused by an ipsilateral facial nerve lesion; however, it may be caused by a central lesion of the facial nerve nucleus and tract in the pons. Facial diplegia is an extremely rare condition that occurs in approximately 0.3% to 2.0% of all facial palsies. Electrodiagnostic studies including direct facial nerve conduction, facial electromyography (EMG), and blink reflex studies are useful for the prognosis and lesion localization in facial nerve palsy. Methodology This retrospective, observational study was conducted at the Neurophysiology Unit, Hamad General Hospital, Doha, Qatar. This study included 11 patients with bilateral facial weakness who visited for electrodiagnostic studies in the neurophysiology laboratory. Results In total, eight (72.7%) patients had facial diplegia, eight (72.7%) had hypo/areflexia, seven (63.6%) had facial numbness, and five (45.5%) had cerebrospinal fluid albuminocytological dissociation. The most frequent cause of facial diplegia in this study was GBS (81.9%). Direct facial nerve conduction stimulation showed that nine (81.8%) patients had bilateral facial nerve low compound muscle action potential amplitudes. The bilateral blink reflex study showed that eight (88.8%) patients had absent bilateral evoked responses. Finally, the EMG study showed that five (55.5%) patients had active denervation in bilateral sample facial muscles. Conclusions Bilateral facial nerve palsy is an extremely rare condition with a varied etiology. Electrodiagnostic studies are useful in detecting the underlying pathophysiologic processes, prognosis, and central or peripheral lesion localization in patients with facial diplegia.
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Clinical Prognostic Factors Associated with Good Outcomes in Pediatric Bell's Palsy. J Clin Med 2021; 10:jcm10194368. [PMID: 34640384 PMCID: PMC8509832 DOI: 10.3390/jcm10194368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/30/2021] [Accepted: 09/22/2021] [Indexed: 11/16/2022] Open
Abstract
The prognosis of children with Bell’s palsy remains unclear due to its relatively low incidence, and thus, the small number of patients included in individual studies. To evaluate the prognosis of children with Bell’s palsy and identify the predictive value of specific factors that contribute to complete recovery, a retrospective cohort study was conducted of all patients with Bell’s palsy who visited the outpatient clinic of our university hospital between January 2005 and December 2020. We identified the parameters associated with a favorable recovery after 6 months in pediatric patients with Bell’s palsy. Factors recorded for each patient included age, sex, side affected by palsy, time between symptom onset and start of treatment, treatment methods, and the House–Brackmann grade (H–B) grade. The results of the multivariable analysis revealed that the lower degree of initial facial nerve paralysis presented as H–B grade II–IV was a significant favorable prognostic factor (OR: 3.86; 95% CI: 1.27–11.70; p < 0.05). Our results showed that the most important factor influencing the complete recovery of Bell’s palsy in children was the lower initial H–B grade at initial presentation.
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Astari AM, Fatimah F, Andarini S. The effect of medical history and compressor on barotrauma. J Public Health Res 2021; 10. [PMID: 33855396 PMCID: PMC8129736 DOI: 10.4081/jphr.2021.2163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/15/2021] [Indexed: 01/02/2023] Open
Abstract
Background: Barotrauma causes damage to an enclosed cavity within the human body due to pressure changes inside and outside the body. This research aims to identify the effect of medical history and compressor on barotrauma. Design and method: The case-control design and total sampling methods were used to obtained data from 174 respondents. Results: The bivariate result showed that the value of medical history was at p=0.006, OR=2.47, with a compressor value of p=0.000, OR=16.29. Furthermore, the multivariate analysis indicated that the compressor has a dominant factor at OR=17.175. Conclusions:: Both medical history and compressor affected barotrauma incidence, with compressor as the most dominant factor. Significance for public health Barotrauma causes damage to the enclosed cavity within the human body due to changes in pressure inside and outside the body. The incidence of barotrauma in Indonesia is high, with medical history and compressor among the common factors affecting its existence. This research describes the effect of medical history and compressor on barotrauma.
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Affiliation(s)
| | | | - Sri Andarini
- Faculty of Medicine, Universitas Brawijaya; Academic hospital of Universitas Brawijaya, Malang.
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Selvamalar V, Othman NAN, Daud MK. A Case Series of Malignant Otitis Externa Mimicking Malignancy. ACTA MEDICA (HRADEC KRÁLOVÉ) 2021; 64:36-41. [PMID: 33855957 DOI: 10.14712/18059694.2021.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Malignant otitis externa is an inflammation of the external auditory canal with preceding osteomyelitis of the temporal bone and the adjacent structures that could be potentially lethal. Malignant otitis externa may present with cranial nerve involvements and massive spread of disease mimicking nasopharyngeal carcinoma or any other malignancies on imaging. Two elderly patients who presented with severe otalgia and significant facial nerve palsy and lower cranial nerve palsies showing extensive spread of disease are reported in this case series. They both had resolution of disease after a prolonged course of antibiotics and cortical mastoidectomy for disease clearance in one of them.
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Affiliation(s)
- Vengathajalam Selvamalar
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Health Campus, University Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Nik Adilah Nik Othman
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Health Campus, University Sains Malaysia, Kubang Kerian, Kelantan, Malaysia. .,Hospital University Sains Malaysia, Health Campus, Kubang Kerian, 16150, Kelantan, Malaysia.
| | - Mohd Khairi Daud
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Health Campus, University Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.,Hospital University Sains Malaysia, Health Campus, Kubang Kerian, 16150, Kelantan, Malaysia
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RESPONSE TO LETTER TO THE EDITOR: "EFFECT OF INTRATYMPANIC DEXAMETHASONE ON BELL'S PALSY: LETTER TO THE EDITOR". Otol Neurotol 2021; 42:483-484. [PMID: 33306664 DOI: 10.1097/mao.0000000000002972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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10
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Induruwa I, Holland N, Gregory R, Khadjooi K. The impact of misdiagnosing Bell's palsy as acute stroke. Clin Med (Lond) 2019; 19:494-498. [PMID: 31732591 DOI: 10.7861/clinmed.2019-0123] [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] [Indexed: 11/27/2022]
Abstract
Idiopathic Bell's palsy can lead to a serious and, sometimes permanently, disfiguring and emotionally challenging facial palsy. Early diagnosis and treatment with corticosteroids are important, as they significantly improve recovery rates. Bell's palsy is a benign condition that should be diagnosed and managed in primary care. Patients who self-present to the emergency department should be managed and discharged without needing admission. We reviewed all patients referred urgently to our hospital with facial weakness and discharged with a diagnosis of Bell's palsy, to explore whether clinicians were confident in making this diagnosis at initial assessment and, if not, how often they sought a specialist opinion. Furthermore, we assessed the impact of its over-investigation and mistreatment on healthcare resources and the patients.
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Affiliation(s)
- Isuru Induruwa
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Negin Holland
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK and Association of British Neurologists, London, UK
| | - Rosalind Gregory
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Kayvan Khadjooi
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Lee SY, Seong J, Kim YH. Clinical Implication of Facial Nerve Decompression in Complete Bell's Palsy: A Systematic Review and Meta-Analysis. Clin Exp Otorhinolaryngol 2019; 12:348-359. [PMID: 31487771 PMCID: PMC6787481 DOI: 10.21053/ceo.2019.00535] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/15/2019] [Indexed: 11/22/2022] Open
Abstract
We compared the therapeutic efficacy of facial nerve decompression (FND) and conservative treatment in patients with Bell’s palsy through a systematic review and meta-analysis. Primary database search was performed in PubMed, Medline, and Embase. After screening, 13 studies were assessed for their eligibility. Among them, seven studies employing either the House-Brackmann grading system (HBGS) or May’s classification (modified HBGS) were selected for quantitative and qualitative analysis. Based on May’s classification, the degree of recovery was classified into complete (HBGS I), fair (HBGS II–III), or failed (HBGS IV–VI) recovery. The outcomes were assessed between 6 and 12 months after surgery. The estimated pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using random effects model. Cohorts were comprised of patients who underwent FND (n=202, 53.0%) and conservative treatments (n=179, 47.0%). In pooled analysis, the rate of complete recovery was significantly higher in the FND group than in the control group (OR, 2.06; 95% CI, 1.22 to 3.48; P=0.007) showing neither heterogeneity nor publication bias. Meanwhile, the rates of fair recovery (OR, 0.71; 95% CI, 0.42 to 1.21; P=0.208) and failed recovery (OR, 0.60; 95% CI, 0.22 to 1.67; P=0.327) in the FND group were similar to that in the control group. In subgroup analyses, there was no significant difference in the OR according to the operation timing and surgical approach. FND can be a possible treatment option for patients with complete Bell’s palsy, especially for complete recovery, which provide insights on decision-making and outcome prediction. However, FND should be determined carefully given the risk of small study effects and possible complications.
