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PubMed2001

Nasopharyngeal abscess and facial paralysis as complications of petrous apicitis: a case report.

An 83-year-old man with a lifelong history of intermittent otorrhea and hearing loss was referred for management of a facial paralysis of 3 weeks' duration. Computed tomography (CT) of the head detected a neoplasm of the nasopharynx along with chronic otomastoiditis. A followup CT suggested the development of a nasopharyngeal abscess, which was confirmed by needle aspiration. A later coronal-projection CT showed definite bone destruction in the anterior petrous apex, confirming suspicions that a petrous apicitis was responsible for the facial paralysis and abscess. This article describes the management of this patient and reviews the historical, medical, and surgical aspects of petrous apicitis.

Abscess↗
PubMed1982

Pontine hemorrhage causing Fisher one-and-a-half syndrome with facial paralysis.

The case of a 58-year-old white man with a history of high blood pressure and chronic obstructive pulmonary disease who developed double vision followed by right-sided facial paralysis is reported. A computerized axial tomogram (CT) scan showed an enhancing lesion in the pontine tegmentum, and the diagnoses of pontine glioma or hemorrhage were considered. Physical findings were limited to the cranial nerves. Conservative management with Decadron for 3 weeks resulted in a prompt clinical improvement, and a CT scan 1 month later showed resolution of the lesion, effectively ruling out a glioma. Total clinical recovery occurred at the end of 6 months. To our knowledge this is the first report of a case of Fisher one-and-a-half syndrome with facial paralysis correlated with computed tomography.

Brain Neoplasms↗
PubMed1977

Vestibular disease, and its relationship to facial paralysis in the horse: a clinical study of 7 cases.

The signs observed in 6 cases of peripheral vestibular disease included incoordination, head tilt and nystagmus. The intensity of the signs varied greatly with duration of the disease, and in 3 cases facial paralysis was also present. Tympanosclerosis was demonstrable in all cases subject to radiology. Trauma was the causative factor in most cases. The causes of, and relationships between, vestibular dysfunction and concomitant facial paralysis are discussed. The exact etiology of the tympanosclerosis is unknown.

Animals↗
PubMed1997

Reproducibility of normal facial motor nerve conduction studies and their relevance in the electrophysiological assessment of peripheral facial paralysis.

To determine the intra-examiner intertrial reproducibility of normal facial motor nerve conduction studies (FNCS) and their relevance in electrophysiological assessments of peripheral facial paralysis, 52 patients with acute unilateral Bell's palsy were examined on two separate occasions 1 months apart. Three electroneurographic methods were assessed. On the unaffected side of the face, FNCS are reliable when performed by a single examiner over time. Nevertheless, compound muscle action potential (CMAP) baseline-to-peak and peak-to-peak amplitude showed a rather high intertrial variability. Reproducibility of the assessed surface electrode recording procedures was similar. Regarding the affected side, in patients with mild axonotmesis of the facial nerve variations of electroneurographic parameters 1 months apart fell within the range of normal intertrial variability. In patients with severe or moderate axonotmesis, the distal latency and the M wave amplitude variations showed significant intertrial variations. Reproducibility of FNCS appears to be similar to that found in limb motor nerves. Normal variability curtails the sensitivity of FNCS in detecting mild facial nerve axonotmesis, although this technique remains useful in severe cases.

Action Potentials↗
PubMedDate not supplied

[Immediate improvement in facial paralysis after surgical decompression (author's transl)].

17 cases of severe facial paralysis were studied before and after microsurgical decompression, by quantitative electromyography (electromyogram integrated in volts) at the site of the zyogmatic arch. -- In 76% of cases, no significant improvement was measured. -- An immediate, frank improvement occurred infrequently (12%), was short-lived and did not have any influence on the final result.

Decompression↗
PubMed1981

Occult neoplasms in facial paralysis.

A review of 14 cases of occult neoplasms associated with facial paralysis indicated that when the onset was gradual over a period of weeks or months, when all of the scientific and technological investigations, including CT scanning, polytomes, neurosensory and otologic tests, sialography, lacrimation, taste, internal acoustic meatus, evaluation of the deep lobe of the parotid, and clinical examination of the parotid and neck were negative, the tumor was almost always found in association with the main trunk of the extratemporal portion of the parotid gland. Of these neoplasms, 80% were malignant tumors of the parotid gland and 15% were neurilemmomas of the main trunk of the facial nerve. The above situation is an indication for human assessment by surgical investigation of the facial nerve, with the first priority being given to the main trunk of the extratemporal portion.

