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A case of bilateral facial paralysis following meningococcal meningitis and herpes simplex infection is reported. The author discusses the differential diagnosis of bilateral facial nerve paralysis which included several diseases and syndromes and concludes by herpetic aetiology.
Facial paralysis is a dreaded complication of parotid surgery. It can lead to a variety of troubling symptoms in the patient, such as ocular problems and nasal obstruction. It can also have a significant emotional impact on the patient because of facial disfigurement and difficulties with communication, eating, and drinking. Successful outcome for patients inflicted with facial paralysis depends on proper selection of the appropriate rehabilitation technique. This article discusses the acute and late management of facial paralysis resulting from parotid surgery.
OBJECTIVE: To investigate a synthetical technique combining static and dynamic states for treating facial paralysis. METHODS: From October 1993 to November 2005, 93 patients (26 males, 67 females; aged 9-69 years; illness course, 6 months to 24 years) with facial paralysis were admitted for treatment, of whom 48 were unknown in their pathological origins, 32 had a history of intracranial or ear operation, 13 had their facial paralysis related to trauma. We applied synthetical techniques for treating facial paralysis, including denerved muscle (extensor hallucis brevis and extensor digitorum brevis) free graft using an operating or chemical technique, temporal muscular flap suspending, treatment of eye closure by uplifting zygomo-malar tissues and temporal muscular flap suspending, brow lifting by the Buried Guiding Suture Appliance, Botox injection, and the nerve amputation of normal side for mandibular marginal ramus paralysis. RESULTS: After the treatment for 82 patients with the method of the denerved muscle free graft combining femoral muscular flap suspending, 3 patients with the method of uplifting zygomo-malar tissues combining temporal muscular flap suspending for eye closure, 15 patients with the method of the Buried Guiding Suture for eyebrow lifting, 4 patients with the Botox injection and nerve amputation of normal side for the mandibular marginal ramus paralysis, 93 patients had a good therapeutic result. The follow-up for 3 months to 10 years in all the patients revealed that 75 patients were satisfied with their treatment results and 13 patients were almost satisfied according to the criteria for the facial symmetrical checking and the House-Brackmann grading system. The technique had advantages of a complete survival of the related small muscles, a hidden incision, less trauma for the Botox injection, and the denerved muscles for surrounding nerve inserting. CONCLUSION: The synthetical technique combining static and dynamic states for treating facial paralysis is a good therapeutic method and the therapies for facial paralysis should vary with the different conditions of the paralysis. We advocate an individuation treatment for facial paralysis.
Patients with satisfactory facial nerve function [House-Brackmann (HB) grade I or II] immediately after acoustic neuroma surgery are at risk for delayed facial paralysis. To study this problem, 255 consecutive patients who underwent acoustic neuroma excision with facial nerve preservation were identified. Delayed facial paralysis occurred in 62 (24.3%) patients; 90% ultimately recovered to their initial postoperative HB grade, and 98.3% recovered to within one grade of their initial HB level. Paralysis occurred at an average of 3.65 postoperative days (range, 1-16 days). The average time to maximal recovery for those with changes of 1, 2, 3, and 4 HB grades was 5.6, 21.5, 39.8, and 50.5 weeks, respectively. The early onset of paralysis (< 48 h after surgery) resulted in shorter average recovery times. Of patients who demonstrated nerve deterioration to grades IV-VI, 20 of 38 required tarsorrhaphy or gold-weight placement. We conclude that the over-whelming majority of patients with delayed facial paralysis after acoustic neuroma surgery do eventually recover to their postoperative HB grade. The magnitude and timecourse of delayed facial paralysis are predictive factors for subsequent recovery.
