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PubMed1999

Not all facial paralysis is Bell's palsy: a case report.

Bell's palsy or idiopathic facial paralysis is the most common cause of unilateral facial paralysis. This case report describes a patient referred for physical therapy evaluation and treatment with a diagnosis of Bell's palsy. On initial presentation in physical therapy the patient had unilateral facial paralysis, ipsilateral regional facial pain and numbness, and a history of a gradual, progressive onset of symptoms. The process of evaluating this patient in physical therapy, as well as the recognition of signs and symptoms typical and atypical of Bell's palsy, are described. This report emphasizes the importance of early recognition of the signs and symptoms inconsistent with a diagnosis of Bell's palsy, and indications for prompt, appropriate referral for additional diagnostic services.

Adult↗
PubMed2002

Neurovascular free-muscle transfer to treat facial paralysis associated with hemifacial microsomia.

Despite the wide spectrum of hemifacial microsomia manifestations, treatment mainly focuses on mandible and ear abnormalities, rather than on facial paralysis. In fact, the surgical treatment of facial paralysis associated with hemifacial microsomia is quite underdeveloped, because the degree of paralysis is frequently incomplete or partial. Timing and type of surgery are also difficult to determine. Neurovascular free-muscle transfer is now a standard procedure for the dynamic smile reconstruction of longstanding facial paralysis. This type of strategy has considerable potential in the treatment of facial paralysis in patients with hemifacial microsomia. We present here our experience with neurovascular free-muscle transfer for smile reconstruction in eight patients with facial paralysis associated with hemifacial microsomia. The age of the patients at the time of surgery ranged from 7 to 28 years old, (average, 13.9 years). Six were male patients and two were female patients. The two-stage method combining gracilis muscle transfer with cross-face nerve grafting was performed in three patients, whereas the one-stage transfer of the latissimus dorsi muscle was performed in five. To construct a natural or near-natural smile, the muscles were transferred into the paralyzed cheek in all except one patient, in whom the latissimus dorsi muscle was transferred into the sublabial area to reconstruct a paralyzed lower lip. A dermal flap segment vascularized with perforating vessels from the latissimus dorsi muscle was simultaneously inserted into the underdeveloped cheek for soft-tissue augmentation in this patient. Muscle contraction was evident in all patients between 4 and 8 months after muscle transfer. Our present series revealed that neurovascular free-muscle transfer is a good option not only for smile reconstruction but also for restoration of the facial contours of patients with hemifacial microsomia. Compared with the two-stage method combining gracilis muscle transfer with cross-face nerve grafting, the one-stage method using the latissimus dorsi muscle has some advantages, including a one-stage operation, a shorter recovery period, and the absence of sequelae that occur after harvesting a sural nerve.

Adolescent↗
PubMed1990

The use of masseter electromyography with electroneurography in the evaluation of facial paralysis.

In the evaluation of facial paralysis, electroneurography provides a quantitative assessment of the degree of degeneration. Near the endpoint of degeneration, the facial musculature compound action potential may be contaminated by masseter artifact resulting from supramaximal stimulation. We propose the use of both masseter electromyography and electroneurography in the evaluation of advanced degeneration to better define the current level for supramaximal stimulation, to eliminate masseter artifact, and to more accurately assess the degree of facial nerve degeneration.

Action Potentials↗
PubMedDate not supplied

Management of facial paralysis in temporal bone fractures: a prospective study analyzing 11 operated fractures.

