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Natour A, Doyle E, DeDio R, Samy RN. Temporal bone fracture related facial palsy: efficacy of decompression with and without grafting. Curr Opin Otolaryngol Head Neck Surg 2024; 32:294-300. [PMID: 39234847 DOI: 10.1097/moo.0000000000001007] [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: 09/06/2024]
Abstract
PURPOSE OF REVIEW This systematic review investigates the recent literature and aims to determine the approach, efficacy, and timing of facial nerve decompression with or without grafting in temporal bone fractures with facial palsy. RECENT FINDINGS The surgical management of facial palsy is reserved for a small population of cases in which electrophysiologic tests indicate a poor likelihood of spontaneous recovery. The transmastoid (TM), middle cranial fossa (MCF), and translabyrinthine (TL) approaches to the facial nerve provide access to the entire intracranial and intratemporal segments of the facial nerve. In temporal bone (TB) related facial palsy, the peri-geniculate and labyrinthine portions of the facial nerve are most commonly affected by either direct trauma and/or subsequent edema. When hearing is still serviceable, the combined TM/MCF approach provides the best access to these regions. In the presence of severe sensorineural hearing loss (SNHL), the TL approach is the most appropriate for total facial nerve exploration (this can be done in conjunction with simultaneous cochlear implantation if the cochlear nerve has not been avulsed). Grade I to III House-Brackmann (HB) results can be anticipated in timely decompression of facial nerve injury caused by edema or intraneuronal hemorrhage. Grade III outcomes, with slight weakness and synkinesis, is the outcome to be expected from the use of interpositional grafts or primary neurorrhaphy. In addition to good eye care and the use of systemic steroids (if not contraindicated in the acute trauma setting), surgical decompression with or without grafting/neurorrhaphy may be offered to patients with appropriate electrophysiologic testing, physical examination findings, and radiologic localization of injury. SUMMARY Surgery of the facial nerve remains an option for select patients. Here, we discuss the indications and results of treatment as well as the best surgical approach to facial nerve determined based on patient's hearing status and radiologic data. Controversy remains about whether timing of surgery (e.g., immediate vs. delayed intervention) impacts outcomes. However, no one with facial palsy due to a temporal bone fracture should be left with a complete facial paralysis.
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Affiliation(s)
- Amed Natour
- Lehigh Valley Health Network-LVHN, Institute for Surgical Excellence, Otolaryngology Head & Neck Surgery, Allentown, Pennsylvania
| | - Edward Doyle
- Cleveland Clinic Foundation, Department of Otolaryngology Head & Neck Surgery Cleveland, Ohio, USA
| | - Robert DeDio
- Lehigh Valley Health Network-LVHN, Institute for Surgical Excellence, Otolaryngology Head & Neck Surgery, Allentown, Pennsylvania
| | - Ravi N Samy
- Lehigh Valley Health Network-LVHN, Institute for Surgical Excellence, Otolaryngology Head & Neck Surgery, Allentown, Pennsylvania
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Leonetti JP, Shukairy MK, North M, Foecking E, Burkman L. A New Surgical Option For Patients with Unresolved Bell's Palsy. Curr Neurol Neurosci Rep 2024; 24:381-387. [PMID: 39046641 DOI: 10.1007/s11910-024-01358-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2024] [Indexed: 07/25/2024]
Abstract
PURPOSE This paper describes a new surgical procedure with electrical stimulation of the facial nerve for unresolved Bell's palsy and compares the facial nerve recovery with another group who underwent traditional middle cranial fossa decompression. RECENT FINDINGS All patients with total unilateral facial paralysis had surgery by the senior author 3 months from onset of Bell's Palsy. Surgical decompression was performed in 13 patients between 1992-2012 (Group 1). Surgical exposure with intraoperative electrical stimulation of the facial nerve in the peri-geniculate region was performed in 47 patients between 2012-2022 (Group 2). The facial recovery at 1 month and 3 month were significantly better in Group 2. The degree of synkinesis was significantly less in Group 2. The trans-mastoid electrical stimulation of the facial nerve is less invasive, requires no hospital stay, and less time off work compared to the middle cranial fossa approach. The earlier facial movement at one month results in less long-term unwanted faulty regeneration or synkinesis.
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Affiliation(s)
- John P Leonetti
- Department of Otolaryngology-Head and Neck Surgery, Loyola University Health System, 2160 S. First Avenue, Maywood, IL, 60153, USA.
| | - M Kareem Shukairy
- Department of Otolaryngology-Head and Neck Surgery, Loyola University Health System, 2160 S. First Avenue, Maywood, IL, 60153, USA
| | - Monique North
- Stritch School of Medicine, Loyola University Chicago, Chicago, IL, USA
| | - Eileen Foecking
- Department of Otolaryngology-Head and Neck Surgery, Loyola University Health System, 2160 S. First Avenue, Maywood, IL, 60153, USA
- Molecular Pharmacology and Neuroscience, Loyola University Health System, Maywood, IL, USA
| | - Lisa Burkman
- Department of Physical Therapy, Loyola University Health System, Maywood, IL, USA
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von Sneidern M, Saaedi A, Varelas AN, Eytan DF. Characterizing the Online Discourse on Facial Paralysis: What Patients Are Asking and Where They Find Answers. Facial Plast Surg Aesthet Med 2024. [PMID: 39093987 DOI: 10.1089/fpsam.2023.0277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024] Open
Abstract
Background: With the rising popularity of online search tools, patients seeking information on facial palsy are increasingly turning to the Internet for medical knowledge. Objective: To categorize the most common online questions about Bell's palsy or facial paralysis and the sources that provide answers to those queries. Methods: Query volumes for terms pertaining to facial palsy were obtained using Google Search trends. The top 40 keywords associated with the terms "Bell's palsy" and "facial paralysis" were extracted. People Also Ask (PAA) Questions-a Google search engine response page feature-were used to identify the top questions associated with each keyword. Results: A total of 151 PAA Questions pertaining to the top 40 keywords associated with "Bell's palsy" and "facial paralysis" were identified. Etiology questions were most frequent (n = 50, 33.1%), meanwhile those pertaining to treatment were most accessible (119.5 average search engine response pages/question, 35.5%). Most sources were academic (n = 81, 53.6%). Medical practice group sites were most accessible (211.9 average search engine response pages/website, 44.8%). Conclusion: Most PAA questions pertained to etiology and were sourced by academic sites. Questions regarding treatment and medical practice sites appeared on more search engine response pages when compared with all other categories.
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Affiliation(s)
- Manuela von Sneidern
- Department of Otolaryngology-Head and Neck Surgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Arman Saaedi
- Department of Otolaryngology-Head and Neck Surgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Antonios N Varelas
- Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Danielle F Eytan
- Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, New York University Grossman School of Medicine, New York, New York, USA
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Greiner RC, Kohlberg GD, Lu GN. Management of facial nerve trauma. Curr Opin Otolaryngol Head Neck Surg 2024; 32:234-238. [PMID: 38695542 DOI: 10.1097/moo.0000000000000976] [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: 05/06/2024]
Abstract
PURPOSE OF REVIEW To present the current literature on management of facial nerve disorder secondary to trauma, with a focus on the utility of electrodiagnostic testing in this setting. RECENT FINDINGS Patients with facial palsy related to temporal bone fractures should be started on high-dose corticosteroids as early as possible. Recent literature on the benefit of surgical intervention in the setting of temporal bone fracture is mixed. Some studies support early surgical decompression whereas others have found no benefit compared with conservative treatment. SUMMARY The management of facial nerve trauma is based on location and extent of injury. Extratemporal trauma and transected nerve should be treated with surgical exploration and tension-free coaptation ideally within 72 h. There are no guidelines for intratemporal facial nerve trauma. Surgical decompression compared with medical management is debated in the literature without consensus and more large studies are needed.
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Affiliation(s)
| | - Gavriel D Kohlberg
- University of Washington Department of Otolaryngology - Head and Neck Surgery, Seattle, Washington, USA
| | - G Nina Lu
- University of Washington Department of Otolaryngology - Head and Neck Surgery, Seattle, Washington, USA
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Kanona H, Saeed SR, Randhawa P, Kimber R, Rodger A, Khalil S, Andrews P. Evaluation of the Patient with Facial Palsy: A Multidisciplinary Approach. Facial Plast Surg 2024; 40:400-406. [PMID: 38301715 DOI: 10.1055/s-0044-1779046] [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: 02/03/2024] Open
Abstract
This article aims to provide an overview of the management of facial palsy within a multidisciplinary team setting and discusses considerations used to develop patient-specific management plans. The national landscape of facial function services is also discussed including suggestions on what may enable a more equitable and sustainable service for the future.
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Affiliation(s)
- Hala Kanona
- The Royal National ENT Hospital, University College London Hospitals, London, United Kingdom
| | - Shakeel R Saeed
- The Royal National ENT Hospital, University College London Hospitals, London, United Kingdom
- The Royal National ENT Hospital and National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom
| | - Premjit Randhawa
- The Royal National ENT Hospital, University College London Hospitals, London, United Kingdom
| | - Rebecca Kimber
- The Royal National ENT Hospital and National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom
| | - Anne Rodger
- The Royal National ENT Hospital and National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom
| | - Sherif Khalil
- The Royal National ENT Hospital, University College London Hospitals, London, United Kingdom
- The Royal National ENT Hospital and National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom
| | - Peter Andrews
- The Royal National ENT Hospital, University College London Hospitals, London, United Kingdom
- The Royal National ENT Hospital and National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom
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Pauna HF, Silva VAR, Lavinsky J, Hyppolito MA, Vianna MF, Gouveia MDCL, Monsanto RDC, Polanski JF, Silva MNLD, Soares VYR, Sampaio ALL, Zanini RVR, Abrahão NM, Guimarães GC, Chone CT, Castilho AM. Task force of the Brazilian Society of Otology - evaluation and management of peripheral facial palsy. Braz J Otorhinolaryngol 2024; 90:101374. [PMID: 38377729 PMCID: PMC10884764 DOI: 10.1016/j.bjorl.2023.101374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 11/25/2023] [Indexed: 02/22/2024] Open
Abstract
OBJECTIVE To review key evidence-based recommendations for the diagnosis and treatment of peripheral facial palsy in children and adults. METHODS Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on peripheral facial palsy were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. RESULTS The topics were divided into 2 main parts: (1) Evaluation and diagnosis of facial palsy: electrophysiologic tests, idiopathic facial palsy, Ramsay Hunt syndrome, traumatic peripheral facial palsy, recurrent peripheral facial palsy, facial nerve tumors, and peripheral facial palsy in children; and (2) Rehabilitation procedures: surgical decompression of the facial nerve, facial nerve grafting, surgical treatment of long-term peripheral facial palsy, and non-surgical rehabilitation of the facial nerve. CONCLUSIONS Peripheral facial palsy is a condition of diverse etiology. Treatment should be individualized according to the cause of facial nerve dysfunction, but the literature presents better evidence-based recommendations for systemic corticosteroid therapy.
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Affiliation(s)
- Henrique Furlan Pauna
- Hospital Universitário Cajuru, Departamento de Otorrinolaringologia, Curitiba, PR, Brazil
| | - Vagner Antonio Rodrigues Silva
- Universidade Estadual de Campinas (UNICAMP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Joel Lavinsky
- Universidade Federal do Rio Grande do Sul (UFRGS), Departamento de Cirurgia, Porto Alegre, RS, Brazil
| | - Miguel Angelo Hyppolito
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Melissa Ferreira Vianna
- Irmandade Santa Casa de Misericórdia de São Paulo, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | | | | | - José Fernando Polanski
- Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Curitiba, PR, Brazil
| | - Maurício Noschang Lopes da Silva
- Hospital de Clínicas de Porto Alegre (UFRGS), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Porto Alegre, RS, Brazil
| | - Vítor Yamashiro Rocha Soares
- Hospital Flávio Santos and Hospital Getúlio Vargas, Grupo de Otologia e Base Lateral do Crânio, Teresina, PI, Brazil
| | - André Luiz Lopes Sampaio
- Universidade de Brasília (UnB), Faculdade de Medicina, Laboratório de Ensino e Pesquisa em Otorrinolaringologia, Brasília, DF, Brazil
| | - Raul Vitor Rossi Zanini
- Hospital Israelita Albert Einstein, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Nicolau M Abrahão
- Universidade Estadual de Campinas (UNICAMP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Guilherme Correa Guimarães
- Universidade Estadual de Campinas (UNICAMP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Carlos Takahiro Chone
- Universidade Estadual de Campinas (UNICAMP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Arthur Menino Castilho
- Universidade Estadual de Campinas (UNICAMP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil.