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Affiliation(s)
- Sang-Yeon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jeon Seong
- Department of Otorhinolaryngology-Head and Neck Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Young Ho Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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Abstract
The field of facial paralysis requires the reconstructive surgeon to apply a wide spectrum of reconstructive and aesthetic principles, using a comprehensive array of surgical tools, including microsurgery, peripheral nerve surgery, and aesthetic facial surgery on the road to optimize patient outcomes. The distinct deficits created by different anatomical levels of facial nerve injury require a fundamental understanding of facial nerve anatomy. Palsy duration, followed by location and mechanism, will determine mimetic muscle salvageability, by means of either direct repair, grafting, or nerve transfers, whereas longer palsy durations will necessitate introducing a new neuromuscular unit, whether by muscle transfer or free functional muscle transplant. A thorough history, physical examination, and basic understanding of ancillary studies, emphasizing palsy duration, location, and mechanism of injury, are critical in evaluation, prognostication, and treatment strategies in traumatic facial palsy patients. The importance of ancillary and aesthetic procedures cannot be overstated. Although these do not provide motion, they constitute essential tools in the treatment of facial paralysis, providing both protective and improved aesthetic outcomes, yielding the highest impact in final surgeon and patient satisfaction, bringing our patients to smile not only on the outside, but also on the inside.
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Liou LS, Chang CY, Chen HJ, Tseng CH, Chen CY, Sung FC. Increased risk of peripheral arterial occlusive disease in patients with Bell's palsy using population data. PLoS One 2017; 12:e0188982. [PMID: 29216223 PMCID: PMC5720702 DOI: 10.1371/journal.pone.0188982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 11/16/2017] [Indexed: 11/19/2022] Open
Abstract
Objective This population-based cohort study investigated the risk of developing peripheral arterial occlusive disease (PAOD) in patients with Bell’s palsy. Methods We used longitudinal claims data of health insurance of Taiwan to identify 5,152 patients with Bell’s palsy newly diagnosed in 2000–2010 and a control cohort of 20,608 patients without Bell’s palsy matched by propensity score. Incidence and hazard ratio (HR) of PAOD were assessed by the end of 2013. Results The incidence of PAOD was approximately 1.5 times greater in the Bell’s palsy group than in the non-Bell’s palsy controls (7.75 vs. 4.99 per 1000 person-years). The Cox proportional hazards regression analysis measured adjusted HR was 1.54 (95% confidence interval (CI) = 1.35–1.76) for the Bell’s palsy group compared to the non-Bell’s palsy group, after adjusting for sex, age, occupation, income and comorbidities. Men were at higher risk of PAOD than women in the Bell’s palsy group, but not in the controls. The incidence of PAOD increased with age in both groups, but the Bell’s palsy group to control group HR of PAOD decreased as age increased. The systemic steroid treatment reduced 13% of PAOD hazard for Bell’s palsy patients, compared to those without the treatment, but not significant. Conclusions Bell’s palsy appears to be associated with an increased risk of developing PAOD. Further pathophysiologic, histopathology and immunologic research is required to explore the underlying biologic mechanism.
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Affiliation(s)
- Li-Syue Liou
- Department of Family Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien City, Hualien County, Taiwan, ROC
- Department of Family Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Xindian Dist., New Taipei City, Taiwan(R.O.C)
- Department of Family and Community Medicine, Tri-Service General Hospital, Neihu District, Taipei City, Taiwan(R.O.C.)
- School of Medicine, National Defense Medical Center, Neihu Dist., Taipei City, aiwan (R.O.C.)
| | - Chih-Ya Chang
- School of Medicine, National Defense Medical Center, Neihu Dist., Taipei City, aiwan (R.O.C.)
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, Neihu District, Taipei City, Taiwan(R.O.C.)
| | - Hsuan-Ju Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan, Taichung, Taichung, Taiwan (R.O.C.)
| | - Chun-Hung Tseng
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan, North District, Taichung, Taiwan (R.O.C.)
- School of Medicine, China Medical University, Taichung, Taiwan, Taichung, Taichung, Taiwan (R.O.C.)
| | - Cheng-Yu Chen
- Department of Family Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Xindian Dist., New Taipei City, Taiwan(R.O.C)
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan, Taichung, Taichung, Taiwan (R.O.C.)
- Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, Taichung, Taiwan; Taichung, Taichung, Taiwan (R.O.C.)
- Department of Health Services Administration, China Medical University, Taichung, Taiwan; Taichung, Taichung, Taiwan (R.O.C.)
- * E-mail:
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Paralysie faciale bilatérale au cours d’une infection à virus d’Epstein–Barr. Arch Pediatr 2017; 24:564-567. [DOI: 10.1016/j.arcped.2017.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 11/21/2016] [Accepted: 03/20/2017] [Indexed: 11/18/2022]
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Ordahan B, Karahan AY. Role of low-level laser therapy added to facial expression exercises in patients with idiopathic facial (Bell's) palsy. Lasers Med Sci 2017; 32:931-936. [PMID: 28337563 DOI: 10.1007/s10103-017-2195-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 03/14/2017] [Indexed: 11/25/2022]
Abstract
The aim of the present study was to investigate the efficacy of low-level laser therapy in conjunction with conventional facial exercise treatment on functional outcomes during the early recovery period in patients with facial paralysis. Forty-six patients (mean age 41 ± 9.7 years; 40 women and 6 men) were randomized into two groups. Patients in the first group received low-level laser treatment as well as facial exercise treatment, while patients in the second group participated in facial exercise intervention alone. Laser treatment was administered at a wavelength of 830 nm, output power of 100 Mw, and frequency of 1 KHz using a gallium-aluminum-arsenide (GaAIAs, infrared laser) diode laser. A mean energy density of 10 J/cm2 was administered to eight points of the affected side of the face three times per week, for a total of 6 weeks. The rate of facial improvement was evaluated using the facial disability index (FDI) before, 3 weeks after, and 6 weeks after treatment. Friedman analysis of variance was performed to compare the data from the parameters repeatedly measured in the inner-group analysis. Bonferroni correction was performed to compare between groups as a post hoc test if the variance analysis test result was significant. To detect the group differences, the Bonferroni Student t test was used. The Mann-Whitney U test was used to compare numeric data between the groups. In the exercise group, although no significant difference in FDI scores was noted between the start of treatment and week 3 (p < 0.05), significant improvement was observed at week 6 (p < 0.001). In the laser group, significant improvement in FDI scores relative to baseline was observed at 3 and 6 weeks (p < 0.001). Improvements in FDI scores were significantly greater at weeks 3 and 6 in the laser group than those in the exercise group (p < 0.05). Our findings indicate that combined treatment with low-level laser therapy (LLLT) and exercise therapy is associated with significant improvements in FDI when compared with exercise therapy alone.
