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PubMed1992

Facial paralysis due to benign parotid tumors.

On rare occasions, facial paralysis associated with a parotid tumor need not denote malignancy. We present two cases in which, contrary to appropriate conventional wisdom, facial paralysis resulted from benign mixed tumors. Each patient presented over 8 years following primary surgical excision. In neither patient was a mass palpable, and facial paralysis was the sole sign of recurrent disease. Each patient had been followed up for several months with a presumptive diagnosis of Bell's palsy prior to discovery of recurrent tumor by radiologic imaging. In each case, at operation the tumor was found to infiltrate the temporal bone via the stylomastoid foramen. Facial paralysis presumably resulted from extrinsic compression of the facial nerve. These two cases add to the few previous reports of facial paralysis due to benign parotid gland tumors.

Adenoma, Pleomorphic↗

PubMed2005

Comparisons of steroid, acyclovir, lipoprostoglandin E1 and steroid + acyclovir treatments in facial paralysis: a rat study.

OBJECTIVE: To induce experimental peripheral facial paralysis by inoculation of HSV1 and to compare the effects of steroid, acyclovir, lipoprostoglandin E2 and steroid + acyclovir treatments in terms of clinical recovery, electrophysiologically and histopathologically. MATERIALS AND METHODS: A total of 132 adult female rats were used in this study. HSV type 1 strain was inoculated at the back of the left ear by using 27 gauge needle. Of all animals, 70 (53%) rats which developed facial paralysis were divided into five groups (n = 14 for each group) as control, steroid + acyclovir, lipoprostaglandin E1, steroid only and acyclovir only. At the end of the 21 days period, the rats were clinically examined and electrophysiological tests were performed, then decapitated and the nerve specimens were obtained. RESULTS: A modified electroneurography (ENoG) test was performed and the latencies and the amplitudes were compared. The findings of the intact side were better, but with no significant difference. Histopathologicaly edema was significantly smaller in all groups compared to the controls (p < 0.05). Similarly, no difference was seen in terms of vacuolar degeneration and Schwann cell hyperchromatisation among the groups and no significant difference in recovery period and rate of facial paralysis when all groups were compared. CONCLUSION: Facial paralysis induced by HSV1 recovered spontaneously within a week. In the treatment of facial paralysis, steroid alone, acyclovir alone, steroid + acyclovir, or lipoprostaglandin E1 all reduced edema in the infected facial nerve but there was no statistical difference in of the rate or degree of recovery.

Acyclovir↗

PubMed1997

Bell's palsy: an update on idiopathic facial paralysis.

Patients with Bell's palsy, or idiopathic facial paralysis, present sporadically in the primary care setting. New evidence implicates reactivated herpes simplex virus (HSV) as the etiologic agent in greater than 70% of cases diagnosed as Bell's palsy. Careful evaluation of the patient with facial paralysis, including history, physical examination, and diagnostic assessment, may mandate the expeditious treatment of facial paralysis to prevent faulty nerve regeneration during the recovery period. Using the results of an objective tool for grading resting facial symmetry, symmetry of voluntary movement, and synkinesis can provide a quantitative measurement for decision making. These data are also useful in documenting progression or regression of the patient's facial paralysis. Administration of acyclovir with prednisone improves the recovery of complete facial functioning following an episode of Bell's palsy. During the acute and convalescent stages, the eye on the affected side must be protected until function is restored to the facial nerve. Residual effects of Bell's palsy lasting more than 6 months may indicate another diagnosis and the need to refer the patient to a specialist.

Acute Disease↗

PubMed1994

The shape of a normal smile: implications for facial paralysis reconstruction.

Sophisticated smile reconstruction for facial paralysis requires an understanding of the facial movements during a normal smile. This study analyzes the direction and extent of movement of the upper and lower lips, nasal labial folds, and nasal base during smiling. Twenty normal subjects were analyzed using cine studies. A stop frame vector analysis was done on reference points on the lips and lower face. The greatest movement occurred at the commissure and upper lip. Intersubject variation in direction and extent of movement is great. Intrasubject variation in movement in comparing left and right sides was also quite large. Techniques of facial paralysis reconstruction that apply forces to the mouth, which mimic the vectors of movement on the patients' normal side, are most likely to provide a symmetrical smile reconstruction.

Adult↗

PubMed1996

Role of herpes simplex virus infection in the pathogenesis of facial paralysis in mice.

