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Sun P, Wang H, Jiang Z, Li L, Fan Z, Han Y. [Diagnosis and treatment of 68 cases of traumatic facial nerve paralysis]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2024; 38:405-410. [PMID: 38686478 DOI: 10.13201/j.issn.2096-7993.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Indexed: 05/02/2024]
Abstract
Objective:To summarize the clinical characteristics and therapeutic effect of traumatic facial nerve palsy. Methods:Sixty-eight cases of traumatic facial nerve palsy were retrospectively analyzed from January 2015 to May 2023. Results:The median course of disease was 33 days. The facial nerve function of the patients was grade HB-Ⅱin 2 cases, grade HB-Ⅲ in 4 cases, grade HB-Ⅳin 16 cases, grade HB-Ⅴ in 37 cases(38 ears), and grade HB-Ⅵ in 9 cases. 42 cases occurred immediately after injury and 26 cases were delayed. CT examination of temporal bone revealed longitudinal fractures in 51 cases(52 ears) , transverse fractures in 6 cases and mixed fractures in 4 cases. No definite temporal bone fracture was found in the remaining 7 cases. The segments of facial nerve injury in 49 cases(50 ears) were geniculate ganglion and adjacent, in 7 cases were vertical segment, in 7 cases were horizontal segment, in 2 cases were horizontal segment and vertical segment; and the other 3 cases could not be evaluated. Conservative treatment with glucocorticoids was used in 23 ears and surgery was used in 46 ears. Patients were followed up 6-24 months after treatment, including 20 cases of grade HB-Ⅰ, 19 cases of grade HB-Ⅱ, 23 cases(24 ears) of grade HB-Ⅲ, 4 cases of grade HB-Ⅳ, and 1 case of grade HB-Ⅴ.One patient was lost to follow-up. After treatment, the facial nerve function of patients was significantly improved(P<0.05), and there were significant differences between conservative treatment group and surgical treatment group in the course of facial nerve palsy, the ratio of facial palsy immediately after injury, the nerve function before treatment and the nerve function after treatment(P<0.05). There were no significant differences in age, sex, hearing condition, temporal bone fracture, facial nerve injury segment and rate of favorable neurologic outcomes(P>0.05). The comparison of patients with neurodegeneration rate>90% and ≤90% showed that the facial nerve function of patients with neurodegeneration rate>90% before treatment was significantly worse(P<0.05), but there was no significant difference between the facial nerve function after treatment(P>0.05). There was no significant difference in facial nerve function between middle fossa approach group and mastoid approach group(P>0.05). Conclusion:Patients with traumatic facial nerve palsy should be evaluated individually. Patients with mild facial nerve palsy, low neurodegeneration rate and short course of disease can be treated conservatively and followed up closely. Patients with severe facial nerve palsy, high neurodegeneration rate and more than 6 weeks of disease can be actively considered surgery. Good prognosis can be obtained by correct evaluation and treatment.
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Affiliation(s)
- Pengcheng Sun
- Department of Otolaryngology-Head and Neck Surgery,Shandong Provincial ENT Hospital,Shandong University,Jinan,250022,China
| | - Haibo Wang
- Department of Otolaryngology-Head and Neck Surgery,Shandong Provincial ENT Hospital,Shandong University,Jinan,250022,China
| | - Zhen Jiang
- Department of Otolaryngology-Head and Neck Surgery,Shandong Provincial ENT Hospital,Shandong University,Jinan,250022,China
| | - Li Li
- Department of Otolaryngology-Head and Neck Surgery,Shandong Provincial ENT Hospital,Shandong University,Jinan,250022,China
| | - Zhaomin Fan
- Department of Otolaryngology-Head and Neck Surgery,Shandong Provincial ENT Hospital,Shandong University,Jinan,250022,China
| | - Yuechen Han
- Department of Otolaryngology-Head and Neck Surgery,Shandong Provincial ENT Hospital,Shandong University,Jinan,250022,China
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Mortensen NB, Bjørndal K. The risk of facial nerve palsy after benign parotidectomy. A quality project. Acta Otolaryngol 2024:1-5. [PMID: 38634637 DOI: 10.1080/00016489.2024.2336557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 03/25/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Facial nerve palsy is a potential complication of parotidectomy for benign salivary gland tumours, necessitating a comprehensive understanding of its incidence and associated risk factors for improved patient counselling and preoperative planning. AIM/OBJECTIVES This single-centre retrospective study aimed to assess the rate of facial nerve palsy following benign parotidectomy at a University Teaching Hospital. MATERIAL AND METHODS Over a 3-year period, 160 patients undergoing parotid surgery for benign tumours were included. Data, encompassing sex, age, operation technique, tumour pathology, facial nerve function, and follow-up duration, were collected from medical records. Exclusion criteria comprised patients with prior parotid gland surgery or preoperative facial nerve palsy. RESULTS The study revealed a 3.75% incidence of facial nerve palsy with no total paralysis post-parotidectomy for benign disease. Pleomorphic adenoma (50.6%) and Warthin's tumour (44.4%) were the predominant tumour types. No significant differences were noted between groups with and without postoperative facial palsy based on obtained covariates. CONCLUSION AND SIGNIFICANCE Our findings endorse partial superficial parotidectomy and extracapsular dissection as low-risk treatments for benign parotid tumours. However, prospective studies are warranted to elucidate recovery rates and long-term consequences of facial nerve palsy, contributing to refined surgical approaches and patient care in parotid surgery.
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Affiliation(s)
- Nicoline Bebe Mortensen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark
- OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Kristine Bjørndal
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark
- OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
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Shapira Y, Ullrich K, Masqood S, Okafor L, Malhotra R. Eyelid Skin Grafting in Young Patients with Facial Nerve Palsy. J Clin Med 2024; 13:2142. [PMID: 38610907 PMCID: PMC11012737 DOI: 10.3390/jcm13072142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 03/25/2024] [Accepted: 04/05/2024] [Indexed: 04/14/2024] Open
Abstract
Background: The aim of this study is to report outcomes of eyelid full-thickness skin grafting augmentation in facial nerve palsy (FNP) patients younger than 50 years of age. Methods: In a retrospective, consecutive case series, nine eyelid skin grafts performed on eight FNP patients with skin contraction (five females; median age 42 years [range, 17-47]) are presented. In most cases, upper eyelid skin grafting was combined with levator recession and anterior lamellar repositioning. Lower eyelid skin grafting was combined with lower retractors recession in all cases. Functional and cosmetic outcomes were measured preoperatively and at early (1-3 months), intermediate (3-6 months), and late (≥12 months) follow-up. Results: The corneal score improved at early follow-up (p = 0.03) and remained improved at late follow-up (p = 0.042). The gentle closure lagophthalmos was improved at late follow-up (p = 0.042). (p = 0.048). The grades of graft color, edge/skin interface, and size improved at 3-6 months post-grafting and remained improved at late follow-up (p < 0.05). Over the follow-up, four patients (50%) were recommended to have further surgical procedures. Conclusions: The preliminary results from this small cohort suggest that eyelid skin grafting is a viable option for young patients prioritizing cosmesis. This technique warrants consideration for its functional benefits.
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Affiliation(s)
- Yinon Shapira
- Department of Ophthalmology, Carmel Medical Center, Haifa 3436212, Israel
| | - Katja Ullrich
- Department of Ophthalmology, Queen Elizabeth Hospital, Adelaide, SA 5011, Australia
| | - Sundas Masqood
- Corneoplastic Unit, Queen Victoria Hospital NHS Trust, East Grinstead RH19 3DZ, UK; (S.M.)
| | - Linda Okafor
- Corneoplastic Unit, Queen Victoria Hospital NHS Trust, East Grinstead RH19 3DZ, UK; (S.M.)
| | - Raman Malhotra
- Corneoplastic Unit, Queen Victoria Hospital NHS Trust, East Grinstead RH19 3DZ, UK; (S.M.)
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Sherlock D, Brown NJ, Chan AY, Campos JK, Olaya J. Successful treatment of unilateral facial nerve palsy in a pediatric patient with syringobulbia and Chiari malformation type I: illustrative case. J Neurosurg Case Lessons 2024; 7:CASE23282. [PMID: 38437673 PMCID: PMC10916844 DOI: 10.3171/case23282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 01/18/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Unlike syringomyelia, syringobulbia is not commonly observed in pediatric patients with Chiari malformation type I (CMI). Previous series have reported the incidence of syringobulbia as between 3% and 4% in these patients. Presentation is typically chronic, with the slow onset of neurological symptoms and cranial nerve (CN) palsies resulting from lower brainstem involvement. The authors report the first case of a pediatric patient with simultaneous CMI, syringobulbia, and unilateral CN VII palsy. OBSERVATIONS A 7-year-old male presented with right facial weakness in addition to headaches, ataxia, urinary incontinence, and falls. Magnetic resonance imaging revealed CMI with a syrinx of the cervicothoracic spine and syringobulbia. Posterior fossa decompression with duraplasty was performed without complications, and the patient was discharged home on postoperation day 5. At the 3-week follow-up, the patient's neurological deficits had largely subsided. At the 3-month follow-up, his CN VII palsy and syringobulbia had completely resolved. LESSONS Pediatric CMI patients with syringomyelia are at risk for developing syringobulbia and brainstem deficits, including unilateral facial palsy. However, craniocervical decompression can prove successful in treating such deficits.
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Affiliation(s)
| | - Nolan J Brown
- Department of Neurological Surgery, University of California, Irvine, California; and
| | - Alvin Y Chan
- Department of Neurological Surgery, University of California, Irvine, California; and
| | - Jessica K Campos
- Department of Neurological Surgery, University of California, Irvine, California; and
| | - Joffre Olaya
- Department of Neurological Surgery, University of California, Irvine, California; and
- Division of Pediatric Neurosurgery, Children’s Hospital of Orange County, Orange, California
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Maurer M, Klaes T, Fiedler M, Taxis J, Schuderer JG, Waiss W, Gottsauner M, Meier JK, Reichert TE, Ettl T. Patient's Perception of Outcome after Extracapsular Fractures of the Mandibular Condyle Differs from Objective Evaluation-Experience of a Third-Level Hospital. J Clin Med 2024; 13:1395. [PMID: 38592235 PMCID: PMC10931758 DOI: 10.3390/jcm13051395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/27/2024] [Accepted: 02/27/2024] [Indexed: 04/10/2024] Open
Abstract
Background: The aim of this study is to assess patients' subjective perception of treatment outcome after extracapsular fractures of the mandibular condyle. Methods: A questionnaire survey regarding facial nerve palsy (FNP), malocclusion, pain, reduction in maximum mouth opening (MMO) and further discomfort after 3, 6, and 12 months was carried out. Patients aged 18 or more presenting with an extracapsular condylar fracture between 2006 and 2020 were identified by purposive sampling Questionnaires were received from 115 patients. Fractures were classified on the basis of the pre-treatment imaging, the way of treatment was obtained from patients' medical records. Data were analyzed using Pearsons' chi-square-test, descriptive statistics and Student's t-test. Results: 93.0% of the fractures were treated by open reduction and internal fixation (ORIF). MMO reduction was the most common post-treatment complication (55.6%). ORIF was associated with less pain after 3 months (p = 0.048) and lower VAS scores compared to conservative treatment (p = 0.039). Comminuted fractures were more frequently associated with post-treatment malocclusion (p = 0.048), FNP (p = 0.016) and MMO reduction (p = 0.001). Bilateral fractures were significantly accompanied by malocclusion (p = 0.029), MMO reduction (p = 0.038) and pain occurrence (p < 0.001). Conclusions: Patients report less pain after ORIF. Comminuted and bilateral fractures seem to be major risk factors for complications. Subjective perception of complications after extracapsular condylar fractures differs from objectively assessed data.