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Affiliation(s)
- Banu Ordahan
- Department of Physical Medicine and Rehabilitation, Konya Education and Training Hospital, Yazırmah, Selçuklu, Konya, Turkey.
| | - Ali Yavuz Karahan
- Department of Physical Medicine and Rehabilitation, Konya Education and Training Hospital, Yazırmah, Selçuklu, Konya, Turkey
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Lee SMK, Lee S, Park JH, Park JJ, Lee S. A close look at an integrative treatment package for Bell's palsy in Korea. Complement Ther Clin Pract 2017; 26:76-83. [DOI: 10.1016/j.ctcp.2016.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 12/20/2016] [Indexed: 01/23/2023]
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Arican P, Dundar NO, Gencpinar P, Cavusoglu D. Efficacy of Low-Dose Corticosteroid Therapy Versus High-Dose Corticosteroid Therapy in Bell's Palsy in Children. J Child Neurol 2017; 32:72-75. [PMID: 27686096 DOI: 10.1177/0883073816668774] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Bell's palsy is the most common cause of acute peripheral facial nerve paralysis, but the optimal dose of corticosteroids in pediatric patients is still unclear. This retrospective study aimed to evaluate the efficacy of low-dose corticosteroid therapy compared with high-dose corticosteroid therapy in children with Bell's palsy. Patients were divided into 2 groups based on the dose of oral prednisolone regimen initiated. The severity of idiopathic facial nerve paralysis was graded according to the House-Brackmann Grading Scale. The patients were re-assessed in terms of recovery rate at the first, third, and sixth months of treatment. There was no significant difference in complete recovery between the 2 groups after 1, 3, and 6 months of treatment. In our study, we concluded that even at a dose of 1 mg/kg/d, oral prednisolone was highly effective in the treatment of Bell's palsy in children.
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Affiliation(s)
- Pinar Arican
- 1 Department of Pediatric Neurology, Izmir Tepecik Education and Research Hospital, Izmir, Turkey
| | - Nihal Olgac Dundar
- 2 Department of Pediatric Neurology, Izmir Katip Celebi University, Izmir, Turkey
| | - Pinar Gencpinar
- 1 Department of Pediatric Neurology, Izmir Tepecik Education and Research Hospital, Izmir, Turkey
| | - Dilek Cavusoglu
- 2 Department of Pediatric Neurology, Izmir Katip Celebi University, Izmir, Turkey
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Wolfovitz A, Yehudai N, Luntz M. Prognostic factors for facial nerve palsy in a pediatric population: A retrospective study and review. Laryngoscope 2016; 127:1175-1180. [PMID: 27641905 DOI: 10.1002/lary.26307] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 07/18/2016] [Accepted: 08/04/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To identify and analyze factors influencing the outcome of facial nerve palsy (FNP) in a pediatric population. STUDY DESIGN Retrospective study. METHODS Sixty-seven pediatric patients (72 consecutive cases) diagnosed with and treated for FNP were divided into two severity subgroups. Associations between recovery in these groups and categorical variables were assessed using the Fisher exact test and for age using the t test. RESULTS Mean age on admission was 12.0 ± 4.5 years. Neither FNP outcome (graded by severity) nor improvement rates (expressed as the percentage of patients achieving a higher FNP grade over time) were influenced by gender, affected side, presence of polyneuropathy, etiology, or recurrent or familial FNP. In cases with comparable final outcome, improvement rates of those diagnosed with severe FNP on presentation (38.9% of cases) were significantly higher than mild-to-moderate FNP. Of the 47 patients who attended a follow-up examination 2 months after discharge, 70.2% have already recovered (by at least one House-Brackmann [H-B] grade) by the time they were discharged, whereas 90.9% achieved H-B grade ≤2, and 72.3% fully recovered (H-B grade 1) 2 months postdischarge. Adding antiviral medication did not affect FNP improvement rates or outcomes. CONCLUSIONS Rates of infectious and traumatic etiology in our patients were higher than reported for adults, but the most common etiology-as in those adults-was idiopathic. Routine extended diagnostic workup was not helpful, and antiviral medications were ineffective. The prognosis of FNP in pediatric patients is excellent, with 90% recovery by 2 months after initial presentation. LEVEL OF EVIDENCE 4 Laryngoscope, 127:1175-1180, 2017.
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Affiliation(s)
- Amit Wolfovitz
- Department of Otolaryngology-Head and Neck Surgery, Bnai-Zion Medical Center, The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Noam Yehudai
- Department of Otolaryngology-Head and Neck Surgery, Bnai-Zion Medical Center, The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Michal Luntz
- Department of Otolaryngology-Head and Neck Surgery, Bnai-Zion Medical Center, The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Tanyeri G, Celik O, Erbas O, Oltulu F, Yilmaz Dilsiz O. The effectiveness of different neuroprotective agents in facial nerve injury: An experimental study. Laryngoscope 2015; 125:E356-64. [DOI: 10.1002/lary.25554] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Gokce Tanyeri
- Department of Otolaryngology-Head & Neck Surgery; Celal Bayar University Faculty of Medicine; Manisa Turkey
| | - Onur Celik
- Department of Otolaryngology-Head & Neck Surgery; Celal Bayar University Faculty of Medicine; Manisa Turkey
| | - Oytun Erbas
- Department of Physiology; Ege University Faculty of Medicine
| | - Fatih Oltulu
- Department of Histology & Embryology; Ege University Faculty of Medicine; Izmir Turkey
| | - Ozlem Yilmaz Dilsiz
- Department of Histology & Embryology; Ege University Faculty of Medicine; Izmir Turkey
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Nemet AY, Vinker S. Considerations and complications after Bells' palsy. J Clin Neurosci 2015; 22:1949-53. [PMID: 26314659 DOI: 10.1016/j.jocn.2015.04.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 04/22/2015] [Accepted: 04/26/2015] [Indexed: 11/18/2022]
Abstract
We present a retrospective, observational study of all patients diagnosed with Bells' palsy (BP) at the Central District of Clalit Health Services from 2003 through to 2012. BP is associated with several complications. We evaluated clinical characteristics including the number of patient visits to general physicians (GP), otolaryngologists, ophthalmologists and neurologists, medications prescribed in the acute phase of BP (steroids and antiviral agents), and the ophthalmic diagnoses. A total of 4463 patients with the diagnosis of BP were included. The incidence per 100,000/year was 87.0, and it increased with age. Patients had significantly more visits to all specialists at 6 months after the BP event. Steroid treatment was prescribed to 50.4% of the patients and antiviral agents to 65.5%. Both treatments were associated with older patient age and female sex. The rate of post BP lagophthalmos and keratitis was 3.45% and 0.63% at 1-3 months, respectively, and both were more likely to develop in older patients. Steroid and/or antiviral treatments were not associated with a decrease in ophthalmic complications. BP may cause ophthalmic complications at a low rate, which are associated with older age. Steroids and antiviral agents appeared to have no effect on ophthalmic complications.
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Affiliation(s)
- Arie Y Nemet
- Department of Ophthalmology, Meir Medical Center, 59 Tchernichovsky Street, Kfar Sava 44281, Israel.
| | - Shlomo Vinker
- Chief Physician's Office, Central Headquarters, Clalit Health Services, Tel Aviv, Israel; Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Kokotis P, Katsavos S. Effects of Wind Chill Factor, Temperature and Other Meteorological Parameters on the Incidence of Bell's Palsy: Results Based on a Retrospective, 7-Year Long, Greek Population Study. Neuroepidemiology 2015; 45:44-9. [PMID: 26227431 DOI: 10.1159/000433542] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 05/10/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The etiology of Bell's palsy (BP), the most common type of dysfunction of the facial nerve, remains unclear despite vigorous research. Data concerning the effects of meteorological factors (MFs) on its appearance are inconclusive. The aim of our study was to examine the demographics of a convenience sample of patients with BP and to determine the effects of several MFs in the recorded number of cases per month (cpm). METHODS We retrospectively reviewed 568 files of BP patients and concomitant data of MFs during an 84-month observation period. Information collected included age, gender, diabetic status, number of cpm (months further categorized as winter or summer), mean daily and monthly temperatures and wind speeds and monthly values of wind chill factor (WCF), a measure dependent on both temperature and wind speed. Potential correlations were estimated by univariate analyses (p = 0.05). RESULTS Demographics were in line with previous research regarding age and diabetic status, but indicative of slight male preponderance. Summer months and mean monthly temperatures showed significant negative correlations with cpm (p = 0.002 and <0.000, respectively) and strong positive correlation with WCF (p < 0.000). CONCLUSIONS MFs can substantially influence the possibility for BP appearance. We propose WCF as a novel, reliable estimator of the overall MF-derived risk.
