[Facial paralysis. Peripheral facial paralysis and its treatment].
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Facial Paralysis↗
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[Idiopathic facial paralysis and facial paralysis due to herpes zoster (follow-up and therapeutic indications)].
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Adrenal Cortex Hormones↗
[Surgical treatment of traumatic facial paralysis].
Facial paralysis caused by cranial traumatism often needs surgical treatment / 28 operations were carried out on a group of 47 paralysed patients. Direct lesion of the facial nerve was in fact common / 10 compressions or contusions, 4 sections. Associated kophosis was frequent (15 cases). Conductive deafness was not uncommon (11 cases). Transverse fractures (5 cases) and complicated fractures (4 cases), true to their reputation for seriousness, all needed surgery and span the four nerve sections observed. Surgery is often delayed due to extensive cranio-cerebral lesions requiring prolonged neuro-surgical nursing care / 16 patients were operated on between the 4th and 8th weeks, 9 patients after the 8th week. The operation was usually carried out through the mastoid. Posteiror lympanotomy enabled the bend and the second portion to be reached and later enabled the ossicular chain to be reconstructed. In two cases involving kophosis, the three portions of the nerve were tackled through the labyrinth. The choice depends on the audiometric, radiological and operative findings. Surgical indications depend on clinical, elecromyographic, audiometric and radiological results. A check was carried out by means of muscular tests in 23 out of 28 cases: --20 decompressions / 15 recuperations of more than 50 p. 100 of which 7 were above 75 p. 100; --3 grafts or sutures / 3 recuperations of 30 p. 100.
Adolescent↗
Lip transposition in patients with facial paralysis.
Since facial reanimation is not always possible in patients with facial paralysis, one must have alternate methods of reconstruction available. Satisfactory static reconstruction of the face may be accomplished with the use of a brow lift, tarsorrhaphy, and correction of the paralyzed mouth. Transposition of the corner of the mouth utilizing the Z-plasty technique has proven to be an effective method to correct the drooling and garbled speech associated with facial paralysis. When combined with a brow lift and tarsorrhaphy, symmetry of the facial appearance while at rest has also been obtained.
Aged↗
Symposium on facial paralysis.
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Facial Paralysis↗
[Facial paralysis in children].
Facial paralyses in children may be grouped under headings displaying a certain amount of individuality. Chronologically, first to be described are neonatal facial paralyses. These are common and are nearly always cured within a few days. Some of these cases are due to the mastoid being crushed at birth with or without the use of forceps. The intra-osseous pathway of the facial nerve is then affected throughout its length. However, a cure is often spontaneous. When this desirable development does not take place within three months, the nerve should be freed by decompressive surgery. The special anatomy of the facial nerve in the new-born baby makes this a delicate operation. Later, in all stages of acute otitis, acute mastoiditis or chronic otitis, facial paralysis can be seen. Treatment depends on the stage reached by the otitis: paracentesis, mastoidectomy, various scraping procedures, and, of course, antibiotherapy. The other causes of facial paralysis in children are very much less common: a frigore or viral, traumatic, occur ring in the course of acute poliomyelitis, shingles or tumours of the middle ear. To these must be added exceptional causes such as vitamin D intoxication, idiopathic hypercalcaemia and certain haemopathies.
Adolescent↗
Delayed facial paralysis after a condylar fracture.
Facial paralysis following facial injuries during childhood is rare. The literature is reviewed and the mechanisms of facial nerve injuries are discussed. The case of a five-year-old boy with facial paralysis 48 hours after a condylar fracture is presented. The surgical and conservative treatment of traumatic facial paralysis is discussed.
Child, Preschool↗
Preoperative facial paralysis in malignant parotid tumours.
Preoperative paralysis of the facial nerve was found in 145 of 1,029 patients with malignant parotid tumours (14%) treated at nine university clinics in Scandinavia. The incidence of facial paralysis varied between the different clinics. A parellelism between the incidence of the facial paralysis and the impairment of the prognosis of the different tumour types is shown. The presence of preoperative facial nerve paralysis in malignant parotid tumours implies a very poor prognosis but the situation is not as hopeless as has been suggested and therefore one must rely on very radical surgery.
