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Muacevic A, Adler JR. Ramsay Hunt Syndrome: An Introduction, Signs and Symptoms, and Treatment. Cureus 2023; 15:e33688. [PMID: 36793818 PMCID: PMC9925029 DOI: 10.7759/cureus.33688] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/12/2023] [Indexed: 01/15/2023] Open
Abstract
Ramsay Hunt syndrome is the complication of the virus varicella-zoster and the infection caused by it, which shows apparent geniculate ganglion involvement. This article discusses the etiology, epidemiology, and pathology of Ramsay Hunt syndrome. Clinically it may be presented as a vesicular rash on the ear or even in the mouth, pain in the ear, and facial paralysis. Some other rare symptoms may also be present, which are also discussed in this article. Skin involvement is also seen in some cases as patterns due to anastomoses between cervical and cranial nerves. This article provides an overview of how the varicella-zoster virus causes facial paralysis and other neurological symptoms. Knowing about this condition and its clinical features is essential to make an early diagnosis and, thus, provide a good prognosis. A good prognosis is required to reduce the nerve damage, prevent further complications, and start an early therapy of acyclovir and corticosteroid. This review also presents a clinical picture of the disease and its complications. The incidence of Ramsay Hunt syndrome has gradually decreased over time because of the development of the varicella-zoster vaccine and better health facilities. The paper also talks about how the diagnosis of Ramsay Hunt syndrome is made and the various treatment options available. Facial paralysis in Ramsay Hunt syndrome presents differently than Bell's Palsy. If not treated for too long, it may cause permanent muscle weakness and may also cause a loss of hearing. It may be confused with simple herpes simplex virus outbreaks or contact dermatitis.
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Inagaki A, Takahashi M, Murakami S. Frequency-dependent hearing outcomes with or without preservation of intact ossicular articulations. Laryngoscope Investig Otolaryngol 2022; 8:185-191. [PMID: 36846434 PMCID: PMC9948566 DOI: 10.1002/lio2.1001] [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: 08/14/2022] [Revised: 11/27/2022] [Accepted: 12/15/2022] [Indexed: 12/28/2022] Open
Abstract
Objective To determine the frequency-specific benefits of ossicular chain preservation compared to performing disarticulations and reconstructions in transmastoid facial nerve decompression surgery in patients with an intact ossicular chain. Methods A retrospective chart review (January 2007 and June 2018) of patients undergoing transmastoid facial nerve decompression on the intact middle ear for severe facial palsy at a tertiary referral center. Surgery was performed with ossicular chain disarticulation on an as-needed basis using either ossicular chain preservation (without ossicular disarticulation), incudostapedial separation, or incus disarticulation technique. Hearing outcomes were assessed. Results The 108 patients were included in this study. Among these, 89 patients underwent ossicular chain preservation, 5 underwent incudostapedial separation and 14 underwent incus repositioning. The proportion of patients with a change in the 4-frequency air conduction pure-tone average of less than 10 dB was 91%, 60%, and 50%, respectively, for the three surgical techniques; these were significantly different (Fisher's exact test, p < .001). Frequency-specific analysis showed that air conduction was significantly better following the ossicular chain preservation technique compared with the incus repositioning technique at stimulation frequencies lower than 250 Hz and higher than 2000 Hz, and compared with the incudostapedial separation technique at 4000 Hz. Analysis of biometric measures determined on CT images suggested that the feasibility of the ossicular chain preservation technique correlates with incus body thickness on coronal CT images. Conclusions Ossicular chain preservation is an effective approach for hearing preservation in transmastoid facial nerve decompression or similar surgical procedures.