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Lee JH, Park IS, Kim J. Ultrasonographic findings of facial muscles in patients with severe facial palsy who showed no improvement for more than 3 months on acute stage. Eur Arch Otorhinolaryngol 2024; 281:2001-2010. [PMID: 38168707 DOI: 10.1007/s00405-023-08426-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION/AIMS The study aimed to visualize the changes in the facial muscles of patients with severe facial palsy who showed no improvement for more than 3 months on acute stage. METHODS The 102 patients with severe facial palsy over House-Brackmann grade IV or an 80% degenerative ratio on ENoG at the initial examination, who showed no improvement for more than 3 months on acute stage were indicated to undergo ultrasonography of the face to evaluate the facial muscles. RESULTS Muscular degeneration was observed in 537/918 muscles (58.5%). Muscle volume shrinkage was observed in 209/918 muscles (22.8%). Fascial adhesions were observed in 209/918 muscles (22.7%). Among all the muscles assessed for degenerative changes, zygomaticus major/minor was the most affected by degenerative changes (91.2%). Degenerative changes were observed in the levator labii superioris muscle in 84.3% patients. The shrinkage was most frequently observed in the zygomaticus major muscle (61/102 patients [59.8%]), followed by the zygomaticus minor muscle (43.1%). Shrinkage of the levator labii suprioris was observed in 24.5% patients. The zygomaticus major/minor muscle had the highest proportion of fascial adhesions in 61.8% and 66.7% patients respectively. The levator labii suprioris muscle showed the lowest proportion of fascial adhesions, with only 7.8% patients being affected. DISCUSSION This study confirmed that the zygomaticus major, zygomaticus minor, and levator labii suprioris muscles, which raise the corner of the mouth, are the first to degenerate in patients with severe facial paralysis. This study demonstrated that ultrasonography is a simple and non-invasive examination for facial paralysis.
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Affiliation(s)
- Ji Hae Lee
- Department of Otorhinolaryngology, Dong-Tan Sacred Heart Hospital, Hallym University College of Medicine, 7 Keunjaebong-gil, Dongtan 1(il)-dong, Hwaseong-si, Gyeonggi-do, 445-907, South Korea
| | - Il-Seok Park
- Department of Otorhinolaryngology, Dong-Tan Sacred Heart Hospital, Hallym University College of Medicine, 7 Keunjaebong-gil, Dongtan 1(il)-dong, Hwaseong-si, Gyeonggi-do, 445-907, South Korea
| | - Jin Kim
- Department of Otorhinolaryngology, Dong-Tan Sacred Heart Hospital, Hallym University College of Medicine, 7 Keunjaebong-gil, Dongtan 1(il)-dong, Hwaseong-si, Gyeonggi-do, 445-907, South Korea.
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8
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Nocini R, Soloperto D, Arietti V, De Cecco F, Fulco G, Monzani D, Marchioni D, Sacchetto L. Subtotal Petrosectomy: Pictorial Review of Clinical Indications and Surgical Approach. Indian J Otolaryngol Head Neck Surg 2024; 76:224-236. [PMID: 38440666 PMCID: PMC10909040 DOI: 10.1007/s12070-023-04131-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/31/2023] [Indexed: 03/06/2024] Open
Abstract
Subtotal petrosectomy (STP) is characterized by obliteration of the middle ear and occlusion of the external auditory canal. The advent of the endoscope has allowed a reduction in morbidity for some conditions such as cholesteatoma and other middle ear disorders, but STP still plays an important role. A retrospective review of medical records and videos of patients who had undergone STP was performed. Perioperative data and images were collected from various clinical cases who had undergone subtotal petrosectomy at our tertiary referral university hospital in Verona. We confronted our experience with a review of the literature to present the main indications for this type of procedure. STP allows a variety of diseases to be managed effectively as it offers the possibility of a definitive healing with radical clearance of temporal bone. Moreover, it can be safely combined with other procedures with a very low complication rate. Although the endoscope represents a revolution in ear surgery, STP, when indicated, is nowadays a surgical option that should be included in the otosurgeon's portfolio.
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Affiliation(s)
- Riccardo Nocini
- Unit of Otolaryngology - Head and Neck Department, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy
| | - Davide Soloperto
- Unit of Otolaryngology - Head and Neck Department, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy
| | - Valerio Arietti
- Unit of Otolaryngology - Head and Neck Department, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy
| | - Francesca De Cecco
- Unit of Otolaryngology - Head and Neck Department, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy
| | - Gianfranco Fulco
- Unit of Otolaryngology - Head and Neck Department, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy
| | - Daniele Monzani
- Unit of Otolaryngology - Head and Neck Department, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy
| | - Daniele Marchioni
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Luca Sacchetto
- Unit of Otolaryngology - Head and Neck Department, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy
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Woo SH, Kim YC, Oh TS. Facial palsy reconstruction. Arch Craniofac Surg 2024; 25:1-10. [PMID: 38461822 PMCID: PMC10924795 DOI: 10.7181/acfs.2023.00528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 10/17/2023] [Accepted: 11/08/2023] [Indexed: 03/12/2024] Open
Abstract
The facial nerve stimulates the muscles of facial expression and the parasympathetic nerves of the face. Consequently, facial nerve paralysis can lead to facial asymmetry, deformation, and functional impairment. Facial nerve palsy is most commonly idiopathic, as with Bell palsy, but it can also result from a tumor or trauma. In this article, we discuss traumatic facial nerve injury. To identify the cause of the injury, it is important to first determine its location. The location and extent of the damage inform the treatment method, with options including primary repair, nerve graft, cross-face nerve graft, nerve crossover, and muscle transfer. Intracranial proximal facial nerve injuries present a challenge to surgical approaches due to the complexity of the temporal bone. Surgical intervention in these cases requires a collaborative approach between neurosurgery and otolaryngology, and nerve repair or grafting is difficult. This article describes the treatment of peripheral facial nerve injury. Primary repair generally offers the best prognosis. If primary repair is not feasible within 6 months of injury, nerve grafting should be attempted, and if more than 12 months have elapsed, functional muscle transfer should be performed. If the affected nerve cannot be utilized at that time, the contralateral facial nerve, ipsilateral masseter nerve, or hypoglossal nerve can serve as the donor nerve. Other accompanying symptoms, such as lagophthalmos or midface ptosis, must also be considered for the successful treatment of facial nerve injury.
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Affiliation(s)
- Soo Hyun Woo
- Department of Plastic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Young Chul Kim
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Suk Oh
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Rajangam J, Lakshmanan AP, Rao KU, Jayashree D, Radhakrishnan R, Roshitha B, Sivanandy P, Sravani MJ, Pravalika KH. Bell Palsy: Facts and Current Research Perspectives. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2024; 23:203-214. [PMID: 36959147 DOI: 10.2174/1871527322666230321120618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 02/07/2023] [Accepted: 02/13/2023] [Indexed: 03/25/2023]
Abstract
Bell palsy is a non-progressive neurological condition characterized by the acute onset of ipsilateral seventh cranial nerve paralysis. People who suffer from this type of facial paralysis develop a droop on one side of their face, or sometimes both. This condition is distinguished by a sudden onset of facial paralysis accompanied by clinical features such as mild fever, postauricular pain, dysgeusia, hyperacusis, facial changes, and drooling or dry eyes. Epidemiological evidence suggests that 15 to 23 people per 100,000 are affected each year, with a recurrence rate of 12%. It could be caused by ischaemic compression of the seventh cranial nerve, which could be caused by viral inflammation. Pregnant women, people with diabetes, and people with respiratory infections are more likely to have facial paralysis than the general population. Immune, viral, and ischemic pathways are all thought to play a role in the development of Bell paralysis, but the exact cause is unknown. However, there is evidence that Bell's hereditary proclivity to cause paralysis is a public health issue that has a greater impact on patients and their families. Delay or untreated Bell paralysis may contribute to an increased risk of facial impairment, as well as a negative impact on the patient's quality of life. For management, antiviral agents such as acyclovir and valacyclovir, and steroid treatment are recommended. Thus, early diagnosis accompanied by treatment of the uncertain etiology of the disorder is crucial. This paper reviews mechanistic approaches, and emerging medical perspectives on recent developments that encounter Bell palsy disorder.
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Affiliation(s)
- Jayaraman Rajangam
- AMITY Institute of Pharmacy, AMITY University, Lucknow, Uttar Pradesh, 226028, India
| | | | - K Umamaheswara Rao
- Department of Pharmacology, Sri Venkateswara Institute of Medical Sciences, Sri Padmavati Mahila Visvavidyalayam, Tirupati, Andhra Pradesh, 517507, India
| | - D Jayashree
- Sree Vidyanikethan College of Pharmacy - Tirupati, Andhra Pradesh-517501, India
| | - Rajan Radhakrishnan
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Healthcare City, P.O Box 505055, Dubai, UAE
| | - B Roshitha
- Sri Venkateswara Institute of Cancer Care and Advanced Research, Tirupati, Andhra Pradesh, 517507, India
| | - Palanisamy Sivanandy
- School of Pharmacy, International Medical University, No 126, Jalan Jalil Perkasa 19, Bukit Jalil 57000 Kuala Lumpur, Malaysia
| | - M Jyothi Sravani
- Sree Vidyanikethan College of Pharmacy - Tirupati, Andhra Pradesh-517501, India
| | - K Hanna Pravalika
- Sree Vidyanikethan College of Pharmacy - Tirupati, Andhra Pradesh-517501, India
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Pingree G, Stingl CS, West E, Wiles A, Coelho D, Petersson R. Intratemporal facial nerve neurofibroma causing facial paralysis in an infant: Case report and review of the literature. Am J Otolaryngol 2024; 45:104078. [PMID: 37806280 DOI: 10.1016/j.amjoto.2023.104078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 09/30/2023] [Indexed: 10/10/2023]
Abstract
This article describes the first recorded case of intratemporal neurofibroma in an infant. A literature review of all other existing cases of intratemporal neurofibroma is performed, finding that the majority of cases involve multiple segments and can be found in the mastoid segment most often. Most common symptoms described included facial paralysis, otalgia, and conductive hearing loss, respectively.
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Affiliation(s)
- Graham Pingree
- Virginia Commonwealth University School of Medicine, Richmond, VA, United States of America.
| | - Cybil Sierra Stingl
- Virginia Commonwealth University School of Medicine, Richmond, VA, United States of America
| | - Emma West
- Dept. of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University Health System, Richmond, VA, United States of America
| | - Austin Wiles
- Dept. of Pathology, Virginia Commonwealth University Health System, Richmond, VA, United States of America
| | - Daniel Coelho
- Dept. of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University Health System, Richmond, VA, United States of America
| | - Rajanya Petersson
- Dept. of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University Health System, Richmond, VA, United States of America; Dept. of Otolaryngology - Head and Neck Surgery, Children's Hospital of Richmond at VCU, Richmond, VA, United States of America
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Furukawa T, Goto T, Abe Y, Sugiyama M, Ito T, Kubota T, Matsui H, Futai K, Kakehata S. The use of basic fibroblast growth factor to treat intractable Bell's palsy administered via transcanal endoscopic ear surgery. Am J Otolaryngol 2024; 45:104020. [PMID: 37604093 DOI: 10.1016/j.amjoto.2023.104020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 08/01/2023] [Accepted: 08/06/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE Facial nerve decompression surgery is an invasive procedure which has hitherto been the main option for patients with severe intractable Bell's palsy which is resistant to drug treatment. We have developed a new salvage treatment for such patients by using minimally invasive transcanal endoscopic ear surgery (TEES) to deliver the biological regenerative agent, basic fibroblast growth factor (bFGF), to the damaged facial nerve. MATERIALS AND METHODS An endoscopic salvage treatment group was studied prospectively and was made up of severe intractable Bell's palsy patients who did not respond to high dose steroid treatment and had an ENoG value of 5 % or less. This surgery group was retrospectively compared to a similar control group who had received high dose steroid only. RESULTS Complete recovery to House-Brackmann (HB) Grade I was achieved by 44.8 % of the endoscopic salvage treatment group which was significantly higher than the 21.2 % of the control group at one-year follow up. Patients with an ENoG value of 1 % to 5 % exhibited a significantly higher complete recovery rate of 71.4 % in the endoscopic salvage treatment group than the 28.6 % of the control group. In addition, no complications were observed including hearing loss. CONCLUSIONS bFGF delivered via TEES shows considerable promise as a new salvage treatment of severe intractable Bell's palsy that is resistant to high dose steroid treatment without the risks presented by facial nerve decompression surgery.
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Affiliation(s)
- Takatoshi Furukawa
- Department of Otolaryngology, Head and Neck Surgery, Yamagata University, Faculty of Medicine, Japan.
| | - Takanari Goto
- Department of Otolaryngology, Head and Neck Surgery, Yamagata University, Faculty of Medicine, Japan
| | - Yasuhiro Abe
- Department of Otolaryngology, Head and Neck Surgery, Yamagata University, Faculty of Medicine, Japan
| | - Motoyasu Sugiyama
- Department of Otolaryngology, Head and Neck Surgery, Yamagata University, Faculty of Medicine, Japan
| | - Tsukasa Ito
- Department of Otolaryngology, Head and Neck Surgery, Yamagata University, Faculty of Medicine, Japan
| | - Toshinori Kubota
- Department of Otolaryngology, Head and Neck Surgery, Yamagata University, Faculty of Medicine, Japan
| | - Hirooki Matsui
- Department of Otolaryngology, Head and Neck Surgery, Yamagata University, Faculty of Medicine, Japan
| | - Kazunori Futai
- Department of Otolaryngology, Head and Neck Surgery, Yamagata University, Faculty of Medicine, Japan
| | - Seiji Kakehata
- Department of Otolaryngology, Head and Neck Surgery, Yamagata University, Faculty of Medicine, Japan
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Johns JD, Pittman C, Briggs SE. Temporal Bone Trauma. Otolaryngol Clin North Am 2023; 56:1055-1067. [PMID: 37385862 DOI: 10.1016/j.otc.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Temporal bone trauma represents a potentially underrecognized condition during head injuries and remains an important consideration during the evaluation of these patients. The temporal bone contains many critical neurovascular structures in addition to the primary organs of the auditory and vestibular systems that may be violated during these injuries. Despite the lack of consensus guidelines on the management of these injuries, this review highlights the current literature regarding the diagnosis and management of temporal bone trauma and its potential complications.