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Affiliation(s)
- Panagiotis Kokotis
- 1st Department of Neurology, Medical School of National and Kapodistrian University of Athens, Aeginition Hospital, Athens, Greece
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Role of electrical stimulation added to conventional therapy in patients with idiopathic facial (Bell) palsy. Am J Phys Med Rehabil 2015; 94:222-8. [PMID: 25171666 DOI: 10.1097/phm.0000000000000171] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine the efficacy of electrical stimulation when added to conventional physical therapy with regard to clinical and neurophysiologic changes in patients with Bell palsy. DESIGN This was a randomized controlled trial. Sixty patients diagnosed with Bell palsy (39 right sided, 21 left sided) were included in the study. Patients were randomly divided into two therapy groups. Group 1 received physical therapy applying hot pack, facial expression exercises, and massage to the facial muscles, whereas group 2 received electrical stimulation treatment in addition to the physical therapy, 5 days per week for a period of 3 wks. Patients were evaluated clinically and electrophysiologically before treatment (at the fourth week of the palsy) and again 3 mos later. Outcome measures included the House-Brackmann scale and Facial Disability Index scores, as well as facial nerve latencies and amplitudes of compound muscle action potentials derived from the frontalis and orbicularis oris muscles. RESULTS Twenty-nine men (48.3%) and 31 women (51.7%) with Bell palsy were included in the study. In group 1, 16 (57.1%) patients had no axonal degeneration and 12 (42.9%) had axonal degeneration, compared with 17 (53.1%) and 15 (46.9%) patients in group 2, respectively. The baseline House-Brackmann and Facial Disability Index scores were similar between the groups. At 3 mos after onset, the Facial Disability Index scores were improved similarly in both groups. The classification of patients according to House-Brackmann scale revealed greater improvement in group 2 than in group 1. The mean motor nerve latencies and compound muscle action potential amplitudes of both facial muscles were statistically shorter in group 2, whereas only the mean motor latency of the frontalis muscle decreased in group 1. CONCLUSIONS The addition of 3 wks of daily electrical stimulation shortly after facial palsy onset (4 wks), improved functional facial movements and electrophysiologic outcome measures at the 3-mo follow-up in patients with Bell palsy. Further research focused on determining the most effective dosage and length of intervention with electrical stimulation is warranted.
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Effects of Electroacupuncture on Facial Nerve Function and HSV-1 DNA Quantity in HSV-1 Induced Facial Nerve Palsy Mice. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 2014:693783. [PMID: 24991226 PMCID: PMC4065775 DOI: 10.1155/2014/693783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 05/20/2014] [Indexed: 01/28/2023]
Abstract
Acupuncture is a common and effective therapeutic method to treat facial nerve palsy (FNP). However, its underlying mechanism remains unclear. This study was aimed to investigate the effects of electroacupuncture on symptoms and content of HSV-1 DNA in FNP mice. Mice were randomized into four groups, an electroacupuncture treatment group, saline group, model animal group, and blank control group. Electroacupuncture was applied at Jiache (ST6) and Hegu (LI4) in electroacupuncture group once daily for 14 days, while electroacupuncture was not applied in model animal group. In electroacupuncture group, mice recovered more rapidly and HSV-1 DNA content also decreased more rapidly, compared with model animal group. We conclude that electroacupuncture is effective to alleviate symptoms and promote the reduction of HSV-1 in FNP.
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Heaton JT, Sheu SH, Hohman MH, Knox CJ, Weinberg JS, Kleiss IJ, Hadlock TA. Rat whisker movement after facial nerve lesion: evidence for autonomic contraction of skeletal muscle. Neuroscience 2014; 265:9-20. [PMID: 24480367 DOI: 10.1016/j.neuroscience.2014.01.038] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 01/03/2014] [Accepted: 01/19/2014] [Indexed: 11/25/2022]
Abstract
Vibrissal whisking is often employed to track facial nerve regeneration in rats; however, we have observed similar degrees of whisking recovery after facial nerve transection with or without repair. We hypothesized that the source of non-facial nerve-mediated whisker movement after chronic denervation was from autonomic, cholinergic axons traveling within the infraorbital branch of the trigeminal nerve (ION). Rats underwent unilateral facial nerve transection with repair (N=7) or resection without repair (N=11). Post-operative whisking amplitude was measured weekly across 10weeks, and during intraoperative stimulation of the ION and facial nerves at ⩾18weeks. Whisking was also measured after subsequent ION transection (N=6) or pharmacologic blocking of the autonomic ganglia using hexamethonium (N=3), and after snout cooling intended to elicit a vasodilation reflex (N=3). Whisking recovered more quickly and with greater amplitude in rats that underwent facial nerve repair compared to resection (P<0.05), but individual rats overlapped in whisking amplitude across both groups. In the resected rats, non-facial-nerve-mediated whisking was elicited by electrical stimulation of the ION, temporarily diminished following hexamethonium injection, abolished by transection of the ION, and rapidly and significantly (P<0.05) increased by snout cooling. Moreover, fibrillation-related whisker movements decreased in all rats during the initial recovery period (indicative of reinnervation), but re-appeared in the resected rats after undergoing ION transection (indicative of motor denervation). Cholinergic, parasympathetic axons traveling within the ION innervate whisker pad vasculature, and immunohistochemistry for vasoactive intestinal peptide revealed these axons branching extensively over whisker pad muscles and contacting neuromuscular junctions after facial nerve resection. This study provides the first behavioral and anatomical evidence of spontaneous autonomic innervation of skeletal muscle after motor nerve lesion, which not only has implications for interpreting facial nerve reinnervation results, but also calls into question whether autonomic-mediated innervation of striated muscle occurs naturally in other forms of neuropathy.
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Affiliation(s)
- James T Heaton
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, United States.
| | - Shu Hsien Sheu
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02114, United States
| | - Marc H Hohman
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, United States
| | - Christopher J Knox
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, United States
| | - Julie S Weinberg
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, United States
| | - Ingrid J Kleiss
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, United States; Department of Otorhinolaryngology and Head & Neck Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Tessa A Hadlock
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, United States
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Zandian A, Osiro S, Hudson R, Ali IM, Matusz P, Tubbs SR, Loukas M. The neurologist's dilemma: a comprehensive clinical review of Bell's palsy, with emphasis on current management trends. Med Sci Monit 2014; 20:83-90. [PMID: 24441932 PMCID: PMC3907546 DOI: 10.12659/msm.889876] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Recent advances in Bell’s palsy (BP) were reviewed to assess the current trends in its management and prognosis. Material/Methods We retrieved the literature on BP using the Cochrane Database of Systematic Reviews, PubMed, and Google Scholar. Key words and phrases used during the search included ‘Bell’s palsy’, ‘Bell’s phenomenon’, ‘facial palsy’, and ‘idiopathic facial paralysis’. Emphasis was placed on articles and randomized controlled trails (RCTs) published within the last 5 years. Results BP is currently considered the leading disorder affecting the facial nerve. The literature is replete with theories of its etiology, but the reactivation of herpes simplex virus isoform 1 (HSV-1) and/or herpes zoster virus (HZV) from the geniculate ganglia is now the most strongly suspected cause. Despite the advancements in neuroimaging techniques, the diagnosis of BP remains one of exclusion. In addition, most patients with BP recover spontaneously within 3 weeks. Conclusions Corticosteroids are currently the drug of choice when medical therapy is needed. Antivirals, in contrast, are not superior to placebo according to most reliable studies. At the time of publication, there is no consensus as to the benefit of acupuncture or surgical decompression of the facial nerve. Long-term therapeutic agents and adjuvant medications for BP are necessary due to recurrence and intractable cases. In the future, large RCTs will be required to determine whether BP is associated with an increased risk of stroke.
