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[Study on clinical effectiveness of acupuncture and moxibustion on acute Bell's facial paralysis: randomized controlled clinical observation].

OBJECTIVE: To investigate the adverse effects of acupuncture on the prognosis, and effectiveness of acupuncture combined with far infrared ray in the patient of acute Bell's facial paralysis within 48 h. METHODS: Clinically randomized controlled trial was used, and the patients were divided into 3 groups: group A (early acupuncture group), group B (acupuncture combined with far infrared ray) and group C (acupuncture after 7 days). The facial nerve functional classification at the attack, 7 days after the attack and after treatment, the clinically cured rate of following-up of 6 months, and the average cured time, the cured time of complete facial paralysis were observed in the 3 groups. RESULTS: There were no significant differences among the 3 groups in the facial nerve functional classification 7 days after the attack, the clinically cured rate of following-up of 6 months and the average cured time (P > 0.05), but the cured time of complete facial paralysis in the group A and the group B were shorter than that in the group C (P < 0.05). CONCLUSION: The patient of acute Bell's facial paralysis can be treated with acupuncture and moxibustion, and traditional moxibustion can be replaced by far infrared way.

Acupuncture Therapy↗

Cataract associated with long-term facial paralysis.

Of 29 patients with postoperative acoustic neuroma, five patients with facial paralysis developed unilateral lens opacities of unknown etiology on the paralyzed side, one to six years after surgery. The corneas were well maintained in all patients by means of either eyelid surgery or flush-fitting scleral contact shells. Four patients had anterior subcapsular opacities and in one patient a mature cataract developed. Thus, cataracts may be associated with long-term facial paralysis.

Aged↗

Ultrastructural analysis of the chorda tympani nerve in facial paralysis from different etiologies.

Twelve chorda tympani segments, removed from as many patients (7 females, 5 males) affected by otosclerosis (3, as controls) and from either idiopathic (4), or traumatic (3) or herpetic (2) facial paralysis, were examined by a transmission electron microscope, in order to verify chordal ultrastructural changes, the gravity of neural damage in the various types of facial paralysis and the role played by chorda tympani on the etiopathogenesis of the idiopathic form. The segments were obtained, while performing a stapedectomy in otosclerotic patients and, in facial palsy, while performing chordal neurotomy or direct decompression of the II and III portio of the VII nerve. The obtained data showed no noteworthy alterations concerning myelinated and unmyelinated nerve fibers and chordae stroma in otosclerotic patients, confirming their reliability as controls. In facial paralysis, both normal ultrastructures and alterations were noticed, even though polymorphic: unravelling and dissociation of the lamellae sheaths up to a point of degeneration with a more or less complete resorption of myelin, accumulation of dense bodies and electron-dense formation, particularly in unmyelinated fibers, vacuoles in myelinated fibers, intracytoplasmic vacuoles in Schwann cells and, in herpetic forms, an occasional presence of inflammatory cells. Such results demonstrate that, in any type of facial paralysis, the ultrastructure of the chorda tympani is constantly involved, probably due to main trunk involvement. In the idiopathic forms the alterations of the chorda look like to degenerative alterations caused by traumato-ischemic events, rather than to cytopathic lesions induced by herpetic virus.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Metabolic facial paralysis in an infant.

A 2-month-old infant developed facial paralysis with a presentation that masqueraded as a possible middle ear tumor. The cause of the paralysis eventually was related to a metabolic consequence of his underlying disorder, cystic fibrosis. To our knowledge, the association of vitamin A imbalance, pseudotumor cerebri, and facial paralysis has not previously been discussed in the otolaryngologic literature.

Cystic Fibrosis↗

[Point-through-point acupuncture for treatment of peripheral facial paralysis].