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Affiliation(s)
- James Dixon Johns
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Gorman Building, 1st Floor, 3800 Reservoir Road NW, Washington DC 20007, USA; Department of Otolaryngology-Head and Neck Surgery, MedStar Washington Hospital Center, 106 Irving Street Northwest, Suite 2700, Washington, DC 20010, USA
| | - Corinne Pittman
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Gorman Building, 1st Floor, 3800 Reservoir Road NW, Washington DC 20007, USA; Department of Otolaryngology-Head and Neck Surgery, MedStar Washington Hospital Center, 106 Irving Street Northwest, Suite 2700, Washington, DC 20010, USA
| | - Selena E Briggs
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Gorman Building, 1st Floor, 3800 Reservoir Road NW, Washington DC 20007, USA; Department of Otolaryngology-Head and Neck Surgery, MedStar Washington Hospital Center, 106 Irving Street Northwest, Suite 2700, Washington, DC 20010, USA.
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14
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Molinari G, Lucidi D, Fernandez IJ, Barbazza A, Vanelli E, Lami F, Federici G, Botti C, Presutti L, D'Angelo R, Rinaldi R, Alicandri-Ciufelli M. Acquired bilateral facial palsy: a systematic review on aetiologies and management. J Neurol 2023; 270:5303-5312. [PMID: 37523065 PMCID: PMC10576676 DOI: 10.1007/s00415-023-11897-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE To systematically review the published cases of bilateral facial palsy (BFP) to gather evidence on the clinical assessment and management of this pathology. METHODS Following PRISMA statement recommendations, 338 abstracts were screened independently by two authors. Inclusion criteria were research articles of human patients affected by BFP, either central or peripheral; English, Italian, French or Spanish language; availability of the abstract, while exclusion criteria were topics unrelated to FP, and mention of unilateral or congenital FP. Only full-text articles reporting the diagnostic work-up, the management, and the prognosis of the BFP considered for further specific data analysis. RESULTS A total of 143 articles were included, resulting a total of 326 patients with a mean age of 36 years. The most common type of the paralysis was peripheral (91.7%), and the autoimmune disease was the most frequent aetiology (31.3%). The mean time of onset after first symptoms was 12 days and most patients presented with a grade higher than III. Associated symptoms in idiopathic BFP were mostly non-specific. The most frequently positive laboratory exams were cerebrospinal fluid analysis, autoimmune screening and peripheral blood smear, and the most performed imaging was MRI. Most patients (74%) underwent exclusive medical treatment, while a minority were selected for a surgical or combined approach. Finally, in more than half of cases a complete bilateral recovery (60.3%) was achieved. CONCLUSIONS BFP is a disabling condition. If a correct diagnosis is formulated, possibilities to recover are elevated and directly correlated to the administration of an adequate treatment.
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Affiliation(s)
- Giulia Molinari
- Department of Otolaryngology - Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Daniela Lucidi
- Department of Otolaryngology - Head and Neck Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Ignacio Javier Fernandez
- Department of Otolaryngology - Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Alice Barbazza
- Department of Otolaryngology - Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - Università di Bologna, Bologna, Italy.
| | - Elena Vanelli
- Department of Otolaryngology - Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Federico Lami
- Department of Otolaryngology - Head and Neck Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Gaia Federici
- Department of Otolaryngology - Head and Neck Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Cecilia Botti
- Department of Otolaryngology - Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Livio Presutti
- Department of Otolaryngology - Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | | | - Rita Rinaldi
- IRCCS Istituto Scienze Neurologiche di Bologna, Bologna, Italy
| | - Matteo Alicandri-Ciufelli
- Department of Otolaryngology - Head and Neck Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
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15
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Hamiter M, Amorosa V, Belden K, Gidley PW, Mohan S, Perry B, Kim AH. Skull Base Osteomyelitis: Historical Perspective, Diagnosis and Management Update. Otolaryngol Clin North Am 2023; 56:987-1001. [PMID: 37479637 DOI: 10.1016/j.otc.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Abstract
SBO is a life-threatening disease that requires a high index of suspicion based on these patients complex underlying medical co-morbidities and clinician's acumen. Once a diagnosis is made, is it critical to communicate and work closely with other multidisciplinary teams (neuroradiology for appropriate choice of imaging study and interpretation; infectious disease for appropriate medical treatment and duration; internist to properly manage their underlying medical co-morbidities). Despite advances in imaging, the diagnosis is first made based on clinical judgment, appropriate culture, and tissue biopsy.
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Affiliation(s)
- Mickie Hamiter
- Department of Otolaryngology, Columbia University Irving Medical Center, New York, NY, USA
| | - Valerianna Amorosa
- Module E, First floor, Corporal Michael J. Crescenz VA Medical Center, University and Woodlawn Avenue, Philadelphia, PA 19104, USA
| | - Katherine Belden
- Division of Infectious Diseases, Thomas Jefferson University Hospital, 1101 Market Street, Suite 2720, Philadelphia, PA 19107, USA
| | - Paul W Gidley
- Department of Head and Neck Surgery, UT MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1445, Houston, TX 77030, USA
| | - Suyash Mohan
- Department of Radiology, 219 Dulles Building, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19004, USA
| | - Brian Perry
- Department of OTO-HNS, UT Health San Antonio, Joe R. and Teresa Lozano Long School of Medicine, 7703 Floyd Curl Drive, MC 7777, San Antonio, TX 78229-3900, USA
| | - Ana H Kim
- Department of Otolaryngology, Columbia University Irving Medical Center, New York, NY, USA.
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Hussain A. Dynamic eyelid reconstruction in facial nerve palsy. Surv Ophthalmol 2023; 68:985-1001. [PMID: 37201598 DOI: 10.1016/j.survophthal.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 05/01/2023] [Accepted: 05/08/2023] [Indexed: 05/20/2023]
Abstract
The consequences of facial nerve palsy and the secondary inability of eyelid closure and blink may lead to devastating complications for the patient, including blindness. Reconstruction techniques to improve eyelid position and function can be broadly classified into 'static' and 'dynamic' techniques. Generally, ophthalmologists have been familiar with static procedures such as upper eyelid loading, tarsorrhaphy, canthoplasty, and lower eyelid suspension. Recently, dynamic techniques are being increasingly described for patients who require definitive strategies to improve eyelid function, once the initial critical goals of corneal protection and vision preservation have been achieved. The choice of technique(s) is dependent upon the status of the main protractor of the eyelid region, as well as the age of the patient, the patient's morbidities and expectations, and surgeon preference. This review shall first describe the clinical and surgical anatomy relevant to the ophthalmic consequences of facial paralysis and discuss methods of defining function and outcomes. A comprehensive review of dynamic eyelid reconstruction is then presented with a discussion of the literature. These various techniques may not be familiar to all clinicians. It is important that ophthalmic surgeons are aware of all options available for their patients. Furthermore, eye care providers must have an understanding of when referral may be appropriate to provide timely intervention and optimal chances of recovery.
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Affiliation(s)
- Ahsen Hussain
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada.
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Lee JM, Yeo SG, Jung SY, Jung J, Kim SS, Yoo MC, Rim HS, Min HK, Kim SH, Park DC. Expression and Role of Toll-like Receptors in Facial Nerve Regeneration after Facial Nerve Injury. Int J Mol Sci 2023; 24:11245. [PMID: 37511005 PMCID: PMC10379409 DOI: 10.3390/ijms241411245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 06/27/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
Facial nerve palsy directly impacts the quality of life, with patients with facial nerve palsy showing increased rates of depression and limitations in social activities. Although facial nerve palsy is not life-threatening, it can devastate the emotional and social lives of affected individuals. Hence, improving the prognosis of patients with this condition is of vital importance. The prognosis of patients with facial nerve palsy is determined by the cause of the disease, the degree of damage, and the treatment provided. The facial nerve can be easily damaged by middle ear and temporal bone surgery, trauma or infection, and tumors of the peripheral facial nerve or tumors surrounding the nerve secondary to systemic disease. In addition, idiopathic, acquired immunodeficiency syndrome and autoimmune diseases may damage the facial nerve. The treatment used for facial paralysis depends on the cause. Treatment of facial nerve amputation injury varies depending on the degree of facial nerve damage, comorbidities, and duration of injury. Recently, interest has increased in Toll-like receptors (TLRs) related to innate immune responses, as these receptors are known to be related to nerve regeneration. In addition to innate immune cells, both neurons and glia of the central nervous system (CNS) and peripheral nervous system (PNS) express TLRs. A comprehensive literature review was conducted to assess the expression and role of TLRs in peripheral nerve injury and subsequent regeneration. Studies conducted on rats and mice have demonstrated the expression of TLR1-13. Among these, TLR2-5 and TLR7 have received the most research attention in relation to facial nerve degeneration and regeneration. TLR10, TLR11, and TLR13 increase during compression injury of the facial nerve, whereas during cutting injury, TLR1-5, TLR8, and TLR10-13 increase, indicating that these TLRs are involved in the degeneration and regeneration of the facial nerve following each type of injury. Inadequate TLR expression or absence of TLR responses can hinder regeneration after facial nerve damage. Animal studies suggest that TLRs play an important role in facial nerve degeneration and regeneration.
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Affiliation(s)
- Jae-Min Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Kyung Hee University Medical Center, Seoul 02447, Republic of Korea
| | - Seung Geun Yeo
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Kyung Hee University Medical Center, Seoul 02447, Republic of Korea
| | - Su Young Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Myongji Hospital, Hanyang University College of Medicine, Goyang 04763, Republic of Korea
| | - Junyang Jung
- Department of Anatomy and Neurobiology, College of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Sung Soo Kim
- Department of Biochemistry and Molecular Biology, College of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Myung Chul Yoo
- Department of Physical Medicine & Rehabilitation, College of Medicine, Kyung Hee University Hospital, Seoul 05278, Republic of Korea
| | - Hwa Sung Rim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Kyung Hee University Medical Center, Seoul 02447, Republic of Korea
| | - Hye Kyu Min
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Kyung Hee University Medical Center, Seoul 02447, Republic of Korea
| | - Sang Hoon Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Kyung Hee University Medical Center, Seoul 02447, Republic of Korea
| | - Dong Choon Park
- Department of Obstetrics and Gynecology, St. Vincent's Hospital, The Catholic University of Korea, Suwon 442723, Republic of Korea
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Chern A, Mudry A, Lustig LR. Bell's Palsy and Its Semantic Change over Time. Otol Neurotol 2023; 44:90-95. [PMID: 36344494 DOI: 10.1097/mao.0000000000003742] [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: 11/10/2022]
Abstract
BACKGROUND From 1821 to 1829, Sir Charles Bell presented cases of facial paralysis from infection, trauma, and unknown causes. As such, "Bell's palsy" initially referred to facial palsy of any etiology. Today, the term is reserved for idiopathic peripheral facial palsy. The objectives of this analysis were to establish when the eponym came to vogue and delineate the semantic shift from its original definition to its current one. METHODS Extensive review of available 19th and 20th century literature mentioning "Bell's palsy" and "Bell's paralysis." RESULTS Historical accounts have eponymously attached Bell's name to facial paralysis as early as the 1840s-Bell's palsy was first used to describe cases of facial palsy of any cause. In 1886, Gowers characterized Bell's palsy as a "neuritis usually within the Fallopian Canal," distinguishing it as a separate etiology. Over the next decades, the definition narrowed to peripheral facial paralysis from cold exposure or unknown causes. By the 1940s, its natural history was well described-an acute, unilateral, idiopathic, and usually self-limited peripheral facial palsy. CONCLUSION The semantic change of a word over time can tell us a remarkable story of its history and origins. Absence of a discrete lesion, lack of proven treatment, and good prognosis without intervention distinguished Bell's palsy from other causes of facial paralysis. Over time, the definition has narrowed from a facial palsy of any cause to an idiopathic peripheral facial palsy. Recent evidence supporting Bell's palsy as a viral mononeuritis may have driven its recent semantic change toward this specific etiology.
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Affiliation(s)
| | - Albert Mudry
- Department of Otolaryngology, Head & Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Lawrence R Lustig
- Department of Otolaryngology-Head & Neck Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center and Columbia University Vagelos College of Physicians and Surgeons
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Freeman MH, Perkins EL, Tawfik KO, O'Malley MR, Labadie RF, Haynes DS, Bennett ML. Facial Paralysis in Skull Base Osteomyelitis - Comparison of Surgical and Nonsurgical Management. Laryngoscope 2023; 133:179-183. [PMID: 35546515 DOI: 10.1002/lary.30161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/18/2022] [Accepted: 04/25/2022] [Indexed: 02/02/2023]
Abstract
TITLE Facial Paralysis in Skull Base Osteomyelitis - Comparison of Surgical and Nonsurgical Management. OBJECTIVE To compare outcomes of surgical and nonsurgical management in cases of facial paresis secondary to skull base osteomyelitis. METHODS A 14 patients presenting with skull base osteomyelitis complicated by facial nerve paresis at a single tertiary referral center from 2009 to 2019 were retrospectively reviewed. Patients were treated with medical therapy with or without surgical intervention, consisting of mastoidectomy and debridement with or without facial nerve decompression. House-Brackmann (HB) Grade was the main outcome measure. RESULTS A 14 patients (average age 68 years, range 58-82 years, 71% male) were analyzed, with 5 undergoing facial nerve decompression (36%), 5 undergoing mastoidectomy without facial nerve decompression (36%), and 4 undergoing medical management alone (28%). Of the 4 patients who underwent medical therapy alone, none experienced significant improvement in facial function. Of the 5 patients who underwent facial nerve decompression, 3 patients experienced improved facial function. Of the 5 patients who underwent mastoidectomy without decompression, 4 experienced improved facial function. There was no clear link between the severity of infection and the severity of facial paresis. When comparing HB score changes before and after treatment across groups, there was no statistically significant difference seen (p = 0.47). CONCLUSIONS Mastoidectomy and debridement with or without facial nerve decompression may improve facial nerve outcomes when compared to isolated medical management, although differences were not of statistical significance. The best facial nerve recoveries occurred in patients undergoing surgery within 14 days of the onset of paralysis. LEVEL OF EVIDENCE 4 - Case Series Laryngoscope, 133:179-183, 2023.