OBJECTIVE: This study was instituted to evaluate patients operated on for traumatic facial paralysis. STUDY DESIGN: A prospective study and literature review. MATERIALS AND METHODS: Between 1996 and 2001, 10 patients with 11 temporal bone fractures resulting in facial paralysis, who were treated by surgical exploration, were handled. One patient had bilateral facial paralysis because of a bilateral temporal bone fracture. All patients had immediate facial paralysis after trauma. The sample included 7 males and 3 females, aged between 8 and 43 years. RESULTS: Of the 11 fractures, 7 (63%) were longitudinal and 4 (37%) were mixed type. There were no transverse fractures. The longitudinal fractures were operated on by the middle cranial fossa (MCF) approach, whereas the mixed fractures were operated on by using a combined approach, consisting of both MCF and transmastoid approaches. The first neurotologic examination and electrophysiological evaluation of the patients were carried out at the earliest 5 days and at the latest 50 days (mean, 25.6 days). The decision for surgery based mainly on electroneurography (ENoG) was possible only in one fracture. In the remaining 10 fractures, the decision for surgery was based mainly on the high-resolution computed tomography (HRCT), taking into account that electromyography (EMG) showed no regeneration potentials. The timing of the surgical intervention ranged from 14 to 75 days (mean, 37.9 days). During the operation, fibrosis at the geniculate ganglion was seen in 5 fractures, impingement of the facial nerve by bone spicules at the geniculate ganglion in 2 fractures, disruption or laceration at the origin of major superficial petrosal nerve also in 2 fractures, and edema around the geniculate ganglion, which is considered a mild form of injury, seen in only 2 fractures. Five fractures showed House-Brackmann (HB) grade 1, 4 patients showed HB grade 2, and 2 patients showed HB grade 3 facial recovery. There were no hearing deterioration or permanent complications related with the procedures. CONCLUSIONS: It is rarely possible to see the patients with traumatic facial paralysis in the early period and thus to perform ENoG in the critical 6 days after facial paralysis. HRCT, with the contribution of EMG and clinical judgment, has the greatest impact in decision making in patients seen late. On the basis of the facial outcomes observed in the present prospective surgical series, the recovery of satisfactory facial nerve function could be achieved, regardless of timing of surgery performed, within the first 3 months after the onset of paralysis. This study demonstrates that unless there is a disruption of the main trunk, necessitating primary end-to-end anastomosis or grafting, the type of injury does not have any clear effect on the facial outcome, as long as appropriate surgical management is applied.

Adult↗
PubMed2007

Facial paralysis associated with glomus jugulare tumors.

OBJECTIVE: To review the intraoperative findings and facial nerve management in nine patients who presented with facial paralysis associated with glomus jugulare tumors. STUDY DESIGN: A retrospective analysis of patient medical records. SETTING: Tertiary care academic medical center. PATIENTS: All patients who presented with facial paralysis and a glomus jugulare tumor who underwent surgical resection of their tumors at our institution. INTERVENTION: A postauricular infratemporal fossa approach for tumor removal and greater auricular interposition neural repair. MAIN OUTCOME MEASURE: Intraoperative facial nerve findings and long-term facial recovery. RESULTS: One hundred two patients underwent a postauricular infratemporal approach for resection of glomus jugulare tumor from July 1988 through July 2005. Nine of these patients presented with ipsilateral facial paralysis. The medial surface of the vertical segment was invaded by tumor in all nine cases. Facial recovery at 2 years was House-Brackmann Grade III in eight patients and Grade IV in one individual. Facial recovery did not significantly change after 2 years (mean follow-up of 7.4 years). DISCUSSION: Facial nerve invasion of the vertical segment occurred in 9 (9%) of 101 patients in our series. Facial nerve resection with interposition grafting resulted in House-Brackmann Grade III in eight (89%) of nine patients. Facial nerve dissection and preservation was not possible when preoperative facial paralysis was evident.

Adult↗
PubMedDate not supplied

[Peripheral facial paralysis: etiology, diagnosis and treatment].

OBJECTIVE: Peripheral facial paralysis is one of the commonest mononeuropathies. The frequency of idiopathic peripheral paralysis or Bell's palsy varies between 62% and 93% of all cases, with an incidence of between 14 and 25 cases per 100,000 inhabitants per year. However, in spite of its relative frequency in the population, there is still no definite unanimously agreed strategy currently used by neurologists. Although its course is relatively benign, up to 16% of the patients show moderate or severe sequelae according to follow-up data in 1,011 untreated patients. In this article we review the aetiology, diagnostic methods and therapeutical strategies at the present time. DEVELOPMENT: The topographic diagnosis of the lesion is based on the symptoms associated with the paralysis. The neurophysiological studies (trigeminofacial reflection and electroneurogram), usually done after the first week are prognoses that permit differentiation of the degree of the lesion (neuropraxis, axonotmesis or neurotmesis). In spite of recent trials with combined therapy (acyclovir and steroids) the most generally accepted treatment at present is still prednisose at a dose of 1 mg/kg/day. CONCLUSIONS: Peripheral facial paralysis is a common condition, usually with no apparent cause and an eminently clinical diagnosis. The electrophysiological studies determine the prognosis. Currently the standard treatment is still oral prednisone.

Acyclovir↗
PubMed1995

Long-term effects of neuromuscular rehabilitation of chronic facial paralysis.