In a previous study, the influence of the midfacial musculature upon growth and development of the maxilla and mandible was established macroscopically. Dry skull measurements revealed a reduced premaxillary, maxillary, mandibular, and anterior corpus length with a simultaneous increase in mandibular ramal height on the paralyzed side. It was demonstrated that these reduced premaxillary and maxillary lengths were among others the result of reduced nasofrontal growth, whereas the increased ramal height was accompanied by condylar growth alterations. This study investigated whether the growth alterations at the mandibular corpus region could be explained by altered periosteal growth at the muscle-bone interface of the zygomatico-auricular muscle and the mandibular corpus, caused by altered muscle activity acting upon the periosteal sleeve. Fifty-six 12-day-old New Zealand White rabbits were randomly assigned to either a control or an experimental group. In the experimental group, left-sided partial facial paralysis was induced surgically when the animals were 12 days old. To study the muscle-bone interface, seven follow-up time intervals were defined between 3.5 and 60 days following the surgery. At these time intervals, four randomly selected control animals and four randomly selected experimental animals were killed. The anterior mandibular corpus region with the muscle-bone interface of the left control hemimandible and the left and right experimental hemimandibles was processed for undecalcified tissue preparation. Quantitative analysis of the total bone area at the muscle-bone interface revealed no significant differences between the left control hemimandible and the left and right experimental hemimandibles. Also, qualitative study of the histologic sections showed no major changes in the appearance or development of the trabecular pattern between the groups. However, slight differences in the distribution pattern of osteoblasts and osteoclasts along the bony surface were found between the left control hemimandible and the left and right experimental hemimandibles, which seemed to explain the alterations in mandibular corpus shape between these groups. It was suggested that these changes in the distribution pattern of osteoblasts and osteoclasts were the result of changes in the loading distribution pattern acting upon the mandible, caused by an altered neuromuscular recruitment pattern of the remaining functionally intact, mandibularly attached muscles. The latter was probably the result of adaptive mandibular positioning in response to an altered occlusal relationship, which was induced by the abnormal maxillary growth as a result of the unilateral partial facial paralysis.
We are developing a prototype of a surgical simulation system for restoring facial expression lost in cases of facial paralysis. Correcting facial paralysis requires careful planning of surgery procedures and accurate prediction of the surgical results. So far techniques to perform this task largely relied on the physician's experience, and there were few quantitative data to refer to. The system we propose is finally aimed at helping the surgeon plan the surgery and predict the results. The 3D model of the face used in our system is generated directly from the CT scan of the patient. The face model consists of skin, skull and selected facial muscles based on anatomy. The mass and spring lattice approach is used to give physical attributes to the face model. The present prototype system lets the user directly manipulate graphical representations of facial expression.
BACKGROUND: Functional evaluation of the facial movements in patients with facial paralysis following a stroke. AIM: To evaluate the function of the facial muscles of patients after central facial paralysis following a stroke. METHOD: Nine patients referred by the Neurology Service were evaluated. The evaluation focused on spontaneous, voluntary and reflex movements. RESULTS: Reflex and voluntary movement of the eyelid and forehead were preserved in all patients. However, spontaneous and voluntary movements of the lips and nose were limited according to the location and extension of lesion. CONCLUSION: The symptoms of central facial paralysis, in which paralysis only of voluntary movements of the lower two-thirds of the face is expected, occurred in the minority of the patients.
BACKGROUND: The satisfactory management of facial paralysis after extirpative skull base surgery has been notoriously difficult. To optimize physical and psychological recovery, early perioperative use of polytef (polytetrafluoroethylene [PTFE]) facial suspension has been used in patients with either profound electrophysiological or anatomical disruption of the facial nerve. OBJECTIVE: To review the efficacy of this clinical algorithm. STUDY DESIGN: Retrospective medical record review. SETTING: Tertiary care University Hospital Inc, University of Cincinnati College of Medicine, Cincinnati, Ohio. PATIENTS AND METHODS: Medical records review of 32 patients who underwent lateral skull base surgery with resultant facial paralysis who had facial rehabilitation using polytef suspension. RESULTS: All patients who underwent polytef facial suspension reported improvement in both facial function as well as aesthetics. One patient had a late extrusion of the polytef implant. CONCLUSION: The early peri-extirpative application of this technique provides psychological and physical support to patients with facial paralysis who are recovering from lateral skull base surgery. Arch Facial Plast Surg. 2000;2:243-248
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Congenital facial palsy is a devastating deformity. At present time there are no reports of the early treatment of this disorder. The treatment may be to supply contralateral auto reinnervation to the affected muscles through a sural-facial nerve graft enhanced by electric field stimulation. The purpose of this paper is to report 5 cases of congenital facial palsy treated by a crossed sural-facial nerve graft, enhanced by electric field stimulation. One year after surgery, clinical and electrodiagnostic examinations indicate appropriate reinnervation activity in all the patients.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Rehabilitation of the midface in chronic facial paralysis is one of the last frontiers in global facial reanimation. The suborbicularis oculi fat pad lift, or SOOF lift, also known as the midface lift, has been popularized in aesthetic surgery literature as a way to restore midface fullness with a youthful appearance while eliminating midface sag associated with aging. These techniques of midface aesthetic rejuvenation have recently been applied in cases of chronic facial paralysis. This article analyzes the role of the midface lift or SOOF lift in cases of facial reanimation and determines whether or not it is of benefit to patients affected by chronic facial paralysis.