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Affiliation(s)
- Michael H Freeman
- The Otology Group, Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elizabeth L Perkins
- The Otology Group, Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kareem O Tawfik
- The Otology Group, Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew R O'Malley
- The Otology Group, Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert F Labadie
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - David S Haynes
- The Otology Group, Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marc L Bennett
- The Otology Group, Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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20
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Wamkpah NS, Kallogjeri D, Snyder-Warwick AK, Buss JL, Durakovic N. Incidence and Management of Facial Paralysis After Skull Base Trauma, an Administrative Database Study. Otol Neurotol 2022; 43:e1180-e1186. [PMID: 36214506 PMCID: PMC9649848 DOI: 10.1097/mao.0000000000003721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Report the incidence of and treatment patterns for facial nerve palsy after skull base fracture. STUDY DESIGN Retrospective cohort study. SETTING IBM MarketScan Commercial Database (2006-2019). PATIENTS Human subjects with skull base fracture, per International Classification of Diseases-9th and 10th Revisions-Clinical Modification diagnosis codes. MAIN OUTCOME MEASURES The primary outcomes were the incidence and median time to facial nerve palsy diagnosis within 30 days of skull base fracture. Secondary outcomes were treatments (corticosteroids, antivirals, facial nerve decompression, botulinum toxin, and facial reanimation), demographics, and rates of hearing loss, vertigo, tympanic membrane rupture, cerebrospinal fluid leak, comorbidities, and loss of consciousness. RESULTS The 30-day incidence of facial nerve palsy after skull base trauma was 1.0% (738 of 72,273 patients). The median (95% confidence interval [CI]) time to diagnosis was 6 (6-7) days, and only 22.9% were diagnosed within 1 day. There were significantly higher rates (risk difference, 95% CI) of hearing loss (26%, 22-29%), tympanic membrane rupture (6.3%, 4.5-8.1%), cerebrospinal fluid leak (6.4%, 4.5-8.3%), comorbidity (14%, 10.4-17.6%), and loss of consciousness (24.3%, 20.7-27.9%). Loss of consciousness was associated with longer median (95% CI) time to facial nerve palsy diagnosis: 10 (9-10) days. Corticosteroids were the most common treatment but only reported for less than one-third of patients. Only eight patients underwent facial nerve decompression. CONCLUSIONS Facial nerve palsy after skull base fracture is associated with higher comorbidity, and the diagnosis is often delayed. Few patients were treated with surgery, and there are inconsistencies in the types and timing of treatments.
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Affiliation(s)
- Nneoma S. Wamkpah
- Department of Otolaryngology—Head and Neck Surgery, Washington University in St. Louis, St. Louis, MO
| | - Dorina Kallogjeri
- Department of Otolaryngology—Head and Neck Surgery, Washington University in St. Louis, St. Louis, MO
| | - Alison K. Snyder-Warwick
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University in St. Louis, St. Louis, MO
| | - Joanna L. Buss
- Institute of Clinical and Translational Sciences, Center for Administrative Data Research, Washington University in St. Louis, St. Louis, MO
| | - Nedim Durakovic
- Department of Otolaryngology—Head and Neck Surgery, Washington University in St. Louis, St. Louis, MO
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21
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Surgical Reconsideration of Traumatic Facial Paralysis. Otol Neurotol 2022; 43:968-972. [PMID: 35970159 DOI: 10.1097/mao.0000000000003633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Despite the different pathophysiological mechanisms underlying Bell's palsy, in assessing severe traumatic facial paralysis, many surgeons rely on electrophysiological criteria to determine whether facial nerve exploration is warranted. To assess the value of preoperative electroneurography (ENoG) and the time of surgery, we analyzed data from three tertiary medical centers. MATERIALS AND METHODS The records of 517 patients with a degenerative ratio (DR) greater than 80% on ENoG were collected, and two groups were defined: group A (90% DR ≤ ENoG) and group B (80% DR ≤ ENoG < 90% DR). The difference in effectiveness of surgery versus conservative treatment was analyzed based on the postoperative outcome determined by the House-Brackmann grading system. The independent-samples t test was used to compare surgery with conservative treatment for each day of surgical exploration. RESULT In groups A and B, the average recovery time from facial paralysis was better in patients who had undergone surgical exploration than in those who had been treated conservatively. In group A, the difference was significant only for patients who underwent surgery within 8 days. In group B, a significant difference was found for patients who underwent surgery within 16 days but also for surgery performed 20 and 30 days after the onset of facial paralysis. DISCUSSION In the surgical treatment of facial paralysis, the criteria for trauma patients should be distinguished from those of patients with Bell's palsy. In traumatic facial paralysis, some axons are more vulnerable to external collapse, and the degree of Wallerian degeneration of the peripheral nervous system will vary depending on the type of injury. The results of this study will help to identify those patients with traumatic facial paralysis who should be treated surgically and when they should be treated.
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22
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Comparison of Medical and Surgical Treatment in Severe Bell's Palsy. J Clin Med 2022; 11:jcm11030888. [PMID: 35160337 PMCID: PMC8836601 DOI: 10.3390/jcm11030888] [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: 12/18/2021] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 02/04/2023] Open
Abstract
(1) Background: The effectiveness of decompression surgery for Bell’s palsy is controversial. This study investigated the effects of facial nerve decompression in patients with severe Bell’s palsy who were expected to have a poor prognosis. (2) Methods: We retrospectively reviewed 1721 patients with Bell’s palsy who visited the Kyung Hee University Hospital between January 2005 and December 2021. Of these, 45 patients with severe Bell’s palsy were divided into two groups; 30 patients were treated conservatively with steroids and antiviral agents alone, while 15 patients underwent additional decompressive surgery after the conservative treatment. Outcomes were measured using House–Brackmann (H–B) grade for least 6 months after treatment was finished and conducted until full recovery was achieved. (3) Results: There was no significant difference in the rate of favorable recovery (H–B grade 1 or 2) between the surgery group and the conservative treatment group (75% vs. 70.0%, p > 0.05). Although H–B grade improvement occurred in both groups, the degree of improvement was not significantly different between groups. (4) Conclusions: Facial nerve decompression surgery in severe Bell’s palsy patients did not significantly improve prognosis beyond that offered by conservative treatment alone. Additional surgical decompression may not be necessary in patients with severe Bell’s palsy if they receive sufficient conservative treatment.
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Bavisetty LM, Rathod J, Bohra R. A retrospective analysis of facial palsy in patients of squamosal chronic suppurative otitis media with diabetes mellitus. MGM JOURNAL OF MEDICAL SCIENCES 2022. [DOI: 10.4103/mgmj.mgmj_69_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Wang Z, Chai Y, Chen Z, Wu H, Wang Z. Endoscopic transcanal facial nerve decompression in Bell's palsy: A pilot study. Am J Otolaryngol 2022; 43:103167. [PMID: 34371460 DOI: 10.1016/j.amjoto.2021.103167] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 05/01/2021] [Accepted: 07/17/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To explore the surgical effects of endoscopic facial nerve decompression in Bell's palsy. MATERIALS AND METHODS This retrospective study included 15 patients with Bell's palsy. All had grade VI (House-Brackmann grading system) complete unilateral facial paralysis before surgery and a >95% reduction in amplitude on electroneurography testing compared to the unaffected side. Their MRI results indicated perineural edema in the geniculate ganglion area. Endoscopic decompression surgery was performed soon after they presented at our hospital. The time between onset of facial paralysis and surgery ranged from 25 to 93 days. All patients had no relevant surgical history or ear diseases. RESULTS At 1-year follow-up, 13 of the 15 (87%) patients had recovered to normal or near-normal facial function (House-Brackmann grade I-II), and all patients had reached House-Brackmann grade III or lower facial function. No obvious air-bone gap or sensorineural hearing loss occurred after surgery, and there were no severe complications or synkinesis. CONCLUSIONS Endoscopic transcanal facial nerve decompression provides a less traumatic and improved exposure of the geniculate ganglion, and may also help prevent permanent severe facial sequela. Results of intraoperative facial nerve stimulation may be related to the length of time required for recovery. The optimal time of surgery after onset of paralysis needs to be investigated further, to identify a post-drug surgical therapy which may be more acceptable for patients. Patients' response to conservative treatments should be assessed as soon as possible so as not to delay surgery.
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Bilge S, Mert GG, Hergüner MÖ, İncecik F, Sürmelioğlu Ö, Bilen S, Yılmaz L. Peripheral facial nerve palsy in children: clinical manifestations, treatment and prognosis. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022; 58:152. [PMCID: PMC9734354 DOI: 10.1186/s41983-022-00596-1] [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] [Received: 11/10/2021] [Accepted: 11/25/2022] [Indexed: 12/13/2022] Open
Abstract
Background Sudden onset of unilateral weakness of the upper and lower muscles of one side of the face is defined as peripheral facial nerve palsy. Peripheral facial nerve palsy is often idiopathic and sometimes it could be due to infectious, traumatic, neoplastic, and immune causes. This study aimed to report the clinical manifestation, evaluation, and prognosis in children with peripheral facial nerve palsy. Methods 57 children under 18 years of age diagnosed with peripheral facial nerve palsy at Çukurova University, Balcalı Hospital, between January 2018 and September 2021, were included in the study. Results The mean age of the children at the time of diagnosis was 9.6 ± 7, 4 years. Thirty-two (56.1%) of the patients were female and 25 (43.9%) were male. A total of 57 patients were diagnosed with peripheral facial nerve palsy and categorized into many groups by etiology: idiopathic Bell’s palsy in 27 (47.5%), infectious in 11 (19.2%), traumatic in 6 (10.5%), and others (due to congenital, immune, neoplastic, Melkersson–Rosenthal syndrome, drug toxicity, and iatrogenic causes) in 13 (22.8%). Forty-six of the children achieved full recovery under oral steroids within 1–7 months. Four patients with acute leukemia, myelodysplastic syndrome, Mobius syndrome and trauma did not recover and two patients (schwannoma, trauma) showed partial improvement. Five patients could not come to follow-up control. Conclusion Peripheral facial nerve palsy is a rare condition in children with different causes. It could be idiopathic, congenital, or due to infectious, traumatic, neoplastic, and immune reasons. So, when a child presents with facial palsy, a complete clinical history and a detailed clinical examination are recommended. Giving attention to the red flag is very important. Peripheral facial nerve palsy in children is considered to have a good prognosis.
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Affiliation(s)
- Serap Bilge
- grid.98622.370000 0001 2271 3229Department of Pediatric Neurology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Gülen Gül Mert
- grid.98622.370000 0001 2271 3229Department of Pediatric Neurology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - M. Özlem Hergüner
- grid.98622.370000 0001 2271 3229Department of Pediatric Neurology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Faruk İncecik
- grid.98622.370000 0001 2271 3229Department of Pediatric Neurology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Özgür Sürmelioğlu
- grid.98622.370000 0001 2271 3229Department of Ear, Nose &Throat, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Sevcan Bilen
- grid.98622.370000 0001 2271 3229Department of Pediatric Emergency, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Levent Yılmaz
- grid.98622.370000 0001 2271 3229Department of Pediatric Emergency, Faculty of Medicine, Çukurova University, Adana, Turkey
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İnan S, Jafarov S. Prognostic role of neutrophil lymphocyte ratio and mean platelet volume in Bell's palsy: Comparison of diabetic and non-diabetic patients. Braz J Otorhinolaryngol 2021; 89:98-103. [PMID: 34895869 PMCID: PMC9874336 DOI: 10.1016/j.bjorl.2021.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 08/28/2021] [Accepted: 10/19/2021] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES A low Neutrophil Lymphocyte Ratio (NLR) has been shown to be associated with good prognosis in Bell's Palsy (BP). However, the effect of chronic diseases that may affect the NLR, including Diabetes Mellitus (DM), has not been clarified in this context. This study aimed to evaluate the relationship between NLR and Mean Platelet Volume (MPV) in BP according to whether it is accompanied by DM, and their relationship with prognosis. METHODS A prospective observational study was conducted from May 2014 to May 2020 in a tertiary referral center, of all 79 consecutive participants diagnosed with BP in department of otolaryngology and 110 consecutive healthy participants admitted to the check-up unit. Patients diagnosed with BP were divided into two groups according to whether they were diagnosed with DM: diabetic BP patients (DM-BP, n = 33) and non-diabetic BP patients without any chronic disease (nonDM-BP, n = 46). Neutrophil (NEUT) and Lymphocyte (LYM) counts, and Mean Platelet Volume (MPV) were assessed from peripheral blood samples, and the NLR was calculated. Prognosis was evaluated using the House-Brackmann Score (HBS) six months after diagnosis. RESULTS The mean NLR was 2.85 ± 1.85 in BP patients and 1.69 ± 0.65 in the control group. The mean NLR was significantly higher in BP patients than healthy controls (p < 0.001). The mean NLR was 2.58 ± 1.83 in the nonDM-BP group, 3.23 ± 1.83 in the DM-BP group, and 1.69 ± 0.65 in the control group. The NLR was significantly higher in the nonDM-BP and DM-BP groups than in the control group (p < 0.05). The recovery was 90% according to the HBS. The optimal cut-off value was 2.41 (p = 0.5). CONCLUSION The NLR was increased in both diabetic and non-diabetic BP and had similar prognostic value in predicting the HBS before treatment in diabetic and non-diabetic patients with BP. MPV wasn't significantly different in diabetic and non-diabetic BP patients compared with the normal population.
