scholarly journals Comprehensive Facial Rehabilitation Improves Function in People With Facial Paralysis: A 5-Year Experience at the Massachusetts Eye and Ear Infirmary

2010 ◽  
Vol 90 (3) ◽  
pp. 391-397 ◽  
Author(s):  
Robin W. Lindsay ◽  
Mara Robinson ◽  
Tessa A. Hadlock
Keyword(s):  
Facial Nerve ◽  
Facial Paralysis ◽  
Physical Therapist ◽  
Tertiary Care ◽  
Average Score ◽  
Home Program ◽  
Grading Scale ◽  
Initial Score ◽  
Facial Function ◽  
Facial Rehabilitation

Background The Facial Grading Scale (FGS) is a quantitative instrument used to evaluate facial function after facial nerve injury. However, quantitative improvements in function after facial rehabilitation in people with chronic facial paralysis have not been shown. Objective The objectives of this study were to use the FGS in a large series of consecutive subjects with facial paralysis to quantitatively evaluate improvements in facial function after facial nerve rehabilitation and to describe the management of chronic facial paralysis. Design The study was a retrospective review. Methods A total of 303 individuals with facial paralysis were evaluated by 1 physical therapist at a tertiary care facial nerve center during a 5-year period. Facial rehabilitation included education, neuromuscular training, massage, meditation-relaxation, and an individualized home program. After 2 months of home exercises, the participants were re-evaluated, and the home program was tailored as necessary. All participants were evaluated with the FGS before the initiation of facial rehabilitation, and 160 participants were re-evaluated after receiving treatment. All participants underwent the initial evaluation at least 4 months after the onset of facial paralysis; for 49 participants, the evaluation took place more than 3 years after onset. Results Statistically significant increases in FGS scores were seen after treatment (P<.001, t test). The average initial score was 56 (SD=21, range=13–98), and the average score after treatment was 70 (SD=18, range=25–100). Limitations A limitation of this study was that evaluations were performed by only 1 therapist. Conclusions For 160 patients with facial paralysis, statistically significant improvements after facial rehabilitation were shown; the improvements appeared to be long lasting with continued treatment. The improvements in the FGS scores indicated that patients can successfully manage symptoms with rehabilitation and underscored the importance of specialized therapy in the management of facial paralysis.

Facial schwannoma: results of a large case series and review

2008 ◽  
Vol 122 (11) ◽  
pp. 1139-1150 ◽  
Author(s):  
B McMonagle ◽  
A Al-Sanosi ◽  
G Croxson ◽  
P Fagan
Keyword(s):  
Facial Nerve ◽  
Current Literature ◽  
Clinical Observation ◽  
Surgical Intervention ◽  
Treatment Algorithm ◽  
Case Series ◽  
Tertiary Referral ◽  
Management Algorithm ◽  
Facial Function ◽  
Facial Rehabilitation

AbstractObjectives and hypothesis:To report a series of 53 cases of facial schwannoma, to review the current literature, addressing contentious issues, and to present a management algorithm.Study design:Retrospective case review combined with review of current literature.Materials and methods:A review of the case notes of 53 patients with intracranial and intratemporal facial schwannoma, from two tertiary referral centres, was undertaken. This represents the largest series of facial schwannomas with clinical correlations in the literature. Data relating to epidemiological, clinical and management details were tabulated and compared with other large series. A review of the current literature was performed, and a management algorithm presented.Results:There were 23 (43 per cent) female and 30 (57 per cent) male patients. Patients' ages at presentation ranged from five to 84 years, with a mean of 49 years. Twenty-five (47 per cent) of the tumours were present on the left side and 28 (53 per cent) on the right side. Hearing loss was the most common presenting symptom, being present in 31/53 (58 per cent) patients, followed by facial weakness in 27/53 (51 per cent). Two patients (4 per cent) were completely asymptomatic, and their facial neuromas were diagnosed incidentally. The schwannoma extended along more than one segment of the facial nerve in 39 patients (74 per cent), with the mean number of segments involved being 2.5. A conservative approach of clinical observation was undertaken in 20 patients (38 per cent). Thirty-three patients (62 per cent) underwent surgery, with a total of 36 procedures. The translabyrinthine approach was most common, being utilised in 17 of the 36 procedures. Two patients underwent revision surgery for residual or recurrent disease on three occasions. There was total removal of tumour in 21 cases; the remainder had subtotal or no removal with drainage or decompression of the tumours. Twenty-one nerve reconstructions were performed, and 18 facial rehabilitation procedures were performed on 14 patients.Discussion:The results of this case series are similar to those of other reported series. The diagnosis of facial schwannoma is now generally made pre-operatively, due to improved imaging techniques and heightened awareness. Clinical assessment of facial function and imaging form the mainstays of surveillance for these tumours. These tumours are managed via clinical observation or surgical intervention; the latter can range from simple procedures (such as drainage of cystic components) to aggressive tumour removal and facial nerve reconstruction. Facial rehabilitation procedures may also be applied. The timing of intervention is contentious; surgical intervention is indicated when facial function deteriorates to a House–Brackmann grade IV level.Conclusion:Facial schwannomas are rare lesions, and reported series are generally small. Due to the complex management issues involved, these tumours are best managed in a tertiary referral setting. Observation is preferred until facial function deteriorates to a House–Brackmann grade III level, at which time surgery is considered. When facial function deteriorates to House–Brackmann grade IV, surgical intervention is indicated. We advocate surgical management based on the treatment algorithm described.