OBJECTIVE: To search for a more effective penetration needling method for peripheral facial paralysis. METHODS: The patients were divided into a treatment group and a control group according to visiting sequence. The treatment group of 50 cases were treated with Yangbai (GB 14)-through-Touwei (ST 8), Yangbai (a little above the original point)-through-Shangxing (GV 23), Sizhukong (TE 23)-through-Yuyao (EX-HN 4), Qianzheng-through-Yingxiang (LI 20), Dicang (ST 4)-through-Jiache (ST 6) and Jiache-through-Yingxiang, at an angle about 45 degrees between the penetration needling direction and local paralysis muscle bundle, and the control group (n=45) with Yangbai-through-Yuyao, Zanzhu (BL 2)-through-Yuyao, Dicang-through-Jiache, Jiache-through-Dicang, Qianzheng-through-Dicang, Sibai (ST 2)-through-Yingxiang. RESULTS: The cured rate and the cured and markedly effective rate were 76.0% and 92.0% in the treatment group, and 55.6% and 75.6% in the control group respectively, with significant differences between the two groups in the cured rate, the cured and markedly effective rate and the therapeutic times for cure. CONCLUSION: The penetration needling method at an angle about 45 degrees between the penetration needling and paralysis muscle bundle is more beneficial to recovery of facial paralysis.

Acupuncture Points↗

Facial paralysis in children: differential diagnosis.

The differential diagnosis in 170 patients between birth and 18 years of age is reviewed. There are a number of obvious physical findings and historical features that allow one to make a diagnosis rather quickly. Pain, vesicles, a red pinna, vertigo, and sensorineural hearing loss suggest herpes zoster oticus. Slow progression beyond three weeks, recurrent facial paralysis involving the same side, facial twitching, weakness, or no return of function after six months indicate a neoplasm. Bilateral simultaneous facial paralysis indicates a cause other than Bell's palsy, such as Guillain-Barré syndrome, pseudobulbar palsy, sarcoidosis, and leukemia. Recurrent facial paralysis associated with a fissured tongue, facial edema, and a positive family history should suggest Melkersson-Rosenthal syndrome.

Abnormalities, Multiple↗

[Facial paralysis: functional and aesthetic rehabilitation techniques].

The diagnosis of a permanent facial paralysis can be devastating to a patient, because of the cosmetic, functional and psychological disorders. Our society places on physical appearance and leads to isolation of patients who are embarrassed with their paralyzed face. The objectives of the facial rehabilitation is to correct the functional and cosmetic losses of the patient. The main functional goals are to protect the eye and reestablish oral competence. The primary cosmetic goals are to create balance and symmetry of the face at rest and to reestablish the coordinated movement of the facial musculature. The surgeon should be familiar with the variety of options available so that an individual plan can be developed based on each patient's clinical picture. History of the facial paralysis, its etiology and the duration of the paralysis are of particular interest as they orientate the rehabilitation plan strategy.

Esthetics↗

New eyebrow lift technique using a semiautomatic suturing device (maniceps) for patients with facial paralysis.

Direct browlift and the traditional fascial suspension technique sometimes leave a prominent scar above the eyebrow. Coronal browlift, mid-forehead browlift, and endoscopic browlift leave no prominent scar, but they are sometimes not suitable for patients with facial paralysis because they have been developed for rejuvenative surgery. The authors present a new browlift fascial suspension technique for patients with facial paralysis. This method uses a semiautomatic suturing device (Maniceps), which they have used to graft three fascial strips to the forehead from the fascia lata, and to suspend and lift the eyebrow with only two small incisions posterior to the hairline. The authors treated 13 facial paralysis patients, with follow-up periods of more than 6 months. The lifted eyebrows adapted to stabilized positions within 3 months. The results in all 13 patients were satisfactory, with no severe complications. This new technique is very useful because it has wide applicability, including facial paralysis patients who experience severe ptosis.

Adult↗

The role of the middle fossa approach in the management of traumatic facial paralysis.

There are several controversial aspects to the management of traumatic facial paralysis. One of these involves the precise nature of surgical intervention once the decision to operate has been made. Between June 1, 1984, and June 30, 1993, we surgically treated 220 cases of traumatic facial paralysis with good cochlear reserve by decompressing the tympanic and mastoid segments via a transmastoid approach followed by decompression of the geniculate ganglion and the distal half of the labyrinthine segment via a middle fossa approach. We discuss the results of surgery via the middle fossa approach, and we review the literature.

Adolescent↗

Velopharyngeal closure in patients with facial paralysis: the fiberscopic examination of the velopharyngeal movements.