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Wang CS, Sakai M, Khurram A, Lee K. Facial nerve palsy in children: A case series and literature review. OTOLARYNGOLOGY CASE REPORTS 2021. [DOI: 10.1016/j.xocr.2021.100297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Recovery from Idiopathic Facial Paralysis (Bell’s Palsy) Using Photobiomodulation in Patients Non-Responsive to Standard Treatment: A Case Series Study. PHOTONICS 2021. [DOI: 10.3390/photonics8080341] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Diminished facial movement and marked facial asymmetry can lead to a consistent psychological burden. Bell′s palsy (BP) is one of the most common causes of facial nerve illness, which comes with unilateral acute facial paresis. Nowadays, no clear guidelines for treating BP are available. We carried out a case series study to test the efficacy of photobiomodulation (PBM) therapy in patients with BP non-responsive to standard treatment. The study was experimentally performed at the Department of Surgical and Diagnostic Sciences, University of Genoa (Genoa, Italy), in accordance with case report guidelines. Patients were referred to our department by colleagues for evaluation to be included in the case series because no consistent improvement was observed at least 3 months from the diagnosis of BP. All the patients interrupted their pharmacological therapy before the initiation of PBM therapy. PBM therapy (808 nm, 1 W irradiated in continuous-wave for 60 s on spot-size 1 cm2; 1 W/cm2; 60 J/cm2; and 60 J) was administered every 2 days until complete resolution. Evaluation of the House-Brackmann scale was performed before and after treatments. Fourteen patients were screened as eligible for the study. Patients were Caucasians (36% females and 64% males) with a mean age ± standard deviation of 56.07 ± 15.21 years. Eleven patients out of 14, who experienced BP a maximum of 6 months, completely recovered through PBM. The three patients that did not show improvement were those who had experienced BP for years. PBM could be a supportive therapy for the management of BP in patients non-responsive to standard treatment. However, randomized controlled trials are necessary to sustain our encouraging results, exclude bias, and better explain the boundary between the time from diagnosis and the recovery of BP through PBM therapy.
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Aslan GG, Aslan A, Surucu S. Transmastoid exposure of the labyrinthine segment of the facial nerve: an anatomical study. Braz J Otorhinolaryngol 2021; 89:30-34. [PMID: 34462204 PMCID: PMC9874353 DOI: 10.1016/j.bjorl.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 06/14/2021] [Accepted: 07/03/2021] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Compression of the labyrinthine segment of the facial nerve by edema has been considered as an important pathology in the majority of the cases of idiopathic facial nerve paralysis. Hence, it is suggested that total decompression of the facial nerve should also include the labyrinthine segment by a middle fossa approach. However, the middle fossa approach requires craniotomy and temporal lobe retraction, which increases the morbidity. The labyrinthine segment of the facial nerve can also be reached through mastoidectomy. However, many ear surgeons are not familiar with this approach due to the lack of anatomical data on this surgical area. OBJECTIVE To study the anatomical limitations of decompression of the labyrinthine segment via transmastoid approach. METHODS Complete mastoidectomy was performed in six adult cadavers heads. Dissection was extended in the zygomatic root and posterior bony wall of the external auditory canal to visualize the incudomallear joint completely. The bone between tympanic segment, lateral and superior semicircular canal's ampullas and middle fossa dural plate was removed. Fine dissection was carried out over tympanic segment of the facial nerve in an anterosuperomedial direction the labyrinthine segment was reached. RESULTS All the mastoids were well pneumatized. Distances between the labyrinthine segment and middle fossa dura, and between the labyrinthine segment and superior semicircular canal, were 2.5 and 4.5 mm on average, respectively. In addition, distances between the middle fossa dura and dome of the lateral semicircular canal, and between the middle fossa dura and tympanic segment were 4.6 mm and 4.3 mm on average, respectively. CONCLUSION It is possible to expose the labyrinthine segment of the facial nerve through mastoidectomy by dissecting the bone in the area between the tympanic segment of the facial nerve, middle fossa dural plate and ampullary ends of the lateral and superior semicircular canals.
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Affiliation(s)
- Gulay Guclu Aslan
- Medical Sciences University, Tepecik Research and Training Hospital, ENT Clinic, Izmir, Turkey.
| | - Asim Aslan
- Manisa Celal Bayar University, Faculty of Medicine, Department of ORL, Manisa, Turkey
| | - Selcuk Surucu
- Koc University, Faculty of Medicine, Department of Anatomy, Istanbul, Turkey
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Touska P, Dudau C, Patel J, Montvila A, Pucetaite M, Obholzer R, Pai I, Connor S. Computed tomographic features of the proximal petrous facial nerve canal in recurrent Bell's palsy. Laryngoscope Investig Otolaryngol 2021; 6:816-823. [PMID: 34401507 PMCID: PMC8356870 DOI: 10.1002/lio2.571] [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: 01/06/2021] [Revised: 03/20/2021] [Accepted: 04/20/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES The primary objective was to determine whether the narrowest dimensions of the labyrinthine facial nerve (LFN) canal on the symptomatic side in patients with unilateral recurrent Bell's palsy (BP) differ from those on the contralateral side or in asymptomatic, age- and gender-matched controls on computed tomography (CT). The secondary objectives were to assess the extent of bony covering at the geniculate ganglion and to record inter-observer reliability of the CT measurements. METHODS The dimensions of the LFN canal at its narrowest point perpendicular to the long axis and the extent of bony covering at the geniculate ganglion were assessed by two radiologists. Statistical analysis was performed using the Wilcoxon signed-rank and Mann-Whitney U tests (LFN canal dimensions) and the Chi-squared test (bony covering at the geniculate ganglion). Inter-observer reliability was evaluated using Intra-Class Correlation (ICC) and Cohen's kappa. RESULTS The study included 21 patients with unilateral recurrent BP and 21 asymptomatic controls. There was no significant difference in the narrowest dimensions of the ipsilateral LFN canal when compared to the contralateral side or controls (P = .43-.94). Similarly, there was no significant difference in the extent of bony covering at the geniculate ganglion when compared to either group (P = .19-.8). Good inter-observer reliability was observed for LFN measurements (ICC = 0.75-0.88) but not for the bony covering at the geniculate ganglion (Cohen's kappa = 0.53). CONCLUSION The narrowest dimensions of the LFN canal and the extent of bony covering at the geniculate ganglion do not differ in unilateral recurrent BP, casting doubt over their etiological significance. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Philip Touska
- Department of RadiologyGuy's & St Thomas' Hospitals NHS Foundation TrustLondonUK
| | - Cristina Dudau
- Department of RadiologyGuy's & St Thomas' Hospitals NHS Foundation TrustLondonUK
- Department of NeuroradiologyKings College Hospital NHS TrustDenmark Hill, LondonUK
| | - Janki Patel
- Department of RadiologyGuy's & St Thomas' Hospitals NHS Foundation TrustLondonUK
| | - Antanas Montvila
- Lithuanian University of Health Sciences, Kaunas ClinicsKaunasLithuania
| | - Milda Pucetaite
- Lithuanian University of Health Sciences, Kaunas ClinicsKaunasLithuania
| | - Rupert Obholzer
- Department of OtolaryngologyGuy's & St Thomas' Hospitals NHS Foundation TrustLondonUK
| | - Irumee Pai
- Department of OtolaryngologyGuy's & St Thomas' Hospitals NHS Foundation TrustLondonUK
- School of Biomedical Engineering & Imaging Sciences Clinical Academic Group, King's CollegeLondonUK
| | - Steve Connor
- Department of RadiologyGuy's & St Thomas' Hospitals NHS Foundation TrustLondonUK
- Department of NeuroradiologyKings College Hospital NHS TrustDenmark Hill, LondonUK
- School of Biomedical Engineering & Imaging Sciences Clinical Academic Group, King's CollegeLondonUK
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Inagaki A, Katsumi S, Sekiya S, Murakami S. Intratympanic steroid therapy for Bell's palsy with poor prognostic results. Sci Rep 2021; 11:8058. [PMID: 33850231 PMCID: PMC8044212 DOI: 10.1038/s41598-021-87551-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 03/30/2021] [Indexed: 11/08/2022] Open
Abstract
In Bell's palsy, electrodiagnosis by electroneurography (ENoG) is widely used to predict a patient's prognosis. The therapeutic options for patients with poor prognostic results remain controversial. Here, we investigated whether early intervention with intratympanic steroid therapy (ITST) is an effective treatment for Bell's palsy patients with poor electrodiagnostic test results (≤ 10% electroneurography value). Patients in the concurrent ITST group (n = 8) received the standard systemic dose of prednisolone (410 mg total) and intratympanic dexamethasone (16.5 mg total) and those in the control group (n = 21) received systemic prednisolone at the standard dose or higher (average dose, 605 ± 27 mg). A year after onset, the recovery rate was higher in the ITST group than in the control group (88% vs 43%, P = 0.044). The average House-Brackmann grade was better in the concurrent ITST group (1.13 ± 0.13 vs 1.71 ± 0.16, P = 0.035). Concurrent ITST improves the facial nerve outcome in patients with poor electroneurography test results, regardless of whether equivalent or lower glucocorticoid doses were administered. This may be ascribed to a neuroprotective effect of ITST due to a higher dose of steroid reaching the lesion due to dexamethasone transfer in the facial nerve.
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Affiliation(s)
- Akira Inagaki
- Departments of Otolaryngology, Head and Neck Surgery, Nagoya City University, Graduate School of Medical Sciences and Medical School, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan.
| | - Sachiyo Katsumi
- Departments of Otolaryngology, Head and Neck Surgery, Nagoya City University, Graduate School of Medical Sciences and Medical School, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Shinji Sekiya
- Departments of Otolaryngology, Head and Neck Surgery, Nagoya City University, Graduate School of Medical Sciences and Medical School, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Shingo Murakami
- Departments of Otolaryngology, Head and Neck Surgery, Nagoya City University, Graduate School of Medical Sciences and Medical School, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
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Escalante DA, Malka RE, Wilson AG, Nygren ZS, Radcliffe KA, Ruhl DS, Vincent AG, Hohman MH. Determining the Prognosis of Bell's Palsy Based on Severity at Presentation and Electroneuronography. Otolaryngol Head Neck Surg 2021; 166:151-157. [PMID: 33784203 DOI: 10.1177/01945998211004169] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the demographics of Bell's palsy and determine how House-Brackmann (HB) grade at nadir and electroneuronography (ENoG) results correlate with HB grade after recovery and development of synkinesis. STUDY DESIGN Retrospective cohort study. SETTING Tertiary care military medical center. METHODS Patients with acute Bell's palsy and adequate follow-up, defined as 6 months or return to HB grade I function, were included. Demographic information, HB scores at nadir and recovery, and ENoG results were collected. RESULTS A total of 112 patient records were analyzed. Ages ranged from 8 to 87 years with peaks at 21 to 25 and 61 to 65 years. Among patients, 16.3% reached a nadir at HB II, 41.9% at HB III, 5.4% at HB IV, 16.3% at HB V, and 20.1% at HB VI. The overall recovery rate was 73.2% to HB I function, 17.0% to HB II, and 9.8% to HB III. The chance of recovery to HB I decreased as the severity of paralysis increased (rs = -1.0, P < .0001). Mean time to recovery to HB I was 6 weeks. Greater degeneration on ENoG suggested worse recovery (rs = 0.62, P = .01). Patients with HB V and VI were most likely to develop synkinesis. CONCLUSION More severe paralysis increased the chance of recovery to HB II or III function. The granularity of this study provides prognostic insights that may inform the counseling of patients with Bell's palsy with respect to prognosis and recovery timeline.