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Affiliation(s)
- Akira Inagaki
- Toyohashi Day‐Surgery ClinicToyohashiJapan,Department of Otolaryngology, Head and Neck SurgeryNagoya City University Graduate School of Medical SciencesNagoyaJapan
| | - Mariko Takahashi
- Department of Otolaryngology, Head and Neck SurgeryAichi Gakuin University School of DentistryNagoyaJapan
| | - Shingo Murakami
- Department of Otolaryngology, Head and Neck SurgeryNagoya City University East Medical CenterNagoyaJapan
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Ferreira VF, Graça CR, Kouyoumdjian JA. Facial Palsy: A Retrospective Study of 416 Cases Based on Electrodiagnostic Consultation. Open Neurol J 2020. [DOI: 10.2174/1874205x02014010015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Facial nerve palsy (FP) is a frequent neurological condition caused mostly by Bell´s Palsy (BP).
Objectives:
The main objective of this study is to describe electrophysiological parameters in a retrospective 28-year review of 416 cases of FP based on electrodiagnostic consultation.
Methods:
In total, 520 exams from 416 patients over a 28-year period were reviewed. Sex, age, etiology, comorbidities, and variables from electroneurography and needle electromyography were analyzed. Cases were grouped as BP (70.7%), injury (16.4%), iatrogenic (10.3%) and Ramsay Hunt syndrome (RHS) (2.6%).
Results:
The mean age was 41 years (3-82), 53.4% female. Diabetes was the most frequent comorbidity. Estimated Axon Loss (EAL), >90%, was found in 50% of the cases, mainly in the iatrogenic group. The amplitude drop of the Compound Muscle Action Potentials (CMAPs) was proportional in the Orbicularis Oculi, Orbicularis Oris and Nasalis muscles. The absence of CMAPs was more frequent in the iatrogenic group and less frequent in the BP one. Bell´s palsy associated with diabetes was more severe. The R1 latency (blink reflex) was significantly longer in the BP group (P>0.001). Synkinesis due to the misdirection of regenerating axons was much more frequent in the BP and RHS groups.
Conclusion:
Bell´s palsy was the most common cause. The EAL was equal in all facial branches. Facial nerve inexcitability was more frequent in the iatrogenic/injury groups. The R1 latency was found to be prolonged in the BP group and the only good prognosis indicator in a few cases. Misdirection reinnervation was more frequent in BP and RHS groups. There was no sex or side predominance.
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Gross GE, Eisert L, Doerr HW, Fickenscher H, Knuf M, Maier P, Maschke M, Müller R, Pleyer U, Schäfer M, Sunderkötter C, Werner RN, Wutzler P, Nast A. [S2k guideline for the diagnosis and therapy of zoster and post-zoster neuralgia]. GMS INFECTIOUS DISEASES 2020; 8:Doc01. [PMID: 32373426 PMCID: PMC7187398 DOI: 10.3205/id000045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Diese Leitlinie richtet sich an Dermatologen, Ophthalmologen, HNO-Ärzte, Pädiater, Neurologen, Virologen sowie Infektiologen, Anästhesisten und Allgemeinmediziner in Klinik und Praxis und dient zur Information für andere medizinische Fachrichtungen, die an der Behandlung des Zoster beteiligt sind. Darüber hinaus soll die Leitlinie Kostenträgern und politischen Entscheidungsträgern zur Orientierung dienen. Die Leitlinie wurde im formellen Konsensusverfahren (S2k) von Dermatologen, Virologen/Infektiologen, Ophthalmologen, HNO-Ärzten, Neurologen, Pädiatern und Anästhesisten/Schmerzmedizinern erstellt. Die Leitlinie stellt einen Überblick über die klinische und molekulare Diagnostik sowie den Antigennachweis, die Antikörperkultur und Viruskultur dar. Diagnostisch besondere Situationen und komplizierte Verläufe der Erkrankung finden ebenfalls Berücksichtigung. Die antivirale Therapie des Zoster und der Postzosterneuralgie wird im Allgemeinen und für besondere Situationen dargelegt. Detaillierte Angaben zur Schmerzbehandlung finden Erwähnung und sind in einer Übersicht dargestellt. Ebenso werden die lokaltherapeutischen Maßnahmen thematisiert.
