Facial nerve to facial canal cross-sectional area ratio in children

Facial Nerve Pathology in Children

Facial nerve pathology in children has devastating functional and psychosocial consequences. Facial palsy occurs less commonly in children than adults with a greater proportion caused by congenital causes. Most pediatric patients have normal life expectancy and few comorbidities and dynamic restoration of facial expression is prioritized. This article will focus on the unique aspects of care for facial palsy in the pediatric population.

Diagnostic value of dynamic contrast-enhanced magnetic resonance imaging in Bell's palsy

BACKGROUND

Bell's palsy (BP) is the most common form of acute facial nerve disorder and is characterized by rapid onset peripheral facial palsy of unknown etiology.

PURPOSE

To explore the diagnostic value of dynamic contrast-enhanced (DCE) magnetic resonance imagine (MRI) in patients with BP particularly in involved segments.

MATERIAL AND METHODS

A retrospective analysis was performed on the patients with BP who underwent routine MRI examinations and volumetric interpolated breath-hold examination (VIBE) sequence-based DCE-MRI before surgery in our department from January 2015 to July 2020. DCE-MRI data postprocessing was performed on Siemens Workstation Extended MR Work Space 2.6.3.5. Statistical analyses were performed using SPSS®v.19.0. The inter-observer reliability was evaluated with kappa identity test and McNemar's test.

RESULTS

Twenty-three patients were included. On conventional contrast-enhanced MRI, the two observers were inconsistent in their diagnosis of lesion segments of facial nerve (Kappa 0.426, P = 0.009). Compared to the results of the surgery, the diagnostic consistency of both observers was general (Kappa 0.476, P < 0.001 and Kappa 0.430, P < 0.001, respectively). The diagnostic results of DCE-MRI for lesion segments of the facial nerve were consistent between the two observers (Kappa 0.929, P < 0.001). Compared to the results of the surgery, the diagnostic consistency of both observers was good (Kappa 0.753, P < 0.001 and Kappa 0.731, P < 0.001, respectively).

CONCLUSION

Compared to conventional MRI, DCE-MRI has good stability and repeatability in the diagnosis of the lesion segments of the facial nerve as well as a good specificity and accuracy.

Diagnostic value of dynamic contrast-enhanced MRI in Bell's palsy: initial experience

AIM

To assess the ability of conventional magnetic resonance imaging (MRI) combined with dynamic contrast-enhanced (DCE)-MRI to accurately identify characteristic imaging findings of Bell's palsy particularly in involved segments.

MATERIALS AND METHODS

A retrospective analysis was performed on MRI images of patients with Bell's palsy in Shanghai Ninth People's Hospital from January 2015 to July 2019. DCE-MRI analysis was performed on a SIEMENS Workstation Extended MR Work Space 2.6.3.5 and by using the T1-weighted volumetric interpolated breath-hold examination (VIBE) sequence. Statistical analyses were performed by using SPSS v. 19.0. The chi-square test was used to compare the accuracy of conventional MRI versus DCE-MRI in imaging the involved segment of the facial nerve.

RESULTS

Combined with the results of the surgery, the accuracy of conventional MRI in imaging the involved segments of the affected facial nerves was 38.5% (5/13), but was 92.3% (12/13) for DCE-MRI. There was a statistically significant difference between the two groups (chi-square value is 8.327, p = 0.004).

CONCLUSION

DCE-MRI is useful to diagnose the involved segments of the affected facial nerve accurately compared to the conventional MRI. This approach has advantages both for the patient, in terms of safety, and for the physician, in terms of the accuracy of the diagnosis.

Treatment of Bell's Palsy Using Monochromatic Infrared Energy: A Report of 2 Cases

OBJECTIVE

The purpose of the study is to describe the use of monochromatic infrared energy (MIRE) therapy in the management of 2 patients with Bell's palsy.