The present study was intended to clarify the role of the facial nerve in velopharyngeal movement and to determine the pathway of the facial nerve innervating the muscles related to velopharyngeal closure in man. Velopharyngeal function in 100 patients with idiopathic peripheral facial paralysis was analyzed using the nasopharyngeal fiberscope (NPF) and neuro-otological examinations. Lack of velopharyngeal closure was observed during Japanese isolated vowels and vowels in consonant-vowel (CV) syllables in patients with facial paralysis. Velopharyngeal opening was found in 85.7% of the subjects with suprastapedial paralysis and in 22.2% of those with infrastapedial paralysis. The facial nerve seemed to affect velopharyngeal movement, at least during vowel productions, through the greater petrosal nerve. Velopharyngeal closure in swallowing and blowing was always demonstrated. Hypernasality during connected speech was not heard in these patients.

Adolescent↗

[Facial paralysis in temporal bone trauma].

OBJECTIVE: To study the cause and treatment of facial paralysis in temporal bone trauma. METHODS: A retrospective review of 28 patients with facial paralysis resulting from temporal bone trauma was conducted, House-Brackmann(H-B) system was used to evaluate the recovery of facial nerve function, U test was employed for statistic analysis. RESULTS: Twenty-six cases underwent following up facial nerve function of all patients was recovery partly after surgery, 46% cases reached H-B II, 84% cases reached H-B III, comparing facial nerve decompression within 4 months of injury to beyond 4 months of injury, recovery to H-B II or more of facial nerve function was 60% and 0%, respectively. The difference was significant(P < 0.05). CONCLUSION: Surgery decompression is effective on facial nerve palsy caused by temporal bone trauma. It is recommended that surgery decompression be carried out as soon as possible since a better prognosis is obtained if it is performed within four months after injury.

Adolescent↗

Analysis of 100 cases of free-muscle transplantation for facial paralysis.

Free-muscle transplantation is the treatment of choice for long-standing facial paralysis. It enables the reconstructive surgeon to restore facial movement and some emotional animation. Despite all technical innovations and 20 years of experience with free-muscle transplantation, the aesthetic and functional outcomes of the surgery are still unpredictable. The present report reviews 100 free-muscle transplantations to the face by a single surgeon and analyzes various preoperative, intraoperative, and postoperative factors in relation to the functional recovery of the muscle transplants. These factors were demographic variables such as age, gender, and etiology as well as intraoperative variables such as choice of muscles, number of nerve coaptations, and ischemia time of the muscle. Additionally, four independent raters not involved in the care of these patients rated standardized preoperative and postoperative videos and judged the functional and aesthetic outcomes. From 1981 to 1993, 93 patients with facial paralysis underwent free-muscle transplantation. A total of 100 muscles were transplanted, since 7 patients received two muscle transplants. There were 33 male and 60 female patients ranging in age from 3 to 57 years, with an average of 22.2 +/- 14.9 years. The gracilis muscle was used in 63 cases of free-muscle transplantation, while the pectoralis minor was used in 34 cases. In 2 patients a segment of the rectus abdominis was transferred, and in 1 patient a small segment of the latissimus dorsi was transferred. In 89 patients the onset of muscle function was reported. The range was from 6 to 48 weeks postoperatively. The average was 21.6 +/- 9.14 weeks after muscle transplantation. The correlations showed a trend to earlier onset of function and higher aesthetic rating in young female patients. The intraoperative ischemia of the free muscle did not correlate with the onset of muscle function. Using a five-step scale of judgments, a higher postoperative rating was seen in 94 percent of the patients, and 80 percent of all patients achieved a moderate or better result.

Adolescent↗

[Transferring neurovascular rectus femoris muscle segment for treatment of facial paralysis].

OBJECTIVE: To investigate a new technique for functional treatment of chronic facial paralysis. METHODS: Based on anatomy of intramuscular neurovascular structure in the rectus femoris muscle, 7 consecutive patients with facial paralysis were treated by using a technique of microsurgically free-transferring neurovascular rectus femoris muscle segment to the face in one-stage. Follow-ups were 10 to 24 months. RESULTS: All of the 7 patients showed significantly improvement in the appearance of the oral commissure and oral competence. No complications occurred in the donor site. CONCLUSIONS: The above mentioned technique may have the advantages of preventing the intramuscular nerve and vessel from the surgical injury during splitting the muscle. It could also maintain the transferred muscular segment in a proper tension in the recipient site.