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Affiliation(s)
- Michael Maurer
- Department of Cranio- and Maxillofacial Surgery, Hospital of the University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
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Franz L, Marioni G, Daloiso A, Biancoli E, Tealdo G, Cazzador D, Nicolai P, de Filippis C, Zanoletti E. Facial Surface Electromyography: A Novel Approach to Facial Nerve Functional Evaluation after Vestibular Schwannoma Surgery. J Clin Med 2024; 13:590. [PMID: 38276096 PMCID: PMC10816927 DOI: 10.3390/jcm13020590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/12/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Vestibular schwannoma (VS) surgery may cause facial nerve damage. However, a comprehensive evaluation of post-operative facial outcomes may be difficult to achieve. Surface electromyography (sEMG) is a promising non-invasive evaluation tool. However, its use in the follow-up after VS surgery has not been reported yet. The main objective was to develop and validate a new sEMG application specifically for the post-VS surgery setting. Secondary goals were to provide a systematic description of facial muscle activity after VS surgery and assess the association between sEMG parameters and Sunnybrook scale scores. METHODS Thirty-three patients with facial palsy following VS surgery were included. The clinical outcomes (Sunnybrook symmetry, movement, and synkinesis scores) and sEMG parameters (signal amplitude normalized by the maximal voluntary contraction (NEMG) and sEMG synkinesis score (ESS, number of synkinesis per movement sequence)) were evaluated at the end of the follow-up. RESULTS In all tested muscles, NEMG variance was significantly higher on the affected side than the contralateral (variance ratio test, p < 0.00001 for each muscle). In total, 30 out of 33 patients (90.9%) showed an ESS ≥ 1 (median: 2.5, IQR: 1.5-3.0). On the affected side, NEMG values positively correlated with both dynamic and overall Sunnybrook scores (Spearman's model, p < 0.05 for each muscle, except orbicularis oculi). ESS significantly correlated with the Sunnybrook synkinesis score (Spearman's rho: 0.8268, p < 0.0001). CONCLUSIONS We described and preliminarily validated a novel multiparametric sEMG approach based on both signal amplitude and synkinesis evaluation specifically for oto-neurosurgery. Large-scale studies are mandatory to further characterize the semiological and prognostic value of facial sEMG.
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Affiliation(s)
- Leonardo Franz
- Phoniatrics and Audiology Unit, Department of Neuroscience (DNS), University of Padova, 31100 Treviso, Italy; (G.M.); (C.d.F.)
- Otolaryngology Unit, Department of Neuroscience (DNS), University of Padova, 35128 Padova, Italy; (A.D.); (E.B.); (G.T.); (D.C.); (P.N.); (E.Z.)
| | - Gino Marioni
- Phoniatrics and Audiology Unit, Department of Neuroscience (DNS), University of Padova, 31100 Treviso, Italy; (G.M.); (C.d.F.)
| | - Antonio Daloiso
- Otolaryngology Unit, Department of Neuroscience (DNS), University of Padova, 35128 Padova, Italy; (A.D.); (E.B.); (G.T.); (D.C.); (P.N.); (E.Z.)
| | - Elia Biancoli
- Otolaryngology Unit, Department of Neuroscience (DNS), University of Padova, 35128 Padova, Italy; (A.D.); (E.B.); (G.T.); (D.C.); (P.N.); (E.Z.)
| | - Giulia Tealdo
- Otolaryngology Unit, Department of Neuroscience (DNS), University of Padova, 35128 Padova, Italy; (A.D.); (E.B.); (G.T.); (D.C.); (P.N.); (E.Z.)
| | - Diego Cazzador
- Otolaryngology Unit, Department of Neuroscience (DNS), University of Padova, 35128 Padova, Italy; (A.D.); (E.B.); (G.T.); (D.C.); (P.N.); (E.Z.)
| | - Piero Nicolai
- Otolaryngology Unit, Department of Neuroscience (DNS), University of Padova, 35128 Padova, Italy; (A.D.); (E.B.); (G.T.); (D.C.); (P.N.); (E.Z.)
| | - Cosimo de Filippis
- Phoniatrics and Audiology Unit, Department of Neuroscience (DNS), University of Padova, 31100 Treviso, Italy; (G.M.); (C.d.F.)
| | - Elisabetta Zanoletti
- Otolaryngology Unit, Department of Neuroscience (DNS), University of Padova, 35128 Padova, Italy; (A.D.); (E.B.); (G.T.); (D.C.); (P.N.); (E.Z.)
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Maurer M, Klaes T, Meier JK, Gottsauner JM, Taxis J, Schuderer J, Reichert TE, Ettl T. Treatment of extracapsular fractures of the mandibular condylar process: A retrospective evaluation of 377 cases. Dent Traumatol 2023; 39:586-596. [PMID: 37485754 DOI: 10.1111/edt.12871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/21/2023] [Accepted: 07/05/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND/AIM Mandibular condylar fractures represent 25%-35% of all mandibular fractures. Despite profound research, there is still a controverse debate about treating these fractures conservatively or by open reduction and internal fixation (ORIF). The aim of this study is to analyse the outcome after open and closed treatment of extracapsular mandibular condyle fractures regarding general characteristics, post-treatment malocclusion, facial nerve palsy (FNP), maximum mouth opening (MMO) and parotid complications. METHODS A retrospective cohort of 377 fractures (350 open, 27 closed treatment) was reviewed by reference to clinical and radiological pre- and postoperative documentation. Follow-up period was 12 months. Pearsons' chi-square-test, correlations, Kruskal-Wallis test and t-test were carried out for statistical analysis. RESULTS The dominant type of fracture was type II in Spiessl and Schroll classification (50.1%). In the open treated fractures, the most common approach was retromandibular transparotid (91.7%). Post-treatment malocclusion occurred in 18.0% and was significantly increased in bilateral fractures (p = .039), in luxation fractures (p = .016) and in patients with full dentition (p = .004). After open reduction and internal fixation (ORIF), temporary FNP was documented in 7.1% whereas a permanent paresis occurred in 1.7%. FNP was significantly associated with high fractures (p = .001), comminution (p = .028) and increased duration of surgery (p = .040). Parotid complications were significantly associated with revision surgery (p = .009). Post-treatment reduction of MMO mainly occurred in female patients (p < .001) as well as in patients with bilateral fractures (p < .001), high fractures (p = .030) and concomitant mandibular (p = .001) and midfacial fractures (p = .009). CONCLUSION Malocclusion seems to be the most frequent long-term complication after open reduction and osteosynthesis of extracapsular mandibular condyle fractures. We suggest ORIF by a transparotid approach to be an appropriate treatment with a low complication rate regarding especially FNP for extracapsular fractures of the mandibular condyle.
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Affiliation(s)
- Michael Maurer
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Tabea Klaes
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Johannes K Meier
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | | | - Jürgen Taxis
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Johannes Schuderer
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Torsten E Reichert
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Tobias Ettl
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
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Jung T, Kim H, Jang M, Kim T, Lee DH, Shin JE, Kim CH. Cerebellopontine angle tumor presenting as acute audiovestibular syndrome. Acta Otolaryngol 2023; 143:951-957. [PMID: 38108643 DOI: 10.1080/00016489.2023.2290202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 11/23/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Acute audiovestibular deficits may be a harbinger of vestibular schwannoma (VS). OBJECTIVE To investigate clinical and laboratory features of 25 consecutive patients with VS presenting with acute audiovestibular deficits. METHODS A symptomatic combination of acute audiovestibular deficits was investigated. Audiometric and vestibular function tests, and internal auditory canal magnetic resonance imaging (IAC MRI) results were evaluated. RESULTS Varying combinations of symptoms may develop in VS patients with acute audiovestibular deficits, of whom sudden hearing loss (HL) without acute vertigo or acute facial nerve palsy (FNP) was most common. The most common audiometric configuration was high-tone hearing loss, and no patient showed low-tone hearing loss. IAC MRI demonstrated that the tumor had an intracanalicular portion and attachment to the bony IAC wall in all patients and widened the IAC wall in some patients. CONCLUSION Different symptomatic combinations of acute audiovestibular deficits may develop in patients with VS. Awareness about the possibility of VS as a cause of sudden HL, acute vertigo, and acute FNP, as well as subsequent IAC MRI scanning is vital to earlier diagnosis of VS in these patients.
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Affiliation(s)
- Taesik Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute of Medical Science, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Hansol Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute of Medical Science, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Minho Jang
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute of Medical Science, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Taehee Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute of Medical Science, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Dong-Han Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute of Medical Science, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Jung Eun Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute of Medical Science, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Chang-Hee Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute of Medical Science, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
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Hayler R, Charters E, Coulson S, Hubert Low TH. Gender differences in perceived speech intelligibility in patients with facial nerve palsy. Int J Speech Lang Pathol 2023:1-6. [PMID: 37907077 DOI: 10.1080/17549507.2023.2259136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
PURPOSE Facial nerve palsy (FNP) affects physical and social function, including speech. There exists discrepancy between professional and patient perception of appearance following FNP; however, speech differences remain unknown. We aimed to compare ratings of speech intelligibility by different listeners. METHOD Patients were identified through the Sydney Facial Nerve Service. FNP related scoring was obtained using the Sunnybrook Facial Grading System, Sydney Facial Grading Score, Facial Disability Index, and Speech Handicap Index. Intelligibility was scored by a speech-language pathologist, member of the public, and patient using a standardised passage. FNP scoring and intelligibility were compared using interclass coefficients (ICC). RESULT Forty patients were recruited (females = 20). There was no difference in FNP scoring, nor between the frequency or types of phonemic errors. Observers' rating of intelligibility had an ICC of 0.807, compared with 0.266 and 0.344 for patients compared to the member of the public and speech-language pathologist respectively. Observers rated males and females intelligibility similar (p > 0.05), but females rated their intelligibility lower than males (74.5 ± 12.8 vs. 82.5 ± 8.4, p = 0.025). CONCLUSION Patients, particularly females, perceive their speech to be less intelligible than observers. Clinicians should be aware of this discrepancy, which does not correlate with physical function.
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Affiliation(s)
- Raymond Hayler
- Sydney Facial Nerve Service, Chris O'Brien Lifehouse, Sydney, Australia
- Department of Medicine, University of New South Wales, Sydney, Australia
- Faculty of Medicine and Health, Macquarie University, Sydney, Australia
| | - Emma Charters
- Sydney Facial Nerve Service, Chris O'Brien Lifehouse, Sydney, Australia
- Head and Neck Department, Chris O'Brien Lifehouse, Sydney, Australia
| | - Susan Coulson
- Sydney Facial Nerve Service, Chris O'Brien Lifehouse, Sydney, Australia
- School of Physiotherapy, and
| | - Tsu-Hui Hubert Low
- Sydney Facial Nerve Service, Chris O'Brien Lifehouse, Sydney, Australia
- Faculty of Medicine and Health, Macquarie University, Sydney, Australia
- Head and Neck Department, Chris O'Brien Lifehouse, Sydney, Australia
- Sydney Medical School, The University of Sydney, Sydney, Australia
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Takada S, Mitani K, Ichikawa T, Sadamasa N, Taki W. Traumatic middle meningeal arteriovenous fistula presenting with long delayed-onset facial nerve palsy without temporal bone fracture: illustrative case. J Neurosurg Case Lessons 2023; 6:CASE23404. [PMID: 37782957 PMCID: PMC10555608 DOI: 10.3171/case23404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 08/28/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Traumatic facial nerve palsy (FNP) without temporal bone fracture (TBF) has a delayed onset in some cases; however, long delayed-onset FNP in this setting has not been reported. The middle meningeal vein (MMV) is one of the venous drainage routes from the facial nerve. Herein, the authors describe a rare case of traumatic middle meningeal arteriovenous fistula (MMAVF) presenting with the long delayed-onset FNP without TBF. OBSERVATIONS A 42-year-old man with pulsatile tinnitus and left FNP was admitted to our hospital 4 weeks after head trauma without TBF. Cerebral angiography revealed an MMAVF between the middle meningeal artery and the MMV on the left side. Seven days after admission, the FNP showed slight improvement, and preoperative angiography revealed decreased shunt flow of the MMAVF. Transarterial coil embolization was successfully performed. Postoperative angiography showed no residual fistula. Two weeks after the procedure, there was complete resolution of the FNP. This clinical course was correlated with the angiographic findings, suggesting that the long delayed-onset FNP was caused by the traumatic MMAVF without TBF. LESSONS In patients presenting with long delayed-onset FNP after head trauma without TBF, the vascular lesion must be evaluated to exclude MMAVF.