To clarify the role and site of herpes simplex virus (HSV) infection in the pathogenesis of facial paralysis, we examined the viral genome by the polymerase chain reaction and the neutralization antibody titer using microplates in an animal model. Following inoculation with HSV type 1 of the KOS strain into mouse auricles, HSV DNA appeared in the ipsilateral facial nerve on the 3rd day, and in bilateral facial nerves and the brain stem on the 10th day only in animals with facial paralysis. In animals without facial paralysis, no HSV DNA was detected in these tissues. The neutralization antibody titer was elevated between 4 and 20 days in all animals, with or without facial paralysis. Facial paralysis developed only on the inoculated side, even though HSV DNA was also present in the contralateral facial nerve. We conclude that HSV infection in the facial nerve and brain stem is prerequisite for facial paralysis, and suggest that an immunologic reaction following viral infection plays a key role in the pathogenesis.

Animals↗

PubMed2005

Evaluation of a new measurement tool for facial paralysis reconstruction.

Evaluation of facial movement, including distance and direction, is essential for anyone interested in facial paralysis reconstruction. The authors' goal was to develop a measurement system that is simple, uses commercially available equipment, takes little time, and provides meaningful and accurate measurements. This technique is called the facial reanimation measurement system. It involves placing dots around the patient's mouth and video recording the patient performing maximal effort smiles. Using a video editing program, one frame showing the patient at rest is overlaid with a second frame showing the patient's smile. This overlaid image is imported into Adobe PhotoShop, where measurements are obtained using tools available in the program. Twenty patients were used to test interrater and intrarater reliability of the facial reanimation measurement system. The accuracy of the measurement process was tested by comparing 10 known distances and angles with those obtained using the facial reanimation measurement system. Both intrarater and interrater reliability of the distance and angle measurements are highly accurate, with intraclass correlations greater than 0.9. The facial reanimation measurement system is accurate to within 0.6 mm and 2.0 degrees when compared with a "known" distance and angle. The facial reanimation measurement system has been used to measure smile movements of more than 200 patients and has been demonstrated to be valuable for detecting changes of facial movements over time. This system is simple and economical and only requires 20 minutes to perform. Although the authors demonstrated evaluation of smile movement, the system may be used to evaluate other movements, such as mouth puckering, eye closure, and forehead elevation.

Adult↗

PubMed2003

Endoscopic dissection of recipient facial nerve for vascularized muscle transfer in the treatment of facial paralysis.

In order to prepare recipient facial nerve branches for neurovascular muscle, transfer in the treatment of facial paralysis, endoscopic facial nerve dissection was employed. Under endoscopy recipient facial nerve branches innervating the zygomaticus major muscle were successfully dissected. A stab incision was sufficient for nerve suture with the donor nerve. This method is preferable for young or female patients in whom conventional cheek incisions should be avoided.

Adolescent↗

PubMed2002

Facial paralysis.

This discussion of facial paralysis as it relates to otology and neuro-otology is a mere primer of all that is known about this complex topic. It is hoped that this discussion has provided the reader with a foundation for evaluating and initiating management for the more common facial nerve disorders. It is further hoped that this less-than-exhaustive discussion will stimulate the reader to continue to study the anatomy and pathology of the facial nerve.

Facial Paralysis↗

PubMedDate not supplied

Lyme borreliosis and facial paralysis--a prospective analysis of risk factors and outcome.

PURPOSE: To evaluate the incidence of Lyme borreliosis in patients with acute idiopathic facial paralysis with special emphasis on the risk factors that explain the poor outcome of facial paralysis and occurrence of Lyme borreliosis. MATERIALS AND METHODS: During a 2-year period, we prospectively studied 503 consecutive patients with acute idiopathic facial paralysis for the presence of Lyme borreliosis. We screened the patients for antibodies to Borrelia burgdorferi and for symptoms or signs related to Lyme borreliosis. Chi-square and logistic regression tests were used for the statistical analysis. Special attention was paid to strict criteria for the diagnosis of Lyme borreliosis. RESULTS: Eleven (2.2%) of the 503 patients with facial paralysis had Lyme borreliosis. Fever, headache, pharyngalgia, enlarged cervical lymph nodes, bilateral paralysis, and arthralgia were more common in patients with Lyme borreliosis than in those without it. In the logistic regression modeling the best combination of explanatory variables for predicting the occurrence of Lyme borreliosis included summer season at the onset of facial paralysis, presence of enlarged cervical lymph nodes, and arthralgia. The best combination of explanatory variables to predict the poor outcome of facial paralysis was total paralysis of facial nerves, recurrent facial paralysis, and hyperacusis. CONCLUSIONS: Lyme borreliosis is an important infectious cause of facial paralysis. In our study, 11 of 503 patients with acute idiopathic facial paralysis had Lyme borreliosis. The screening for serum antibodies in addition to the thorough evaluation of the history of the patient and of the patient's clinical signs or symptoms possibly linked with Lyme borreliosis, are essential when diagnosing Lyme borreliosis.