CLINICAL FEATURES

Two patients presented to a chiropractic clinic with Bell's palsy that was diagnosed by a medical physician. Both patients were treated using MIRE. The acute patient was a 32-year-old male. He presented with left facial palsy 1 day before the consultation. He was unable to puff the left cheek and close the left eyelid. He had difficulty raising the left eyebrow. The chronic case was a 46-year-old lady. Prior to the first consultation, she was treated with corticosteroid and electro-acupuncture for one and a half years, with incomplete recovery. When first seen, the left corner of mouth drooped and she had difficulty raising her left eyebrow.

INTERVENTION AND OUTCOME

Monochromatic infrared energy therapy, emitting 890 nm infrared light, was placed on the post-auricular area, pre-auricular area, the temple and mandibular area of the affected side. Each treatment lasted 30 minutes. Photographs were taken every week to document changes. The acute case received 19 treatments in 6 weeks. He reported an improvement of 95%. The chronic case received a total of 45 treatments in 9 months. She rated an improvement of 50%. At the conclusion of treatment, she was able to close her left eyelid and puff her left cheek but still could not raise her left eyebrow.

CONCLUSION

These 2 patients seemed to respond to a different degree to the MIRE therapy. As 71% of patients with Bell's palsy recover uneventfully without any treatment, the present study describes the course of care but cannot confirm the effectiveness of MIRE therapy in the management of Bell's palsy.

Differences in the diameter of facial nerve and facial canal in bell's palsy--a 3-dimensional temporal bone study

Bell's palsy is hypothesized to result from virally mediated neural edema. Ischemia occurs as the nerve swells in its bony canal, blocking neural blood supply. Because viral infection is relatively common and Bell's palsy relatively uncommon, it is reasonable to hypothesize that there are anatomic differences in facial canal (FC) that predispose the development of paralysis. Measurements of facial nerve (FN) and FC as it follows its tortuous course through the temporal bone are difficult without a 3D view. In this study, 3D reconstruction was used to compare temporal bones of patients with and without history of Bell's palsy.

METHODS

Twenty-two temporal bones (HTBs) were included in the study, 12 HTBs from patients with history of Bell's palsy and 10 healthy controls. Three-dimensional models were generated from HTB histopathologic slides with reconstruction software (Amira), diameters of the FC and FN were measured at the midpoint of each segment.

RESULTS

The mean diameter of the FC and FN was significantly smaller in the tympanic and mastoid segments (p = 0.01) in the BP group than in the controls. The FN to FC diameter ratio (FN/FC) was significantly bigger in the mastoid segment of BP group, when compared with the controls. When comparing the BP and control groups, the narrowest part of FC was the labyrinthine segment in control group and the tympanic segment in the BP.

CONCLUSION

This study suggests an anatomic difference in the diameter of FC in the tympanic and mastoid segments but not in the labyrinthine segment in patients with Bell's palsy.

Clinical feasibility of temporal bone magnetic resonance imaging as a prognostic tool in idiopathic acute facial palsy

OBJECTIVE

To assess the feasibility of temporal bone magnetic resonance imaging for evaluating the severity and prognosis of idiopathic acute facial nerve palsy.

METHODS

Forty-four patients with idiopathic acute facial nerve palsy who had undergone gadolinium-enhanced magnetic resonance imaging were selected retrospectively. The degree of radiological facial nerve enhancement was determined using quantitative analysis (with region-of-interest measurements for separate facial nerve segments) and using subjective visual analysis. The clinical severity of facial nerve palsy was then correlated with the degree of facial nerve enhancement.

RESULTS

The visually determined degree of facial nerve enhancement did not correlate significantly with the House-Brackmann grade at either the early or late stages (p > 0.05). Results using the region-of-interest system were similar (p > 0.05).

CONCLUSION

Temporal bone magnetic resonance imaging is not essential for patients with acute facial nerve palsy.

Bell's palsy in children: relationship between electroneurography findings and prognosis in comparison with adults

OBJECTIVES

To investigate the correlation between electroneurography (ENoG) findings and the prognosis of Bell's palsy in children compared with adults.