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Affiliation(s)
- Derek A Escalante
- Otolaryngology-Head and Neck Surgery, Madigan Army Medical Center, Tacoma, Washington, USA
| | - Ronit E Malka
- Otolaryngology-Head and Neck Surgery, San Antonio Military Medical Center, San Antonio, Texas, USA
| | | | - Zachary S Nygren
- Otolaryngology-Head and Neck Surgery, Madigan Army Medical Center, Tacoma, Washington, USA
| | | | - Douglas S Ruhl
- Otolaryngology-Head and Neck Surgery, Madigan Army Medical Center, Tacoma, Washington, USA
| | | | - Marc H Hohman
- Otolaryngology-Head and Neck Surgery, Madigan Army Medical Center, Tacoma, Washington, USA
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Menchetti I, McAllister K, Walker D, Donnan PT. Surgical interventions for the early management of Bell's palsy. Cochrane Database Syst Rev 2021; 1:CD007468. [PMID: 33496980 PMCID: PMC8094225 DOI: 10.1002/14651858.cd007468.pub4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Bell's palsy is an acute unilateral facial paralysis of unknown aetiology and should only be used as a diagnosis in the absence of any other pathology. As the proposed pathophysiology is swelling and entrapment of the nerve, some surgeons suggest surgical decompression of the nerve as a possible management option; this is ideally performed as soon as possible after onset. This is an update of a review first published in 2011, and last updated in 2013. This update includes evidence from one newly identified study. OBJECTIVES To assess the effects of surgery in the early management of Bell's palsy. SEARCH METHODS On 20 March 2020, we searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, Embase, ClinicalTrials.gov and WHO ICTRP. We handsearched selected conference abstracts for the original version of the review. SELECTION CRITERIA We included all randomised controlled trials (RCTs) or quasi-RCTs involving any surgical intervention for Bell's palsy. Trials compared surgical interventions to no treatment, later treatment (beyond three months), sham treatment, other surgical treatments or medical treatment. DATA COLLECTION AND ANALYSIS Three review authors independently assessed trials for inclusion, assessed risk of bias and extracted data. We used standard methodological procedures expected by Cochrane. The primary outcome was complete recovery of facial palsy at 12 months. Secondary outcomes were complete recovery at three and six months, synkinesis and contracture at 12 months, psychosocial outcomes at 12 months, and side effects and complications of treatment. MAIN RESULTS Two trials with 65 participants met the inclusion criteria; one was newly identified at this update. The first study randomised 25 participants into surgical or non-surgical (no treatment) groups using statistical charts. One participant declined surgery, leaving 24 evaluable participants. The second study quasi-randomised 53 participants; however, only 41 were evaluable as 12 declined the intervention they were allocated. These 41 participants were then divided into early surgery, late surgery or non-surgical (no treatment) groups using alternation. There was no mention on how alternation was decided. Neither study mentioned if there was any attempt to conceal allocation. Neither participants nor outcome assessors were blinded to the interventions in either study. There were no losses to follow-up in the first study. The second study lost three participants to follow-up, and 17 did not contribute to the assessment of secondary outcomes. Both studies were at high risk of bias. Surgeons in both studies used a retro-auricular/transmastoid approach to decompress the facial nerve. For the outcome recovery of facial palsy at 12 months, the evidence was uncertain. The first study reported no differences between the surgical and no treatment groups. The second study fully reported numerical data, but included no statistical comparisons between groups for complete recovery. There was no evidence of a difference for the early surgery versus no treatment comparison (risk ratio (RR) 0.76, 95% confidence interval (CI) 0.05 to 11.11; P = 0.84; 33 participants; very low-certainty evidence) and for the early surgery versus late surgery comparison (RR 0.47, 95% CI 0.03 to 6.60; P = 0.58; 26 participants; very low-certainty evidence). We considered the effects of surgery on facial nerve function at 12 months very uncertain (2 RCTs, 65 participants; very low-certainty evidence). Furthermore, the second study reported adverse effects with a statistically significant decrease in lacrimal control in the surgical group within two to three months of denervation. Four participants in the second study had 35 dB to 50 dB of sensorineural hearing loss at 4000 Hz, and three had tinnitus. Because of the small numbers and trial design we also considered the adverse effects evidence very uncertain (2 RCTs, 65 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS There is very low-certainty evidence from RCTs or quasi-RCTs on surgery for the early management of Bell's palsy, and this is insufficient to decide whether surgical intervention is beneficial or harmful. Further research into the role of surgical intervention is unlikely to be performed because spontaneous or medically supported recovery occurs in most cases.
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Affiliation(s)
| | - Kerrie McAllister
- Department of Otolaryngology, North Glasgow University NHS Trust, Glasgow, UK
| | - David Walker
- Department of Otolaryngology, North Glasgow University NHS Trust, Glasgow, UK
| | - Peter T Donnan
- Tayside Centre for General Practice, University of Dundee, Dundee, UK
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Luu NN, Chorath KT, May BR, Bhuiyan N, Moreira AG, Rajasekaran K. Clinical practice guidelines in idiopathic facial paralysis: systematic review using the appraisal of guidelines for research and evaluation (AGREE II) instrument. J Neurol 2021; 268:1847-1856. [PMID: 33389026 DOI: 10.1007/s00415-020-10345-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/19/2020] [Accepted: 12/04/2020] [Indexed: 12/18/2022]
Abstract
Bell's palsy, or idiopathic facial paralysis, is a peripheral facial palsy of unknown cause that presents as sudden, unilateral weakness of the muscles of the face. Prompt treatment of Bell's palsy is critical in order for patients to achieve complete recovery of facial function. Delays in diagnosis and management can result in permanent facial defects. A number of clinical practice guidelines (CPG) exist to guide clinical decision-making in patients presenting with idiopathic facial paralysis. However, to date, there has been no comprehensive review of the methodological rigor and quality of these CPGs. Thus, the objective of the authors is to appraise the existing CPGs to ensure safe and effective practices. A total of eight guidelines met the inclusion criteria and were appraised. Only two CPGs achieved an overall rating of 'High', having five or more quality domains scoring > 60%. Across the CPGs, the domains of rigor of development, stakeholder involvement, and applicability has the lowest overall scores with 48.1%, 43.9%, and 43.1%, respectively. Based on the AGREE II instrument, the methodological rigor and quality of CPGs for Bell's palsy is low to average. In particular, future guidelines for Bell's palsy should look to the quality domains of rigor of development, stakeholder involvement, and applicability as the greatest opportunities for improvement.
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Affiliation(s)
- Neil N Luu
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, 800 Walnut St, 18th Floor, Philadelphia, PA, 19010, USA
| | - Kevin T Chorath
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, 800 Walnut St, 18th Floor, Philadelphia, PA, 19010, USA
| | - Brandon R May
- University of Texas Health Science Center-San Antonio, Texas, USA
| | - Nuvid Bhuiyan
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, 800 Walnut St, 18th Floor, Philadelphia, PA, 19010, USA
| | - Alvaro G Moreira
- University of Texas Health Science Center-San Antonio, Texas, USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, 800 Walnut St, 18th Floor, Philadelphia, PA, 19010, USA.
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
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Inagaki A, Takahashi M, Murakami S. Facial and hearing outcomes in transmastoid nerve decompression for Bell's palsy, with preservation of the ossicular chain. Clin Otolaryngol 2020; 46:325-331. [PMID: 33236466 PMCID: PMC7983904 DOI: 10.1111/coa.13671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/04/2020] [Accepted: 11/15/2020] [Indexed: 11/27/2022]
Abstract
Objectives Facial nerve decompression is a salvage treatment for Bell's palsy patients for whom a poor prognosis is anticipated with standard medical treatment. The transmastoid approach is a frequently performed approach, but it remains unknown if this surgery is effective when the ossicular chain is preserved. This study aimed to determine the efficacy of facial nerve decompression using the transmastoid approach in Bell's palsy. Design, setting and participants This retrospective study included patients who had undergone transmastoid facial nerve decompression with ossicular chain preservation and patients who met the criteria for surgery, but received only medical treatment between January 2007 and May 2019, at a single centre. Main outcome measures Attainment of House‐Brackmann grade I at 12 months after onset of facial palsy. Results The recovery rate to House‐Brackmann grade I in the decompression group in the early phase (≤18 days after onset) was higher than that of the medical treatment group, although the difference was not significant (70% vs 47%, P = .160). However, within this early surgery group, a subgroup of cases with ≥95% facial nerve degeneration demonstrated a significant improvement in recovery rate (73% vs 30%, P = .018). Among surgeries performed in the late phase (≥19 days), only a subgroup with ≥95% facial nerve degeneration was available for analysis, and the difference in recovery rate was not significant compared with medical treatment alone (26% vs 30%, P = 1.00). Post‐surgical hearing evaluation demonstrated that average hearing deterioration was 1.3 dB which was non‐significant, suggesting this procedure does not cause hearing loss. Conclusions Transmastoid facial nerve decompression with ossicular chain preservation in the early phase after symptom‐onset is an effective salvage treatment for severe Bell's palsy with ≥95% facial nerve degeneration.
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Affiliation(s)
- Akira Inagaki
- Departments of Otolaryngology-Head and Neck Surgery, Graduate School of Medical Sciences and Medical School, Nagoya City University, Nagoya, Japan
| | - Mariko Takahashi
- Departments of Otolaryngology-Head and Neck Surgery, Graduate School of Medical Sciences and Medical School, Nagoya City University, Nagoya, Japan
| | - Shingo Murakami
- Departments of Otolaryngology-Head and Neck Surgery, Graduate School of Medical Sciences and Medical School, Nagoya City University, Nagoya, Japan
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Calistri V, Mancini P, Raz E, Nicastri M, Tinelli E, Russo FY, Fiorelli M, De Seta E, Carpentieri D, De Vincentiis M, Caramia F. fMRI in Bell's Palsy: Cortical Activation is Associated with Clinical Status in the Acute and Recovery Phases. J Neuroimaging 2020; 31:90-97. [PMID: 33146926 DOI: 10.1111/jon.12798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/18/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Using functional magnetic resonance imaging (fMRI), we explored cortical activation in patients with acute Bell's palsy (BP) and analyzed its correlates with clinical status in the acute phase, and with 6-month outcome. METHODS Twenty-four right-handed patients with acute BP within 15 days of onset and 24 healthy controls underwent fMRI during performance of unilateral active (hemi-smiling) and passive lip movement tasks with both the paretic and the normal lip. The degree of paresis was evaluated during the acute stage and at the 6-month follow up using the House-Brackmann (HB) grading scale. Complete recovery was defined as HB grade II or less at the end of the 6-month period. The difference in the HB grade (ΔHB) between the acute stage and the 6-month follow up was used to evaluate clinical improvement. RESULTS There were 24 patients with unilateral acute BP. HB grades ranged from III to VI. At 6 months, 11 patients (46%) had completely recovered and 12 (50%) were partially improved. Compared with healthy subjects, BP patients had a significantly greater activation of the frontal areas and the insula ipsilateral to the paretic side. In BP patients, there was an inverse correlation between the activation of the ipsilateral hemisphere when moving the paretic side and the degree of paresis at baseline. An association was also observed between activation and clinical outcome (both complete recovery and ΔHB). CONCLUSIONS In patients with BP, fMRI may represent a useful tool to predict long-term outcome, guide therapeutic approach, and monitor treatment response.
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Affiliation(s)
- Valentina Calistri
- Department of Human Neurosciences, Neuroradiology Unit, Sapienza University, Rome, Italy
| | | | - Eytan Raz
- Department of Radiology, Neuroradiology Unit, New York University School of Medicine, New York, NY
| | - Maria Nicastri
- Department of Sense Organs, Sapienza University, Rome, Italy
| | - Emanuele Tinelli
- Department of Human Neurosciences, Neuroradiology Unit, Sapienza University, Rome, Italy
| | | | - Marco Fiorelli
- Department of Human Neurosciences, Neuroradiology Unit, Sapienza University, Rome, Italy
| | - Elio De Seta
- Department of Sense Organs, Sapienza University, Rome, Italy
| | - Daniele Carpentieri
- Department of Human Neurosciences, Neuroradiology Unit, Sapienza University, Rome, Italy
| | | | - Francesca Caramia
- Department of Human Neurosciences, Neuroradiology Unit, Sapienza University, Rome, Italy
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Andresen NS, Zhu V, Lee A, Sebetka W, Kimura J, Hansen MR, Gantz BJ, Sun DQ. Electrodiagnostic testing in acute facial palsy: Outcomes and comparison of methods. Laryngoscope Investig Otolaryngol 2020; 5:928-935. [PMID: 33134541 PMCID: PMC7585247 DOI: 10.1002/lio2.458] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/17/2020] [Accepted: 08/30/2020] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To study the relationship between various electrodiagnostic modalities in acute facial palsy. SETTING Academic tertiary care center. PATIENTS One-hundred and six patients who presented with traumatic or non-traumatic acute facial paralysis (House-Brackmann, HB, grade 6/6) between 2008 and 2017 and underwent acute electrodiagnostic testing. INTERVENTION Electroneurography (ENoG) using nasolabial fold (NLF) or nasalis muscle (NM) methods, and volitional electromyography (EMG) in all patients. MAIN OUTCOME MEASURES Percent degeneration of ipsilateral facial nerve compound muscle action potentials (CMAP) on NLF- and NM-ENoG, presence or absence of muscle unit potentials (MUPs) on EMG. RESULTS Extent of facial nerve degeneration measured by NLF- and NM-ENoG were highly correlated (r = 0.85, P < .01) on each test and on serial testing. NLF- and NM-ENoG concordantly diagnosed ≥90% degeneration in 44 patients (80%), of whom 32 patients were diagnosed to have 100% degeneration by both methodologies. Absence of MUPs on EMG was 63% sensitive and 92% specific for ≥90% degeneration on ENoG, with a positive predictive value of 90%. For patients with Bell's palsy, percent degeneration on ENoG was also correlated to HB score at 1 year. Surgical decompression resulted in mean HB scores of 2.2 and 3.0 for patients with Bell's palsy and trauma, respectively. CONCLUSIONS NM-ENoG may be a valid and comparable method to NLF-ENoG for predicting the recovery of facial nerve function in acute paralysis. Absence of MUPs on EMG is a specific measure of severe degeneration and highly predictive of candidacy for surgical decompression. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Nicholas S. Andresen
- Department of Otolaryngology‐Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Vivian Zhu
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of Iowa Hospitals and ClinicsIowa CityIowaUSA
| | - Andrew Lee
- Department of Otolaryngology‐Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Wendy Sebetka
- Department of NeurologyUniversity of Iowa Hospitals and ClinicsIowa CityIowaUSA
| | - Jun Kimura
- Department of NeurologyUniversity of Iowa Hospitals and ClinicsIowa CityIowaUSA
| | - Marlan R. Hansen
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of Iowa Hospitals and ClinicsIowa CityIowaUSA
- Department of NeurosurgeryUniversity of Iowa Hospitals and ClinicsIowa CityIowaUSA
| | - Bruce J. Gantz
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of Iowa Hospitals and ClinicsIowa CityIowaUSA
- Department of NeurosurgeryUniversity of Iowa Hospitals and ClinicsIowa CityIowaUSA
| | - Daniel Q. Sun
- Department of Otolaryngology‐Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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George E, Richie MB, Glastonbury CM. Facial Nerve Palsy: Clinical Practice and Cognitive Errors. Am J Med 2020; 133:1039-1044. [PMID: 32445717 DOI: 10.1016/j.amjmed.2020.04.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 12/13/2022]
Abstract
Facial paralysis is the most common cranial nerve paralysis and the majority of these are idiopathic. Idiopathic facial nerve paralysis, or Bell palsy, typically presents acutely, affects the entire face, may be associated with hyperacusis, a decrease in lacrimation, salivation, or dysgeusia, and typically resolves spontaneously. The diagnosis of idiopathic facial paralysis is made after a thorough history and physical examination to exclude alternative etiologies and follow-up to ensure recovery of facial function. Atypical presentation, recurrent paralysis, additional neurologic deficits, lack of facial recovery in 2-3 months, or a history of head and neck or cutaneous malignancy are concerning for alternative causes of facial paralysis requiring workup. The erroneous use of the eponym Bell palsy to refer to all causes of facial paralysis, regardless of the history and presentation, may result in cognitive errors, including premature closure, anchoring bias, and diagnosis momentum. Hence, we recommend replacing the eponym Bell palsy with idiopathic facial nerve paralysis.