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Affiliation(s)
- Shigeki Takada
- Department of Neurosurgery, Stroke Center, Koseikai Takeda Hospital, Kyoto, Japan; and
| | - Koki Mitani
- Department of Neurosurgery, Stroke Center, Koseikai Takeda Hospital, Kyoto, Japan; and
| | - Tomonori Ichikawa
- Department of Neurosurgery, Stroke Center, Koseikai Takeda Hospital, Kyoto, Japan; and
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Nobutake Sadamasa
- Department of Neurosurgery, Stroke Center, Koseikai Takeda Hospital, Kyoto, Japan; and
| | - Waro Taki
- Department of Neurosurgery, Stroke Center, Koseikai Takeda Hospital, Kyoto, Japan; and
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11
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Hedayati Amlashi N, Rajabi MT, Shafie M, Heidarzadeh S, Rajabi MB, Hosseini SS, Haadi A, Soltani P. Videographic analysis of blink dynamics in patients with chronic progressive external ophthalmoplegia, myogenic ptosis, and facial nerve palsy using smartphone camera: A comparative analysis. Health Sci Rep 2023; 6:e1631. [PMID: 37867790 PMCID: PMC10588348 DOI: 10.1002/hsr2.1631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/18/2023] [Accepted: 10/05/2023] [Indexed: 10/24/2023] Open
Abstract
Background and Aims Congenital myogenic ptosis (CMP), chronic progressive external ophthalmoplegia (CPEO), and facial nerve palsy (FNP) are among the disorders which can seriously affect the blink dynamics of patients. Smartphone videography is a simple, convenient, and inexpensive way to capture eyelid movement. This study has measured and compared a variety of blink dynamics in these patients compared to healthy controls using 2-dimensional smartphone videography to enhance the utility of this method in both clinical and research settings. Methods A total of 30 adult participants with a complaint of impaired eyelid movements including 10 with CMP, 10 with CPEO, and 10 with unilateral FNP, as well as 10 healthy controls were recruited. Using a smartphone camera with a resolution of 240 frames per second in 720 p, various blink dynamics were measured. Results All case groups had significantly lower values of peak and average closing velocities, average opening velocity, and palpebral aperture and significantly higher values of eyelid closing duration, compared to controls. FNP participants also had significantly lower values in the full blink rate and peak opening velocity (POV) measures, and CPEO patients showed significantly lower values in the POV. Other measures were not statistically significantly different compared to healthy controls. Conclusion Our results indicated that all patients with CMP, FNP, and CPEO had different blinking dynamics compared to healthy controls, which is consistent with previous studies. Smartphone videography has achieved sufficient resolution and frame-rate to provide valuable information and anatomic details for clinical and research purposes. Further studies could utilize smartphone videography for further investigation and confirmation of the methodology in various conditions.
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Affiliation(s)
| | - Mohammad Taher Rajabi
- Eye Research Center, Farabi Eye HospitalTehran University of Medical SciencesTehranIran
| | - Mahan Shafie
- School of MedicineTehran University of Medical SciencesTehranIran
| | - Somayeh Heidarzadeh
- Eye Research Center, Farabi Eye HospitalTehran University of Medical SciencesTehranIran
| | | | | | - Ainaaz Haadi
- School of MedicineTehran University of Medical SciencesTehranIran
| | - Parnian Soltani
- School of MedicineTehran University of Medical SciencesTehranIran
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12
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Marszał J, Bartochowska A, Klimza H, Nogal P, Wierzbicka M. Irreversible facial nerve palsy as a revelator ofparotid gland cancer. Otolaryngol Pol 2023; 77:8-13. [PMID: 38032327 DOI: 10.5604/01.3001.0053.4090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
<br><b>Introduction:</b> Bell's palsy is still the diagnosis of exclusion. In most patients it does not progress, it is unilateral, and selflimiting. Additionally, the majority of patients recover spontaneously within 3 weeks. It is well known that all patients with irreversible facial nerve paresis (FNP) need further examinations to exclude the organic, infectious, metabolic, and autoimmunological causes of the palsy. The goal of the study was to assess the frequency of malignancies hidden under the diagnosis of "Bell's palsy".</br> <br><b>Aim:</b> We aimed to create a diagnostic algorithm to avoid failures concerning patients whose only symptom of parotid gland cancer was irreversible FNP.</br> <br><b>Material and methods:</b> We analyzed 253 consecutive patients with FNP treated in our department in the last 5 years. The subject of the study was "Bell's palsy" cases. All patients with irreversible FNP were reassessed in 6-12 months. We underlined all shortcomings in the diagnostics of those in whom malignancies were found in MRI of the neck and presented the proposal for a diagnostic algorithm to avoid missing such an entity.</br> <br><b>Results:</b> Bell's palsy was observed in 157/253 patients (62.06%), in 36/157 (22.92%) it remained permanent. In 4/36 patients (11.11%) with irreversible FNP, which constituted 2.54% of all "Bell's palsy" cases, parotid gland deep lobe mass was found in MRI. In one patient, infiltration of the skull base was diagnosed. Adenoid cystic carcinoma was confirmed in final histopathology in all cases.</br> <br><b>Conclusions:</b> Our experience has shown that irreversible FNP can be a revelator of the malignant tumor located in the deep lobe of the parotid gland. Contrast-enhanced MRI covering intra- and extracranial segments of the facial nerve should be ordered in all cases of FNP without recovery after 4 months. Repeated imaging should be considered in undiagnosed cases. The main point of our study is to underline that the assessment of the deep lobe of the parotid gland with MRI should be included in the standard diagnostic protocol in all irreversible "Bell's palsy" cases.</br>.
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Affiliation(s)
- Joanna Marszał
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences
| | - Anna Bartochowska
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences
| | - Hanna Klimza
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences
| | - Piotr Nogal
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences
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13
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Kondoh T, Lee K, Higashino M, Mizowaki T, Tanaka H, Takaishi Y. Facial Nerve Neurolymphomatosis That Extends to Both the Brainstem and Extracranial Regions. Cureus 2023; 15:e44551. [PMID: 37789998 PMCID: PMC10544763 DOI: 10.7759/cureus.44551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 10/05/2023] Open
Abstract
A 73-year-old female developed right facial paralysis of House-Brackmann (H-B) grade III and was diagnosed with Bell's palsy. After three months of steroid therapy, she developed progressive hearing loss, and an MRI revealed a tumor in the right internal auditory canal. Within a few months, the right facial nerve palsy recurred, and the patient was treated with Gamma Knife radiosurgery. The tumor in the irradiated region disappeared, but new dysphagia was observed, and a right parotid gland tumor was detected for the first time. Tumors of the right parotid gland and the digastric muscle of the jaw were surgically resected, and a diagnosis of diffuse large B-cell lymphoma was made. The tumor had invaded the cranial nerves and brainstem region, and the patient did not wish to undergo further medical therapy. This was a case of malignant lymphoma that started as facial paralysis and invaded the brainstem, and testing for possible lymphoma at an early stage prior to radiotherapy was desirable.
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Affiliation(s)
| | - Kana Lee
- Otolaryngology, Shinsuma General Hospital, Kobe, JPN
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14
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Al-Busaidi T, Al-Muqaimi N, Al-Bulushi F. One Disease, Multiple Hits: Acute Myeloid Leukemia With t(10;11) Presenting With Leukemic Lung Infiltration as First Presentation and Facial Nerve Palsy at Relapse. Cureus 2023; 15:e43726. [PMID: 37727193 PMCID: PMC10505682 DOI: 10.7759/cureus.43726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 09/21/2023] Open
Abstract
Acute myeloid leukemia (AML) with t(10;11) is associated with poor outcomes. We report a rare case of monoblastic AML with mixed lineage leukemia (MLL) gene rearrangement t(10;11)(p11.2;q23) in a patient with extensive leukemic lung infiltration on his initial presentation leading to rapid deterioration following induction chemotherapy. Complete remission with negative cytogenetics was achieved following a limited induction due to acute respiratory failure. The patient subsequently relapsed with central nervous system involvement presenting with unliteral left lower motor neuron facial nerve palsy with cerebrospinal fluid positive for monoblasts. Few unusual and challenging features were encountered with this patient including leukemic lung infiltration with extremely high lactate dehydrogenase (LDH) at the time of his initial presentation, rapid onset acute respiratory failure with no other identified causes within 48 hours of commencing induction chemotherapy. Additionally, achieving remission with only two days on induction chemotherapy and finally a stormy relapse with central nervous system involvement and left facial nerve palsy.
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15
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Yu M, Virani A, Akhouri S. Bell's Palsy Secondary to COVID-19 Infection. Cureus 2023; 15:e39037. [PMID: 37323361 PMCID: PMC10266432 DOI: 10.7759/cureus.39037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/15/2023] [Indexed: 06/17/2023] Open
Abstract
SARS-CoV-2 (COVID-19) is known to present with a variety of features, with the most common being upper and lower respiratory tract symptoms. However, there are emerging reports of COVID-19 infections with extrapulmonary manifestations, including neurological conditions. We report a case of a patient who presented to his primary care physician with symptoms of Bell's Palsy after recovering from a COVID-19 infection. He was given timely and appropriate treatment that resolved symptoms without residual neurological deficits.
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Affiliation(s)
- Matthew Yu
- Family Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, USA
| | - Anna Virani
- Family Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, USA
| | - Shweta Akhouri
- Family Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, USA
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16
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Abstract
This study aimed to investigate the effect of electrical stimulation on poly(d,l-lactide-co-ε-caprolactone) nerve guidance conduits (NGCs) in promoting the recovery of facial function and nerve regeneration after facial nerve (FN) injury in a rat model. In the experimental group, both the NGC and transcutaneous electrical nerve stimulation (ES) were used simultaneously; in the control group, only NGC was used. ES groups were divided into two groups, and direct current (DC) and charge-balanced pulse stimulation (Pulse) were applied. The ES groups showed significantly improved whisker movement than the NGC-only group. The number of myelinated neurons was higher in ES groups, and the myelin sheath was also thicker and more uniform. In addition, the expression of neurostructural proteins was also higher in ES groups than in the NGC-only group. This study revealed that FN regeneration and functional recovery occurred more efficiently when ES was applied in combination with NGCs.
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Affiliation(s)
- Goeun Choe
- Center for Biomaterials, Biomedical Research Institute, Korea Institute of Science and Technology (KIST), Seoul 02792, Korea
| | - Ul Gyu Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
- Samsung Advanced Institute for Health Sciences & Technology, Department of Health Sciences and Technology, Sungkyunkwan University, Seoul 06351, Korea
| | - Seongryeol Ye
- Center for Biomaterials, Biomedical Research Institute, Korea Institute of Science and Technology (KIST), Seoul 02792, Korea
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Suwon 08826, Korea
| | - Sujee Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Jin Yoo
- Center for Biomaterials, Biomedical Research Institute, Korea Institute of Science and Technology (KIST), Seoul 02792, Korea
| | - Young Sang Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Youngmee Jung
- Center for Biomaterials, Biomedical Research Institute, Korea Institute of Science and Technology (KIST), Seoul 02792, Korea
- School of Electrical and Electronic Engineering, YU-KIST Institute, Yonsei University, Seoul 03722, Korea
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17
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Abstract
OBJECTIVE To describe a case of persistent facial nerve palsy after middle meningeal artery (MMA) embolization for chronic subdural hematoma (cSDH). METHODS A literature search was conducted for publications within the last 10 years of facial nerve palsy following cerebral circulation embolization procedures. RESULTS With inconsistencies between previously believed pathophysiology and clinical features, other mechanisms causing cSDH such as angiogenesis and capillary formation have been proposed. MMA embolization has evolved as a therapeutic approach to reduce recurrence of subdural hematoma; however, postoperative neural complications such as cranial nerve palsies are poorly described in the literature. CONCLUSIONS cSDH is increasingly more common and is on trajectory to become the most prevalent cranial neurosurgical condition. MMA embolization is described as a safe and minimally invasive procedure; however, as a relatively new procedure further research is needed to elucidate associated complications.
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Affiliation(s)
- Ally Ferber
- Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, New Jersey, USA
| | - Yi Zhou
- Department of Physical Medicine and Rehabilitation, JFK Johnson Rehabilitation Institute, Edison, New Jersey, USA
| | - Brian Greenwald
- Department of Physical Medicine and Rehabilitation, JFK Johnson Rehabilitation Institute, Edison, New Jersey, USA
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18
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Patel S, Bhakta A, Wortsman J, Aryal BB, Shrestha DB, Joshi T. Pontine Infarct Resulting in Millard-Gubler Syndrome: A Case Report. Cureus 2023; 15:e34869. [PMID: 36923200 PMCID: PMC10010748 DOI: 10.7759/cureus.34869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/29/2023] [Indexed: 02/13/2023] Open
Abstract
Millard-Gubler syndrome is a crossed brainstem syndrome involving the facial nerve, abducens nerve, and the pyramidal tracts, typically resulting in ipsilateral facial weakness and contralateral hemiparesis. Here we report the case of a 76-year-old female with no pertinent past medical history who presented to the emergency department with acute left-sided facial droop and right upper extremity sensory loss. A pontine infarction was identified on imaging and she was managed medically with complete recovery. Pontine infarction can result in Millard-Gubler syndrome and present with facial weakness and subtle contralateral limb symptoms.
