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At least 271 records · Page 15Linked to original sources
PubMed1998

[Idiopathic facial paralysis].

Although acute idiopathic facial paresis is often labelled "Bell's palsy", historical studies show that Nicolaus Anton Friedreich (1761-1836) from Würzburg was the first physician to describe the typical symptoms of the disorder in 1797, approximately 24 years prior to the paper published by Sir Charles Bell. Diagnostics has now improved to the extent that acute idiopathic facial palsy can more frequently be assigned to etiologies caused by inflammatory disorders. Herpes simplex virus type I and Borrelia burgdorferi are particularly relevant. Underestimation of the degree of paresis is, particularly in children, a drawback of the clinical examination. "Incomplete eyelid closure" is not a reliable indicator of remaining nerve function. For this reason complete electromyography (EMG) is recommended in all cases of severe facial paresis. Since electroneurography does not reliably reflect the degree of denervation present, needle EMG is preferred. The therapy of the facial palsy of unclear etiology is still not well defined. Nevertheless, we recommend that a combined treatment should be used early, at least in patients with disfiguring pareses. Combinations may consist of cortisone, virostatic agents and hemorrheologic substances and possibly antibiotics. Surgical decompression of the facial nerve remains controversial, since positive surgical results lack statistical support. Individual instructions for facial exercises, massage and muscle relaxation can support rehabilitation and possibly reduce the production of pathological synkinesia. Electrical stimulation should not be used. There are a number of possibilities available to reduce the effects of misdirected reinnervation, especially the use of botulinum-A-toxin. However, intensive diagnosis and therapy in the early phase of paresis are decisive in obtaining a favorable outcome. Further refinements in rehabilitation and comparative multicenter controlled studies are still required for future improvements in affected patients.

Adult↗
PubMed2001

[Image analysis system for detection facial paralysis].

BACKGROUND: Evaluation of facial nerve paresis depends on visual assessment and naturally differs from examiner to examiner. An objective measurement instrument is presented. PATIENTS AND METHOD: Facial features are automatically localized by a parametric face model in videos of a face during relaxation and exercises. Gray-level information is analyzed by a special steerable filter and used to identify symmetries. The computer system was tested in 19 individuals. RESULTS: Automatic localization of facial features such as the upper arc of the head and ears was correct in 95%, the eyes in 82%, and the mouth in 73%. Lid paresis was correctly recognized in seven of ten (70%) and oral paresis in 10 of 12 (83%) cases. Unaffected eyelid movements were identified in eight of nine (89%) and healthy oral regions in all seven (100%) cases. CONCLUSION: The computer system presented is able to automatically localize facial features and to identify facial nerve paresis. It is a considerable step toward automatic and objective grading of facial nerve paresis.

Diagnosis, Computer-Assisted↗
PubMed1976

Selective neurectomies to achieve symmetry in partial and complete facial paralysis.

Experience with selective facial neurectomies, in partial and total palsies, is reported. If under careful control by faradic stimulation the area to be weakened is conpletely, and the neighbouring musculature partly denervated, consistently satisfactory results can be predicted. Evidence suggests that rather than recovery of motion by axon regeneration, there is a marked tendency for collateral regeneration of peripheral facial nerve fibres from muscles left intact, into denervated muscles.

Eyelids↗
PubMedDate not supplied

[Electroneurographic study in facial paralysis].

We studied the facial electroneurography (facial ENoG) in 20 normal subjects and 37 patients with facial palsy and their different etiologies. Facial ENoG was performed for the first time within 3 days after palsy onset. We carried out anamnesis, physical and functional exploration (Schirmer's test, stapedial reflex and electrogustometry) as well as motor valuation and facial ENoG. These last two test were performed, not only in the first 72 hours after the onset, but also 7, 15 and 21 days later, in the first month and in successive months until complete recovery of the facial movement or for six months in cases of partial recovery. We studied two parameters of facial ENoG: amplitude and latency. We discovered that the ENoG revealed the progression of the Wallerian degeneration in the distal nerve beginning from the lesion. Therefore, we consider that the amplitude is the most reliable data in the facial ENoG.

Adolescent↗
PubMed2005

[Observation on therapeutic effects of different methods on peripheral facial paralysis at different stages].

OBJECTIVE: To observe therapeutic effects of different therapeutic methods for treatment of peripheral facial paralysis at different stages. METHODS: In the treatment group, 26 cases at acute stage were treated by acupuncture at corresponding acupoints at the healthy side, 15 cases at resting stage by acupuncture at the affected side with shallow needling method, and 2 cases at restoration stage by routine acupuncture and moxibustion, and their therapeutic effects were compared with the control group of 36 cases who were treated by routine acupuncture and moxibustion. The acupoints selected in the two groups were same. RESULTS: The cured-markedly effective rate was 97.7% in the treatment group and 75.0% in the control group with a very significant difference between the two groups (P < 0.01). The treatment group needed 2.7 therapeutic courses and the control group needed 4.0 courses in average with a very significant difference between the two groups (P < 0.01). CONCLUSION: Different acupuncture methods at different stages are better than routine acupuncture method in treatment of peripheral facial paralysis.