The purpose of this study was to determine if there is a relationship between the appearance of facial paralysis and physical or psychological stress. Subjects were 55 patients (23 men, 32 women) with facial paralysis (32 with Bell's palsy, 23 with Ramsay Hunt syndrome) who visited the Department of Otolaryngology, Nihon University Itabashi Hospital, from August 1994 to March 1996. At the time of the initial visit, patients were asked if they had any physical or psychological stress one week before the occurrence of facial paralysis. The degree of psychological stress was rated by Niina's Psychological Stress Response Scale 50 Items Revised (PSRS-50R). Answers were obtained from 52 of the 55 subjects. Forty patients (76.9%) reported that they had felt physically fatigued, suggesting some type of relationship between the occurrence of facial paralysis and physical stress. Twenty-seven patients (51.9%) reported the existence of psychological stress. However, the evaluation of psychological stress by PSRS-50R did not reveal a high level of psychological stress in any patient, indicating lack of a strong relationship between the occurrence of facial paralysis and psychological stress. Stepwise regression analyses were made to study the relationship between the degree of paralysis at the time of the initial visit and factors which affect the prognosis of the paralysis. Those patients who reported physical fatigue before the appearance of facial paralysis had more abnormal values on the nerve excitability test than those who did not report such fatigue.
OBJECTIVE: To observe therapeutic effect of aponeurotic system penetration needling on peripheral facial paralysis. METHODS: One hundred and ten cases of peripheral facial paralysis were randomly divided into a Jingjin group (n=68) and a control group (n=42). The therapeutic effects of acute stage, resting stage and sequela stage, and the relation between the facial nerve lesion degree and the therapeutic effect were investigated. RESULTS: The effective rates of the two needling methods were respectively 98.5% and 90.5%, the Jing1in group being better than the control group (P < 0.05); at the acute stage, the therapeutic effect of acupuncture was obvious, and the therapeutic effect at the sequela stage and for the patient of nerve faulty type in the Jingjin group were better than that of the control group (P < 0.05). CONCLUSION: Acupuncture and moxibustion has definite therapeutic effect on facial paralysis at the acute stage and in the patient of nerve active type, and aponeurotic system penetration needling can be used for the patient of facial paralysis at the sequela stage or with nerve faulty type.
OBJECTIVE: To assess the psychological distress, the ways of coping with that stress, and the self-esteem of patients with facial paralysis after acoustic neuroma surgery. Possible predictors and associations between these measures were also explored. STUDY DESIGN: Four validated questionnaires were completed by patients with facial paralysis after acoustic neuroma surgery: 1) the Derriford Appearance Scale (DAS) to measure psychological distress, 2) the COPE questionnaire to measure how patients cope with facial paralysis, 3) the Personal Report questionnaire to measure the self-esteem of patients, and 4) the Facial Paralysis Questionnaire (FPQ) to measure the severity of facial paralysis. PATIENTS: One hundred three patients with facial paralysis after surgical removal of acoustic tumors. RESULTS: Distress spanned a wide range in these patients. There was no statistically significant association between the level of distress and the grade of facial paralysis or between time since operation and levels of distress. Women had higher levels of distress (P = .02) and a significant negative correlation was found between levels of distress and age (r = -0.28, P = .005). High levels of distress were associated with low levels of self-esteem, as shown by the significant negative correlation between level of distress and self-esteem (r = -0.59, P = .01). A significant correlation between distress and maladaptive coping (r = 0.31, P = .002) was also found. Stepwise multiple regression of the distress scores revealed that self-esteem was the most important contributing factor (standardized coefficient beta -0.60, P = .0001), followed by age (beta -0.24, P = .006) and sex (beta -0.21, P = .04). This model explained 44% of the distress variance. CONCLUSION: Clinicians must be aware of the distress felt by some patients experiencing facial palsy after acoustic neuroma surgery and that the level of distress may not be related to the clinical grade of the facial nerve paralysis. People with low self-esteem, young people, and women suffer from more distress due to the facial palsy. Clinicians should thoroughly counsel patients before and after surgery and should implement measures that increase patients' self-esteem and decrease their distress, especially in these high-risk groups.
It has been reported that tumour invasion of the facial canal does not necessarily produce facial paralysis. The purpose of this paper is to present the facial nerve pathology in cases of facial paralysis caused by malignant neoplasms. Forty-seven temporal bones acquired from patients who died of malignant neoplasms were used for this analysis. Of the 47, 18 temporal bones (38.3%) had temporal bone metastasis or invasion. In 6 cases, the tumour destroyed the bony facial canals exposing the facial nerves to the invading tumour cells. The records of the patients showed that only half of the patients had facial paralysis. Those in whom tumour cells invaded the facial nerve beyond the epineural sheath had complete facial paralysis before death.