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Affiliation(s)
- Shivangi Patel
- Internal Medicine, Ross University School of Medicine Barbados Campus, Barbados, BRB
| | - Ashika Bhakta
- Internal Medicine, Ross University School of Medicine Barbados Campus, Barbados, BRB
| | - Joshua Wortsman
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, USA
| | - Barun B Aryal
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, USA
| | | | - Tilak Joshi
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, USA
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19
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Cegielski V, Gratton S. Case report: Left gaze and facial nerve palsies after ventral intermediate thalamic nucleus deep brain stimulation implantation. Front Neurol 2023; 14:1130087. [PMID: 36937536 PMCID: PMC10018204 DOI: 10.3389/fneur.2023.1130087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/06/2023] [Indexed: 03/06/2023] Open
Abstract
Deep brain stimulation (DBS) to the ventral intermediate nucleus (VIM) of the thalamus has become a common procedure for some refractory, medication-resistant movement disorders like essential tremors. The most common adverse effects from this surgery include dysarthria and gait disturbances. This case report details a left gaze and ipsilateral facial nerve palsy following overshot cannula insertion into the pons during a VIM DBS procedure. Initial patient presentation after surgery revealed significant impairment of horizontal gaze to the left. This improved during follow-up visits and after the recession of the bilateral medial recti. When considering complications of the VIM DBS procedure, surgeons should be aware of the risks of cannula overshot given the anatomic proximity between the thalamus and brainstem. Furthermore, patients should be aware of this risk when making their surgical decision. All patients who undergo VIM DBS should be assessed for cranial nerve deficits after placement.
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Affiliation(s)
- Victoria Cegielski
- Department of Neurology, School of Medicine, University of Missouri–Kansas City, Kansas City, MO, United States
- Department of Ophthalmology, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, United States
- *Correspondence: Victoria Cegielski
| | - Sean Gratton
- Department of Neurology, School of Medicine, University of Missouri–Kansas City, Kansas City, MO, United States
- Department of Ophthalmology, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, United States
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20
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Muacevic A, Adler JR, Singh R, AC V, Sutare A. Facial Nerve Palsy as Complication in COVID-19 Associated Mucormycosis: A Case Series. Cureus 2022; 14:e33077. [PMID: 36726898 PMCID: PMC9886373 DOI: 10.7759/cureus.33077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2022] [Indexed: 12/30/2022] Open
Abstract
Mucormycosis is an opportunistic fungal infection indicating a high mortality rate. Among six varieties of involved sites, rhino cerebral mucormycosis (RCM) is not the most uncommon. During the COVID-19 pandemic, with the increase, in predisposing conditions incidence rate of mucormycosis progressed. For aggressive treatment, an early diagnosis can be armored to reduce morbidity and mortality. Clinically RCM poses non-specific symptoms and signs delaying diagnosis. This is associated with orbital cellulitis and sinusitis, one-sided headache behind the eye, diplopia, blurring of visions, nasal congestion, rhinorrhea, epistaxis, nasal hypoesthesia, facial pain and numbness, and a history of black nasal discharge. Not commonly the complications of cranial nerve involvement have been reported. In the present case series, three presentations of facial nerve palsy in COVID-19 associated with mucormycosis are added to the literature database.
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21
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Muacevic A, Adler JR, Huang A, Usman M, Subhedar S, Decker T, Quansah R. Spider Bite-Induced Facial Nerve Palsy. Cureus 2022; 14:e32162. [PMID: 36601209 PMCID: PMC9806285 DOI: 10.7759/cureus.32162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 12/03/2022] [Indexed: 12/05/2022] Open
Abstract
Spider bites, while rarely confirmed beyond a doubt, should always be in the differential for any severe symptoms or infection out of proportion to presentation with the suspected presence of appropriate vectors. While most arthropod bites will only result in mild localized irritation, the potential to cause severe cutaneous and systemic effects should not be overlooked. We present one such case, in which a presumed brown recluse (Loxosceles reclusa) bite on the neck resulted in severe illness with systemic manifestations. The patient presented to the emergency room minimally responsive with left-sided facial nerve palsy and septic shock. While the admitting physician initially prioritized stabilizing the patient, he noted the left-sided cervical cellulitis. Thorough history taking revealed that the patient had been worsening since being bitten by a spider three days prior to admission. After a month-long hospital stay and multidisciplinary treatment, the patient was transferred to a larger center with facial paralysis still present.
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22
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Kang D, Goo B, Kim JH, Kim JH, Nam SS. Clinical use of thread embedding acupuncture for facial nerve palsy: A web-based survey. Medicine (Baltimore) 2022; 101:e31507. [PMID: 36451397 PMCID: PMC9704900 DOI: 10.1097/md.0000000000031507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Although thread embedding acupuncture (TEA) is widely used for facial nerve palsy (FNP) in Korea, it lacks clinical evidence. Therefore, a large-scale and long-term clinical trial is needed. It is necessary to standardize and optimize TEA treatment for clinical study. Hence, we collected information about how TEA in the facial region is performed in clinical practice using a web-based survey. A questionnaire was developed consisting of 22 essential items and 30 optional items including demographic characteristics, purpose of TEA, adverse events (AE), direct medical cost, required time, and current state of TEA treatment on FNP. The questionnaire was sent via e-mail to 23,910 traditional Korean medicine doctors (TKMD). A total of 427 respondents answered the questionnaire. The most common response for the purpose for TEA was cosmetic, followed by musculoskeletal disease and nervous system disease. The most common AE that resolved without medical treatment was bruising (90.4%). The most common AE that required medical treatment was dimple (30.5). Many respondents commonly used TEA for the sequelae of FNP (71.8%). The most frequent sequelae of FNP for which TEA was used as contracture around the mouth (75.3%). The most preferred treatment method was insertion of 6-10 monofilament threads using a 29-gauge needle at intervals of 2.2 ± 1.59 weeks in the sequelae period. The results of this survey can be used to standardize and optimize the procedure of TEA for FNP for further clinical research.
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Affiliation(s)
- Dahae Kang
- Industry-Academic Cooperation Foundation, Kyung Hee University, Seoul, Republic of Korea
| | - Bonhyuk Goo
- Department of Acupuncture & Moxibustion, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Jung-Hyun Kim
- Department of Acupuncture & Moxibustion, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Joo-Hee Kim
- Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Sangji University, Wonju-si, Republic of Korea
| | - Sang-Soo Nam
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
- *Correspondence: Sang-Soo Nam, Department of Acupuncture & Moxibustion, College of Korean Medicine, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea (e-mail: )
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23
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Mualem W, Alexander AY, Bambakidis P, Michalopoulos GD, Kerezoudis P, Link MJ, Peris-Celda M, Mardini S, Bydon M. Predictors of favorable outcome following hypoglossal-to-facial nerve anastomosis for facial nerve palsy: a systematic review and patient-level analysis of a literature-based cohort. J Neurosurg 2022; 138:1034-1042. [PMID: 35962964 DOI: 10.3171/2022.6.jns22240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/15/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Facial nerve palsy is a debilitating condition that can arise from iatrogenic, traumatic, or congenital causes. One treatment to improve function of the facial muscles after facial nerve injury is hypoglossal-to-facial nerve anastomosis (HFA). HFA's efficacy and predictors of its success vary in the literature. Here, the authors present a patient-level analysis of a literature-based cohort to assess outcomes and investigate predictors of success for HFA. METHODS Seven electronic databases were queried for studies providing baseline characteristics and outcomes of patients who underwent HFA. Postoperative outcomes were measured using the House-Brackmann (HB) grading scale. A change in HB grade of 3 points or more was classified as favorable. A cutoff value for time to anastomosis associated with a favorable outcome was determined using the Youden Index. RESULTS Nineteen articles with 157 patients met the inclusion criteria. The mean follow-up length was 27.4 months, and the mean time to anastomosis after initial injury was 16 months. The end-to-side and end-to-end anastomosis techniques were performed on 84 and 48 patients, respectively. Of the 130 patients who had available preoperative and postoperative HB data, 60 (46.2%) had a favorable outcome. Time from initial injury to anastomosis was significantly different between patients with favorable and unfavorable outcomes (7.3 months vs 29.2 months, respectively; p < 0.001). The optimal cutoff for time to anastomosis to achieve a favorable outcome was 6.5 months (area under the curve 0.75). Patients who underwent anastomosis within 6.5 months of injury were more likely to achieve a favorable outcome (73% vs 31%, p < 0.001). CONCLUSIONS HFA is an effective method for restoring facial nerve function. Favorable outcomes for facial nerve palsy may be more likely to occur when time to anastomosis is within a 6.5-month window.
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Affiliation(s)
- William Mualem
- 1Neuro-Informatics Laboratory, Mayo Clinic, Rochester.,2Department of Neurologic Surgery, Mayo Clinic, Rochester
| | - A Yohan Alexander
- 1Neuro-Informatics Laboratory, Mayo Clinic, Rochester.,2Department of Neurologic Surgery, Mayo Clinic, Rochester
| | | | - Giorgos D Michalopoulos
- 1Neuro-Informatics Laboratory, Mayo Clinic, Rochester.,2Department of Neurologic Surgery, Mayo Clinic, Rochester
| | | | - Michael J Link
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester
| | | | - Samir Mardini
- 4Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mohamad Bydon
- 1Neuro-Informatics Laboratory, Mayo Clinic, Rochester.,2Department of Neurologic Surgery, Mayo Clinic, Rochester
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24
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Suzuki S, Bandoh N, Goto T, Kubota A, Uemura A, Kono M, Sato R, Takeda R, Sakaue S, Yamaguchi-Isochi T, Nishihara H, Takei H, Harabuchi Y. A retrospective study of parotid gland tumors at a single institution. Oncol Lett 2022; 24:207. [PMID: 35720490 PMCID: PMC9178697 DOI: 10.3892/ol.2022.13328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/06/2022] [Indexed: 11/13/2022] Open
Abstract
The aim of the present study was to analyze the clinical characteristics, surgical treatments and clinical outcome of patients with parotid gland tumors and to compare the results with those cited in the literature. A retrospective study was conducted in 140 patients (male, n=77; female, n=63) with parotid gland tumors who underwent parotidectomy at Hokuto Hospital Department of Otolaryngology-Head and Neck Surgery (Obihiro, Japan) between April 2007 and December 2021. Of the 140 patients enrolled, 118 (84.3%) patients had benign tumors, including 63 (45%) patients with pleomorphic adenomas and 43 (30.7%) patients with Warthin tumors, and 22 patients (15.7%) had parotid carcinoma. Comparison of the three groups of patients with parotid gland tumors indicated that pack years as an indicator of smoking status were significantly higher in patients with Warthin tumors than in those with parotid carcinomas (P=0.011) or pleomorphic adenoma (P<0.001). Fine-needle aspiration cytology (FNAC) was non-diagnostic for only 6 (4.3%) of 140 patients. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of FNAC by both conventional smear and liquid-based cytology (LBC) for parotid carcinomas were 70, 99, 93.3, 94.4 and 82.9%, respectively. Among the 22 patients with parotid carcinoma, extended total/total and superficial parotidectomy were performed in 10 (45%) and 11 (50%) cases, respectively. Total and selective neck dissection of the area from level II to I, II and III were performed in 6 (24%) and 7 (32%) patients, respectively. Postoperative radiotherapy (50 Gy) was performed in 15 (68%) patients. The overall survival (OS) and disease-free survival (DFS) rates at 5 years were 51.5 and 76.4%, respectively. Univariate analysis revealed that age >65 years was significantly associated with poorer 5-year OS (P<0.001) and DFS (P<0.001). Multivariate analysis revealed that an age of more than 65 years combined with high-grade histologic malignancy was associated with worse DFS (P=0.02; hazard ratio, 3.628; 95% confidence interval, 1.283-9.514). In conclusion, the clinical characteristics and treatment outcomes of parotid gland tumors were consistent with the results of previous reports. Smoking may be closely related to the pathogenesis of Warthin tumors. LBC potentially provides improved accuracy in FNAC.