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Affiliation(s)
- Elizabeth George
- Department of Radiology and Biomedical Imaging, University of California San Francisco.
| | - Megan B Richie
- Department of Neurology, University of California San Francisco
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Shokri T, Saadi R, Schaefer EW, Lighthall JG. Trends in the Treatment of Bell's Palsy. Facial Plast Surg 2020; 36:628-634. [PMID: 32791532 DOI: 10.1055/s-0040-1713808] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The aim of the study is to: (1) evaluate national trends in care of facial paralysis, namely Bell's palsy, patients to identify the types of treatments patients are receiving and treatment gaps and (2) identify if newer, more complex surgical therapies published in the literature are being employed. Data were collected from the MarketScan Commercial Claims and Encounters Database by Truven Health. From the database, all inpatient and outpatient claims with International Classification of Diseases, 9th Revision, Clinical Modification diagnosis codes for facial paralysis/dysfunction between 2005 and 2013 were extracted. Trends in medical and surgical management were evaluated specifically cataloging the use of steroids, antivirals, botulinum toxin, surgical and rehabilitation service current procedural terminology codes. A total of 42,866 of patients with a formal diagnosis of Bell's palsy were identified with 39,292 (92%) adults and 3,754 (8%) children (< 18 years old), respectively. Steroids were provided to 50.1% of children and 59.8% of adults and antivirals were prescribed to 26.2 and 39.4% of the children and adults, respectively. Within the first 2 years after diagnosis, 0.5% of children and 0.9% of adults received surgery, 0.1% of children and 0.8% of adults received botulinum toxin treatments, and 10.9% of children and 21.5% of adults received rehabilitation services. Despite the limitations of a claims database study, results showing trends in care of facial paralysis are still nonsurgical with many patients receiving no treatment at all. Although limited literature has shown an increase in the use of pharmacotherapy as well as techniques including physiotherapy, chemodenervation, and various surgical therapies, these interventions may be underutilized.
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Affiliation(s)
- Tom Shokri
- Department of Otolaryngology, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania
| | - Robert Saadi
- Department of Otolaryngology, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania
| | - Eric W Schaefer
- Department of Public Health Sciences, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania
| | - Jessyka G Lighthall
- Section of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania
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Kim SJ, Lee HY. Acute Peripheral Facial Palsy: Recent Guidelines and a Systematic Review of the Literature. J Korean Med Sci 2020; 35:e245. [PMID: 32743989 PMCID: PMC7402921 DOI: 10.3346/jkms.2020.35.e245] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 06/04/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND This study reviews recent literature on facial palsy guidelines and provides systematic reviews on related topics of interest. METHODS An electronic database search was performed to identify recent guidelines dealing with facial nerve palsy, systematic reviews and recent meta-analysis published between 2011 and 2019 (inclusive). The literature search used the search terms "Bell's palsy," "Ramsay-Hunt syndrome," "Facial palsy," "Facial paralysis," "Facial paresis," "Guideline," "Meta-analysis," "Systematic review," and "Randomized controlled trial." Only studies written in English were used. RESULTS The characteristics of treatment trends for facial palsy have been reviewed over the past decade. The most prominent change noted may be the shift from the conventional House-Brackmann facial nerve grading system to the Sunnybrook and eFACE systems. In addition, the results of serial meta-analyses indicate increasing agreement with the use of surgical decompression of the facial nerve. Beyond steroids or combined steroid-antiviral treatment, various novel drugs and treatments have been tried. For long-standing facial paralysis and postparetic synkinesis sequelae after facial palsy, facial reanimation has been highlighted and the necessity of new paradigms have been raised. CONCLUSION For peripheral facial paralysis, various changes have been made, not only in the facial nerve grading systems, but also in medical treatments, from surgical procedures to rehabilitation, during the last decade.
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Affiliation(s)
- Su Jin Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Eulji University School of Medicine, Daejeon, Korea
| | - Ho Yun Lee
- Department of Otolaryngology-Head and Neck Surgery, Ewha Womans University School of Medicine, Seoul, Korea.
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Fieux M, Franco-Vidal V, Devic P, Bricaire F, Charpiot A, Darrouzet V, Denoix L, Gatignol P, Guevara N, Montava M, Roch JA, Tankéré F, Tronche S, Veillon F, Vergez S, Vincent C, Lamas G, Tringali S. French Society of ENT (SFORL) guidelines. Management of acute Bell's palsy. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 137:483-488. [PMID: 32636146 DOI: 10.1016/j.anorl.2020.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AQFThe authors present the guidelines of the French Society of ENT and Head and Neck Surgery (SFORL) regarding the management of Bell's palsy in adults. After a literature review by a multidisciplinary workgroup, guidelines were drawn up based on retrieved articles and group-members' experience, then read over by an independent group to edit the final version. Guidelines were graded A, B, C or "expert opinion" according to decreasing level of evidence. Thorough ENT and neurological clinical examination is recommended in all patients presenting with peripheral facial palsy to confirm diagnosis of Bell's palsy. MRI with gadolinium enhancement should explore the entire course of the facial nerve, if possible within the first month. ENMG should be performed to assess prognosis for recovery. In confirmed Bell's palsy, corticosteroid therapy should be implemented as early as possible (ideally within 72h) at a dose of 1mg/kg/day for 7-10 days. Antiviral therapy should be associated to steroids in patients with severe and early-onset disease and in Ramsay-Hunt syndrome. Isolated antiviral therapy is not recommended. To date, there is no evidence that surgical facial nerve decompression provides benefit.
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Affiliation(s)
- M Fieux
- Service d'Otologie et d'Otoneurologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Chemin du Grand Revoyet, 69495 Pierre-Bénite, France
| | - V Franco-Vidal
- Service ORL et Chirurgie Cervico-Faciale, Hôpital Pellegrin, Place Amélie Raba-Léon, 33076 Bordeaux, France
| | - P Devic
- Service de Neurologie Clinique et Fonctionnelle, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Chemin du Grand Revoyet, 69495 Pierre-Bénite, France
| | - F Bricaire
- Service des Maladies Infectieuses, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, Boulevard de l'Hôpital, 75013 Paris, France
| | - A Charpiot
- Service ORL et Chirurgie Cervico-Faciale, Hôpital de Hautepierre, 1, Avenue de Molière, 67200 Strasbourg, France
| | - V Darrouzet
- Service ORL et Chirurgie Cervico-Faciale, Hôpital Pellegrin, Place Amélie Raba-Léon, 33076 Bordeaux, France
| | - L Denoix
- Service d'Otologie et d'Otoneurologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Chemin du Grand Revoyet, 69495 Pierre-Bénite, France
| | - P Gatignol
- Service ORL et Chirurgie Cervico-Faciale, Hôpital Pitié-Salpêtrière, AP-HP, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - N Guevara
- Service ORL et Chirurgie Cervico-Faciale, Centre Hospitalier de Nice, IUFC, 31, Avenue de Valombrose, 01600 Nice, France
| | - M Montava
- Service ORL et Chirurgie Cervico-Faciale, Hôpital de la Conception, AP-HM, 147, Boulevard Baille, 13005 Marseille, France
| | - J A Roch
- Service de Radiologie, Hôpital Privé Jean Mermoz, 55, Avenue Jean Mermoz, 69008 Lyon, France
| | - F Tankéré
- Service ORL et Chirurgie Cervico-Faciale, Hôpital Pitié-Salpêtrière, AP-HP, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - S Tronche
- SFORL, 26, Rue Lalo, 75016 Paris, France
| | - F Veillon
- Service de Radiologie, Hôpital de Hautepierre, 1, Avenue de Molière, 67200 Strasbourg, France
| | - S Vergez
- Service ORL et Chirurgie Cervico-Faciale, Hôpital Larrey, 24, Chemin de Pouvourville, 31059 Toulouse, France
| | - C Vincent
- Service ORL et Chirurgie Cervico-Faciale, Hôpital Salengro, Rue Michel Polonowski, 59037 Lille, France
| | - G Lamas
- Service ORL et Chirurgie Cervico-Faciale, Hôpital Pitié-Salpêtrière, AP-HP, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - S Tringali
- Service d'Otologie et d'Otoneurologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Chemin du Grand Revoyet, 69495 Pierre-Bénite, France.
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Concurrent Treatment With Intratympanic Dexamethasone for Moderate-Severe Through Severe Bell's Palsy. Otol Neurotol 2020; 40:e1018-e1023. [PMID: 31469789 DOI: 10.1097/mao.0000000000002377] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine whether early intervention with intratympanic steroid injection, known as concurrent intratympanic steroid therapy, is effective as a supplement to systemic steroid therapy for treating moderate-severe to severe Bell's palsy. DESIGN An open-label historical control trial. SETTING Tertiary referral center. PARTICIPANTS A total of 35 Bell's palsy patients presenting with House-Brackmann grade IV or higher were treated with intratympanic steroid therapy concurrent with standard systemic treatment and compared with 108 patients treated with standard systemic therapy alone started within 7 days of onset. INTERVENTIONS In the concurrent intratympanic steroid therapy group, patients received both 410 mg of prednisolone (standard dose) and 1.65 mg of intratympanic dexamethasone for 10 consecutive days. Patients in the control group received the standard dose, or more, of systemic prednisolone. Both groups were additionally treated with valacyclovir. MAIN OUTCOMES AND MEASURES The primary outcome measure was restoration of a House-Brackmann score of grade I. RESULTS The rate of recovery to House-Brackmann Grade I was higher for the concurrent intratympanic steroid therapy group than for the control group (94% vs 73%, p = 0.008). The adjusted odds ratio was 5.47 (95% confidence interval: 1.18-25.21, p = 0.029). CONCLUSIONS The recovery rate was higher for concurrent intratympanic steroid therapy treatment than for standard-of-care control treatment, regardless of whether steroid with lower or equivalent glucocorticoid action was administered. This result suggests that concurrent treatment with intratympanic steroid therapy is a potentially beneficial supplement to systemic steroid administration.