Acute Disease↗

PubMed1976

[CSF-evaluation in unilateral, bilateral and alternant facial paralysis (author's transl)].

Etiology of idiopathic facial paralysis remains mostly unknown because further investigations seem unnecessary being the only symptom. Differentiated evaluation of CSF however for cytological or proteinous abnormalities should be performed aside serological examinations. In 9 patients treated within 8 months in our hospital diagnosis could be made by these procedures. Inflammation, if cause of facial paralysis, can only call pleocytosis, if localised within or next to the leptomeninges; protein of CSF perhaps will increase, if local inflammation of the nerve is more distant to subarachnoid space. "Idiopathic facial paralysis" however will not exclude focal inflammation far from subarachnoid space. Surgical decompression should not be performed without previous examination of CSF in regard of it's uncertain success.

Adult↗

PubMed1989

Total facial nerve decompression for recurrent facial paralysis: an update.

Recurrent facial paralysis (RFP) is a rare disorder that in some individuals may lead to worsening sequelae. Melkersson-Rosenthal syndrome is a variant of RFP that is associated with recurrent facial edema. In the past, decompression of the mastoid segment of the facial nerve has not been successful in preventing recurrences. In 1981 we began performing total facial nerve decompression for RFP and in 1986 reported its efficacy in one patient with Melkersson-Rosenthal syndrome and in another in whom both nerves were decompressed for alternating bilateral paralysis. An additional four cases with 3 to 8 years of followup demonstrate no recurrences in any patient. Total facial nerve decompression for RFP in selected patients appears efficacious in preventing recurrences. Decompression will remain investigational until further followup is obtained. Furthermore, its salutary effect should not be extrapolated to Bell's palsy without further study.

Adolescent↗

PubMed1999

[Effect of decompression or transplantation of the facial nerve on serious advanced facial paralysis].

OBJECTIVE: To investigate operative effect on serious advanced facial paralysis. METHOD: 28 cases (28 sides) with serious facial paralysis underwent decompression or transplantation of facial nerve. RESULT: After following up 0.5-2 years postoperatively, the total, most or partial and no recovery were 14 cases (50%), 12 cases (42%) and 2 cases (7.1%) respectively. CONCLUSION: The operation performed as early as possible can be an effective procedure for correcting serious advanced facial paralysis if conservative treatment could be confirmed to be helpless.

Adolescent↗

PubMed1986

Cheiloplasty in the treatment of facial paralysis.

There have been dramatic improvements in the treatment of facial paralysis. These include the successful use of free autogenous nerve grafting, nerve crossover techniques, regional masticatory muscle transposition, and free muscle grafts. The techniques are applied to total, partial, and regional paresis. The bulk of information on rehabilitation of the face has come from clinical empiricism, but basic research in nerve and muscle physiology and attempts at multiple classifications regarding indications and criteria have added to the splendor of this drama. One facet that has not been emphasized is the use of cheiloplasty in long-standing facial paralysis. Long-standing facial paralysis has both a neural and muscular deficit that cannot be rectified by a single concept or operation. It is essential to regionalize the rehabilitation, implant a kinetic muscular potential, supply some static support and elevation, and address the nonfunctional muscles about the paralyzed lips. This latter concept includes lip shortening and lip-flap transposition. A coordinated combination of these techniques has the best opportunity of maximizing the improvement in long-standing facial paralysis associated with severe muscle atrophy.

Chronic Disease↗

PubMed1995

Early temporalis muscle transposition for the management of facial paralysis.