Facial Paralysis↗

Auditory dysfunction with facial paralysis.

A series of 58 patients with idiopathic facial paralysis were studied to determine if a concomitant cochlear or eight nerve auditory dysfunction could be identified with traditional audiologic tests. Results indicated that only those patients with a facial nerve lesion, proximal to the stapedius branch, experienced reduced tolerance for loud sounds, reduction of speech discrimination at high-intensity levels, and abnormal loudness growth. Such findings suggest that changes in auditory function, accompanying facial nerve paralysis, are a mechanical effect due to absence of stapedial action. Site of lesion tests in this sample failed to demonstrate eighth nerve dysfunction and, thus, does not support a theory of polyneuropathy that involves the auditory nerve.

Adolescent↗

Delayed facial paralysis after stapedotomy using KTP laser.

OBJECTIVE: Delayed facial paralysis after stapes surgery is uncommon and has been reported after traditional, nonlaser techniques for stapedotomy. The purpose of this paper is to inform the reader of the potential risk of delayed facial nerve paralysis associated with the use of the potassium titanyl phosphate (KTP) laser for stapedotomy. Etiologic mechanisms are discussed. STUDY DESIGN: The study was a descriptive study-case report. SETTING: The study was conducted at a university-based otologic practice. PATIENTS: Two patients with otosclerosis and delayed onset facial palsy 5 to 7 days after uncomplicated stapedotomy using the KTP laser were included in the study. INTERVENTION: Potassium titanyl phosphate laser stapedotomy was performed. Patients received treatment of facial palsy with a tapering course of oral steroids. MAIN OUTCOME MEASURE: House-Brackmann facial nerve grade scores were used. RESULTS: Improvement of House-Brackmann facial nerve scores from Grade VI to Grade I-II in one patient, and improvement from Grade IV to Grade I-II in the other was seen. CONCLUSION: The probable etiology of delayed facial palsy is viral neuritis from reactivation of dormant virus within the facial nerve, initiated by thermal stress of the KTP laser. Presentation and resolution of the facial palsy is similar to other types of delayed facial palsy resulting from nonlaser techniques of stapes surgery and other types of middle ear and neurotologic surgeries previously reported.

Facial Nerve↗

Diagnosis and treatment of idiopathic facial paralysis.

Bell's palsy is a diagnosis of exclusion; other causes of facial paralysis that might be confused with Bell's palsy should be considered in order that appropriate treatment for these conditions is not delayed. Diagnostic tests for Bell's palsy are presented. Prednisone is the recommended treatment for patients with complete facial paralysis; occasionally, selected patients may require surgical decompression.

Craniocerebral Trauma↗

Relationship between idiopathic peripheral facial paralysis and climate.

We attempted to analyse a relationship between idiopathic peripheral facial paralysis and climate. One hundred and thirty-seven patients, 76 female and 61 male, were studied. The occurrence was not correlated with the mean temperature, mean humidity or mean atmospheric pressure. It can be assumed that unfavorable weather conditions, i.e. a wide temperature range, a lower percentage of sunshine and cloudy days, may bring on idiopathic peripheral facial paralysis.

Adolescent↗

[Facial paralysis in benign parotid tumor: case report and review of the literature].

Generally, typical symptoms are significant for malignant parotid tumours: The infiltration of surrounding structures and facial paralysis. A case is reported where a benign parotid tumour (lymphadenitis) caused facial paralysis. Parotidectomy and the removal of the lymph node near the stylomastoid foramen led to complete restitution. A review of the literature of the past 40 years mentions 16 cases of benign neoplasms of the parotid gland that caused facial paralysis, such as pleomorphic adenoma, Warthin's tumour, oncocytoma, benign parotid cysts, chronic parotitis, lymphadenitis and parotid abscess.

Adult↗