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Affiliation(s)
- Gerd E. Gross
- Universitätsmedizin Rostock, Universitätsklinik für Dermatologie und Venerologie, Rostock, Deutschland
| | - Lisa Eisert
- Vivantes Klinikum Neukölln, Klinik für Dermatologie und Venerologie, Berlin, Deutschland
| | - Hans Wilhelm Doerr
- Universitätsklinikum Frankfurt, Institut für Medizinische Virologie, Frankfurt (Main), Deutschland
| | - Helmut Fickenscher
- Christian-Albrechts-Universität zu Kiel und Universitätsklinikum Schleswig-Holstein, Institut für Infektionsmedizin, Kiel, Deutschland
| | - Markus Knuf
- Helios Dr. Horst Schmidt Kliniken Wiesbaden, Kinder- und Jugendklinik, Wiesbaden, Deutschland
| | - Philip Maier
- Universitätsklinikum Freiburg, Klinik für Augenheilkunde, Freiburg, Deutschland
| | - Matthias Maschke
- Krankenhaus der Barmherzigen Brüder Trier, Klinik für Neurologie, Neurophysiologie und neurologische Frührehabilitation, Trier, Deutschland
| | - Rainer Müller
- Medizinische Fakultät Carl Gustav Carus der Technischen Universität Dresden, Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Dresden, Deutschland
| | - Uwe Pleyer
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augenklinik, Berlin, Deutschland
| | - Michael Schäfer
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Anästhesiologie und operative Intensivmedizin, Berlin, Deutschland
| | - Cord Sunderkötter
- Universitätsklinikum Halle (Saale), Universitätsklinik und Poliklinik für Dermatologie und Venerologie, Halle (Saale), Deutschland
| | - Ricardo N. Werner
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Dermatology, Venereology and Allergy, Division of Evidence-based Medicine (dEBM), Berlin, Deutschland
| | - Peter Wutzler
- Universitätsklinikum Friedrich-Schiller-Universität Jena, Virologie, Jena, Deutschland
| | - Alexander Nast
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Dermatology, Venereology and Allergy, Division of Evidence-based Medicine (dEBM), Berlin, Deutschland,*To whom correspondence should be addressed: Alexander Nast, Charité – Universitätsmedizin Berlin Department of Dermatology, Venereology und Allergy Division of Evidence-based Medicine (dEBM), Charitéplatz 1, 10117 Berlin, Deutschland, Tel.: +49(0)30-450618313, Fax: +49(0)30-4507518977, E-mail:
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Inagaki A, Minakata T, Katsumi S, Murakami S. Concurrent treatment with intratympanic dexamethasone improves facial nerve recovery in Ramsay Hunt syndrome. J Neurol Sci 2020; 410:116678. [DOI: 10.1016/j.jns.2020.116678] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 12/20/2019] [Accepted: 01/08/2020] [Indexed: 11/25/2022]
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Contrast-enhanced magnetic resonance imaging of facial nerve swelling in patients with severe Ramsay Hunt syndrome. Auris Nasus Larynx 2019; 46:687-695. [PMID: 30630650 DOI: 10.1016/j.anl.2018.12.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/23/2018] [Accepted: 12/27/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE In Ramsay Hunt syndrome, contrast enhancement of magnetic resonance (MR) imaging seen in the affected facial nerve in the majority of cases, but its clinical significance has not been well investigated to date. The aim of this study was to elucidate the clinical significance of this imaging sign by quantitively investigating the correlation between the signal increase and swelling of the facial nerve. We also investigated the temporal change in this sign and its correlation with recovery. METHODS We retrospectively evaluated swelling of the facial nerve in 16 patients with severe Ramsay Hunt syndrome who underwent both contrast-enhanced magnetic resonance imaging and facial nerve decompression surgery via a transmastoid approach alone or in combination with a middle cranial approach. All the patients had a Yanagihara score of ≤8 points and facial nerve degeneration of ≥90% confirmed by either a nerve excitability test or electroneurography. Swelling of the facial nerve was evaluated intraoperatively using a 4-point grading system. RESULTS A significant correlation was observed between contrast enhancement on T1-weighted images and facial nerve swelling in the labyrinthine segment, geniculate ganglion, and pyramidal segment (P = 0.030, P = 0.018, and P = 0.037, respectively). Furthermore, the contrast enhancement increased significantly as more time elapsed after the onset of facial palsy (mean ± standard error, 14.7 ± 2.3 days, range, 5-42 days) in the geniculate ganglion and pyramidal segment (correlation coefficient, 0.546 and 0.689, P = 0.022 and P = 0.002, respectively). Patients with good recovery (Yanagihara score of ≥36) showed significantly lower contrast enhancement in the tympanic and mastoid segments (P = 0.021 and 0.020, respectively) than those who with poor recovery. CONCLUSION In particular segments of the facial nerve, contrast enhancement on T1-weighted image correlated with facial nerve swelling and recovery. These observations underscore the clinical significance of contrast enhancement on T1-weighted images in patients with Ramsay Hunt syndrome.