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Affiliation(s)
- Anthony Zandian
- Department of Anatomical Sciences, School of Medicine, St. George's University, St. George's, Grenada
| | - Stephen Osiro
- Department of Anatomical Sciences, School of Medicine, St. George's University, St. George's, Grenada
| | - Ryan Hudson
- Department of Anatomical Sciences, School of Medicine, St. George's University, St. George's, Grenada
| | - Irfan M Ali
- Department of Anatomical Sciences, School of Medicine, St. George's University, St. George's, Grenada
| | - Petru Matusz
- Department of Anatomy, Victor Babes University of Medicine and Dentistry, Timisoara, Romania
| | - Shane R Tubbs
- Pediatric Neurosurgery, Children's Hospital, Birmingham, USA
| | - Marios Loukas
- Department of Anatomical Sciences, School of Medicine, St. George's University, St. George, Grenada
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Samsudin WSW, Sundaraj K. Clinical and non-clinical initial assessment of facial nerve paralysis: A qualitative review. Biocybern Biomed Eng 2014. [DOI: 10.1016/j.bbe.2014.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lamina S, Hanif S. Pattern of facial palsy in a typical Nigerian specialist hospital. Afr Health Sci 2012; 12:514-7. [PMID: 23515232 DOI: 10.4314/ahs.v12i4.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Data on incidence of facial palsy is generally lacking in Nigeria. OBJECTIVE To assess six years' incidence of facial palsy in Murtala Muhammed Specialist Hospital (MMSH), Kano, Nigeria. METHOD The records of patients diagnosed as facial problems between January 2000 and December 2005 were scrutinized. Data on diagnosis, age, sex, side affected, occupation and causes were obtained. RESULTS A total number of 698 patients with facial problems were recorded. Five hundred and ninety four (85%) were diagnosed as facial palsy. Out of the diagnosed facial palsy, males (56.2%) had a higher incidence than females; 20-34 years age group (40.3%) had a greater prevalence; the commonest cause of facial palsy was found out to be Idiopathic (39.1%) and was most common among business men (31.6%). Right sided facial palsy (52.2%) was predominant. Incidence of facial palsy was highest in 2003 (25.3%) and decreased from 2004. CONCLUSION It was concluded that the incidence of facial palsy was high and Bell's palsy remains the most common causes of facial (nerve) paralysis.
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Affiliation(s)
- S Lamina
- Department of Biomedical Technology, School of Health Technology, Federal University of Technology, Owerri, Nigeria.
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Abstract
The facial nerve is one of the most commonly injured cranial nerves. Once injured, the effects on form, function, and psyche are profound. We review the anatomy of the facial nerve from the brain stem to its terminal branches. We also discuss the physical exam findings of facial nerve injury at various levels. Finally, we describe various reconstructive options for reanimating the face and restoring both form and function.
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Lee CC, Su YC, Chien SH, Ho HC, Hung SK, Lee MS, Chou P, Chiu BCH, Huang YS. Increased stroke risk in Bell's palsy patients without steroid treatment. Eur J Neurol 2012; 20:616-22. [DOI: 10.1111/j.1468-1331.2012.03765.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 04/24/2012] [Indexed: 11/30/2022]
Affiliation(s)
- C.-C. Lee
- Community Medicine Research Center and Institute of Public Health, National Yang-Ming University; Taipei Taiwan
- Department of Otolaryngology; Buddhist Dalin Tzu Chi General Hospital; Chiayi Taiwan
- Cancer Center; Buddhist Dalin Tzu Chi General Hospital; Chiayi Taiwan
- School of Medicine; Tzu Chi University; Hualian Taiwan
| | - Y.-C. Su
- Cancer Center; Buddhist Dalin Tzu Chi General Hospital; Chiayi Taiwan
- School of Medicine; Tzu Chi University; Hualian Taiwan
- Division of Hematology-Oncology, Department of Internal Medicine; Buddhist Dalin Tzu Chi General Hospital; Chiayi Taiwan
| | - S.-H. Chien
- School of Medicine; Tzu Chi University; Hualian Taiwan
- Division of Plastic Surgery, Department of Surgery; Buddhist Dalin Tzu Chi General Hospital; Chiayi Taiwan
| | - H.-C. Ho
- Department of Otolaryngology; Buddhist Dalin Tzu Chi General Hospital; Chiayi Taiwan
- Cancer Center; Buddhist Dalin Tzu Chi General Hospital; Chiayi Taiwan
- School of Medicine; Tzu Chi University; Hualian Taiwan
| | - S.-K. Hung
- Cancer Center; Buddhist Dalin Tzu Chi General Hospital; Chiayi Taiwan
- School of Medicine; Tzu Chi University; Hualian Taiwan
- Department of Radiation Oncology; Buddhist Dalin Tzu Chi General Hospital; Chiayi Taiwan
| | - M.-S. Lee
- Cancer Center; Buddhist Dalin Tzu Chi General Hospital; Chiayi Taiwan
- School of Medicine; Tzu Chi University; Hualian Taiwan
- Department of Radiation Oncology; Buddhist Dalin Tzu Chi General Hospital; Chiayi Taiwan
| | - P. Chou
- Community Medicine Research Center and Institute of Public Health, National Yang-Ming University; Taipei Taiwan
| | - B. C.-H. Chiu
- Department of Health Studies; University of Chicago; Chicago IL USA
| | - Y.-S. Huang
- Division of Neurology, Department of Internal Medicine; Buddhist Dalin Tzu Chi General Hospital; Chiayi Taiwan
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Is this persistent tumor the cause of Bell palsy or something more severe? JAAPA 2012. [DOI: 10.1097/01720610-201202000-00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Barr JS, Katz KA, Hazen A. Surgical management of facial nerve paralysis in the pediatric population. J Pediatr Surg 2011; 46:2168-76. [PMID: 22075352 DOI: 10.1016/j.jpedsurg.2011.06.036] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 06/28/2011] [Accepted: 06/29/2011] [Indexed: 12/27/2022]
Abstract
BACKGROUND In the pediatric patient population, both the pathology and the surgical managements of seventh cranial nerve palsy are complicated by the small size of the patients. Adding to the technical difficulty is the relative infrequency of the diagnosis, thus making it harder to become proficient in the management of the condition. The magnitude of the functional and aesthetic deficits these children manifest is significantly troubling to both the patient and the parents, which makes immediate attention, treatment, and functional restoration essential. METHODS A literature search using PubMed (http://www.pubmed.org) was undertaken to identify the current state of surgical management of pediatric facial paralysis. RESULTS Although a multitude of techniques have been used, the ideal reconstructive procedure that addresses all of the functional and cosmetic needs of these children has yet to be described. Certainly, future research and innovative thinking will yield progressively better techniques that may, one day, emulate the native facial musculature with remarkable precision. CONCLUSION The necessity for surgical intervention in children with facial nerve paralysis differs depending on many factors including the acute/chronic nature of the defect as well as the extent of functional and cosmetic damage. In this article, we review the surgical procedures that have been used to treat pediatric facial nerve paralysis and provide therapeutic facial reanimation.