METHODS

Twenty-two children and 92 adults with Bell's palsy who underwent ENoG between 8 days and 4 weeks from the onset of symptoms were retrospectively enrolled. The time to maximal recovery and rate of favorable recovery (House-Brackmann grade I or II) was assessed. Children (C) and adults (A) were further subdivided into low (<10%) or high (≧10%) subgroups according to their ENoG values (affected versus unaffected side) at initial evaluation. The numbers in each subgroup were as follows: C-low (n = 8), A-low (n = 21), C-high (n = 14), and A-high (n = 71).

RESULTS

Of the 22 children assessed, 2 of the 4 patients who showed a total loss of evoked potentials on the affected side (0% ENoG value) exhibited an unfavorable recovery. The remaining 20 patients achieved a favorable recovery eventually. Patients in group C-low reached a maximal recovery of facial movement significantly later than those in group C-high (p < 0.001). Time to maximal recovery of facial movement in group A-low was later than that in group C-low, although the difference was not statistically significant (p = 0.15). The patients in group A-high reached a maximal recovery significantly later than those in group C-high (p < 0.05).

CONCLUSION

Bell's palsy seems to recover earlier in children than adults when matched for severity. The presence of an identifiable response in ENoG, irrespective of its amplitude, may indicate a favorable recovery of facial movement in children.

Do children with Bell's palsy benefit from steroid treatment? A systematic review

OBJECTIVE

To conduct an updated systematic review on the outcome of Bell's palsy (BP) in children following steroid treatment.

DATA SOURCES

MEDLINE, EMBASE, Cochrane Library and BIOSIS Previews electronic databases were searched obtaining articles published between 2000 and 2010 without any language restriction.

REVIEW METHODS

Articles describing children aged 0-18 years with BP treated solely with corticosteroids were included. In studies including various etiologies for facial palsy; cases of BP treated with steroids were selected and when available, untreated patients as well for comparison. The outcome measure was facial movements following steroidal treatment based on different clinical scales. Controlled clinical trials, prospective and historical cohort studies, cross sectional studies and case series were included.

RESULTS

A total of 2293 papers were initially identified. Following review by two authors, 68 papers were analyzed in a hard-copy format. Finally, 6 studies were eligible to be included in the systematic review. Four of the studies included children with BP exclusively while the remaining studies described various etiologies of facial palsy. Type of steroid and duration of treatment were inconsistently specified. Outcome measures used include the House-Brackmann scale, Yanagihara grading system and clinical evaluation. Studies analyzed were retrospective cohorts or case-series and were categorized as level 4 of evidence.

CONCLUSION

There were no controlled trials and level 4 publications predominate. Therefore, the role of steroid treatment for BP in children is still inconclusive. Further studies are required.

Reconstruction of facial nerve injuries in children

Facial nerve trauma is uncommon in children, and many spontaneously recover some function; nonetheless, loss of facial nerve activity leads to functional impairment of ocular and oral sphincters and nasal orifice. In many cases, the impediment posed by facial asymmetry and reduced mimetic function more significantly affects the child's psychosocial interactions. As such, reconstruction of the facial nerve affords great benefits in quality of life. The therapeutic strategy is dependent on numerous factors, including the cause of facial nerve injury, the deficit, the prognosis for recovery, and the time elapsed since the injury. The options for treatment include a diverse range of surgical techniques including static lifts and slings, nerve repairs, nerve grafts and nerve transfers, regional, and microvascular free muscle transfer. We review our strategies for addressing facial nerve injuries in children.

Is the width of the labyrinthine portion of the fallopian tube implicated in the pathophysiology of Bell's palsy?: a prospective clinical study using computed tomography

OBJECTIVES/HYPOTHESIS

The pathogenetic mechanisms underlying Bell's palsy remain obscure, despite the extensive relevant research. Magnetic resonance imaging (MRI) studies have strongly indicated that facial nerve edema cannot be regarded as the sole etiologic factor, because it might persist long after full clinical recovery, or might be demonstrated in the clinically unaffected side or healthy controls. The aim of this study was to investigate the hypothesis that a narrow facial canal might be implicated in the pathophysiology of Bell's palsy.

