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Song Y, McHugh C, Tirino J, Hadlock T, Santos F. Middle Fossa Decompression for Recurrent Facial Palsy: Prevalence and Surgical Outcomes. Laryngoscope 2023; 133:1222-1227. [PMID: 37042775 DOI: 10.1002/lary.30344] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To investigate the surgical outcomes in patients treated for recurrent facial nerve palsy (RFP) at a quaternary facial nerve referral center. METHODS A retrospective chart review was performed on 132 patients with RFP who presented to our institution's facial nerve clinic from 2001 to 2021. Records were analyzed for etiology of palsy, facial nerve function, and recurrence rates. Pre- and post-operative audiometric outcomes were also assessed in surgically managed patients. RESULTS 6.8% of RFP patients underwent surgical decompression. For patients who did not undergo surgery, the House-Brackmann (HB) score was 2.9 ± 1.3 (SD) at the initial clinic visit, and 2.4 ± 1.3 (SD) at the last clinic visit. This difference was significantly different (p = 0.01, t-test). For surgical patients, the pre-operative HB score was 2.9 ± 0.9 (SD) and post-operative HB score was 1.8 ± 0.6 (SD), which were significantly different (p = 0.01, t-test). The number of facial palsy episodes also decreased pre- and post-operatively from 3.5 ± 0.8 (SD) to 0.2 ± 0.4 (SD) episodes, which were significantly different (p < 0,001, t-test). Audiometric outcomes were not significantly different pre- and post-surgery (p = 0.31, t-test for PTA; p = 0.34, t-test for WRS). CONCLUSION Facial nerve decompression for RFP patients with incomplete functional recovery may be an effective treatment for decreasing the frequency and severity of facial palsy episodes. LEVEL OF EVIDENCE 4 Laryngoscope, 133:1222-1227, 2023.
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Affiliation(s)
- Yohan Song
- Department of Otolaryngology-Head and Neck Surgery, Division of Otology, Neurotology, and Skull Base Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher McHugh
- Department of Otolaryngology-Head and Neck Surgery, Division of Otology, Neurotology, and Skull Base Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer Tirino
- Department of Otolaryngology-Head and Neck Surgery, Division of Otology, Neurotology, and Skull Base Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Tessa Hadlock
- Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Felipe Santos
- Department of Otolaryngology-Head and Neck Surgery, Division of Otology, Neurotology, and Skull Base Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
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Tampio AJF, Chorney SR, Nicholas BD. Recurrent Facial Nerve Paresis in a Child With Chronic Otitis Media With Effusion. EAR, NOSE & THROAT JOURNAL 2019; 99:187-189. [PMID: 30955376 DOI: 10.1177/0145561319839933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Alex J F Tampio
- Department of Otolaryngology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Stephen R Chorney
- Department of Otolaryngology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Brian D Nicholas
- Department of Otolaryngology, SUNY Upstate Medical University, Syracuse, NY, USA
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Karalok ZS, Taskin BD, Ozturk Z, Gurkas E, Koc TB, Guven A. Childhood peripheral facial palsy. Childs Nerv Syst 2018; 34:911-917. [PMID: 29427137 DOI: 10.1007/s00381-018-3742-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 01/31/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The objectives of this study were to evaluate the demographic and clinical characteristics, causes, treatment patterns, outcome, and recurrence of childhood peripheral facial palsy. METHODS We performed a retrospective study of 144 peripheral facial palsy patients, under 18 years old in a tertiary care pediatric hospital. Medical charts were reviewed to analyze the age, gender, side of facial nerve paralysis, family history, cause, grading by the House-Brackmann Facial Nerve Grading Scale (HBS), results of diagnostic tests, therapies, outcomes, and recurrence. RESULTS Causes were as follows: 115 idiopathic (Bell's palsy) facial palsy (79.9%), 17 infections (11.8%) (9 otitis media, 4 varicella zoster virus (VZV) infection, 3 tooth abscess, and 1 group A β-hemolytic streptococcus infection), 7 trauma (4.9%), 4 congenital-syndrome (2.8%), and 1 (0.7%) arterial hypertension. There was no difference in age, sex, family history, grading, or outcome between idiopathic and cause-defined facial palsy. At the end of the first year, our recovery rates were 98.3%. No significant difference in recovery outcome was detected between the patients who were treated with and without steroid treatment. Thirteen (9%) patients had recurrent attacks, and no differences in the outcomes of patients with recurrent facial palsy were observed. Recurrence time ranged from 6 months to 6 years. CONCLUSION The results of this study indicate that both Bell's palsy and cause-defined facial palsy in children have a very good prognosis. Medical treatment based on corticosteroids is not certainly effective in improving outcomes in children. Recurrent attacks occurred in 6 years from the onset which leads to the conclusion that we should have a long-term follow-up of patients diagnosed with Bell's palsy.