Acupuncture Points↗
PubMedDate not supplied

[Peripheral facial paralysis. The value of clinical neurophysiology].

AIMS: The aim of this study was to review the value of neurophysiological exploration in peripheral facial paralysis in the literature and in our own experience. METHOD: Peripheral facial paralysis is a frequently occurring cranial neuropathy with an acute presentation. Its striking clinical expression is usually in strong contrast to its benign prognosis, except for a small percentage of cases in which the existence of acute injury to the nerve (axonotmesis) will cause it to progress unfavourably, either due to the absence of nerve regeneration or because this is inadequate or insufficient. A neurophysiological study aids diagnosis and the functional and prognostic assessment. CONCLUSIONS: We recommend the utilisation of standardised studies involving a comprehensive electromyographic and electroneurographic evaluation of the facial territory, including reflexology (blink reflex). Use of a suitable methodology in the neurophysiological study of this neuropathy will allow us to complete the diagnosis and to evaluate progress, even from very early days (early surgical approach prior to the onset of nerve degeneration), all of which is decisive in the prognosis of injury throughout the process.

Blinking↗
PubMed1989

[Prognostic study of Bell's facial paralysis].

A prospective study was carried out to objectively quantify the most important predictor factors in idiopathic facial paralysis (Bell's palsy). Step-wise discriminant analysis was applied to data prospectively obtained from 570 patients with Bell's palsy treated in the ENT Department of La Paz Hospital between January 1983 and January 1986. In all, 37 variables were studied in each patient. With data obtained from these variables a linear discriminant function was obtained, with an overall accuracy of 95%. The rate of correct prediction is 95.8% for patients with an expected complete facial recovery, and 90.9% for the group of patients with an expected recovery of less than 100%. The discriminant function obtained is a well adaptable method for routine practice in order to objectively assess the prognosis of patients with Bell's palsy. Prognosis is one of the most challenging problems concerning idiopathic facial paralysis. The early determination of prognosis in Bell's palsy is the necessary basis for assessing the effect of different therapeutic approaches. A number of methods and parameters are used in the prognostic evaluation of Bell's palsy. To know the exact weight of each one of these factors in the determination of the course of the disease we have performed an statistical study by means of discriminant analysis (DA).

Adult↗
PubMed2006

[Clinical observation on moxibustion and acupuncture at Zusanli (ST 36) for treatment of refractory facial paralysis].

OBJECTIVE: To observe clinical therapeutic effect of moxibustion and acupuncture at Zusanli (ST 36) on refractory facial paralysis. METHODS: Sixty cases were randomly divided into a test group and a control group, 30 cases in each group. The control group were treated with acupuncture at Hegu (LI 4), Taichong (LR 3), Touwei (ST 8), etc. , and the test group with acupuncture at the same points as those in the control group plus moxibustion and acupuncture at Zusanli (ST 36) with a warm-heat sense transmitting into the depth of the point along the needle body for the patient. RESULTS: The total effective rate of 93.3% in the test group was significantly better than 76.7 in the control group (P < 0.05); in the test group, the total effective rate for the patients with needling sensation propagating along the channel was 100%, which was significantly superior to 80.00% in the patients with no needling sensation propagating along the channel (P < 0.05). CONCLUSION: Moxibustion and acupuncture at Zusanli (ST 36) activating sensation propagating along channel as main way has a better therapeutic effect on refractory facial paralysis.

Acupuncture Points↗
PubMed1992

[Incidence of Borrelia burgdorferi infection in isolated facial paralysis. A prospective study].

Between the causes of facial paralysis, similar to Bell's palsy, recently are included those due to some families of spirochaeta (Borrelia burgdorferi) transmitted through tick-bite. These bacteria, besides de facial palsy, may produce several degrees of lymphocytic meningitis and subsequently the paralysis of the face, sometimes clumsy or recurrent. The treatment being the antibiotic drugs, never the corticoids. In the paper are explained prospectively the incidence of this disease in the AA's environment.

Adolescent↗
PubMed1992

Prognostic value of evoked and standard electromyography in acute facial paralysis.