STUDY DESIGN

Prospective clinical study.

METHODS

A high-resolution computerized tomography of the temporal bone with 1-mm thick contiguous axial sections was performed in 25 patients with unilateral Bell's palsy. The width of the fallopian tube was measured at the meatal foramen and the middle part of its labyrinthine segment.

RESULTS

When using paired Student t tests, the measured width of the affected ear was found significantly smaller than that of the unaffected side, both at the meatal foramen (P = .007) and at the middle part of the labyrinthine segment (P = .03).

CONCLUSIONS

Bell's palsy seems to usually coincide with the narrower fallopian tube of the patient. This anatomical detail, supported by previous MRI studies, seems to indicate that an asymmetry between the right and left fallopian tube might be a necessary pathogenetic mechanism for the development of a facial nerve edema into Bell's palsy in the narrower fallopian canal. More studies on large healthy populations are needed before a notable facial canal asymmetry is linked to a higher risk for developing Bell's palsy.

Outcomes of facial palsy in children

CONCLUSIONS

Facial palsy in children might be an alarming sign of serious underlying disease such as tumor, systemic disease or congenital anomalies and the recovery is poor in those cases. Therefore, careful investigation and differential diagnosis are essential in children. Prednisolone does not make a significant difference in the outcome in the treatment of children with Bell's palsy. The prognosis of Bell's palsy in the pediatric group is good; patients usually recover within 3 months.

OBJECTIVES

To review and analyze the etiology, management, and outcome of facial palsy in children.

PATIENTS AND METHODS

Using a retrospective chart review, patients under the age of 15 years with a diagnosis of facial palsy were collected from 1996 to 2002.

RESULTS

A total of 56 cases (29 male, 27 female) with a mean age of 6.9±4.5 years were included in this analysis. Causes of facial palsy were Bell's palsy (44 patients, 78.6%), neoplastic (4 patients, 7.1%), head injury (3 patients, 5.4%), congenital (3 patients, 5.4%), or infectious (2 patients, 3.6%). In Bell's palsy there was no significant difference in the recovery rate between the groups with or without prednisolone treatment and between the groups that received medication within 1 week of syndrome onset or after more than 1 week.

Magnetic resonance imaging of the intratemporal facial nerve in idiopathic peripheral facial palsy

The aim of this study was to investigate the prevalence of facial nerve involvement with gadolinium-enhanced magnetic resonance imaging (Gd-MRI) in patients with idiopathic peripheral facial palsy (IPFP), and to discuss the localization and the pattern of enhancement. A total of 13 patients (9 female, 4 male) with IFPF were included in this study. Topographic tests and electromyography (EMG) were performed, and MRI was taken. Ten subjects whose cranial MRIs were taken for nonorganic pathology served as the control group. Twelve of 13 paralytic facial nerves had enhancement on postcontrast images. Two facial nerves of the control group demonstrated enhancement. We found a correlation between the enhancement of the facial nerve and the time for recovery. The average time from the onset of facial palsy to the recovery in patients with enhancement was 14 weeks, whereas it was 6 weeks in patient with no enhancement. Finally, all patients had complete recovery of the facial nerve function. We concluded that contrast enhancement of the paralytic facial nerve can be a radiological sign of a neural inflammation and may indicate a prolonged recovery.

Facial nerve paralysis due to chronic otitis media

OBJECTIVE

To present the characteristics of facial paralysis caused by chronic otitis media. The role of cholesteatoma, bony dehiscence, the duration of the disease, and the results of surgical therapy in facial paralysis were reviewed.

STUDY DESIGN

Retrospective case review.

SETTING

Tertiary care referral center.

PATIENTS

A total of 24 patients (6 women, 18 men; age range, 17-74 yr) with facial paralysis were included in the study.