scholarly journals Neoplastic causes of nonacute facial paralysis: A review of 221 cases

2016 ◽  
Vol 95 (9) ◽  
pp. 390-396 ◽  
Author(s):  
John P. Leonetti ◽  
Sam J. Marzo ◽  
Douglas A. Anderson ◽  
Joshua M. Sappington
Keyword(s):  
Facial Nerve ◽  
Facial Paralysis ◽  
Medical Center ◽  
Demographic Data ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Clinical Signs ◽  
Surgical Approaches ◽  
Facial Weakness ◽  
Gradual Onset

We conducted a retrospective review to assess the clinical presentation of patients with tumor-related nonacute complete peripheral facial weakness or an incomplete partial facial paresis and to provide an algorithm for the evaluation and management of these patients. Our study population was made up of 221 patients—131 females and 90 males, aged 14 to 79 years (mean: 49.7)—who had been referred to the Facial Nerve Disorders Clinic at our tertiary care academic medical center over a 23–year period with a documented neoplastic cause of facial paralysis. In addition to demographic data, we compiled information on clinical signs and symptoms, radiologic and pathologic findings, and surgical approaches. All patients exhibited gradual-onset facial weakness or facial twitching. Imaging identified an extratemporal tumor in 128 patients (58%), an infratemporal lesion in 55 patients (25%), and an intradural mass in 38 (17%). Almost all of the extratemporal tumors (99%) were malignant, while 91 % of the infratemporal and intradural tumors were benign. A transtemporal surgical approach was used in the 93 infratemporal and intradural tumor resections, while the 128 extratemporal lesions required a parotidectomy with partial temporal bone dissection. The vast majority of patients (97%) underwent facial reanimation. We conclude that gradual-onset facial paralysis or twitching may occur as a result of a neoplastic invasion of the facial nerve along its course from the cerebellopontine angle to the parotid gland. We caution readers to beware of a diagnosis of “atypical Bell's palsy.”

Prognostic Value of the Blink Reflex in Acoustic Neuroma Surgery

2002 ◽  
Vol 127 (3) ◽  
pp. 153-157 ◽  
Author(s):  
Vincent Darrouzet ◽  
Malcolm Hilton ◽  
Darren Pinder ◽  
Jio-Ling Wang ◽  
Jean Guerin ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Prognostic Value ◽  
Polynomial Regression ◽  
Care Center ◽  
Tertiary Care ◽  
Early Response ◽  
Blink Reflex ◽  
Healthy Side ◽  
The Difference ◽  
Facial Function

OBJECTIVE: The study goal was to demonstrate that blink reflex analysis can predict postoperative facial nerve outcome in cerebellopontine angle tumor surgery. STUDY DESIGN, SETTING, AND PATIENTS: In an open and prospective study conducted at a single tertiary care center over 3 years, 91 subjects with a vestibular schwannoma filling the internal auditory meatus were enrolled and operated on via a translabyrinthine approach. The difference in latency of the early response (δR1) of the blink reflex between the pathologic side and the healthy side was calculated in every patient during a complete electrophysiologic examination of the facial nerve performed on the day before surgery. MAIN OUTCOME MEASURES: δR1 was compared with the other preoperative data (tumor volume, facial function), with the perioperative observations (difficulties with the dissection of the facial nerve), and especially with the postoperative status after 1 year. The statistical study was conducted using polynomial regression. RESULTS: Patients with a negative or zero δR1 have normal facial function at 1 year. For those with a positive δR1 the outcome is not favorable unless the tumor is small. For patients presenting with an immediate complete facial paralysis, the value of δR1 is also indicative of facial function outcome. CONCLUSION: Statistical analysis shows that the blink reflex, through δR1, has an excellent prognostic value in anticipating the difficulties with facial nerve dissection and postoperative facial function after 1 year.