Temporalis muscle transposition is a reliable surgical technique for the reanimation of patients with long-standing facial paralysis. It is often employed when facial nerve reinnervation via crossover or cable grafting is not possible. Temporalis muscle transposition can also be used for the immediate treatment of complete facial paralysis due to insults leaving the facial nerve anatomically intact but requiring a prolonged recovery time (more than 1 year). Because temporalis muscle transposition does not interfere with neuronal regeneration, it may be employed early in the management of complete facial paralysis when recovery is predicted to be extended and incomplete. The authors report their experience with early temporalis muscle transposition in the management of facial paralysis in 56 patients with an anatomically intact facial nerve. More than 90% of these patients achieved improved symmetry at rest as well as purposeful movement at the corner of the mouth. In the last 30 patients, the temporoparietal fascial flap was simultaneously harvested and successfully used to obliterate the donor site defect. In conjunction with the immediate implantation of a gold weight in the ipsilateral upper eyelid, this approach to the early management of facial paralysis helps reduce the period of facial disability from years to weeks in a select group of patients.

Adult↗

PubMed1997

[Case report: a traumatic facial paralysis caused by a fish].

BACKGROUND: Due to the increase in worldwide tourism more and more unusual injuries are observed. CASE: We report on a patient who was diving near the Maledives, where a fish weighing 30 kg collided with his head. Four to five hours later he suffered from paralysis of the facial nerve. During an operation performed after his return a part of the jaw of the fish was removed from the retromandibular fossa. The fish jaw had compressed the facial nerve. RESULT: Three months later the function of the nerve was normal again. CONCLUSION: Even simple accidents require a detailed patient history and the use of computed tomography. This made it possible to determine the cause of this unusual facial paralysis and cure the patient.

Animals↗

PubMed1977

Auditory symptoms associated with herpes zoster or idiopathic facial paralysis.

Auditory symptoms (hyperacusis, tinnitus, decreased hearing) have long been recognized to accompany herpetic or idiopathic facial paralysis. Twenty-nine percent of 1,080 patients with idiopathic facial paralysis and 37 percent of 172 with herpes zoster oticus facial paralysis had auditory symptoms. Abnormal related sensori-neural hearing loss was documented in only 11 of these 377 patients with auditory complaints. All of the 11 had a diagnosis of herpes zoster oticus. Sensori-neural hearing loss occurs in only about 6.5 percent of patients with herpes zoster facial paralysis, and no confirmed case of such loss in idiopathic facial paralysis has been reported. In patients presenting with sensori-neural hearing loss accompanying facial paralysis believed to be idiopathic, herpes zoster should be suspected even in the absence of vesicles. Factors favorable for recovery of auditory function include age 64 years or younger, mild initial hearing loss, a cochlear pattern of hearing loss, and absence of vertigo. Recovery of auditory function does take place; however, a high-tone sensori-neural loss may persist except in younger patients.

Adolescent↗

PubMed2004

Free proximal gracilis muscle and its skin paddle compound flap transplantation for complex facial paralysis.

Gracilis functioning free-muscle transplantation for the correction of pure facial paralysis has been a preferred method used by many reconstructive microsurgeons. However, for complex facial paralysis, the deficits include facial paralysis along with soft-tissue, mucosa, and/or skin defects. No adequate solution has been proposed. Treatment requests in those patients are not only for facial reanimation but also for correction of the defects. Of 161 patients with facial paralysis treated with gracilis functioning free-muscle transplantation from 1986 to 2002, eight patients (5 percent) presented with complex deficits requiring not only facial reanimation but also aesthetic correction of tissue defects. The tissue defects included an intraoral defect created following contracture release (one patient), infra-auricular radiation dermatitis with contour depression (one patient), temporal depression following a temporalis muscle-fascia transfer (one patient), ear deformity (two patients), and infra-auricular atrophic tissue with contour depression (three patients). A compound flap, consisting of a gracilis muscle with its overlying skin paddle separated into two components, was transferred for simultaneous correction of both problems. The blood supply to the gracilis and to the skin paddle originated from the same source vessel and therefore required the anastomosis of only one set of vessels. The versatility of this compound flap allows for a wide arc of rotation of the skin paddle around the muscle. All flaps were transferred successfully without complications. Satisfactory results of facial reanimation were recorded in five patients after all stages were completed. The remaining three patients are undergoing physical therapy and waiting for revision of the skin paddle.

Adolescent↗

PubMedDate not supplied

Facial paralysis with an inflammatory parotid mass.

Facial paralysis in association with a parotid mass is usually associated with a diagnosis of malignancy. Benign parotid neoplasms and inflammatory processes resulting in facial paralysis are extremely rare. This report describes such a case and highlights some of the difficulties surrounding the diagnosis and management of these cases.

Biopsy, Needle↗