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For Whom the Bell's Toll: Recurrent Facial Nerve Paralysis, A Retrospective Study and Systematic Review of the Literature. Otol Neurotol 2020; 40:517-528. [PMID: 30870370 DOI: 10.1097/mao.0000000000002167] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To examine the etiology, clinical course, and management of recurrent peripheral facial nerve paralysis. METHODS Retrospective review at a single tertiary academic center and systematic review of the literature. Clinical presentation, laboratory and imaging findings, treatment and outcome for all cases of recurrent ipsilateral, recurrent contralateral, and bilateral simultaneous cases of facial paralysis are reviewed. RESULTS Between 2000 and 2017, 53 patients [41.5% men, 29 median age of onset (range 2.5 wk-75 yr)] were evaluated for recurrent facial nerve paralysis at the authors' institution. Twenty-two (41.5%) cases presented with ipsilateral recurrences only, while the remaining 31 patients (58.5%) had at least 1 episode of contralateral recurrent paralysis. No cases of bilateral simultaneous facial nerve paralysis were observed. The median number of paretic events for all patients was 3 (range 2-20). The median nadir House-Brackmann score was 4, with a median recovery to House-Brackmann grade 1.5 over a mean recovery time of 61.8 days (range 1-420 d). Diagnostic evaluation confirmed Melkersson-Rosenthal syndrome in four (7.5%) cases, neurosarcoidosis in two (3.7%), traumatic neuroma in one (1.9%), Ramsay Hunt syndrome in one (1.9%), granulomatosis with polyangiitis in one (1.9%), and neoplastic causes in three (5.7%) cases [facial nerve schwannoma (n = 2; 3.7%), metastatic squamous cell carcinoma to the deep lobe of the parotid gland (n = 1; 1.9%)]; ultimately, 77.4% (41) of cases were deemed idiopathic. Facial nerve decompression via a middle cranial fossa approach was performed in three (5.7%) cases without subsequent episodes of paralysis. CONCLUSION Recurrent facial nerve paralysis is uncommon and few studies have evaluated this unique population. Recurrent ipsilateral and contralateral episodes are most commonly attributed to idiopathic facial nerve paralysis (i.e., Bell's palsy); however, a subset harbor neoplastic causes or local manifestations of underlying systemic disease. A comprehensive diagnostic evaluation is warranted in patients presenting with recurrent facial nerve paralysis and therapeutic considerations including facial nerve decompression can be considered in select cases.
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Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as Prognostic Hematologic Markers of Bell's Palsy: A Meta-analysis. Otol Neurotol 2020; 40:681-687. [PMID: 31083100 DOI: 10.1097/mao.0000000000002166] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Bell's palsy (BP) is the most common cause of unilateral peripheral facial paralysis, and inflammation has been proposed as the main pathological cause. The study aim was to investigate the relationship between hematologic inflammatory markers, including the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), and BP. DATA SOURCES The following key words were used to search PubMed and Scopus for English language articles: Bell's palsy, facial palsy, facial paresis or facial paralysis, neutrophil, lymphocyte, and platelet. STUDY SELECTION Articles related to BP with NLR or PLR data. DATA EXTRACTION The data included patient profiles, House-Brackmann score, treatment modality, NLR, and PLR. DATA SYNTHESIS Seven articles were selected. A random effect model was used to analyze the aggregated data. Six of these articles that included the NLR and two that included the PLR of BP and control patients were analyzed for the difference between BP and control patients. Three articles that included the NLR of the recovery and nonrecovery groups were analyzed for the relationship between NLR and recovery. CONCLUSIONS The NLR was significantly higher for the BP patients than for the controls. Furthermore, the NLR was significantly lower for the recovery group than for the nonrecovery group. A high NLR was associated with poor prognosis and related to the severity of facial nerve inflammation. There was no significant difference between the PLRs of the BP patients and controls. The NLR, but not the PLR, was found to be a useful prognostic indicator of BP.
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A large case series of temporal bone fractures at a UK major trauma centre with an evidence-based management protocol. The Journal of Laryngology & Otology 2020; 134:205-212. [PMID: 32122408 DOI: 10.1017/s0022215120000419] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To review the management of temporal bone fractures at a major trauma centre and introduce an evidence-based protocol. METHODS A review of reports of head computed tomography performed for trauma from January 2012 to July 2018 was conducted. Recorded data fields included: mode of trauma, patient age, associated intracranial injury, mortality, temporal bone fracture pattern, symptoms and intervention. RESULTS Of 815 temporal bone fracture cases, records for 165 patients met the inclusion criteria; detailed analysis was performed on the records of these patients. CONCLUSION Temporal bone fractures represent high-energy trauma. Initial management focuses on stabilisation of the patient and treatment of associated intracranial injury. Acute ENT intervention is directed towards the management of facial palsy and cerebrospinal fluid leak, and often requires multidisciplinary team input. The role of nerve conduction assessment for immediate facial palsy is variable across the UK. The administration of high-dose steroids in patients with temporal bone fracture and intracranial injury is not advised. A robust evidence-based approach is introduced for the management of significant ENT complications associated with temporal bone fractures.
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Nerve Integrity Monitor Responses to Direct Facial Nerve Stimulation During Facial Nerve Decompression Surgery Can Predict Postoperative Outcomes. Otol Neurotol 2020; 41:704-708. [PMID: 32080029 DOI: 10.1097/mao.0000000000002594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To test whether the threshold of nerve integrity monitor (NIM) responses during facial nerve decompression surgery can predict the postoperative outcome. STUDY DESIGN Retrospective study. SETTING University hospital. PATIENTS Twenty peripheral facial palsy patients who underwent transmastoid decompression surgery. INTERVENTION During decompression surgery, thresholds of NIM responses were measured via direct facial nerve stimulation at three sites: the geniculate ganglion (GG), the second genu (2 G), and the stylomastoid foramen. MAIN OUTCOME MEASURES Facial nerve function was evaluated before and 6 months after surgery using the Yanagihara grading score (maximum score = 40 points). Complete recovery was defined as an improvement of the grading score to ≥ 36 points without synkinesis. Variables including age, sex, disease (Bell's palsy or Ramsay Hunt syndrome), time after onset, Yanagihara grading score, and electroneurography before surgery, and the thresholds of NIM responses during surgery were compared in the complete and incomplete recovery groups. NIM responders were defined as those exhibiting a NIM response of < 1.5 mA at any site. Postoperative Yanagihara grading scores in NIM responders and NIM nonresponders were compared. RESULTS No variables differed significantly in the complete and incomplete recovery groups before surgery. NIM response thresholds in the complete recovery group at the GG and the 2nd G were significantly lower than the corresponding thresholds in the incomplete recovery group. The postoperative Yanagihara grading scores of NIM responders were significantly better than those of NIM nonresponders. CONCLUSION NIM responses to intraoperative direct facial nerve stimulation were useful for predicting outcomes after decompression surgery.
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Bouzbouz A, Abdulhakeem B, Ballage A, Rouadi S, Abada R, Roubal M, Mahtar M. Facial paralysis in Bell's palsy: Familial history and recurrence tendency in pediatric population. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2019.101346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Malka R, Guarin DL, Mohan S, Hernández IC, Gorelik P, Mazor O, Hadlock T, Jowett N. Implantable wireless device for study of entrapment neuropathy. J Neurosci Methods 2020; 329:108461. [PMID: 31626845 PMCID: PMC7325518 DOI: 10.1016/j.jneumeth.2019.108461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 10/02/2019] [Accepted: 10/07/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Disease processes causing increased neural compartment pressure may induce transient or permanent neural dysfunction. Surgical decompression can prevent and reverse such nerve damage. Owing to insufficient evidence from controlled studies, the efficacy and optimal timing of decompression surgery remains poorly characterized for several entrapment syndromes. NEW METHOD We describe the design, manufacture, and validation of a device for study of entrapment neuropathy in a small animal model. This device applies graded extrinsic pressure to a peripheral nerve and wirelessly transmits applied pressure levels in real-time. We implanted the device in rats applying low (under 100 mmHg), intermediate (200-300 mmHg) and high (above 300 mmHg) pressures to induce entrapment neuropathy of the facial nerve to mimic Bell's palsy. Facial nerve function was quantitatively assessed by tracking whisker displacements before, during, and after compression. RESULTS At low pressure, no functional loss was observed. At intermediate pressure, partial functional loss developed with return of normal function several days after decompression. High pressure demonstrated complete functional loss with incomplete recovery following decompression. Histology demonstrated uninjured, Sunderland grade III, and Sunderland grade V injury in nerves exposed to low, medium, and high pressure, respectively. COMPARISON WITH EXISTING METHODS Existing animal models of entrapment neuropathy are limited by inability to measure and titrate applied pressure over time. CONCLUSIONS Described is a miniaturized, wireless, fully implantable device for study of entrapment neuropathy in a murine model, which may be broadly employed to induce various degrees of neural dysfunction and functional recovery in live animal models.
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Affiliation(s)
- Ronit Malka
- Health Science and Technology Division, Harvard Medical School/Massachusetts Institute of Technology, Boston, MA, USA; Surgical Photonics and Engineering Laboratory, Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA.
| | - Diego L Guarin
- Surgical Photonics and Engineering Laboratory, Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA
| | - Suresh Mohan
- Surgical Photonics and Engineering Laboratory, Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA
| | - Iván Coto Hernández
- Surgical Photonics and Engineering Laboratory, Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA
| | - Pavel Gorelik
- Research Instrumentation Core, Department of Neurobiology, Harvard Medical School, Boston, MA, USA
| | - Ofer Mazor
- Research Instrumentation Core, Department of Neurobiology, Harvard Medical School, Boston, MA, USA
| | - Tessa Hadlock
- Surgical Photonics and Engineering Laboratory, Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA
| | - Nate Jowett
- Surgical Photonics and Engineering Laboratory, Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA
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Hu S, Kan H, Kan J, Li C, Yuan A, Xu C, Wang A, Wang Y, Bao X, Shen T, Wu H. Longitudinal Changes in Functional Connectivity of the Caudate Is Associated With Recovery From Bell's Palsy. Front Aging Neurosci 2019; 11:295. [PMID: 31787890 PMCID: PMC6853889 DOI: 10.3389/fnagi.2019.00295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 10/14/2019] [Indexed: 11/13/2022] Open
Abstract
Several studies have demonstrated through resting-state functional magnetic resonance imaging (fMRI) that functional connectivity changes are important in the recovery from Bell's palsy (BP); however, these studies have only focused on the cortico-cortical connectivity. It is unclear how corticostriatal connectivity relates to the recovery process of patients with BP. In the present study, we evaluated the relationship between longitudinal changes of caudate-based functional connectivity and longitudinal changes of facial performance in patients with intractable BP. Twenty-one patients with intractable BP underwent resting-state fMRI as well as facial behavioral assessments prior to treatment (PT) and at the middle stage of treatment (MT); and 21 age- and sex-matched healthy controls (HC) were recruited and received the same protocol. The caudate was divided into dorsal and ventral sub-regions and separate functional connectivity was calculated. Compared with HC, patients with intractable BP at the PT stage showed decreased functional connectivity of both the dorsal and ventral caudate mainly distributed in the somatosensory network, including the bilateral precentral gyrus (MI), left postcentral gyrus, media frontal gyrus, and superior temporal gyrus (STG). Alternatively, patients in the MT stage showed decreased functional connectivity primarily distributed in the executive network and somatosensory network, including the bilateral cingulate cortex (CC), left anterior cingulate cortex (LACC), inferior prefrontal gyrus (IFG), MI, STG, and paracentral lobe. The longitudinal changes in functional connectivity of both the dorsal and ventral caudate were mainly observed in the executive network, including the right ACC, left CC, and IFG. Functional connectivity changes in the right ACC and left IFG were significantly correlated with changes in facial behavioral performance. These findings indicated that corticostriatal connectivity changes are associated with recovery from BP.
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Affiliation(s)
- Sheng Hu
- Department of Medical Information Engineering, Anhui University of Chinese Medicine, Hefei, China
| | - Hongxing Kan
- Department of Medical Information Engineering, Anhui University of Chinese Medicine, Hefei, China
| | - Junling Kan
- Department of Medical Information Engineering, Anhui University of Chinese Medicine, Hefei, China
| | - Chuanfu Li
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Aihong Yuan
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - ChunSheng Xu
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Anqin Wang
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Yi Wang
- Department of Medical Information Engineering, Anhui University of Chinese Medicine, Hefei, China
| | - Xuan Bao
- Department of Medical Information Engineering, Anhui University of Chinese Medicine, Hefei, China
| | - Tongping Shen
- Department of Medical Information Engineering, Anhui University of Chinese Medicine, Hefei, China
| | - Hongli Wu
- Department of Medical Information Engineering, Anhui University of Chinese Medicine, Hefei, China
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Xing F, Ouyang Y, Li X. Total facial nerve decompression in severe idiopathic recurrent facial palsy: its long-term follow-up results. Acta Otolaryngol 2019; 139:1049-1051. [PMID: 31550952 DOI: 10.1080/00016489.2019.1663364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: The long-term outcomes of total facial nerve decompression (TFND) in severe idiopathic recurrent facial palsy (IRFP) are still unknown. Aims/objectives: To explore the long-term follow-up results of TFND in IRFP. Materials and methods: Twenty-eight patients suffering from severe IRFP were enrolled. Patients were offered conventional therapy or TFND and were categorized into control or operation group. The follow-up lasted for at least 6 years. Comparison was made in terms of relapse of facial palsy as well as outcomes of facial nerve. Results: There were 16 participants in operation group, whose follow-up lasted for 10.4 ± 1.3 years. In contrast, there were 12 participants in control group, who were followed up lasted for 11.2 ± 1.2 years. No participants suffered relapse in the operation group while seven out of 12 participants (58.3%) encountered relapse with regard to control group (p < .05). In terms of facial nerve results, 16 out of 18 participants (88.9%) reached satisfactory outcomes of facial nerve (HB grade I or II) while only four out of 12 participants (33.3%) achieved satisfactory outcomes in control group (p < .05). Conclusions and significance: In terms of severe IRFP, TFND can defend patients from relapse in a long period, and enhance recovery of facial nerve.
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Affiliation(s)
- Fang Xing
- Department of Otorhinolaryngology Head and Neck Surgery, Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, China
| | - Yudan Ouyang
- Department of Oncology and Hematology, Shaoyang Central Hospital, Shaoyang, China
| | - Xiaowen Li
- Department of Otolaryngology, Head and Neck Surgery, Peking University Health Science Center, Beijing, China
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