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Affiliation(s)
- Jason S Barr
- Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, NY 10016, USA
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Numthavaj P, Thakkinstian A, Dejthevaporn C, Attia J. Corticosteroid and antiviral therapy for Bell's palsy: a network meta-analysis. BMC Neurol 2011; 11:1. [PMID: 21208452 PMCID: PMC3025847 DOI: 10.1186/1471-2377-11-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Accepted: 01/05/2011] [Indexed: 01/08/2023] Open
Abstract
Background Previous meta-analyses of treatments for Bell's palsy are still inconclusive due to different comparators, insufficient data, and lack of power. We therefore conducted a network meta-analysis combining direct and indirect comparisons for assessing efficacy of steroids and antiviral treatment (AVT) at 3 and 6 months. Methods We searched Medline and EMBASE until September 2010 using PubMed and Elsviere search engines. A network meta-analysis was performed to assess disease recovery using a mixed effects hierarchical model. Goodness of fit of the model was assessed, and the pooled odds ratio (OR) and 95% confidence interval (CI) were estimated. Results Six studies (total n = 1805)were eligible and contributed to the network meta-analysis. The pooled ORs for resolution at 3 months were 1.24 (95% CI: 0.79 - 1.94) for Acyclovir plus Prednisolone and 1.02 (95% CI: 0.73 - 1.42) for Valacyclovir plus Prednisolone, versus Prednisolone alone. Either Acyclovir or Valacyclovir singly had significantly lower efficacy than Prednisolone alone, i.e., ORs were 0·44 (95% CI: 0·28 - 0·68) and 0·60 (95% CI: 0·42 - 0·87), respectively. Neither of the antiviral agents was significantly different compared with placebo, with a pooled OR of 1·25 (95% CI: 0·78 - 1·98) for Acyclovir and 0·91 (95% CI: 0·63 - 1·31) for Valacyclovir. Overall, Prednisolone-based treatment increased the chance of recovery 2-fold (95% CI: 1·55 - 2·42) compared to non-Prednisolone-based treatment. To gain 1 extra recovery, 6 and 26 patients need to be treated with Acyclovir and prednisolone compared to placebo and prednisolone alone, respectively. Conclusions Our evidence suggests that the current practice of treating Bell's palsy with AVT plus corticosteroid may lead to slightly higher recovery rates compared to treating with prednisone alone but this does not quite reach statistical significance; prednisone remains the best evidence-based treatment.
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Affiliation(s)
- Pawin Numthavaj
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Abstract
BACKGROUND Bell's palsy or idiopathic facial palsy is an acute facial paralysis due to inflammation of the facial nerve. A number of studies published in China have suggested acupuncture is beneficial for facial palsy. OBJECTIVES The objective of this review was to examine the efficacy of acupuncture in hastening recovery and reducing long-term morbidity from Bell's palsy. SEARCH STRATEGY We updated the searches of the Cochrane Neuromuscular Disease Group Trials Specialized Register (24 May 2010), The Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 2, 2010), MEDLINE (January 1966 to May 2010), EMBASE (January 1980 to May 2010), AMED (January 1985 to May 2010), LILACS (from January 1982 to May 2010) and the Chinese Biomedical Retrieval System (January 1978 to May 2010) for randomised controlled trials using 'Bell's palsy' and its synonyms, 'idiopathic facial paralysis' or 'facial palsy' as well as search terms including 'acupuncture'. Chinese journals in which we thought we might find randomised controlled trials relevant to our study were handsearched. We reviewed the bibliographies of the randomised trials and contacted the authors and known experts in the field to identify additional published or unpublished data. SELECTION CRITERIA We included all randomised controlled trials involving acupuncture by needle insertion in the treatment of Bell's palsy irrespective of any language restrictions. DATA COLLECTION AND ANALYSIS Two review authors identified potential articles from the literature search, extracted data and assessed quality of each trial independently. All disagreements were resolved by discussion between the review authors. MAIN RESULTS The literature search and handsearching identified 49 potentially relevant articles. Of these, six RCTs were included involving 537 participants with Bell's palsy. Two more possible trials were identified in the update than the previous version of this systematic review, but both were excluded because they were not real RCTs. Of the six included trials, five used acupuncture while the other one used acupuncture combined with drugs. No trial reported on the outcomes specified for this review. Harmful side effects were not reported in any of the trials. Poor quality caused by flaws in study design or reporting (including uncertain method of randomisation, allocation concealment and blinding) and clinical differences between trials prevented reliable conclusions about the efficacy of acupuncture. AUTHORS' CONCLUSIONS The quality of the included trials was inadequate to allow any conclusion about the efficacy of acupuncture. More research with high quality trials is needed.
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Affiliation(s)
- Ning Chen
- West China Hospital, Sichuan UniversityDepartment of NeurologyChengduChina
| | - Muke Zhou
- West China Hospital, Sichuan UniversityDepartment of NeurologyChengduChina
| | - Li He
- West China Hospital, Sichuan UniversityDepartment of NeurologyChengduChina
| | - Dong Zhou
- West China Hospital, Sichuan UniversityDepartment of NeurologyChengduChina
| | - N Li
- West China HospitalDepartment of Acupuncture and MoxibustionSichuan UniversityChengduSichuanChina610041
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Effect of physiotherapy on facial nerve regeneration. Physiotherapy 2010. [DOI: 10.2478/v10109-010-0067-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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37
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Abstract
A variety of congenital, traumatic, vascular, inflammatory, and neoplastic processes may affect the facial nerve. Prudent use of CT and MR imaging combined with a complete understanding of facial nerve anatomy helps in narrowing the differential diagnosis. The precise anatomic course of the facial nerve must be charted in patients who undergo middle ear surgery. Also of great importance is recognition of the fact that the facial nerve may be affected in cancers of the head and neck by perineural spread. This article reviews the anatomy of the facial nerve and relevant, current clinical evaluation and imaging strategies.
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Affiliation(s)
- Prashant Raghavan
- Division of Neuroradiology, University of Virginia Health System, Charlottesville, VA 22908, USA.
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38
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Abstract
The ophthalmologist may be the first clinician to see a patient who presents with acute facial nerve palsy. Under such circumstances the ophthalmologist should make every effort to establish the underlying cause of the facial palsy and ensure that the patient's cornea is adequately protected. This article reviews the anatomy of the facial nerve, the varied disorders that may cause a facial palsy, a detailed evaluation of such a patient, and the various medical and surgical treatments available.
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Cockerham K, Aro S, Liu W, Pantchenko O, Olmos A, Oehlberg M, Sivaprakasam M, Crow L. Application of MEMS technology and engineering in medicine: a new paradigm for facial muscle reanimation. Expert Rev Med Devices 2008; 5:371-81. [PMID: 18452387 DOI: 10.1586/17434440.5.3.371] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Translational research may lead to development of micro-electromechanical system-based devices to treat muscle and nerve dysfunctions whose current treatments are inadequate and, at best, palliative. This paper discusses the development of engineered microsystems as a treatment option for palsies of the seventh cranial nerve and the potential application of these devices as a platform technology for treatment of other nervous dysfunctions. The engineering techniques for electrical and chemical stimulation of denervated muscle are discussed along with current caveats from clinical and engineering standpoints. As opposed to current treatments, miniaturized implants offer the possibility of the reduced toxicity and increased specificity of direct drug delivery. As with the increased miniaturization of other technologies, engineering of these increasingly small implantable microsystems holds great promise for the future development of yet smaller, even nanoscale, implantable devices.
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Affiliation(s)
- Kimberly Cockerham
- Department of Ophthalmology, Stanford University, Stanford, CA 94305, USA.
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40
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He L, Zhou MK, Zhou D, Wu B, Li N, Kong SY, Zhang DP, Li QF, Yang J, Zhang X. Acupuncture for Bell's palsy. Cochrane Database Syst Rev 2007:CD002914. [PMID: 17943775 DOI: 10.1002/14651858.cd002914.pub3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Bell's palsy or idiopathic facial palsy is an acute facial paralysis due to inflammation of the facial nerve. A number of studies published in China have suggested acupuncture is beneficial for facial palsy. OBJECTIVES The objective of this review was to examine the efficacy of acupuncture in hastening recovery and reducing long-term morbidity from Bell's palsy. SEARCH STRATEGY We searched the Cochrane Neuromuscular Disease Group Trials Register, MEDLINE (January 1966 to April 2006), EMBASE (January 1980 to April 2006), LILACS (from January 1982 to April 2006) and the Chinese Biomedical Retrieval System (January 1978 to April 2006) for randomised controlled trials using 'Bell's palsy' and its synonyms, 'idiopathic facial paralysis' or 'facial palsy' as well as search terms including 'acupuncture'. Chinese journals in which we thought we might find randomised controlled trials or controlled clinical trials relevant to our study were handsearched. We reviewed the bibliographies of the randomised trials and contacted the authors and known experts in the field to identify additional published or unpublished data. SELECTION CRITERIA We included all randomised or quasi-randomised controlled trials involving acupuncture in the treatment of Bell's palsy irrespective of any language restrictions. DATA COLLECTION AND ANALYSIS Two review authors identified potential articles from the literature search and extracted data independently using a data extraction form. The assessment of methodological quality included allocation concealment, patient blinding, differences at baseline of the experimental groups and completeness of follow-up. Two review authors assessed quality independently. All disagreements were resolved by discussion between the review authors. MAIN RESULTS Six studies including a total of 537 participants met the inclusion criteria. Five of them used acupuncture while another one used acupuncture combined with drugs. No trials reported on the outcomes specified for this review. Harmful side effects were not reported in any of the trials. Flaws in study design or reporting (particularly uncertain allocation concealment and substantial loss to follow-up) and clinical differences between trials prevented conclusions about the efficacy of acupuncture. AUTHORS' CONCLUSIONS The quality of the included trials was inadequate to allow any conclusion about the efficacy of acupuncture. More research with high quality trials is needed.