Adult↗
PubMed1993

[Psychosocial problems and coping with illness by patients with defective healing after facial paralysis].

Twenty patients with defective healing following idiopathic or infection-induced facial paralysis (group 1) and 14 patients with defective healing after excision of an acoustic neuroma and subsequent hypoglossal-facial nerve anastomosis (group 2) were questioned as to their psychosocial conditions. The principle gueries involved the impact of facial impairment on social activities, behavior in public, professional performance and communication, as well as strategies in coping with disfigurement. One third of the patients (with a majority in group 2) experienced stigmatization and a feeling of embarrassment or anxiety in public. Many patients minimized facial expressions and communication in order to hide their paralyses. In particular, patients in group 2 frequently had to change their employment and had great problems in accepting their conditions. Additional problems had with a clinical diagnosis of "acoustic neuroma" involved greater stress and more pronounced social withdrawal than experienced by the patients with idiopathic pareses.

Adaptation, Psychological↗
PubMed2002

Cyclosporine-associated facial paralysis in a child with renal transplant.

Cyclosporine (CsA)-associated neurotoxicity has been reported in recipients of solid organ and bone marrow transplants. These neurological side effects are usually mild and resolve with temporary reduction or withdrawal of CsA. We report a 16-year-old renal transplant recipient who developed tremor, tinnitus, and peripheral facial paralysis during oral CsA treatment. Her serum magnesium level was below the normal range and her peripheral facial paralysis did not improve with the cessation of the drug.

Adolescent↗
PubMed1997

A double-muscle transfer using a divided rectus femoris muscle for facial-paralysis reconstruction.

There are two types of smiling: without exposure of the teeth (usual smile), and with their exposure (square smile). Performance of the former involves use of the major zygomatic muscle, while the latter is created by the major zygomatic and the depressor labii inferior muscles. The function of the depressor labii inferioris muscle cannot be ignored in facial paralysis reconstruction. A double-muscle transfer using a divided rectus femoris muscle for one-stage reconstruction of both the major zygomatic muscle and the depressor labii inferior muscle is described. The patient suffered facial paralysis caused by an extracranial schwannoma originating from the facial nerve. After the tumor was removed, divided rectus femoris muscle segments were transferred to reconstruct the major zygomatic muscle and the depressor labii inferior muscle. After the pedicle vessel of the muscles was anastomosed to the recipient facial vessel, the long motor nerve of the proximal divided muscle was cross-faced and coapted directly to the prepared contralateral buccal branch. The short motor nerve of the distal muscle segment was sutured to the ipsilateral masseteric nerve. The advantages of divided rectus femoris muscle transfers are that (1) independent muscle contraction can be reconstructed; (2) no tongue or trapezius muscle atrophy occurs because the masseteric nerve is used as the motor source of the labial depressor; (3) only one muscle is sacrificed for muscle grafts; and (4) it is a one-stage reconstruction.

Adult↗
PubMed1987

Topographic diagnosis of facial paralysis by the assay of lysozyme concentration in tears.

Lysozyme in tears is secreted from the main lacrimal gland innervated by a parasympathetic nerve via the greater petrosal nerve. Lysozyme activity in tears was analysed in 10 cases of unilateral facial paralysis due to the cerebellopontine angle (CPA) tumor and 10 normal cases. The lysozyme concentration in tears on the paralysed side collected by Schirmer No. 2 test was significantly lower than that on the healthy side, or bilateral sides of normal subjects. This decreased concentration on the paralysed side is due to the interruption of the reflex are at the level of CPA. It is concluded that our new method is more useful for topographical diagnosis of facial paralysis than is the conventional Schirmer's filter paper test.

Adult↗
PubMed2001

Change in gene expression in facial nerve nuclei and the effect of superoxide dismutase in a rat model of ischemic facial paralysis.

Peripheral nerve injury induces changes in gene expressions of a variety of neuroactive substances in cell somata, which may have roles in the adaptive response to the injury, neuronal survival, growth and regeneration. In this study, we designed a rat model of ischemic peripheral facial paralysis with a selective embolization technique, and observed mRNA expression of calcitonin gene-related peptide (CGRP), c-jun, and growth associated protein (GAP)-43 in facial nerve nuclei using in situ hybridization histochemistry. The rats were demonstrated to have a transient facial paralysis consistently, and thus this method was regarded as a model of minor peripheral nerve injury. The mRNA of CGRP, c-jun and GAP-43 showed a distinct pattern of induction and time course of increase after the ischemic nerve injury. The results suggest that the small injury to the peripheral nerve was able to induce changes in mRNA expression in the cell body of motoneurons. We also investigated the protective effect of superoxide dismutase (SOD), which is a free radical-scavenging enzyme involved in cellular antioxidant defenses. The SOD treatment clearly alleviated the behavioral impairment and decreased the CGRP mRNA expression at 3rd day after injury. These data suggest that a free radical generated by the ischemia may be partially responsible for ischemic nerve damage and the change in gene expression in motoneurons.