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Affiliation(s)
- Shiori Suzuki
- Department of Otolaryngology-Head and Neck Surgery, Hokuto Hospital, Obihiro, Hokkaido 080-0833, Japan.,Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical University, Asahikawa, Hokkaido 078-8510, Japan
| | - Nobuyuki Bandoh
- Department of Otolaryngology-Head and Neck Surgery, Hokuto Hospital, Obihiro, Hokkaido 080-0833, Japan
| | - Takashi Goto
- Department of Otolaryngology-Head and Neck Surgery, Hokuto Hospital, Obihiro, Hokkaido 080-0833, Japan
| | - Akinobu Kubota
- Department of Otolaryngology-Head and Neck Surgery, Hokuto Hospital, Obihiro, Hokkaido 080-0833, Japan.,Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical University, Asahikawa, Hokkaido 078-8510, Japan
| | - Akihiro Uemura
- Department of Otolaryngology-Head and Neck Surgery, Hokuto Hospital, Obihiro, Hokkaido 080-0833, Japan
| | - Michihisa Kono
- Department of Otolaryngology-Head and Neck Surgery, Hokuto Hospital, Obihiro, Hokkaido 080-0833, Japan.,Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical University, Asahikawa, Hokkaido 078-8510, Japan
| | - Ryosuke Sato
- Department of Otolaryngology-Head and Neck Surgery, Hokuto Hospital, Obihiro, Hokkaido 080-0833, Japan.,Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical University, Asahikawa, Hokkaido 078-8510, Japan
| | - Ryuhei Takeda
- Department of Otolaryngology-Head and Neck Surgery, Hokuto Hospital, Obihiro, Hokkaido 080-0833, Japan.,Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical University, Asahikawa, Hokkaido 078-8510, Japan
| | - Shota Sakaue
- Department of Otolaryngology-Head and Neck Surgery, Hokuto Hospital, Obihiro, Hokkaido 080-0833, Japan.,Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical University, Asahikawa, Hokkaido 078-8510, Japan
| | | | - Hiroshi Nishihara
- Genomics Unit, Keio Cancer Center, Keio University School of Medicine, Shinjukuku, Tokyo 160-8582, Japan
| | - Hidehiro Takei
- Department of Pathology and Translational Pathobiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, USA
| | - Yasuaki Harabuchi
- Department of Otolaryngology-Head and Neck Surgery, Hokuto Hospital, Obihiro, Hokkaido 080-0833, Japan.,Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical University, Asahikawa, Hokkaido 078-8510, Japan
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Salih AM, Baba HO, Saeed YA, Muhialdeen AS, Kakamad FH, Mohammed SH, Hammood ZD, Salih KM, Salih RQ, Hussein DA, Hassan HA. Pattern of facial nerve palsy during parotidectomy: a single-center experience. J Int Med Res 2022; 50:3000605221108930. [PMID: 35808820 PMCID: PMC9274412 DOI: 10.1177/03000605221108930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study was performed to report and analyze the prevalence of permanent facial nerve paralysis following parotidectomy for various benign and malignant lesions in a single center. METHODS This single-center retrospective study included all patients who underwent parotidectomy (total and superficial) for benign and malignant tumors and chronic inflammatory diseases during a 6-year period. Patients who had previously undergone an operation of the parotid gland and those with preoperative facial weakness were excluded. RESULTS The study included 127 patients ranging in age from 14 to 83 years (median, 45.89 years). Most patients were female (n = 83, 65.4%). The most prevalent procedure was superficial parotidectomy (n = 117, 92.1%), followed by total parotidectomy (n = 6, 4.7%). The average operative duration was 138 minutes (range, 80-400 minutes). Histopathology revealed that 109 (85.8%) patients had benign tumors, 14 (11.0%) had malignant tumors, and 4 (3.1%) had chronic sialadenitis. Only two patients sustained an injury to the cervical branch of the facial nerve. CONCLUSION In this single-center experience of parotid surgery, the rates of transient and permanent facial paralysis were acceptably low at 9.0% and 1.6%, respectively, for all pathologies.
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Affiliation(s)
- Abdulwahid M Salih
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq.,College of Medicine, University of Sulaimani, Sulaimani, Iraq
| | - Hiwa O Baba
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq.,Kscien Organization, Hamdi Street, Azadi Mall, Sulaimani, Kurdistan, Iraq
| | | | - Aso S Muhialdeen
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq.,Kscien Organization, Hamdi Street, Azadi Mall, Sulaimani, Kurdistan, Iraq.,Sulaimani Teaching Hospital, Sulaimani, Kurdistan, Iraq
| | - Fahmi H Kakamad
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq.,College of Medicine, University of Sulaimani, Sulaimani, Iraq.,Kscien Organization, Hamdi Street, Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Shvan H Mohammed
- Kscien Organization, Hamdi Street, Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Zuhair D Hammood
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq.,Kscien Organization, Hamdi Street, Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Karzan M Salih
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq.,Iraqi Board for Medical Specialties General Surgery Department, Sulaimani Center, Sulaimani, Iraq
| | - Rawezh Q Salih
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq.,Kscien Organization, Hamdi Street, Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Dahat A Hussein
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq.,Kscien Organization, Hamdi Street, Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Hunar A Hassan
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq.,Kscien Organization, Hamdi Street, Azadi Mall, Sulaimani, Kurdistan, Iraq
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26
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Gilliland J, Ritto F, Tiwana P. Complications of the Transmasseteric Anteroparotid Approach for Subcondylar Fractures: A Retrospective Study. Craniomaxillofac Trauma Reconstr 2022; 15:66-71. [PMID: 35265280 PMCID: PMC8899356 DOI: 10.1177/19433875211016923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Study Design A retrospective analysis of patients with subcondylar fractures treated via a transmasseteric anteroparotid approach by the Oral and Maxillofacial Department at the University of Oklahoma. Objective The goal of this study was to evaluate complications, morbidity, and safety with the transmasseteric anteroparotid approach for treatment of subcondylar fractures, and compare it to other findings previously reported in the literature. Methods A retrospective study was conducted that consisted of 23 surgically treated patients in the past 2 years for subcondylar fractures. Only patients with pre-operative malocclusion and who underwent open reduction with internal fixation with the transmasseteric anteroparotid (TMAP) approach were included. Exclusion criteria included 1) patients treated with closed reduction 2) patients who failed the minimum of 1, 3, and 6-week post-operative visits. The examined parameters were the degree of mouth opening, occlusal relationship, facial nerve function, incidence of salivary fistula and results of imaging studies. Results 20 of the surgically treated patients met the inclusion criteria. Two patients were excluded due to poor post-operative follow up and 1 was a revision of an attempted closed reduction by an outside surgeon that presented with pre-existing complications. There were no cases of temporary or permanent facial nerve paralysis reported. There were 3 salivary fistulas and 2 sialoceles, which were managed conservatively and resolved within 2 weeks, and 2 cases of inadequate post-surgical maximal incisal opening (<40 mm) were observed. Conclusion The transmasseteric anteroparotid approach is a safe approach for open reduction and internal fixation of low condylar neck and subcondylar fractures, and it has minimal complications.
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Affiliation(s)
- Jared Gilliland
- Jared Gilliland, DDS, Department of Oral and Maxillofacial Surgery, University of Oklahoma Health, 1201 N Stonewall Ave, Oklahoma City, OK 73104-5410, USA.
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27
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Veisi A, Najafi M, Hassanpour K, Bagheri A. Facial and Abducens Nerve Palsies Following COVID-19 Vaccination: Report of Two Cases. Neuroophthalmology 2022; 46:203-206. [PMID: 35574171 PMCID: PMC9103272 DOI: 10.1080/01658107.2022.2032204] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 12/11/2022] Open
Abstract
A broad spectrum of neurological side effects has been reported after immunisation for COVID-19, including functional neurological disorders, cerebral vascular events, cerebral venous thrombosis, intracerebral haemorrhage, neuroleptic malignant syndrome, cranial nerve palsies, and otologic manifestations. Multiple cranial neuropathies have also been reported following vaccination in which involvement of VII nerve is the most prevalent, followed by the VI, III, and IV nerves. We describe two male patients, one with with facial nerve palsy and the other with abducens nerve palsy following COVID-19 vaccination. The patient with facial nerve palsy received the AstraZeneca vaccine 2 days before the symptoms began. In contrast, the patient with the abducens palsy had received his first dose of the Sinopharm vaccine 7 days previously. Both patients demonstrated a gradual recovery within the next 2 months. Further studies are required to investigate the proper relationship between cranial nerve palsies and vaccinations.
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Affiliation(s)
- Amirreza Veisi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Najafi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kiana Hassanpour
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Bagheri
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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28
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Poudyal P, Nepal G, Yadav SK, Neupane Y, Dutta H, Pokhrel S, Gaire P. Keratosis obturans: A rare cause of facial nerve palsy. Clin Case Rep 2022; 10:e05410. [PMID: 35154726 PMCID: PMC8819644 DOI: 10.1002/ccr3.5410] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 01/13/2022] [Accepted: 01/25/2022] [Indexed: 11/06/2022] Open
Abstract
Keratosis obturans, caused by the deposition of desquamated keratin plug in the external auditory canal can present with facial palsy. Young patients presenting with facial palsy, earache, and gradual hearing loss should be suspected for Keratosis obturans.
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Affiliation(s)
- Prasanta Poudyal
- Department of Otorhinolaryngology‐Head and Neck SurgeryTribhuvan University Teaching HospitalKathmanduNepal
| | - Gaurav Nepal
- Department of Internal MedicineTribhuvan University Teaching HospitalKathmanduNepal
| | - Sushil Kumar Yadav
- Maharajgunj Medical CampusTribhuvan University Institute of MedicineKathmanduNepal
| | - Yogesh Neupane
- Department of Otorhinolaryngology‐Head and Neck SurgeryTribhuvan University Teaching HospitalKathmanduNepal
| | - Heempali Dutta
- Department of Otorhinolaryngology‐Head and Neck SurgeryTribhuvan University Teaching HospitalKathmanduNepal
| | - Shishir Pokhrel
- Department of Otorhinolaryngology‐Head and Neck SurgeryTribhuvan University Teaching HospitalKathmanduNepal
| | - Prabin Gaire
- Department of PathologyMaharajgunj Medical CampusTribhuvan University Institute of MedicineKathmanduNepal
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29
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Abstract
BACKGROUND The aetiology of idiopathic facial nerve palsy (Bell's palsy, BP) and sudden sensorineural hearing loss (SSNHL) are not known. It has been proposed that common respiratory tract viruses play a part in the pathophysiology of these diseases. OBJECTIVES The incidence of many infectious diseases decreased during the lockdown of the society that took place during the COVID-19 pandemic. We investigated a possible change in the incidence of BP and SSNHL during the lock-down. MATERIAL AND METHODS We searched the patient records for all BP and SSNHL cases between 1 Jan 2017 - 31 Aug 2020 at the hospital district of Helsinki and Uusimaa that covers a population of about 1.2 million. RESULTS The mean monthly incidence on BP decreased during the COVID-19 pandemic lock-down. No change in the SSNHL incidence was discovered. CONCLUSIONS AND SIGNIFICANCE There is reason to speculate that one aetiologic reason for BP are transmittable respiratory tract pathogens.
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Affiliation(s)
- Lena Hafrén
- Department of Otorhinolaryngology-Head and Neck Surgery, HUS Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Riitta Saarinen
- Department of Otorhinolaryngology-Head and Neck Surgery, HUS Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Marie Lundberg
- Department of Otorhinolaryngology-Head and Neck Surgery, HUS Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Department of Clinical Allergy and Immunology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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30
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Adachi S, Ishida A, Saito M, Fujiwara K, Fukumura S. Unrecovered synkinesis as a sequela of facial nerve palsy in Kawasaki disease. Pediatr Int 2022; 64:e14673. [PMID: 34550631 DOI: 10.1111/ped.14673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/11/2021] [Accepted: 02/24/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Shuhei Adachi
- Department of Pediatrics, Steel Memorial Muroran Hospital, Muroran, Japan
| | - Aya Ishida
- Department of Pediatrics, Steel Memorial Muroran Hospital, Muroran, Japan
| | - Makoto Saito
- Department of Pediatrics, Steel Memorial Muroran Hospital, Muroran, Japan
| | - Keishi Fujiwara
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shinobu Fukumura
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
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31
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Cavalcante-Neto JF, dos Reis GC, Esmeraldo MA, dos Santos BRF, Leal PRL, da Ponte KF, Cristino-Filho G, Ribeiro EML. Eight-and-a-Half Syndrome Secondary to Neurotoxoplasmosis: A Rare Case Report. Neuroophthalmology 2022; 46:335-338. [PMID: 36337230 PMCID: PMC9635541 DOI: 10.1080/01658107.2022.2043390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Eight-and-a-half syndrome (EHS) is a neuro-ophthalmological condition characterised by horizontal gaze palsy, internuclear ophthalmoplegia, and ipsilateral facial palsy. Albeit rare, EHS is a well reported condition in the literature, with several reports presenting multiple aetiologies. Infarcts are the cause in more than half the cases. Human immunodeficiency virus (HIV)-related cases are rare, and are probably underreported in low- and middle-income countries. In this report, we describe EHS secondary to neurotoxoplasmosis in a 40-year-old HIV-positive Brazilian man. EHS secondary to neurotoxoplasmosis is a challenging diagnosis, with important differential diagnoses, notably for HIV patients.