Although chronic facial dysfunction can be improved with neuromuscular biofeedback therapy, it is uncertain whether this improvement is maintained after such therapy ends, or whether post-therapy, home exercise programs optimize this improvement. We aimed to clarify these issues. Post-therapy facial function, in 38 previously treated patients, was blindly assessed using the House grading system, 1 to 41 months after ending therapy. Results were compared with pre-therapy function. It was found that post-therapy function was better than pre-therapy function in most patients (40%), it was worse in some (26%), and was unchanged in the rest. This surprising result occurred because, although most patients who recently stopped therapy (1 to 6 mo) had improved significantly, the longer other patients were out of therapy, the more they had tended to deteriorate, particularly those who had been practicing. Results suggested that unsupervised, post-therapy, home exercise programs may be detrimental, and that new post-therapy programs may be required to maintain the benefits of regular therapy.

Adolescent↗
PubMed2000

Variations on the "baby-sitter" procedure for reconstruction of facial paralysis.

Four cases of fresh facial paralysis were treated using the "baby-sitter" procedure, with fairly satisfactory results obtained. This procedure involves a combination of cross-face nerve grafting and a nerve cross-over technique such as using a hypoglossal-facial nerve or accessory-facial nerve anastomosis. Two stages are required. Nerve cross-over and cross-face nerve grafting using the sural nerve are performed in the first stage. After 1 year nerve anastomosis between the stump of the cross-face nerve graft and that of a buccal branch in the paralyzed cheek is performed during the second stage. The recovery of facial animation through this method is good, with patients able to create a near-natural smile. Electromyography demonstrates double innervation in the paralyzed cheek area.

Accessory Nerve↗
PubMed1997

Pediatric facial paralysis--a spirochetal infection with good prognosis?

The aim of the study was to investigate the possible signs of chronic spirochetal infection in 27 children with a history of facial paralysis with onset of symptoms during May-October 1985-1993. These children had not been studied at the time of facial paralysis for possible Lyme borreliosis and none of these children had received antimicrobial therapy at that time. The patients were interviewed with special reference to symptoms and signs of Lyme borreliosis and thereafter examined clinically and with laboratory tests. None of the patients showed signs or symptoms of chronic Lyme borreliosis. One child-now a 14-year old girl-had a 4-fold rise in serum Borrelia burgdorferi antibodies as a sign of a recent infection. According to our prospective studies on pediatric facial paralysis in Finland (over 50% of children presenting with facial paralysis during May-October have Lyme borreliosis), we have a reason to assume that at least some in our study group had a facial paralysis caused by Borrelia burgdorferi infection. The results of our study indicate that facial paralysis has a favorable prognosis and in short-term follow-up the children do not have symptoms or signs of chronic Lyme borreliosis.

Adolescent↗
PubMed1982

Our experience with Freilinger's method for dynamic correction of facial paralysis.

Eight patients with unilateral facial paralysis of differing aetiology and duration were treated according to Freilinger's method, which includes cross-face nerve grafting and six to eight months later, transposition of a denervated (temporal) muscle flap to the nasolabial area. The end of the cross-face nerve graft is inserted into the muscle flap. Our experience and results with this technique are discussed. It is clear that the combination of cross-face nerve grafting and transposition of a denervated muscle flap is a valid principle. However, a muscle with a greater excursion and one that is easier to denervate is to be preferred to the temporal muscle.

Adolescent↗
PubMed1982

Intraoral masseter muscle transposition: use with reconstruction of regional facial paralysis.

The treatment of regional facial paralysis of the lips and commissure by masseter muscle transposition is well accepted and usually accomplished by an external approach. The intraoral transfer demonstrates distinct advantages for the rehabilitation of midfacial regional paresis. The procedure is performed totally intraorally, which exposes the masseter muscle before transposing the anterior portion in a subcutaneous tunnel to the upper and lower lips. The effects of this transposition are direct support and immediate contraction, with eventual myoneurotization of the surrounding perioral musculature. The indications, operative considerations, and results in 22 cases are reported. This technique considerably advances the procedural approaches of the reconstructive surgeon and in used either in conjunction with other reconstructive modalities or as a primary procedure in selected cases.

Facial Paralysis↗
PubMed1998

[Clinical and experimental study on facial paralysis in temporal bone fracture].

To study the main prognostic factors and significance of facial nerve decompression of facial paralysis in temporal bone fracture, the main relative prognostic factors of 64 patients with facial paralysis were analyzed. Experimental model of facial paralysis was made. Expansion rate of facial nerve in facial canal opening group and non-opening group was measured and observed under electron microscope. The main factors affecting the prognosis were facial nerve decompression and selection of surgery time. Expansion rate of facial nerve in opening group was significantly higher than that of non-opening group. Injury degree of nerve fiber of non-opening group was severe. It is suggested that early facial nerve decompression is of beneficial to restoration of facial nerve function.