Animals↗
PubMed1995

Comprehensive management of the eye in facial paralysis.

OBJECTIVE: To determine guidelines for the management of paralyzed eyelids following facial palsy, including surgical indications, timing, and type of procedure(s). DESIGN: Prospective analysis of 60 patients diagnosed as having complete facial palsy. Follow-up ranged from 18 to 36 months. PATIENTS: All subjects had a complete unilateral facial palsy of various origins. Ages ranged from 6 to 81 years. INTERVENTIONS: Forty patients underwent evoked electromyography and blink reflex testing of the facial nerve. Twenty additional patients had a known fifth-degree nerve injury that did not require testing. MAIN OUTCOME MEASURE: Lack of interval improvement in clinical results of examination and/or evoked electromyography, coupled with length of time from injury, were used to determine surgical candidacy. All patients with fifth-degree nerve injury were considered surgical candidates, with clinical examination results of eyelid function used to determine which procedure(s) to be performed. RESULTS: Of the 60 patients evaluated with facial palsy, 43 patients required surgical restoration of eyelid function. Forty-one patients required gold weight implants; 18 of these also required shortening of the lower eyelid. Two additional patients underwent eyelid shortening without gold weight implantation. Seventeen patients were treated only with corneal lubricants and moisturizers. No gold weights extruded; there were no infections. Two patients required revision of their lower eyelid surgery owing to progressive laxity. Four patients have had their gold weights removed an average of 9.5 months following insertion. CONCLUSIONS: The degree of neural injury and its associated regeneration time, determined clinically and by evoked electromyography, are useful factors to assist in patient selection, surgical timing, and type of procedure(s) necessary to fully rehabilitate the upper and lower eyelids following facial paralysis.

Adolescent↗
PubMedDate not supplied

Early gold weight lid implant for rehabilitation of faulty eyelid closure with facial paralysis: an alternative to tarsorrhaphy.

Although tarsorrhaphy has been the mainstay of treatment for lagophthalmus associated with facial paralysis, it has many drawbacks which make it a less than ideal procedure. Gold weight implantation is a functionally and cosmetically superior alternative in many patients. Eighteen patients with both reversible and irreversible facial (eyelid) paralysis underwent early gold weight implantation for rehabilitation of faulty eyelid closure with satisfactory results. The advantages and disadvantages of this technique, when compared with other methods of correcting paralytic lagophthalmus, are discussed.

Blinking↗
PubMed1991

[Idiopathic facial paralysis and magnetic resonance tomography (MRT)].

We investigated 15 patients with unilateral facial paralysis using gadolinium(Gd)-DTPA (diethylenetriamine pentaacetic acid) enhanced (magnetic resonance imaging (MRI). Eleven were idiopathic and 1 each was due to basal skill trauma, Lyme's disease, Foville's syndrome and herpes zoster oticus. Ten of 11 Bell's palsies showed a significant enhancement of the facial nerve on the paralysed side. In all cases enhancement was shown in the labyrinthine segment, in 9 in the meatal segment, in 8 in the mastoid segment and in 7 in the tympanic segment also. Follow-up Gd-enhanced MRI investigation was performed 3-11 months later in 8 patients. In 1 case with incomplete return of function after 3 months MRI enhancement was decreased. We could not find any correlation between the intensity of the Gd enhancement and the course, severity or outcome of Bell's palsy, or stapedius reflex audiometry. The mechanisms and aetiology of the Gd enhancement in Bell's palsy seem to be non-specific phenomena which are also found in post-traumatic facial lesions, for instance. Nevertheless, the ability to image the facial nerve in Bell's palsy provides a new means of examination in this disorder. In our opinion Gd-enhanced MRI is recommended in cases of recurrent or "atypical" Bell's palsy and in cases with total loss of electrical excitability, to exclude tumours. It is further suggested that MRI may provide valuable information concerning areas which may require surgical exploration or decompression.

Adolescent↗