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Affiliation(s)
- Joaquim Francisco Cavalcante-Neto
- Department of Neurology, Federal University of Ceará, Sobral, Brazil
- CONTACT Joaquim Francisco Cavalcante-Neto Federal University of Ceará, 100, Avenida Comandante Maurocélio Rocha Pontes, Sobral, Ceará62042-280, Brazil
| | | | | | | | - Paulo Roberto Lacerda Leal
- Department of Neurology, Federal University of Ceará, Sobral, Brazil
- Department of Neurology, Santa Casa de Misericórdia de Sobral, Sobral, Brazil
| | - Keven Ferreira da Ponte
- Department of Neurology, Federal University of Ceará, Sobral, Brazil
- Department of Neurology, Santa Casa de Misericórdia de Sobral, Sobral, Brazil
| | - Gerardo Cristino-Filho
- Department of Neurology, Federal University of Ceará, Sobral, Brazil
- Department of Neurology, Santa Casa de Misericórdia de Sobral, Sobral, Brazil
| | - Espártaco Moraes Lima Ribeiro
- Department of Neurology, Federal University of Ceará, Sobral, Brazil
- Department of Neurology, Santa Casa de Misericórdia de Sobral, Sobral, Brazil
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32
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Galindo-Ferreiro A, Marqués-Fernández V, Sanchez-Tocino H, Schellini SA. Objective assessment of eyelid position and tear meniscus in facial nerve palsy. Orbit 2021; 41:700-707. [PMID: 34958290 DOI: 10.1080/01676830.2021.1992789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate lower lid position and tear meniscus in peripheral idiopathic facial nerve palsy (FNP). METHODS A prospective study enrolled patients with peripheral idiopathic FNP and epiphora. Data were collected on patient demographics, House-Brackmann (HB) scale, digital photographs of the face, and tear meniscus at the 1st, 30, and 90 day after onset of FNP. Marginal reflex distance to the upper (MRD1) and lower eyelid (MRD2) were evaluated using ImageJ software. Anterior segment optical coherence tomography (OCT) was performed to measure the tear menis- cus. P< .05 was considered statistically significant. RESULTS Sixteen patients were evaluated. The HB scale at presentation was grade III in six patients (37.5%). At 90 day, nine patients (56.25%) were grade I-normal. Three (18.7%) had upper lid retraction, three (18.7%) upper eyelid asymmetry and 7 (43.75%), lower eyelid retraction. The difference between MRD2-FNP with MRD2-healthy side was 0.51 ± 1.9 mm at the 1st visit, decreasing to 0.09 ± 1.47 mm at 90 days (P= .877). Tear meniscus measurements were significantly higher in FNP at the 1st visit (P= .001). The decrease in MRD2 was statistically correlated with the reduction of the tear meniscus area (TMA) (r = 0.67; P= .007) at 90 days. No correlation was found between HB and TMA. There is a difference in TMA between age groups at the 1st day(p= .009). Eldest group had higher HB scales. CONCLUSION Quantitative evaluation of eyelid position and tear meniscus are effective to document the evolution of FNP and can serve as a clue of orbicularis recovery.
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Affiliation(s)
| | | | | | - Silvana A Schellini
- Department of Ophthalmology, Medical School, State University of São Paulo - UNESP - University Campus, São Paulo, Brazil
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33
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Shafiq A, Salameh MA, Laswi I, Mohammed I, Mhaimeed O, Mhaimeed N, Mhaimeed N, Paul P, Mushannen M, Elshafeey A, Fares A, Holroyd S, Zakaria D. Neurological Immune Related Adverse Events Post-COVID-19 Vaccination: A Systematic Review. J Clin Pharmacol 2021; 62:291-303. [PMID: 34921562 DOI: 10.1002/jcph.2017] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 12/14/2021] [Indexed: 11/07/2022]
Abstract
The COVID-19 pandemic has affected millions of individuals worldwide. The global scientific effort to design an effective vaccine against this virus has led to the development of several vaccine candidates. The expedited roll-out of these vaccines has created some public distrust regarding the safety of these new vaccines. This review compiles clinical data from reports of diagnosed immune-related neurological events that have occurred post-COVID-19 vaccine administration with the exception of those secondary to hematological abnormalities. A systematic literature search was performed, using several databases, to identify reports of post-vaccination adverse neurological events. The search resulted in 18 studies that met our criteria. These studies included 78 patients who had received COVID-19 vaccines and experienced at least one neurological adverse effect. The most common neurological event was Facial nerve palsy (62.3% of all events). Other less frequently reported events included the reactivation of herpes zoster, Guillain-Barre Syndrome, other demyelinating diseases, and neuropathy. The underlying mechanism was hypothesized to be related to vaccine-induced type 1 interferon production leading to decreased tolerance of the myelin sheath antigens. Other hypotheses include vaccine-induced transient lymphopenia and immune dysregulation. Most of the reported events were time-limited and resolved spontaneously. Given the rarity of reported neurological events compared to the total number of vaccines administered, and the similarity in the incidence of events between COVID-19 vaccines and other more common vaccines, there is little evidence to support a causal relationship between COVID-19 vaccines and adverse neurological events. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ameena Shafiq
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Al Luqta St. Ar-Rayyan, Doha, P.O. Box 24144, Qatar
| | - Mohammad A Salameh
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Al Luqta St. Ar-Rayyan, Doha, P.O. Box 24144, Qatar
| | - Ibrahim Laswi
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Al Luqta St. Ar-Rayyan, Doha, P.O. Box 24144, Qatar
| | - Ibrahim Mohammed
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Al Luqta St. Ar-Rayyan, Doha, P.O. Box 24144, Qatar
| | - Omar Mhaimeed
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Al Luqta St. Ar-Rayyan, Doha, P.O. Box 24144, Qatar
| | - Nada Mhaimeed
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Al Luqta St. Ar-Rayyan, Doha, P.O. Box 24144, Qatar
| | - Narjis Mhaimeed
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Al Luqta St. Ar-Rayyan, Doha, P.O. Box 24144, Qatar
| | - Pradipta Paul
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Al Luqta St. Ar-Rayyan, Doha, P.O. Box 24144, Qatar
| | - Malik Mushannen
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Al Luqta St. Ar-Rayyan, Doha, P.O. Box 24144, Qatar
| | - Abdallah Elshafeey
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Al Luqta St. Ar-Rayyan, Doha, P.O. Box 24144, Qatar
| | - Ahmed Fares
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Al Luqta St. Ar-Rayyan, Doha, P.O. Box 24144, Qatar
| | - Sean Holroyd
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Al Luqta St. Ar-Rayyan, Doha, P.O. Box 24144, Qatar
| | - Dalia Zakaria
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Al Luqta St. Ar-Rayyan, Doha, P.O. Box 24144, Qatar
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34
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Mehta R, Nagarkar NM, Ksbs KS, Ty SS, Arora RD, Aggarwal A. Facial Nerve Palsy in COVID-19-Associated Mucormycosis Patients: A Case Series. Cureus 2021; 13:e19208. [PMID: 34873538 PMCID: PMC8638780 DOI: 10.7759/cureus.19208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 12/02/2022] Open
Abstract
Sinonasal mucormycosis is a deadly fungal illness that primarily affects diabetics who are uncontrolled. Numerous cranial nerves can be involved; however, facial nerve palsy has only been observed in a few cases. The main objective of this research is to highlight facial nerve involvement as a clinical sign of sinonasal mucormycosis. Nasal stuffiness, headaches, eye pain, orbital edema, ophthalmoplegia, and vision loss are common symptoms in these mucormycosis patients. The study was done in the Department of Otolaryngology & Head and Neck Surgery, All India Institute of Medical Sciences (AIIMS), Raipur, India. Nevertheless, 17 patients with facial nerve palsy (lower motor nerve palsy) and sinonasal mucormycosis arrived at our department. All patients were diabetic, and a majority of patients got Schirmer's test positive with severe stage. In the case of mucormycosis, facial nerve palsy is an unusual but noteworthy symptom. This could be misinterpreted as a cerebrovascular accident (CVA), causing the therapy to be delayed. This is critical as early identification, surgical debridement, and adequate therapy of the underlying metabolic imbalance, as well as amphotericin B, are critical for a successful treatment outcome in mucormycosis.
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Affiliation(s)
- Rupa Mehta
- Otolaryngology, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Nitin M Nagarkar
- Otolaryngology, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | | | - Sree Sudha Ty
- Pharmacology, Shri Shankaracharya Institute of Medical Sciences, Bhilai, IND
| | - Ripu Daman Arora
- Otolaryngology, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Aakash Aggarwal
- Otolaryngology, All India Institute of Medical Sciences, Raipur, Raipur, IND
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35
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Kishmiryan A, Gautam J, Acharya D, Singh BM, Ohanyan A, Arakelyan A, Vahanyan A, Shoura S. Cephalic tetanus manifesting as isolated facial nerve palsy- a case report from rural Armenia. J Infect Dev Ctries 2021; 15:1770-1773. [PMID: 34898510 DOI: 10.3855/jidc.13817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 04/02/2021] [Indexed: 10/31/2022] Open
Abstract
Cephalic tetanus is a rare clinical form of tetanus, clinically characterized by trismus and cranial nerve palsy involving one or more cranial nerves, facial nerve being the most common. We report a case of cephalic tetanus with left-sided lower motor facial nerve palsy in a 66-year-old non-immunized patient after an untreated laceration injury. The patient had dysphagia, spasm of the muscles of mastication, asymmetry of the left side of the face, cough, shortness of breath, and stiffness of neck muscles. The presentation was unique given that the facial nerve palsy appeared prior to the occurrence of trismus, which misled the initial diagnosis towards Bell's palsy. He was successfully treated with tetanus antitoxin without any adverse events. Although widespread use of tetanus vaccine has led to a dramatic decline in this fatal disease, sporadic disease occurrence is still possible, particularly in individuals without up-to-date vaccinations. In this case report we illustrate the importance of early recognition of cephalic tetanus prior to the development of the full clinical picture. The early initiation of therapy is the key to recovery from this deadly disease. Physicians are encouraged to include cephalic tetanus as a cause of facial nerve palsy in their differential. In particular, paying attention to cases manifesting early after head or neck injury.
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Affiliation(s)
- Armen Kishmiryan
- Presence St Francis Hospital, Amita Health, Evanston, IL, United States
| | | | - Deeksha Acharya
- Srinivas Institute of Medical Sciences and Research Center, Mangalore, India
| | | | - Armen Ohanyan
- Nork Infectious Clinical Hospital, Yerevan, Republic of Armenia
| | - Anna Arakelyan
- Yerevan State Medical University After Mkhitar Heratsi, Yerevan, Republic of Armenia
| | - Anush Vahanyan
- Yerevan State Medical University After Mkhitar Heratsi, Yerevan, Republic of Armenia
| | - Sami Shoura
- John H. Stroger Jr Hospital of Cook County, Chicago, IL, United States
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Obtulovičová K, Sičák M, Kališ A, Buday T. Chondroblastoma of the Temporal Bone: A Case Report and Literature Review. Acta Medica (Hradec Kralove) 2021; 64:170-173. [PMID: 34779383 DOI: 10.14712/18059694.2021.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Temporal bone chondroblastoma is a rare, locally aggressive tumour originating from immature cartilage, which recurs to a high degree. Treatment is surgical. Radiotherapy is reserved for recurrence. We describe a case of a 15-year-old-boy choosing a conservative surgical approach with reconstruction of the posterior canal wall. This study aims to report a rare pediatric case. METHODS A literature review was performed to better understand temporal bone chondroblastomas, to describe their histopathological and radiological characteristics and to establish the optimal surgical and non-surgical treatments. The research of previous published data was done using PubMed with keywords mentioned below. RESULTS Authors present a case of a 15-year-old boy with hearing impairment and facial nerve palsy. Conservative surgery with reconstruction of the tympanic membrane and posterior wall of the external auditory canal, restoring the hearing has been performed. We did not administer any adjuvant therapies. No sign of recurrence was observed 1 year after primary surgery. Facial nerve function is normal, and hearing is satisfactory. CONCLUSION Chondroblastomas account for less than 1% of primary bone tumours. Temporal bone chondroblastoma is rare, locally aggressive, with a high prevalence of recurrence. This study describes specific histopathological and radiological findings, the chosen surgical approach and follow-up to improve the management and the prognosis of patients affected with this particular clinical entity.