INTERVENTION

Canal wall down mastoidectomy was performed in 14 patients (58.3%), modified radical mastoidectomy was performed in seven patients (25%), and intact canal wall mastoidectomy was performed in three patients (16.7%). All patients had decompression of the fallopian canal from the geniculate ganglion to the stylomastoid foramen without opening the epineural sheath.

RESULTS

Eighteen patients (75%) had gradual onset of facial paralysis. The most common associated symptom with facial paralysis was vertigo in six patients. Twelve patients (50%) had no associated symptoms. Facial paralysis was the sole complication in 21 patients (87.9%). Three patients had multiple complications. Labyrinthitis was the most common associated complication. Facial paralysis was associated with congenital cholesteatoma in one patient. Fourteen patients (58.3%) demonstrated dramatic recovery within 3 months after surgery. Intraoperatively, cholesteatomas were found in 17 of the patients (70.8%). The fallopian canal was intact in four patients (none of them had a cholesteatoma), and 20 patients had bone destruction or dehiscence (three patients had no cholesteatoma). The tympanic segment was the most common site of involvement in 14 patients (58.3%).

CONCLUSION

A middle ear cholesteatoma was present in the majority of patients with facial paralysis caused by chronic otitis media. Gradual onset of facial paralysis was the most frequent pattern. Facial paralysis presented poor prognosis regardless of the presence of a cholesteatoma. There was no statistical difference among the results of surgical techniques.

Paediatric facial paralysis. Current opinion in evaluation and management

Facial palsy in the paediatric age group is less common than in adults, but poses its own problems because clinical diagnosis and investigations are more difficul. i' perform. In recent years, electroneuronography (EnoG) has proved to be useful for prognosis, and in many endemic areas, neuroborreliosis (Lyme'sDisease) has proved to be the commonest cause of this condition in children. Fortunately the prognosis in children appears to be better than in adults.

Facial nerve paralysis of dental origin in children

Dental causes of facial nerve paralysis are rare and have not been previously reported in children. Two children are described with facial nerve paralysis of dental origin. The underlying mechanism of action and pathogenesis are discussed.

Facial nerve paralysis induced by herpes simplex virus in mice: an animal model of acute and transient facial paralysis

We have been the first to succeed in producing an acute and transient facial paralysis simulating Bell's palsy, by inoculating herpes simplex virus into the auricles or tongues of mice. The KOS strain of the virus was injected into the auricle of 104 mice and the anterior two thirds of the tongue in 30 mice. Facial paralysis developed between 6 and 9 days after virus inoculation, continued for 3 to 7 days, and then recovered spontaneously. The animals were painlessly sacrificed between 6 and 20 days after inoculation for histopathologic and immunocytochemical study. Histopathologically, severe nerve swelling, inflammatory cell infiltration, and vacuolar degeneration were manifested in the affected facial nerve and nuclei. Herpes simplex virus antigens were also detected in the facial nerve, geniculate ganglion, and facial nerve nucleus. The pathophysiologic mechanisms of the facial paralysis are discussed in light of the histopathologic findings, in association with the causation of Bell's palsy.

Facial nerve palsy in children: clinical aspects of diagnosis and treatment

Eighty-two children with facial palsy aged less than 6 years were examined. Sixty-four cases, excluding patients with congenital and traumatic palsy, were distributed through the ages, but a predominant tendency to symptomatic palsy for cases aged less than 2 years was observed. Facial movement scoring was not practical in prognostic diagnosis in cases aged under 4 years, while ENoG was useful in all age-groups. Of 58 cases of acute peripheral facial palsy, 29 were observed clinically but given no treatment, 9 were given steroids, and 16 were given vitamins and other drugs. In the patients with acute peripheral facial palsy in whom a follow up study was performed, 56 cases (96.6%) showed complete recovery. The time of recovery was independent of treatment. Facial palsy in children is considered to have a good prognosis regardless of treatment. Steroid administration thus does not appear to be necessary in children with acute facial palsy.