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Affiliation(s)
- L He
- West China Hospital, Sichuan University, Department of Neurology, Wai Nan Guo Xue Xiang #37, Chengdu, Sichuan, China, 610041.
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41
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Borges A, Casselman J. Imaging the cranial nerves: part II: primary and secondary neoplastic conditions and neurovascular conflicts. Eur Radiol 2007; 17:2332-44. [PMID: 17268799 DOI: 10.1007/s00330-006-0572-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Accepted: 12/28/2006] [Indexed: 11/29/2022]
Abstract
There have been unprecedented improvements in cross-sectional imaging in the last decades. The emergence of volumetric CT, higher field MR scanners and higher resolution MR sequences is largely responsible for the increasing diagnostic yield of imaging in patients presenting with cranial nerve deficits. The introduction of parallel MR imaging in combination with small surface coils allows the depiction of submillimetric nerves and nerve branches, and volumetric CT and MR imaging is able to provide high quality multiplanar and curved reconstructions that can follow the often complex course of cranial nerves. Seeking the cause of a cranial nerve deficit is a common indication for imaging, and it is not uncommon that radiologists are the first specialists to see a patient with a cranial neuropathy. To increase the diagnostic yield of imaging, high-resolution studies with smaller fields of view are required. To keep imaging studies within a reasonable time frame, it is mandatory to tailor the study according to neuro-topographic testing. This review article focuses on the contribution of current imaging techniques in the depiction of primary and secondary neoplastic conditions affecting the cranial nerves as well as on neurovascular conflicts, an increasingly recognized cause of cranial neuralgias.
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Affiliation(s)
- Alexandra Borges
- Radiology Department, Instituto Português de Oncologia Francisco Gentil- Centro de Lisboa, Rua Professor Lima Basto, 1093 Lisboa Codex, Portugal.
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42
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Malik TH, Kelly G, Ahmed A, Saeed SR, Ramsden RT. A Comparison of Surgical Techniques Used in Dynamic Reanimation of the Paralyzed Face. Otol Neurotol 2005; 26:284-91. [PMID: 15793421 DOI: 10.1097/00129492-200503000-00028] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To compare the outcomes of three surgical techniques used in the rehabilitation of the paralyzed face. STUDY DESIGN Retrospective study. SETTING University-based tertiary referral center. PATIENTS Between 1976 and 2000, rehabilitative facial nerve surgery was performed on 70 adult patients with varying underlying diseases. INTERVENTION Three methods of facial nerve rehabilitative surgery were performed: end-to-end anastomosis, cable nerve graft interposition, and classic faciohypoglossal transposition. MAIN OUTCOME MEASURES The House-Brackmann grade was scored at 6, 12, 24, and 36 months by the two senior authors. A favorable outcome was defined as House-Brackmann Grade </= III. Other parameters recorded were repair technique, age, nerve rerouting, whether the repair was immediate or delayed, and the anatomic position of the nerve defect in relation to the geniculate ganglion. RESULTS Data were available on 66 patients (94%), of whom 13 had an end-to-end anastomosis, 25 a cable nerve graft interposition, and 28 a classic faciohypoglossal transposition. At 24 months, a House-Brackmann Grade </= III was achieved in 84.6% of those who underwent end-to-end anastomosis, 56.0% of those who underwent cable nerve graft interposition, and 25.0% of those who underwent classical faciohypoglossal transposition. End-to-end anastomosis and cable nerve graft interposition were superior to classic faciohypoglossal transposition (log-rank test, p = 0.0013). Twenty-five percent of all cases demonstrated improvement in House-Brackmann grade after 24 months. Increasing age at the time of repair was associated with a poorer outcome (p = 0.03 on logistic regression). CONCLUSION End-to-end anastomosis confers the best facial function, followed by cable nerve graft interposition and then classic faciohypoglossal transposition. Contrary to some previous opinions, improvement in facial function can still occur 2 years after surgical repair, particularly with classic faciohypoglossal transposition.
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Affiliation(s)
- Tass H Malik
- University Department of Otorhinolaryngology-Head and Neck Surgery, Manchester Royal Infirmary, Oxford Road, Manchester, England, UK
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43
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Borges A. Trigeminal neuralgia and facial nerve paralysis. Eur Radiol 2005; 15:511-33. [PMID: 15690205 DOI: 10.1007/s00330-004-2613-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2004] [Accepted: 11/30/2004] [Indexed: 10/25/2022]
Abstract
The trigeminal nerve is the largest of the cranial nerves. It provides sensory input from the face and motor innervation to the muscles of mastication. The facial nerve is the cranial nerve with the longest extracranial course, and its main functions include motor innervation to the muscles of facial expression, sensory control of lacrimation and salivation, control of the stapedial reflex and to carry taste sensation from the anterior two-thirds of the tongue. In order to be able adequately to image and follow the course of these cranial nerves and their main branches, a detailed knowledge of neuroanatomy is required. As we are dealing with very small anatomic structures, high resolution dedicated imaging studies are required to pick up normal and pathologic nerves. Whereas CT is best suited to demonstrate bony neurovascular foramina and canals, MRI is preferred to directly visualize the nerve. It is also the single technique able to detect pathologic processes afflicting the nerve without causing considerable expansion such as is usually the case in certain inflammatory/infectious conditions, perineural spread of malignancies and in very small intrinsic tumours. Because a long course from the brainstem nuclei to the peripheral branches is seen, it is useful to subdivide the nerve in several segments and then tailor the imaging modality and the imaging study to that specific segment. This is particularly true in cases where topographic diagnosis can be used to locate a lesion in the course of these nerves.
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Affiliation(s)
- Alexandra Borges
- Department of Radiology, IPOFG, R. Prof. Lima Basto, 1093, Lisbon, Portugal.
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44
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Abstract
BACKGROUND Bell's palsy or idiopathic facial palsy is an acute facial paralysis due to inflammation of the facial nerve. A number of studies published in China have suggested acupuncture is beneficial for facial palsy. OBJECTIVES The objective of this review was to examine the efficacy of acupuncture in hastening recovery and reducing long-term morbidity from Bell's palsy. SEARCH STRATEGY We searched the Cochrane Neuromuscular Disease Group Register, MEDLINE (January 1966 to December 2002), EMBASE (January 1980 to December 2002), LILACS (from January 1982 to December 2002) and the Chinese Biomedical Retrieval System (January 1978 to December 2002) for randomised controlled trials using 'Bell's palsy' and its synonyms, 'idiopathic facial paralysis' or 'facial palsy' as well as search terms including 'acupuncture'. Chinese journals in which we thought we might find randomised controlled trials or controlled clinical trials relevant to our study were handsearched. We reviewed the bibliographies of the randomised trials and contacted the authors and known experts in the field to identify additional published or unpublished data. SELECTION CRITERIA We included all randomised or quasi-randomised controlled trials involving acupuncture in the treatment of Bell's palsy irrespective of any language restrictions. DATA COLLECTION AND ANALYSIS Two reviewers identified potential articles from the literature search and extracted data independently using a data extraction form. The assessment of methodological quality included allocation concealment, patient blinding, differences at baseline of the experimental groups and completeness of follow-up. Two reviewers assessed quality independently. All disagreements were resolved by discussion between the reviewers. MAIN RESULTS Three studies including a total of 238 patients met the inclusion criteria. Two of them used acupuncture while the third used acupuncture combined with drugs. No trials reported on the outcomes specified for this review. Three included studies showed that the therapeutic effect of acupuncture alone was superior to that of medication or that acupuncture combined with medication was better than medication alone. Harmful side-effects were not reported in any of the trials. Flaws in study design or reporting (particularly uncertain allocation concealment and substantial loss to follow-up) and clinical differences between trials prevented a meta-analysis. REVIEWER'S CONCLUSIONS The quality of the included trials was inadequate to allow any conclusion about the efficacy of acupuncture. More research with high quality trials is needed.