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Affiliation(s)
- Zeynep Selen Karalok
- Department of Pediatric Neurology, Ankara Children's Hematology-Oncology Training and Research Hospital, Ankara, Turkey
| | - Birce Dilge Taskin
- Department of Pediatric Neurology, Ankara Children's Hematology-Oncology Training and Research Hospital, Ankara, Turkey
| | - Zeynep Ozturk
- Department of Pediatric Neurology, Ankara Children's Hematology-Oncology Training and Research Hospital, Ankara, Turkey.
| | - Esra Gurkas
- Department of Pediatric Neurology, Ankara Children's Hematology-Oncology Training and Research Hospital, Ankara, Turkey
| | - Tuba Bulut Koc
- Department of Pediatrics, Ankara Children's Hematology-Oncology Training and Research Hospital, Ankara, Turkey
| | - Alev Guven
- Department of Pediatric Neurology, Ankara Children's Hematology-Oncology Training and Research Hospital, Ankara, Turkey
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Viteri B, Koch N, Dapul H, Bonadio W. Facial nerve palsy in a 3-year-old child with severe hypertension. Am J Emerg Med 2015; 33:1844.e3-6. [DOI: 10.1016/j.ajem.2015.04.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 04/09/2015] [Indexed: 10/23/2022] Open
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Tomek M, Nandoskar A, Chapman N, Gabriel C. Facial nerve palsy in the setting of malignant hypertension: a link not to be missed. QJM 2015; 108:145-6. [PMID: 22696152 DOI: 10.1093/qjmed/hcs110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Tomek
- From the Department of Medicine, Charing Cross Hospital, Department of Neurology, Department of Clinical Pharmacology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - A Nandoskar
- From the Department of Medicine, Charing Cross Hospital, Department of Neurology, Department of Clinical Pharmacology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - N Chapman
- From the Department of Medicine, Charing Cross Hospital, Department of Neurology, Department of Clinical Pharmacology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - C Gabriel
- From the Department of Medicine, Charing Cross Hospital, Department of Neurology, Department of Clinical Pharmacology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
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Jörg R, Milani GP, Simonetti GD, Bianchetti MG, Simonetti BG. Peripheral facial nerve palsy in severe systemic hypertension: a systematic review. Am J Hypertens 2013; 26:351-6. [PMID: 23382485 DOI: 10.1093/ajh/hps045] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Signs of nervous system dysfunction such as headache or convulsions often occur in severe systemic hypertension. Less recognized is the association between severe hypertension and peripheral facial nerve palsy. The aim of this study was to systematically review the literature on the association of peripheral facial palsy with severe hypertension. METHODS Systematic review of Medline, Embase, Web of Science, and Google Scholar from 1960 through December 2011 and report of two cases. RESULTS The literature review revealed 24 cases to which we add two cases with severe hypertension and peripheral facial palsy. Twenty-three patients were children. Palsy was unilateral in 25 cases, bilateral in one case, and recurred in nine. The time between the first facial symptoms and diagnosis of hypertension was a median of 45 days (range, 0 days-2 years). In five case series addressing the complications of severe hypertension in children, 41 further cases of peripheral facial palsy were listed out of 860 patients (4.8%). CONCLUSIONS The association between severe hypertension and peripheral facial palsy is mainly described in children. Arterial hypertension is diagnosed with a substantial delay. Outcome is favorable with adequate antihypertensive treatment. The pathophysiology is still debated.
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Affiliation(s)
- Rinaldo Jörg
- Division of Pediatrics, Mendrisio and Bellinzona Hospitals and University of Berne, Switzerland
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7
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Differential diagnosis of recurrent or bilateral peripheral facial palsy. The Journal of Laryngology & Otology 2012; 126:833-6. [DOI: 10.1017/s002221511200120x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:To describe the differential diagnosis of recurrent or bilateral peripheral facial palsy.Method:Case report and literature review.Results:Two patients with recurrent, alternating, peripheral facial palsy are described. In both patients, additional investigation was performed to search for a specific diagnosis. In the first patient, only a positive family history was found, indicating a possible familial susceptibility. In the other patient, diabetes mellitus and hypertension were identified as risk factors.Conclusion:There is an important and extensive differential diagnosis of recurrent or bilateral facial palsy. However, in a large proportion of patients the cause remains unknown.