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Lindström J, Grahn A, Zetterberg H, Studahl M. Cerebrospinal fluid viral load and biomarkers of neuronal and glial cells in Ramsay Hunt syndrome. Eur J Neurosci 2016; 44:2944-2949. [PMID: 27643680 DOI: 10.1111/ejn.13403] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/31/2016] [Accepted: 09/13/2016] [Indexed: 11/29/2022]
Abstract
Reactivation of varicella zoster virus (VZV) can manifest with facial palsy diagnosed as Ramsay Hunt Syndrome (RHS) or Ramsay Hunt Syndrome zoster sine herpete (RHS-ZSH). These syndromes are associated with poor prognosis despite treatment with antivirals and corticosteroids. Concentrations of biomarkers such as neurofilament protein (NFL), S-100β protein and glial fibrillary acidic protein (GFAp) have previously been measured in cerebrospinal fluid (CSF) to assess neuronal damage and glial pathology. We employed immunochemical methods to measure concentrations of NFL, S-100β protein and GFAp in CSF from patients with RHS (n = 15) and RHS-ZSH (n = 13) diagnosed by detection of VZV DNA in the CSF by quantitative PCR, and compared with a control group (n = 52). The biomarker concentrations were correlated with CSF viral load and outcome measured by House-Brackmann score. NFL and GFAp concentrations were increased compared with controls (P = 0.008 and P = 0.04), while S-100β levels were decreased. This pattern was more pronounced in patients with RHS compared to the patients with RHS-ZSH (NS and P = 0.028). The amount of viral DNA in CSF correlated with increased GFAp (P = 0.003) and NFL (P = 0.006). No correlations were found between biomarker concentrations and patient outcome. Patients with facial palsy caused by VZV had biochemical signs of neuronal damage and astrogliosis. High amounts of viral DNA may be associated with the degree of damage on neuronal and astroglial cells. Prospective studies are warranted to elucidate the association of elevated biomarkers in the CSF and outcome assessed by more sensitive tests.
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Affiliation(s)
- Johan Lindström
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Diagnosvägen 21, Gothenburg, SE-416 85, Sweden
| | - Anna Grahn
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Diagnosvägen 21, Gothenburg, SE-416 85, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
| | - Marie Studahl
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Diagnosvägen 21, Gothenburg, SE-416 85, Sweden
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Komori M, Yamada K, Hinohira Y, Aritomo H, Yanagihara N. Width of the normal facial canal measured by high-resolution cone-beam computed tomography. Acta Otolaryngol 2013; 133:1227-32. [PMID: 24125193 DOI: 10.3109/00016489.2013.816443] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS In the facial canal, discrepancies between left and right side measurements at each point may be useful in the assessment and diagnosis of facial canal-related pathologies. OBJECTIVES This study was performed to obtain accurate and high-resolution images of the normal facial canal and measure its widths on cross-sections of the canal at anatomically and clinically important sites using high-resolution cone-beam computed tomography (CBCT). METHODS CBCT volume data of bilateral temporal bones were obtained from 28 healthy adult volunteers. The widths of the bony facial canals were measured at the meatal foramen, the cochleariform process, the stapes, the pyramidal eminence, and the point of emergence of the chorda tympani in the vertical segment. RESULTS The widths of the facial canal at each point were similar bilaterally (r = 0.54-0.85, p < 0.01), but showed regional differences and site-specific variations. The narrowest of the five sites was the level of the meatal foramen (p < 0.05), as reported previously. The second narrowest site was the level of the stapes (p < 0.01) followed in order by the level of the cochleariform process, the pyramidal eminence, and the point of emergence of the chorda tympanis (p < 0.01).