Global vs Regional HB Score: Reporting Facial Nerve Function

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P55-P56
Author(s):  
Shari D. Reitzen ◽  
Anil K Lalwani
Keyword(s):  
Facial Nerve ◽  
Strongly Correlated ◽  
Nerve Function ◽  
Global Score ◽  
Facial Nerve Function ◽  
Video Clips ◽  
Grading Scale ◽  
Reader Reliability ◽  
Facial Function ◽  
Marked Tendency

Objective To determine the reliability of the House-Brackmann facial nerve grading scale in the setting of differential function across its branches. Methods 14 physicians of different levels were provided with digital video clips of 11 patients with differential facial nerve functioning, and asked to report facial nerve function as a traditional global score and as a regional score based on the House-Brackmann scale for the forehead, eye, nose, and mouth. Agreements between the traditional global score and the regional scores, as well as inter-rater agreement, were analyzed. Results In patients with variable facial weakness, a single House-Brackmann score did not fully communicate their facial function. The single House-Brackmann score most strongly correlated with the regional scoring of the nose/midface (59%), followed by the mouth (51%), eye (48%), and forehead (35%). Overall inter-reader reliability was relatively strong for the midface (kappa=0.503) and global scores (kappa=0.541), followed by the mouth (k=0.419), the forehead (k=0.330), and the eye (k=0.302). There was a marked tendency for reader agreement to increase among those with more clinical experience. Reader agreement of the forehead (k=0.597) and eye (k=0.469) were strong only among experienced readers. Conclusions In patients with differential facial function, a single global score is inadequate to describe facial function, and in this study, most directly correlated with the function of the midface. Regional assessment using the House-Brackmann grading scale more fully communicates facial function and increases in reliability with experience.

scholarly journals Parotidectomy and Facial Paralysis, A Retrospective Review at A Tertiary Care Hospital

2021 ◽  
Vol 10 (3) ◽  
pp. 164-168
Author(s):  
Israr ud Din ◽  
Muhammad Junaid ◽  
Imran Khan ◽  
Arshad Aziz ◽  
Sakhawat Khan ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Facial Paralysis ◽  
Tertiary Care ◽  
Occurrence Rate ◽  
Facial Nerve Paralysis ◽  
Care Hospital ◽  
Female Population ◽  
Nerve Paralysis ◽  
Parotid Tumors ◽  
Parotid Surgery

Background: Facial Nerve is in close proximity with parotid gland and encountered during parotid surgery.  Facial nerve   paralysis   has   15 to 66% occurrence rate after parotidectomies. The objective of this study was to find out the frequency of facial paralysis resulting from superficial or total parotidectomies done for various parotid tumors. Material and Methods: This retrospective study was conducted at the Department of ENT, Khyber Teaching Hospital, Peshawar from January 2018 to May 2020. A total of 203 patients were reviewed for data on demographics, parotidectomies, histopathology and facial paralysis. The information on facial paralysis was compared against various parameters. Results:   The mean age of   the participants was 46.12 ± 11.11 years. The most common parotid tumor was pleomorphic adenoma (68.9%) followed by mucoepidermoid carcinoma. 57 (28.07%) patients showed facial paralysis with a higher rate of occurrence in total parotidectomy (40.90%). Among 57 patients with facial paralysis, 6 (10.53%) showed permanent facial paralysis. Conclusion: Tendency of permanent facial paralysis is high with total parotidectomies. Female population and elderly have a slightly higher rate of facial paralysis. The duration of procedure has no effect on the occurrence of facial paralysis.

Salivation Testing in Traumatic Facial Paralysis

1973 ◽  
Vol 82 (1) ◽  
pp. 17-22 ◽  
Author(s):  
Mark May ◽  
Frank E. Lucente ◽  
Joseph E. Harvey ◽  
William F. Marovitz
Keyword(s):  
Facial Nerve ◽  
Facial Paralysis ◽  
Salivary Flow ◽  
Submandibular Salivary Gland ◽  
Facial Nerve Paralysis ◽  
Nerve Paralysis ◽  
Delayed Onset ◽  
Nerve Excitability ◽  
Abnormal Response ◽  
Facial Function