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Pavlou E, Gkampeta A, Arampatzi M. Facial nerve palsy in childhood. Brain Dev 2011; 33:644-50. [PMID: 21144684 DOI: 10.1016/j.braindev.2010.11.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 11/09/2010] [Accepted: 11/10/2010] [Indexed: 01/08/2023]
Abstract
Facial nerve palsy in children is usually idiopathic but can also result from many conditions such as neoplasias, systemic diseases, or congenital anomalies with poor prognosis. Children with idiopathic facial palsy (Bell's palsy) have a very good prognosis, while treatment with prednisone does not certainly improve the outcome. The causes of facial nerve palsy in childhood differ from those in adults. A detailed investigation and differential diagnosis are recommended for facial palsy in children.
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Affiliation(s)
- Evangelos Pavlou
- 2nd Department of Pediatrics, Aristotle University of Thessaloniki, AHEPA General Hospital, Thessaloniki, Greece.
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Michalopoulos K, Bajaj Y, Strachan DR. Recurrent facial nerve palsy caused by a facial cyst. Br J Hosp Med (Lond) 2008; 69:475. [DOI: 10.12968/hmed.2008.69.8.30748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Yogesh Bajaj
- Department of Otolaryngology, Head and Neck Surgery, Bradford Royal Infirmary, Bradford BD9 6RJ
| | - David R Strachan
- Department of Otolaryngology, Head and Neck Surgery, Bradford Royal Infirmary, Bradford BD9 6RJ
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Iglesias S, Hinojosa J, Esparza J, Muñoz A, Otero A. Congenital aneurysm presenting as peripheral facial paresis. Pediatr Neurosurg 2007; 43:504-6. [PMID: 17992041 DOI: 10.1159/000108796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2006] [Accepted: 10/01/2006] [Indexed: 11/19/2022]
Abstract
The incidence of intracranial aneurysms in infancy is relatively rare. They are infrequent in children less than 1 year old, and are an exception in the neonatal period. They usually originate in the internal carotid artery bifurcation, posterior circulation and seldom in the territory of the distal middle cerebral artery distribution. Infants often present with nonspecific symptoms: irritability, lethargy, vomiting, seizures and coma. Sometimes, they may present with unexpected clinical symptoms such as peripheral facial palsy. Subarachnoid hemorrhage is the most frequent presentation in this kind of aneurysms. Intracerebral hematoma is unusual. We present the case of a 10-week-old child harboring a middle cerebral artery aneurysm. To our knowledge, this is the first case of an aneurysm presenting as a peripheral facial paresis in a pediatric patient.
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Affiliation(s)
- S Iglesias
- Pediatric Neurosurgical Department, Hospital 12 de Octubre, Madrid, Spain.
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Portman RJ, McNiece KL, Swinford RD, Braun MC, Samuels JA. Pediatric hypertension: diagnosis, evaluation, management, and treatment for the primary care physician. Curr Probl Pediatr Adolesc Health Care 2005; 35:262-94. [PMID: 16077462 DOI: 10.1016/j.cppeds.2005.06.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ronald J Portman
- Division of Pediatric Nephrology and Hypertension, University of Texas-Huston Medical School, Houston, Texas, USA
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12
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Scola Yurrita B, Ramírez Calvo C, Scola Pliego E. Parálisis facial recidivante idiopática. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2004; 55:343-5. [PMID: 15554591 DOI: 10.1016/s0001-6519(04)78534-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We report a 34 year old female patient with six episodes of idiopathic right facial palsy, all of wich had total recovery. Idiopathic recurrent facial palsy is a rare entity, with a few cases in the literature. Recurrent facial palsy is usually in the setting of a family history and have both autosomal dominant and recessive inheritance or in the setting of hypertension and diabetes. A review of the literature does not report a previous case with six episodes.
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Abstract
This article reviews selected recent literature specifically concerning pediatric hypertension, much of which has focused on measurement and monitoring of blood pressure, as well as on evaluating antihypertensive medications. Normative data for blood pressure in children have been widely available for some time, based upon seated in-office measurements. In recent years, ambulatory blood pressure monitoring (ABPM), facilitated by user-friendly instrumentation, has become more commonplace, though norms are not based on large populations. However, ABPM has important uses in assessing blood pressure as well as in monitoring antihypertensive. This review discusses issues involved in determining blood pressure, as well as the utility of ABPM in several situations. Recent developments concerning pediatric antihypertensive therapy are considered, as well as new information relevant to the diagnosis, course and treatment of hypertension in children and adolescents.
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Affiliation(s)
- Umbereen S Nehal
- Division of Pediatric Nephrology, MassGeneral Hospital for Children, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
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