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Abstract
Ramsay Hunt syndrome is defined as herpes zoster oticus associated with an acute peripheral facial nerve paresis and quite often with other cranial nerve lesions. The combination of motor, sensory and autonomic involvement leads to a variety of neurological damage patterns, i. e. facial muscle paresis, hearing and balance disorders, sensory problems and disturbances of taste as well as lacrimal and nasal secretion. Additional variability of the clinical picture of Ramsay Hunt syndrome is produced by varying patterns of skin involvement explained by individual anastomoses between cranial and cervical nerves. Knowledge of these findings and an early diagnosis of Ramsay Hunt syndrome are important as prognosis of cranial nerve damage depends on the time at which acyclovir-corticosteroid therapy is started.
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Affiliation(s)
- Gunnar Wagner
- Department of Dermatology, Allergology and Phlebology, Klinikum Bremerhaven Reinkenheide, Postbrookstrasse 103, Bremerhaven, Germany.
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Kim J, Chung SM, Moon IS, Lee HK, Lee WS. Correlation between enhanced MRI and surgical findings in herpes zoster oticus. Acta Otolaryngol 2009; 129:900-5. [PMID: 18836966 DOI: 10.1080/00016480802430625] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
CONCLUSION This study demonstrates good correlation between enhanced MRI and surgical findings. OBJECTIVES This study investigated the reliability of enhanced magnetic resonance imaging (MRI) to make a surgical decision on the strategy for facial nerve decompression in herpes zoster oticus, by determining the degree of correlation between contrast enhancement in MRI and the pathologic change in the facial nerve. SUBJECTS AND METHODS This retrospective study of 13 patients, who underwent facial nerve decompression with herpes zoster oticus, was designed to compare gadolinium-enhanced segment of facial nerve on MRI and the pathologically changed segment confirmed by surgical exploration, grouping them by the timing of operation after onset of facial paralysis. RESULTS Commonly enhanced segments on MRI were the labyrinthine, intracanalicular, and geniculate ganglion, found in 84%, 69%, and 69% of all patients, respectively. The most common pathologic segment was the labyrinthine segment (92%), followed by the geniculate ganglion (84%).
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Abstract
PURPOSE To investigate the correlation between gadolinium enhanced magnetic resonance image (MRI) results and surgical findings of facial nerves in Bell's palsy and Ramsay Hunt syndrome. MATERIALS AND METHODS From 1995 to 2004, MRI was performed on 13 patients with Bell's palsy or Ramsay Hunt syndrome, who were offered with surgical decompression of the facial nerve through the middle cranial fossa approach. Gadolinium enhanced MRI was performed on all patients and the enhancement of the facial nerve was evaluated by radiology specialists. Operative findings including the degree of the facial nerve segment swelling were examined. Furthermore, the time interval from the onset of palsy to surgery was evaluated. RESULTS Swelling of facial nerve segments was found in patients with enhanced facial nerves from MRI. The swelling of the facial nerve in the labyrinthine segment in particular was identified in all patients with enhanced labyrinthine segments in MRI. The intraoperative swelling of geniculate ganglion of facial nerve was found in 78% of patients with enhanced facial segment in MRI (p=0.01). The intraoperative swelling of tympanic segment was observed from fourth to ninth weeks after the onset of palsy. CONCLUSION MRI enhancement of facial nerves in Bell's palsy and Ramsay Hunt syndrome is associated with the extent of intratemporal lesions of facial nerves, especially in the labyrinthine segment.