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Affiliation(s)
- L He
- Department of Neurology, First University Hospital, West China University of Medical Sciences, Chengdu 610041, Sichuan, China
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45
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Abstract
A review of the literature on clinical manifestations of facial paralysis shows a lack of well-integrated, cohesive methods of classification. The aim of the classification system presented here is to provide a clinically relevant, generalized scheme for categorization, focusing on clinical presentation and general etiology. This article will also describe some of the more common conditions that have shaped the organization of the classification charts.
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Affiliation(s)
- Louise M Westin
- Hospital for Sick Children, University of Toronto, Ontario, Canada
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46
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Abstract
OBJECTIVE: Paralysis of the marginal mandibular branch of the facial nerve can be a debilitating condition resulting in compromised speech and oral incompetence. We describe a static procedure performed to address the functional and cosmetic deficits seen with an adynamic lip.
METHODS: Three patients with complete facial nerve paralysis were evaluated after the scarless lip rehabilitation, a modification of the traditional wedge resection of the lower lip. The procedure is novel in that the removal of lip laxity and advancement of the contralateral innervated lip is achieved without an external facial skin incision.
RESULTS: All 3 patients in the study reported improvement in oral competence and lip symmetry; however, articulation was less consistently affected. All 3 patients were able to drink from a glass without leaking from their oral commissure. No complications were seen in this series of patients.
CONCLUSION: Oral incompetence and asymmetry are often the overlooked sequelae from complete facial nerve paralysis. Scarless lip rehabilitation of the adynamic lip is a novel, safe, and effective means to improve these functional and aesthetic deficits.
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Affiliation(s)
- Dov C Bloch
- Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic Surgery, University of California at San Francisco, 94143, USA.
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47
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Abstract
This discussion of facial paralysis as it relates to otology and neuro-otology is a mere primer of all that is known about this complex topic. It is hoped that this discussion has provided the reader with a foundation for evaluating and initiating management for the more common facial nerve disorders. It is further hoped that this less-than-exhaustive discussion will stimulate the reader to continue to study the anatomy and pathology of the facial nerve.
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Affiliation(s)
- James E Benecke
- Ear and Hearing Specialists, Inc., 3023 North Ballas Road, #675, Missouri Baptist Medical Center, St. Louis, MO 63131, USA
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48
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Lathrop SL, Ball R, Haber P, Mootrey GT, Braun MM, Shadomy SV, Ellenberg SS, Chen RT, Hayes EB. Adverse event reports following vaccination for Lyme disease: December 1998-July 2000. Vaccine 2002; 20:1603-8. [PMID: 11858868 DOI: 10.1016/s0264-410x(01)00500-x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
CONTEXT The vaccine adverse event reporting system (VAERS) monitors vaccine safety post-licensure. Although events reported to VAERS are not necessarily causally associated with vaccination, VAERS reports can be used to identify possible safety concerns that occur at too low a rate to have been identified prior to licensure. OBJECTIVE To evaluate adverse events following Lyme disease vaccination reported to VAERS during the first 19 months of the vaccine's licensure. DESIGN, SETTING, AND PARTICIPANTS Analysis of all VAERS reports of adverse events following vaccination for Lyme disease in the US from 28 December 1998 to 31 July 2000. MAIN OUTCOME MEASURE We evaluated reported adverse events for unexpected patterns in age, gender, time to onset, dose number, and clinical characteristics and compared them to adverse events observed in clinical trials of this vaccine. RESULTS Over 1,400,000 doses were distributed and 905 adverse events were reported to VAERS, 440 in men and 404 in women, with ages ranging from 10 to 82 years. The majority (56%) of adverse events occurred after administration of the first dose. The most frequently reported adverse events were arthralgia (250), myalgia (195), and pain (157). There were 59 reports coded as arthritis, 34 as arthrosis, 9 as rheumatoid arthritis, and 12 as facial paralysis. Sixty-six (7.4%) events were classified as serious, involving life-threatening illness, hospitalization, prolongation of hospitalization, persistent or significant disability/incapacity, or death. Twenty-two hypersensitivity reactions were reported. CONCLUSION Based on reporting to VAERS, we did not detect unexpected or unusual patterns of reported adverse events following Lyme disease vaccine administration, other than hypersensitivity reactions, compared with adverse events observed in clinical trials.
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Affiliation(s)
- Sarah L Lathrop
- Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, GA 30333, USA
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49
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Costa E, Sacramento E, Lopes AA, Bina JC. Facial nerve palsy associated with leptospirosis. Rev Soc Bras Med Trop 2001; 34:219-20. [PMID: 11391446 DOI: 10.1590/s0037-86822001000200011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This case report describes the findings of a 27-year-old black male from Bahia, Brazil, who developed facial palsy during the convalescence phase of leptospirosis. The patient recovered without neurological sequel. This work calls attention to a possible association between leptospirosis and facial palsy.
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Affiliation(s)
- E Costa
- Department of Medicine, Escola Bahiana de Medicina e Saúde Pública
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50
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Abstract
Normal facial movement is required for chewing, swallowing, speaking, and protecting the eye. Bell's palsy causes most cases of acute, unilateral facial palsy; infection with herpes simplex virus (HSV) type 1 may be its major cause. Varicella zoster virus (VZV) reactivation (Ramsay Hunt syndrome) is less common, but may appear without skin lesions in a form indistinguishable from Bell's palsy. Symptoms improve in nearly all patients with Bell's palsy, and most patients with Ramsay Hunt syndrome, but many are left with functional and cosmetic deficits. Steroids are frequently used to optimize outcomes in Bell's palsy, but proof of their effectiveness is marginal. Oral prednisone has been studied extensively, although some reports have suggested a higher recovery rate with intravenous steroids. Given the existing data, we support the use of oral prednisone in those patients with complete facial palsy, and no contraindications to their use (Fig. 1). In this author's opinion, the greatly increased cost and inconvenience of intravenous steroids cannot be justified by the data available. Antiviral agents may also be effective in treatment of Bell's palsy; HSV is susceptible to acyclovir and related agents. There have been few investigations of acyclovir treatment in Bell's palsy, but one controlled study showed added benefit when the drug was used with prednisone. The risk and cost of acyclovir is low enough that we support its use, with oral steroids, in those patients with complete facial paralysis. Several small studies have implied that oral acyclovir improves the outcome of facial palsy for patients with Ramsay Hunt syndrome. Although these studies do not prove efficacy, evidence for the benefits of antiviral agents in other forms of zoster is strong enough to recommend their use when the facial nerve is involved. VZV is less sensitive to acyclovir than HSV, so higher doses are recommended to treat Ramsay Hunt syndrome. Because some Ramsay Hunt syndrome patients with partial facial palsy do not fully recover, we recommend oral antiviral agents in all patients suspected of having zoster. There is weak evidence to suggest additional benefit of oral steroids in facial zoster, and their use can be supported in immunocompetent individuals. Facial nerve decompression surgery for Bell's palsy and herpes zoster oticus has experienced varying levels of enthusiasm over the years. Recent work implies that early, extensive decompression of the nerve through a middle fossa craniotomy may benefit patients at high risk for persistent deficits. However, until this procedure is subjected to a rigorous, controlled trial comparing it with maximal medical therapy, it is difficult to justify the very high costs and risk.
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