Adenoma↗
Idiopathic facial paralysis in the dog.
Facial nerve paralysis of acute onset is reported in seven mature dogs, five of which were cocker spaniels. The clinical signs were characterised by ear drooping, lip commissural paralysis, sialosis, and collection of food on the paralysed side of the mouth. All dogs showed absent menace responses and trigeminofacial/acousticofacial reflexes. Horner's syndrome was not present in any dog. In four dogs, bilateral facial paralysis developed. The facial paralysis was unrelated to otitis media. Electrodiagnostic studies revealed denervation potentials and absent evoked muscle potentials. Facial nerve biopsies from two cases showed nerve fibre degeneration and apparent loss of larger diameter myelinated fibres. The condition has been termed idiopathic facial paralysis since the aetiopathogenesis is presently unknown.
Animals↗
Surgical and nonsurgical management of facial paralysis following closed head injury.
The outcomes of facial nerve decompression, surgical exploration, and nonsurgical treatment for facial paralysis following closed head injury were analyzed in 30 patients with an intact facial nerve, and complete evaluation. Objective evaluation of outcome was achieved by calculation of a Facial Paralysis Recovery Profile and Recovery Index (Profile minus complications). Twelve of 15 patients with incomplete facial paralysis were treated medically. All followed patients with incomplete paralysis and bilaterally equal facial nerve excitability had a Recovery Index of + 10 (complete recovery of function, no complications). Three with partial denervation had a Recovery Profile of + 10 with mild contracture and synkinesis. The average Recovery Profiles for all patients treated by decompression, exploration, or nonsurgically were respectively 4.0, 5.7, and 5.7. The Recovery Indices were +1.8, +3, and +2.7, respectively. Where nerve excitability had become abnormal, facial nerve decompression was of no benefit in traumatic facial paralysis due to closed head injury. Nerve excitability tests of peripheral branches are of great value for prognosis and selection of patients who do not need surgical intervention. Substitution of facial nerve exploration for facial nerve decompression seems reasonable. Polytomography of the facial canal is invaluable in selection of patients for operation.
Adolescent↗
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↗
[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↗
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↗
[Bilateral facial paralysis].
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.
Adult↗
[Treatment of congenital facial paralysis with crossed innervation of facial nerve and electric field stimulation].
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.
Combined Modality Therapy↗
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↗
[Recent developments in electrical tests applied to the study of facial paralysis].
We have already shown the spontaneous development over a period of time of idiopathic facial paralysis, in relation to the extent of the resulting disfigurement, by means of analytical clinical measurement representing the sum of 19 factors constituting the force of contraction, tonus, coordination and hemispasm. This spontaneous development takes place in 3 stages: --an initial period up to the 15th day; --an intermediate period during which there is clinically total facial paralysis; --a period of recuperation. The duration of this development in relation to the extent of sequelae enables a rough distinction to be made between: a) benign facial paralysis in which disfigurement is nil or very slight (1 to 6 p. 100), incomplete paralysis or complete paralysis in which recuperation starts about the 15th day at the earliest, or at about the 4th month at the latest; c) very serious facial paralysis with moderate (38 to 66 p. 100), or considerable (66 to 100 p. 100) disfigurement and in which recuperation starts at the end of the 3rd month at the earliest. The authors have attempted to indicate how effective very prompt quantitative electrical procedures are in helping to assess the seriousness of ultimate permanent disfigurement (see article).
Electrodiagnosis↗
[Facial paralysis and tuberculous otitis. Significance of early neural decompression].
Facial paralyses associated with tuberculous otitis have consistently had a bad prognosis. This is bound up with delay in diagnosing the tuberculous nature of the lesions and with slow-acting medical treatment. The facial nerve must be decompressed immediately and not delayed until medical treatment has failed. This attitude is particularly necessary in two types of circumstances in which the tuberculous origin should be under suspicion as a matter of routine / firstly when facial paralysis appears in the secondary sequelae of ear surgery and, secondly, when facial paralysis is a complication in chronic otitis without cholesteatoma.
Adult↗