When to explore for traumatic facial paralysis has been based upon time of onset and changes in nerve excitability testing. This study indicates that testing for submandibular salivary flow is the method of choice for making a decision to operate. Thirty consecutive patients with traumatic facial paralysis were studied for the prognostic value of whether time of onset was immediate or delayed. Immediate onset has a poorer prognosis than when the onset is delayed but time of onset is not completely reliable. Seventeen percent of the patients with an immediate onset had complete return and 29% with a delayed onset had an incomplete return. Nerve excitability testing was more accurate than time of onset but the test has a major limitation. There was a delay of up to three days between injury and the first detection of nerve excitability abnormality in patients who had an incomplete return. The salivation test performed by cannulating the submandibular salivary gland ducts and comparing the flow in terms of number of drops from each side overcame the time delay limitation of the nerve excitability test. Decrease in salivation to 25% or less when comparing the normal to the paralyzed side tended to antedate abnormal nerve excitability by several days in patients with serious nerve damage. Experimental sectioning of the facial nerve in a group of animals demonstrated immediate loss of salivary flow on the injured side whereas nerve excitability did not become abnormal until two days later. Two patients with traumatic facial paralysis were operated based upon a reduced salivary flow of 25% or less before nerve excitability became abnormal. Both had complete return of facial function. Three patients with a salivary flow of 25% or less who were not operated later developed abnormal response to nerve excitability and had incomplete return of facial function. The salivation test should be included in the prognostic evaluation of patients with traumatic facial nerve paralysis since it may be the earliest indicator for decompression of the nerve.

scholarly journals Masseteric–facial nerve neurorrhaphy: results of a case series

2017 ◽  
Vol 126 (1) ◽  
pp. 312-318 ◽  
Author(s):  
Federico Biglioli ◽  
Valeria Colombo ◽  
Dimitri Rabbiosi ◽  
Filippo Tarabbia ◽  
Federica Giovanditto ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Facial Paralysis ◽  
Postoperative Bleeding ◽  
Case Series ◽  
Morbidity Rate ◽  
Nerve Function ◽  
Facial Reanimation ◽  
Grade Ii ◽  
Grading Scale ◽  
Masseteric Nerve

OBJECTIVE Facial palsy is a well-known functional and esthetic problem that bothers most patients and affects their social relationships. When the time between the onset of paralysis and patient presentation is less than 18 months and the proximal stump of the injured facial nerve is not available, another nerve must be anastomosed to the facial nerve to reactivate its function. The masseteric nerve has recently gained popularity over the classic hypoglossus nerve as a new motor source because of its lower associated morbidity rate and the relative ease with which the patient can activate it. The aim of this work was to evaluate the effectiveness of masseteric–facial nerve neurorrhaphy for early facial reanimation. METHODS Thirty-four consecutive patients (21 females, 13 males) with early unilateral facial paralysis underwent masseteric–facial nerve neurorrhaphy in which an interpositional nerve graft of the great auricular or sural nerve was placed. The time between the onset of paralysis and surgery ranged from 2 to 18 months (mean 13.3 months). Electromyography revealed mimetic muscle fibrillations in all the patients. Before surgery, all patients had House-Brackmann Grade VI facial nerve dysfunction. Twelve months after the onset of postoperative facial nerve reactivation, each patient underwent a clinical examination using the modified House-Brackmann grading scale as a guide. RESULTS Overall, 91.2% of the patients experienced facial nerve function reactivation. Facial recovery began within 2–12 months (mean 6.3 months) with the restoration of facial symmetry at rest. According to the modified House-Brackmann grading scale, 5.9% of the patients had Grade I function, 61.8% Grade II, 20.6% Grade III, 2.9% Grade V, and 8.8% Grade VI. The morbidity rate was low; none of the patients could feel the loss of masseteric nerve function. There were only a few complications, including 1 case of postoperative bleeding (2.9%) and 2 local infections (5.9%), and a few patients complained about partial loss of sensitivity of the earlobe or a small area of the ankle and foot, depending on whether great auricular or sural nerves were harvested. CONCLUSIONS The surgical technique described here seems to be efficient for the early treatment of facial paralysis and results in very little morbidity.

Magnetic resonance imaging of the facial nerve in children with idiopathic facial paralysis

2000 ◽  
Vol 122 (4) ◽  
pp. 556-559
Author(s):  
Don L. Burgio ◽  
Shoab Siddique ◽  
Michael Haupert ◽  
Robert J. Meleca
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Facial Nerve ◽  
Facial Paralysis ◽  
Recovery Time ◽  
Time Course ◽  
Resonance Imaging ◽  
Yield Information ◽  
Facial Function

The role of gadolinium-enhanced MRI (Gd-MRI) in the diagnosis of idiopathic facial paralysis (IFP) in children is not well defined. Fourteen children with IFP were evaluated to assess the use of Gd-MRI for the presence and pattern of enhancement and its usefulness in predicting the recovery of facial function. Six of 14 children had enhancement of the facial nerve on Gd-MRI, whereas 8 had none. Enhancement was noted in the tympanic, mastoid, and most commonly in the distal intracanalicular and labyrinthine segments. The average time from onset of paresis to recovery in patients with enhancement was 19.3 weeks, whereas in those with no enhancement, mean recovery time was 9.5 weeks ( P = 0.003, t test). All 14 patients eventually had recovery to House-Brackmann grade I or II. Gd-MRI is not required for all children with IFP but may yield information about the time course of recovery of facial function.

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