Adolescent↗
PubMed2000

[Compared characteristics of peripheral facial paralysis according to HIV status in Bobo-Dioulasso (Burkina Faso)].

Facial paralysis is a well-described manifestation of HIV infection. We report 27 cases of peripheral facial paralysis observed at Bobo-Dioulasso Hospital in a prospective study over a period of 9 months: 55 of the cases were HIV positive and 12/15 (80%) were in the 20-39 age group. Nine out of 11 females and 6 out of 16 males were seropositive. 13 of the cases were at stage B of CDC classification and 2 at stage C. ESR was elevated in all the HIV patients. CSF examination revealed lymphocytic pleiocytosis, elevated proteins and a positive HIV serology. CD4 counts were obtained in 8 cases and were under 400/mm3 in 4 cases. The clinical presentation was more severe in HIV seropositives with a longer duration of symptoms. Isolated peripheral facial paralysis associated with an elevated ESR in young adults suggest HIV infection and should lead to HIV counselling and testing.

Acquired Immunodeficiency Syndrome↗
PubMed2006

[Analysis on therapeutic effects of different acupuncture times on peripheral facial paralysis].

OBJECTIVE: To observe clinical therapeutic effects of different acupuncture times on peripheral facial paralysis. METHODS: Forty-nine cases of peripheral facial paralysis were randomly divided into 2 groups, group A and B. The group A received acupuncture, once daily, and the group B twice each week. Their therapeutic effects were assessed after 3 courses. RESULTS: The acupuncture times were not direct proportion to the therapeutic effect (P<0.01), with no significant difference between the two groups in the cured rate (P>0.05). CONCLUSION: Acupuncture treatment can select twice each week for peripheral facial paralysis.

Acupuncture Points↗
PubMed1979

The opercular syndrome--diagnostic trap in facial paralysis.

We describe a patient with a left facial paralysis and hemotympanum following left parieto-occipital skull trauma. The initial admission diagnosis of intratemporal facial nerve injury secondary to temporal bone fracture was incorrect. Normal facial movements during involuntary activity (yawning, laughing at a joke) and focal seizure activity on the paralyzed side of the face, seen subsequently, indicated the site of lesion as supranuclear. The diagnosis of opercular syndrome was made. This syndrome can result when the contralateral frontal lobe is injured. Supranuclear weakness of muscles supplied by the hypoglossal or spinal accessory nerves is also present. Unlike other central paralyses, the facial paralysis in operculum syndrome may not demonstrate "forehead sparing" and consequently it may be mistaken for a peripheral paralysis. The neuroanatomic basis for the syndrome is discussed. Signs and symptoms are outlined to help the otolaryngologist avoid this diagnostic pitfall.

Adult↗
PubMed1995

[Reconstruction of chronic facial paralysis by free gracilis muscle transfer. Apropos of 59 cases].

Surgical repair of facial paralysis is designed to restore automatic and uniform facial expression. The authors report their experience of 64 patients with longstanding facial paralysis treated by revascularized and reinnervated gracilis muscle transfer. Reinnervation of the gracilis muscle was obtained by anastomosis of its motor nerve to the facial nerve on the healthy side following preliminary transfacial nerve graft. 59 patients were followed for 1 to 8 years; the mean duration of facial paralysis was 14 years in this series. The authors modified the gracilis muscle harvesting technique by decreasing the muscle mass to a minimum. Two complications were observed: one severe infection leading to thrombosis of the anastomosed vessels and one intraoperative technical difficulty concerning the nerve anastomosis. The results were considered to be good in 72% of cases and excellent in 5% of cases in terms of facial expression. However, good results were not obtained in muscle transfer for palpebral paralysis, in which the authors prefer to make the eyelid heavier by inserting a gold weight implant after modifying this technique to lower the rejection rate.

Adolescent↗
PubMed1989

Facial paralysis in chronic suppurative otitis media.

Sixty-four patients with a facial paralysis due to chronic suppurative otitis media were treated by surgical decompression during the 10-year period 1973 to 1982. Paralysis was clinically complete in 66% and incomplete in 34% of the patients. Cholesteatoma was found in 80%. Otogenic facial paralysis was more common as an isolated lesion not associated with other complications. When present, bone destruction of the facial canal was most frequently seen in its tympanic portion. The occurrence of facial paralysis did not depend on the extent of destruction of the facial canal. Facial nerve function recovered completely in 70%, partially in 24% and failure occurred in 6% of the patients.

Chronic Disease↗