Ninety-one patients with idiopathic (n = 62) and traumatic (n = 29) facial paralyses were available for evaluation at least 1 year after the onset of paralysis. In nine cases of idiopathic paralysis and in 12 cases of traumatic paralysis, total intratemporal nerve decompression was performed. The remaining patients were treated with steroids alone. All patients underwent evoked electromyography (EEMG) testing within 2 weeks of the onset of paralysis. Facial nerve recovery was graded using the House-Brackmann facial nerve recovery scale. Subjects were grouped according to maximal decline of compound muscle action potential (CAP), as determined by EEMG, and by level of recovery 1 year after onset of paralysis. Among patients who did not undergo surgical decompression of the facial nerve, incomplete clinical recovery (grade III or higher) was significantly associated with CAP decline of greater than 90% (p less than 0.05) for idiopathic paralysis. In contrast, there was no significant association between CAP decline of greater than 90% and clinical outcome in traumatic paralysis. These findings support previous reports of the prognostic value of EEMG in idiopathic facial paralysis, but suggest that this test may have less predictive value in the evaluation of facial paralysis as a result of trauma.

Action Potentials↗
PubMed2005

General practitioners' referral pattern for children with acute facial paralysis.

INTRODUCTION: The relative incidence of paediatric Bell's palsy is two to four times less than the condition in adults. The number encountered in our otolaryngology department falls short of the above prediction. This could either reflect the general practitioners' (GPs) patterns of referral or a lower incidence in our locality. METHODS: Postal questionnaires were sent to our local GPs to determine their referral practice when managing children presenting with acute facial paralysis. RESULTS: Of 233 questionnaires, 172 (74 per cent) were returned and analysed. Fifty-four per cent of GPs referred their patients to the local paediatric services, 22 per cent to an otolaryngologist, and the remaining 24 per cent of GPs were confident in diagnosing and managing Bell's palsy in children themselves. DISCUSSION AND CONCLUSION: Of the GPs surveyed 78 per cent did not refer children presenting with acute facial paralysis to an otolaryngologist. We suggest minimum investigations for acute facial paralysis in children before diagnosing Bell's palsy and stipulate otolaryngology referral for all.

Acute Disease↗
PubMed1998

Facial paralysis: a presenting feature of rhabdomyosarcoma.

The purpose of this paper is to present a child with embryonal rhabdomyosarcoma involving the left middle ear, who initially presented with unilateral facial paralysis. A 5-year-old boy presented with a 4-week history of left-sided facial weakness, associated with persistent otitis media on that side. Examination revealed complete left lower motor neuron facial weakness and hearing loss. A myringotomy revealed a soft tissue mass behind the tympanic membrane. Biopsy and oncologic assessment confirmed a stage II, group III left middle ear embryonal rhabdomyosarcoma. Despite debulking surgery, local irradiation and multiple chemotherapeutic courses the child deteriorated quickly. He developed carcinomatous meningitis and died 9 months after his initial presentation. In conclusion, middle ear tumors should be considered in the differential diagnosis of unresolving otitis media, particularly when associated with persistent ipsilateral facial paralysis. An ear mass, discharge, facial swelling, or systemic symptoms may be initially absent despite the presence of this aggressive malignancy. Careful examination of the middle ear is recommended in children with facial weakness. A myringotomy incision may be necessary including a complete assessment of the middle ear cavity, particularly when there is no fluid return.

Child, Preschool↗
PubMed1997

Neuromuscular retraining for facial paralysis.

Neuromuscular retraining is an effective method for rehabilitating facial musculature in patients with facial paralysis. This nonsurgical therapy has demonstrated improved functional outcomes and is an important adjunct to surgical treatment for restoring facial movement. Treatment begins with an intensive clinical evaluation and incorporates appropriate sensory feedback techniques into a patient-specific, comprehensive, home therapy program. This article discusses appropriate patients, timelines for referral, and basic treatment practices of facial neuromuscular retraining for restoring function and expression to the highest level possible.

Adult↗
PubMedDate not supplied

[Electrodiagnosis of peripheral facial paralysis. Significance of stimulation tests--detection].

Electroneurography at present constitutes an indispensable method for the investigation of peripheral facial paralysis. It should be carried out at an early stage, in the form of three successive examinations at 3 day intervals. If decompression is necessary, it should theoretically be carried out during the first 15 days, before destruction of nerves, which is a feature of sequelae, can take place. Electroneuronography appears to be, for this purpose, on a par with histology. The authors urge that patients suffering from from facial paralysis should be referred to O.-R.-L. departments right from the start and not when all other methods of treatment have been tried, often with reprehensible empiricism, and found unsuccessful.

Electric Stimulation↗
PubMed1987

Electrophysiological prognosis in facial paralysis.

Electrical prognosis was evaluated in 79 patients with facial paralysis, of spontaneous (n = 43) or post-traumatic origin (n = 36). Three electrophysiological tests were employed jointly: detection, stimulation and stimulodetection. The patients were reviewed at least 1 year later, in order to appreciate the agreement between the electrical prognosis and the clinical outcome (satisfactory or not). Those patients with a favourable prognosis on electrical testing had in the majority of cases a satisfactory outcome. The accuracy of the prognosis was also better in cases of early examination (within 15 days) and partial paralysis.

Adolescent↗