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Affiliation(s)
- In Sup Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, 612 Eonjuro, Gangnam-gu, Seoul, Korea.
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Carlson DS, Pfadt E. When your patient has acute facial paralysis. Nursing 2005; 35:54-5. [PMID: 15818257 DOI: 10.1097/00152193-200504000-00042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Learn to distinguish between Bell's palsy and Ramsay Hunt syndrome.
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Neto HS, Camilli JA, Marques MJ. Trigeminal neuralgia is caused by maxillary and mandibular nerve entrapment: Greater incidence of right-sided facial symptoms is due to the foramen rotundum and foramen ovale being narrower on the right side of the cranium. Med Hypotheses 2005; 65:1179-82. [PMID: 16084672 DOI: 10.1016/j.mehy.2005.06.012] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2005] [Accepted: 06/09/2005] [Indexed: 12/01/2022]
Abstract
Trigeminal neuralgia (TN) is the most important disease of the trigeminal nerve. Vascular compression of the dorsal root of the trigeminal nerve by aberrant loop of blood vessels is currently accepted as the most common cause of TN. The right side of the face is affected by TN twice as often as the left side, but there are no anatomical reasons for the blood vessels loop to be more frequent on the right side of the cranial fossa. Additionally, vascular compression in asymptomatic patients and in TN patients without aberrant blood vessels has been reported, thereby arguing against the idea that vascular compression alone is responsible for TN. Anatomical and radiological studies have shown that the rotundum and ovale foramens on the right side of the human cranium are significantly narrower than on the left side. The rotundum and ovale foramens are crossed by the maxillary and mandibular nerves, respectively, and are the nerves most affected in TN. Based on demographic and epidemiological data of TN patients, and on anatomical findings in the foramens, we hypothesized that entrapment of the maxillary and mandibular nerves when they cross the ovale and rotundum foramens is a primary cause of TN and accounts for the higher incidence of TN on the right sided.
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Affiliation(s)
- Humberto Santo Neto
- Departamento de Anatomia, Instituto de Biologia, Universidade Estadual de Campinas (UNICAMP), CP 6109, Campinas 13084-971, SP, Brazil.
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Aizawa H, Ohtani F, Furuta Y, Sawa H, Fukuda S. Variable patterns of varicella-zoster virus reactivation in Ramsay Hunt syndrome. J Med Virol 2004; 74:355-60. [PMID: 15332286 DOI: 10.1002/jmv.20181] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The mechanism by which reactivation of varicella-zoster virus (VZV) causes facial paralysis in Ramsay Hunt syndrome remains unclear. The relationship between VZV load and the onset of facial paralysis was analyzed in 42 patients with Ramsay Hunt syndrome. The patients were divided into three groups according to the times of appearance of zoster and of facial paralysis; group I (zoster preceding, n = 13), group II (simultaneous, n = 22), group III (paralysis preceding, n = 7). A real-time quantitative PCR assay was used to measure VZV DNA copy number in saliva, and paired sera were assayed for anti-VZV IgG and IgM antibodies. In group I, the VZV DNA-positive rate was low and virus load decreased gradually after the initial hospital visit around the time of onset of paralysis. The level of anti-VZV antibodies had in most cases already increased at that time. In group III, viral load tended to increase after the onset of paralysis and peaked around the time of appearance of zoster. The level of anti-VZV antibodies was low at the onset of paralysis but showed a significant increase when paired sera were tested. In group II, virus load and changes in level of anti-VZV antibodies either resembled group I or group III behavior. These results indicate that facial paralysis in Ramsay Hunt syndrome can occur at various times between the early and the regression phase of VZV reactivation, suggesting that there are variable patterns of development of facial nerve dysfunction caused by VZV reactivation and the progression of neuritis.
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Affiliation(s)
- Hiroshi Aizawa
- Department of Otolaryngology-Head & Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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