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Affiliation(s)
- Katarína Obtulovičová
- Otorinolaryngology/Head & Neck Surgery Clinic, the Central Military Hospital - Faculty Hospital, Ružomberok, Slovakia.
| | - Marián Sičák
- Otorinolaryngology/Head & Neck Surgery Clinic, the Central Military Hospital - Faculty Hospital, Ružomberok, Slovakia
| | - Adrian Kališ
- Catholic University in Ružomberok, Slovakia.,Institute of Pathology, the Central Military Hospital - Faculty Hospital, Ružomberok, Slovakia
| | - Tomáš Buday
- The Jessenius Medical Faculty of Comenius University in Martin, Slovakia
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Sato K, Mano T, Niimi Y, Toda T, Iwata A, Iwatsubo T. Facial nerve palsy following the administration of COVID-19 mRNA vaccines: analysis of a self-reporting database. Int J Infect Dis 2021; 111:310-312. [PMID: 34492394 PMCID: PMC8418051 DOI: 10.1016/j.ijid.2021.08.071] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/21/2021] [Accepted: 08/30/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives: Facial nerve palsy (or Bell's palsy) has occasionally been reported following the administration of coronavirus disease 2019 (COVID-19) mRNA vaccines (BNT162b2 and mRNA-1273). Our study investigated such cases using a large self-reporting database from the USA (Vaccine Adverse Event Reporting System [VAERS]). Methods: A disproportionality analysis, adjusted for age and sex, was conducted for VAERS reports from individuals who were vaccinated at the age of 18 years or over, between January 2010 and April 2021. Results: The analysis revealed that the adverse events following immunization (AEFI) of facial nerve palsy, after administration of COVID-19 mRNA vaccines, was significantly highly reported, both for BNT162b2 (reporting odds ratio [ROR] 1.84; 95% confidence interval [CI] 1.65–2.06) and mRNA-1273 (ROR 1.54; 95% CI 1.39–1.70). These levels were comparable to that following influenza vaccination reported before the COVID-19 pandemic (ROR 2.04; 95% CI 1.76–2.36). Conclusions: Our pharmacovigilance study results suggest that the incidence of facial nerve palsy as a non-serious AEFI may be lower than, or equivalent to, that for influenza vaccines. This information might be of value in the context of promoting worldwide vaccination, but needs to be validated in future observational studies.
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Affiliation(s)
- Kenichiro Sato
- Department of Neurology, Graduate School of Medicine, University of Tokyo; Department of Neuropathology, Graduate School of Medicine, University of Tokyo; Unit for Early and Exploratory Clinical Development, University of Tokyo Hospital
| | - Tatsuo Mano
- Department of Neurology, Graduate School of Medicine, University of Tokyo
| | - Yoshiki Niimi
- Unit for Early and Exploratory Clinical Development, University of Tokyo Hospital
| | - Tatsushi Toda
- Department of Neurology, Graduate School of Medicine, University of Tokyo
| | - Atsushi Iwata
- Department of Neurology, Tokyo Metropolitan Geriatric Medical Center Hospital.
| | - Takeshi Iwatsubo
- Department of Neuropathology, Graduate School of Medicine, University of Tokyo; Unit for Early and Exploratory Clinical Development, University of Tokyo Hospital
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Yang CJ, Yoshida T, Sugimoto S, Teranishi M, Sone M. Facial nerve palsy associated with chronic recurrent multifocal osteomyelitis. Pediatr Int 2021; 63:1125-1127. [PMID: 34142754 DOI: 10.1111/ped.14563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 10/19/2020] [Accepted: 11/12/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Cheng-Jui Yang
- Department of 1Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tadao Yoshida
- Department of 1Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satofumi Sugimoto
- Department of 1Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaaki Teranishi
- Department of 1Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Michihiko Sone
- Department of 1Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Jain E, Pandav K, Regmi P, Michel G, Altshuler I. Facial Diplegia: A Rare, Atypical Variant of Guillain-Barré Syndrome and Ad26.COV2.S Vaccine. Cureus 2021; 13:e16612. [PMID: 34447646 PMCID: PMC8381448 DOI: 10.7759/cureus.16612] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2021] [Indexed: 11/07/2022] Open
Abstract
This potentially life-threatening disease poses an interesting perspective on adverse events that can occur or can be exacerbated following the Ad26.COV2.S (Johnson & Johnson) vaccine. The authors report findings in a 65-year-old female patient who experienced facial diplegia, an atypical variant of Guillain-Barré syndrome, two weeks after receiving the Ad26.COV2.S vaccine against coronavirus disease 2019. Post-approval pharmacovigilance of each vaccine helps better understand the long-term outcomes, and reporting adverse events is crucial for advancements in medical knowledge.
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Affiliation(s)
- Esha Jain
- Medicine, American University of Antigua, St. John's, ATG
| | - Krunal Pandav
- Division of Research & Academic Affairs, Larkin Community Hospital, South Miami, USA
| | | | - George Michel
- Internal Medicine, Larkin Community Hospital, South Miami, USA
| | - Ida Altshuler
- Neurology, Richmond University Medical Center, New York, USA
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Homsy SP, Repo JP, Lindford AJ, Uimonen MM, Lassus P. Validation of the Finnish FACE-Q for use in patients undergoing surgery for functional problems or malignancy. J Plast Surg Hand Surg 2021; 56:270-276. [PMID: 34428115 DOI: 10.1080/2000656x.2021.1964981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The aim of this study was to produce a Finnish version of the FACE-Q scales Satisfaction with Forehead and Eyebrows, Adverse effects: Forehead, Eyebrows and Scalp, and Adverse effects: Cheeks, Lower face and Neck, and assess the performance of these scales and the Satisfaction with Facial Appearance, Satisfaction with Outcome and Appearance-related Psychosocial Distress in patients who had undergone surgery for functional problems or malignancy affecting the forehead or cheeks. The general health-related outcomes instrument 15 D was used as a reference. Patients who had undergone a frontal lift, a direct brow lift, a facelift or an excision of a facial tumor in Helsinki University Hospital plastic surgery department in 2009-2019 were identified. A postal survey study was conducted with 305 patients, of whom 135 (44%) responded. Diagnoses included facial nerve dysfunction (53%), brow ptosis (21%) and skin, mucosal or salivary gland tumor (20%). The FACE-Q scales displayed high internal consistency (Cronbach's alphas ≥0.80) and good reliability on repeat administration. The exploratory factor analysis revealed unifactorial influences for all scales except the Adverse effects: Forehead, Eyebrows and Scalp. Weak correlations with 15 D dimensions were detected. The FACE-Q scales evaluated here are suitable for use in patients with functional problems or malignancy.
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Affiliation(s)
- S Pauliina Homsy
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jussi P Repo
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Andrew J Lindford
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mikko M Uimonen
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Patrik Lassus
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Abstract
BACKGROUND There are various treatments for facial nerve palsy, and research into this topic is ongoing. In the present study, we carried out bibliometric and visualized analyses to identify the trends of research into facial nerve palsy treatment. METHODS To identify articles, the SCOPUS database was searched for articles published from its inception to December 27, 2020. The search was conducted twice, with Search 1 investigating general treatment trends and Search 2 narrowing the scope to complementary and alternative treatment. The extracted keywords were analyzed using the Visualization Of Similarities (VOS) viewer. Through analysis of keywords, research hotspots in the treatment of facial nerve palsy were identified. RESULTS A total of 1609 and 223 articles were identified in Searches 1 and 2, respectively. The number of articles published each year showed a tendency to increase, and most of the studies were only conducted in a few countries. In terms of subject area, "medicine" was overwhelmingly the most common(77.6%). Based on the analysis of 316 keywords in Search1, "medication treatment," and "complementary and alternative treatment" were the hotspots of research. CONCLUSION This study provides the overall trends of facial nerve palsy treatment. To date, research on medication treatment has been main focus, and antiviral use among medication treatment and complementary and alternative treatment has emerged in recent years.
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Affiliation(s)
- Bonhyuk Goo
- Department of Acupuncture & Moxibustion, Kyung Hee University Hospital at Gangdong, Gangdong-gu
| | - Ha-Na Kim
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Dongdaemun-gu
| | - Jung-Hyun Kim
- Department of Acupuncture & Moxibustion, Kyung Hee University Hospital at Gangdong, Gangdong-gu
| | - Sang-Soo Nam
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Kyung Hee University, Dongdaemun-gu, Seoul, Republic of Korea
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Makuszewska M, Fus Ł, Bartoszewicz R, Niemczyk K. Solitary breast cancer metastasis to the facial nerve. Breast J 2021; 27:838-840. [PMID: 34387907 DOI: 10.1111/tbj.14279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/28/2021] [Accepted: 07/30/2021] [Indexed: 11/29/2022]
Abstract
Facial nerve (FN) palsy, as a solitary symptom, resulting from metastatic tumor is not frequent. In this article, we report an unusual case of the breast cancer metastasis to the labyrinthine segment of a facial nerve.
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Affiliation(s)
- Maria Makuszewska
- Department of Otolaryngology Head and Neck Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Łukasz Fus
- Department of Pathology, Medical University of Warsaw, Warsaw, Poland
| | - Robert Bartoszewicz
- Department of Otolaryngology Head and Neck Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Kazimierz Niemczyk
- Department of Otolaryngology Head and Neck Surgery, Medical University of Warsaw, Warsaw, Poland
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Imamura K, Hosoya M, Kasuya K, Shimanuki MN, Shinden S, Ogawa K, Oishi N. Labyrinthine destruction caused by inflammatory pseudotumor of the temporal bone: A report of three cases and review of the literature. Laryngoscope Investig Otolaryngol 2021; 6:857-865. [PMID: 34401513 PMCID: PMC8356880 DOI: 10.1002/lio2.609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/12/2021] [Accepted: 06/16/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Inflammatory pseudotumors (IPTs) are rare, idiopathic, and inflammatory lesions that are histopathologically benign. Here, we present three cases of labyrinthine destruction caused by an IPT. METHODS The first patient was a 74-year-old male with a mass lesion extending from the inner ear to the external ear canal. The second patient was a 62-year-old female with a foliated polycystic lesion in the petrous bone on the dorsal side of the left internal auditory canal. The third patient was a 68-year-old female with a mass extending from the inner ear to the middle ear, destroying the semicircular canal and cochlea. RESULTS In two cases, we performed surgical resection successfully with no recurrence. In the other case, the lesion showed shrinkage after chemotherapy for colorectal cancer incidentally found during the examination process. CONCLUSION Surgical technique and indication for IPT should be based on the location and function of the lesion. In addition, there is room to consider pharmacotherapy as a treatment option for IPT of the temporal bone. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Kanako Imamura
- Department of Otorhinolaryngology‐Head and Neck SurgeryKeio University School of MedicineTokyoJapan
| | - Makoto Hosoya
- Department of Otorhinolaryngology‐Head and Neck SurgeryKeio University School of MedicineTokyoJapan
| | - Kento Kasuya
- Department of Otorhinolaryngology‐Head and Neck SurgeryKeio University School of MedicineTokyoJapan
| | - Marie N. Shimanuki
- Department of OtolaryngologySaiseikai Utsunomiya HospitalUtsunomiya‐shiJapan
| | - Seiichi Shinden
- Department of OtolaryngologySaiseikai Utsunomiya HospitalUtsunomiya‐shiJapan
| | - Kaoru Ogawa
- Department of Otorhinolaryngology‐Head and Neck SurgeryKeio University School of MedicineTokyoJapan
| | - Naoki Oishi
- Department of Otorhinolaryngology‐Head and Neck SurgeryKeio University School of MedicineTokyoJapan
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Yamamoto H, Kojima T, Okanoue Y, Otsuki S, Hasebe K, Yuki R, Hori R. Impact of Changing Surgical Strategies on Clinical Outcomes in Patients with Parotid Carcinoma: A 53-Year Single-Institution Experience. Medicina (Kaunas) 2021; 57:medicina57080745. [PMID: 34440951 PMCID: PMC8399018 DOI: 10.3390/medicina57080745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/18/2021] [Accepted: 07/21/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: We investigated the clinical outcomes of patients who underwent surgery for parotid carcinoma in a single institution during a 53-year period. This study aimed to estimate the impact of changing the surgical approach to parotid carcinoma on clinical outcomes including the incidence rate of the facial nerve palsy. Materials and Methods: Sixty-seven patients with parotid carcinoma who underwent surgery between 1966 and 2018 were retrospectively reviewed. Group A consisted of 29 patients who underwent surgery from 1966 to 2002, and Group B consisted of 38 patients from 2002 to 2018. Treatment outcomes were estimated. Additionally, candidate prognostic factors of Group B, the current surgical approach group, were evaluated. Results: Partial parotidectomy and total parotidectomy were performed in 35 and 32 patients, respectively. Partial parotidectomy was performed in 4 patients in Group A and 31 patients in Group B, with a predominant increase in Group B. The facial nerve was preserved in 43 patients, among whom 8 in Group A (8/17; 47.1%) and 7 in Group B (7/26; 26.9%) had temporary postoperative facial nerve palsy. Postoperative radiotherapy was performed on 35 patients. The 5-year OS, DSS, and DFS rates for Group A were 77.1%, 79.9%, and 71.5%, respectively. The 5-year OS, DSS, and DFS rates for Group B were 77.1%, 77.1%, and 72.4%, respectively. Clinical T4 stage, clinical N+ stage, stage IV disease, and tumor invasion of the facial nerve were independent prognostic factors in Group B. Conclusions: The incidence of facial nerve palsy in the current surgical approach group decreased compared with that in the previous surgical approach group. The current surgical management and treatment policies for parotid carcinoma have led to improved outcomes.
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Affiliation(s)
- Hirotaka Yamamoto
- Department of Otolaryngology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara 632-8552, Japan; (H.Y.); (T.K.); (Y.O.); (S.O.); (K.H.); (R.Y.)
- Department of Otolaryngology, Shizuoka City Hospital, 10-93 Otte-cho, Aoi-ku, Shizuoka 420-8630, Japan
| | - Tsuyoshi Kojima
- Department of Otolaryngology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara 632-8552, Japan; (H.Y.); (T.K.); (Y.O.); (S.O.); (K.H.); (R.Y.)
| | - Yusuke Okanoue
- Department of Otolaryngology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara 632-8552, Japan; (H.Y.); (T.K.); (Y.O.); (S.O.); (K.H.); (R.Y.)
| | - Shuya Otsuki
- Department of Otolaryngology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara 632-8552, Japan; (H.Y.); (T.K.); (Y.O.); (S.O.); (K.H.); (R.Y.)
| | - Koki Hasebe
- Department of Otolaryngology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara 632-8552, Japan; (H.Y.); (T.K.); (Y.O.); (S.O.); (K.H.); (R.Y.)
| | - Ryohei Yuki
- Department of Otolaryngology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara 632-8552, Japan; (H.Y.); (T.K.); (Y.O.); (S.O.); (K.H.); (R.Y.)
| | - Ryusuke Hori
- Department of Otolaryngology—Head and Neck Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Aichi, Japan
- Correspondence: ; Tel.: +81-562-93-9291
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Bayır Ö, Karagöz T, Alpaslan Pınarlı F, Sarıbaş GS, Özoğul C, Keseroğlu K, Saylam G, Çadallı Tatar E, Karahan S, Öcal B, Korkmaz MH. Impact of fetal brain tissue derived mesenchymal stem cell and fibrin glue on facial nerve crash injury. Turk J Med Sci 2021; 51:1481-1490. [PMID: 33244948 PMCID: PMC8283470 DOI: 10.3906/sag-2004-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 11/26/2020] [Indexed: 01/09/2023] Open
Abstract
Background/aim To evaluate the clinical and histopathological effects of fetal brain tissue derived mesenchymal stem cells (FBTMSC) and fibrin glue (FG) on the facial nerve (FN) regeneration in rats with traumatic FN injury. Materials and methods Twenty-eight Sprague Dawley rats were included in the study and divided into 4 groups. Traumatic FN injury (FP) was created by a surgical clamp compression to the main trunk of left FN in all groups. In the control group (group 1) no treatment was applied, in group 2 (FBTMSC group) 2 × 106 FBTMSC was injected, in group 3 (FG group) only FG was applied, in group 4 (FBTMSC and FG groups) both FBTMSC and FG were applied to the injured section of the nerve. The FN functions were evaluated clinically, immediately after the procedure and at 3rd, 5th, and 8th weeks postoperatively. The FNs of all subjects were excised after the 8th week; then the rats were sacrificed. The presence of stem cells in the injured zone was assessed using bromo-deoxyuridine (BrdU), and apoptosis was determined by the TUNEL method. Results After the damage, total FP was observed in all subjects. Statistically significant functional improvement was observed in group 4 compared to all other groups (P < 0.005). TUNEL-positive cell count was statistically significantly higher in the control group than the other groups (P < 0.001). TUNEL-positive cell count was statistically significantly lower in group 4 than the other groups. The proportion of BrdU-stained cells in group 4 (5%) was higher than group 2 (2%). Conclusion Clinically and histopathologically FBTMSC applied with FG may play a promising role as a regenerative treatment in posttraumatic FP.
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Affiliation(s)
- Ömer Bayır
- Department of Otolaryngology Head and Neck Surgery, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Tuğba Karagöz
- Department of Otorhinolaryngology and Head and Neck Surgery, Kaman State Hospital, Kırşehir, Turkey
| | | | - Gülistan Sanem Sarıbaş
- Department of Histology and Embryology, Faculty of Medicine, Ahi Evran University, Kırşehir, Turkey
| | - Candan Özoğul
- Department of Histology and Embryology, Faculty of Medicine, University of Kyrenia, Girne, Turkish Republic of Nothern Cyprus
| | - Kemal Keseroğlu
- Department of Otolaryngology Head and Neck Surgery, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Güleser Saylam
- Department of Otolaryngology Head and Neck Surgery, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Emel Çadallı Tatar
- Department of Otolaryngology Head and Neck Surgery, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Sevilay Karahan
- Department of Biostatistics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Bülent Öcal
- Department of Otolaryngology Head and Neck Surgery, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Mehmet Hakan Korkmaz
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
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Abstract
Lyme neuroborreliosis (LNB) is an infectious disease, developing after a tick bite and the dissemination of Borrelia burgdorferi sensu lato spirochetes reach the nervous system. The infection occurs in children and adults but with different clinical courses. Adults complain of radicular pain and paresis, while among the pediatric population, the most common manifestations of LNB are facial nerve palsy and/or subacute meningitis. Moreover, atypical symptoms, such as fatigue, loss of appetite, or mood changes, may also occur. The awareness of the various clinical features existence presented by children with LNB suspicion remains to be of the greatest importance to diagnose and manage the disease.
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Zain S, Petropoulou K, Mirchia K, Hussien A, Mirchia K. COVID-19 as a rare cause of facial nerve neuritis in a pediatric patient. Radiol Case Rep 2021; 16:1400-1404. [PMID: 33824691 PMCID: PMC8015400 DOI: 10.1016/j.radcr.2021.03.063] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 03/26/2021] [Accepted: 03/28/2021] [Indexed: 11/23/2022] Open
Abstract
COVID-19 has been noted to present with neurological symptoms in nearly 30% of patients. While children are more likely to be asymptomatic, neurological involvement has been observed. We present the case of a 23-month-old previously healthy female who was brought to the emergency room for a new-onset facial droop. The patient tested positive for COVID-19 but was otherwise asymptomatic. Magnetic resonance imaging of the brain with and without contrast revealed abnormal enhancement along the canalicular segment of the right cranial VII extending to the first genu suggestive of cranial nerve neuritis. Given that our case involves a pediatric patient with no significant comorbidities presenting with facial drop, COVID-19 should be considered on the differential when evaluating causes of new onset peripheral nerve palsies.
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Affiliation(s)
- Sultan Zain
- College of Medicine, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210, USA
| | - Kalliopi Petropoulou
- Department of Radiology, Upstate University Hospital, 750 E Adams St, Syracuse, NY 13210, USA
| | - Kanish Mirchia
- Department of Pathology, Upstate University Hospital, 750 E Adams St, Syracuse, NY 13210, USA
| | - Abdelmohsen Hussien
- Department of Radiology, Upstate University Hospital, 750 E Adams St, Syracuse, NY 13210, USA
| | - Kavya Mirchia
- Department of Radiology, Upstate University Hospital, 750 E Adams St, Syracuse, NY 13210, USA
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Kawata R, Kinoshita I, Omura S, Higashino M, Nishikawa S, Terada T, Haginomori SI, Kurisu Y, Hirose Y, Tochizawa T. Risk Factors of Postoperative Facial Palsy for Benign Parotid Tumors: Outcome of 1,018 Patients. Laryngoscope 2021; 131:E2857-E2864. [PMID: 34002863 DOI: 10.1002/lary.29623] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/05/2021] [Accepted: 05/10/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the rate of postoperative facial palsy in benign parotid tumors, as well as its risk factors, pathology, and clinical results. STUDY DESIGN Retrospective analysis. METHODS We performed a retrospective analysis of data from patients whose initial operation for a benign parotid tumor had been performed in our department between 1999 and 2020. RESULTS We included 1,018 patients in this study. The most common tumor observed was pleomorphic adenoma (614 patients), followed by Warthin tumor (234 patients). Fine-needle aspiration cytology and frozen section biopsy were used to identify the tumor histopathology. The overall rate of postoperative facial nerve palsy was 19.5%; the rate was significantly higher in patients with large-diameter tumors or deep lobe tumors. Postoperative facial palsy improved within 24 months of surgery in all cases. There were no cases with permanent facial palsy. CONCLUSIONS Postoperative facial nerve palsy developed regularly after surgery to remove benign parotid tumors despite preservation of the nerve. Palsy rate was high in patients with large tumors or deep lobe tumors. Despite the high risk of facial palsy in these patients and the benign nature of the tumor, we recommend surgery rather than follow-up observation, as the risk of postoperative facial palsy may increase as the tumor grows. It is important to provide an accurate explanation on the risks of postoperative complications to all patients to obtain appropriate informed consent for surgery. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Ryo Kawata
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Ichita Kinoshita
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Shuji Omura
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Masaaki Higashino
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Shuji Nishikawa
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Tetsuya Terada
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Shin-Ichi Haginomori
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Yoshitaka Kurisu
- Department of Pathology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Yoshinobu Hirose
- Department of Pathology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Takeshi Tochizawa
- Institutional Research Office, Osaka Medical College, Takatsuki, Osaka, Japan
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Jain A, Sudharshan M, Vijayakumar C, Kumbhar U, Nelamangala Ramakrishnaiah VP. Colossal Parotid Tumors: A Diagnostic and Surgical Challenge. Cureus 2021; 13:e14539. [PMID: 34017654 PMCID: PMC8129954 DOI: 10.7759/cureus.14539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Tumors of the salivary glands constitute 3% of all head and neck tumors. The parotid gland (PG) is the most common site involved in 85% of cases. PG tumors' size varies from a few millimeters to several centimeters and is about 2-6 cm on average. However, because of insidious growth and asymptomatic nature, untreated tumors of the PG can attain large size. Pleomorphic adenoma (PA), as large as 33 cm in size or 26.5 kg in weight, has been reported in the literature. Similarly, untreated Warthin’s tumor (WT) rarely becomes giant, size up to 20 cm is reported. Giant PG tumors are commonly symptomatic and have a rare tendency to become malignant. We are reporting two giant PG tumors with different histopathological diagnoses, PA and WT of size 15x15 cm and 10x8 cm, respectively. Therefore, with a size of 10 cm, our case is the second-largest WT reported in the literature. Both the giant PG tumors were present for 15-20 years, and mild pain and discomfort were the only symptoms. We had the differential preoperative tissue diagnosis in fine-needle aspiration cytology (FNAC) because of varying consistency. Contrast-enhanced computed tomography (CECT) and magnetic resonance imaging (MRI) of the neck were done for these cases for preoperative planning. Compared to the former, the latter was more informative about nerve involvement preoperatively. Both the patients underwent superficial parotidectomy, and meticulous dissection was done to identify and safeguard the facial nerve and its branches. We had a challenge in closing the flaps, which was achieved with an acceptable cosmetic outcome. Both the patients were discharged in stable condition with minimal facial nerve weakness.
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Affiliation(s)
- Ankit Jain
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
| | - Mahalingam Sudharshan
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
| | - Chellappa Vijayakumar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
| | - Uday Kumbhar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
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Zanella G, Andrade S, Cont G, Pavan M, Nider S, Barbi E, Risso FM. Two newborns with crooked mouths. Arch Dis Child Educ Pract Ed 2021; 106:100-102. [PMID: 31270143 DOI: 10.1136/archdischild-2018-316754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 06/18/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Giada Zanella
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Stefanny Andrade
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Gabriele Cont
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health - IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Matteo Pavan
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health - IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Silvia Nider
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health - IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Egidio Barbi
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy.,Department of Pediatrics, Institute for Maternal and Child Health - IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Francesco Maria Risso
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health - IRCCS 'Burlo Garofolo', Trieste, Italy
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