scholarly journals Nerve conduction study in rehabilitation of patients with residuals and complications of long-standing Bell's palsy

2018 ◽  
Vol 27 (3) ◽  
pp. 39-45
Author(s):  
A. Pashov
Keyword(s):  
Facial Nerve ◽  
Facial Expressions ◽  
Reference Electrode ◽  
Bell’S Palsy ◽  
Grading System ◽  
Standard Protocol ◽  
Bell's Palsy ◽  
Facial Muscles ◽  
Detailed Assessment ◽  
Time Required

From every 100 cases of Bell’s palsy (idiopathic peripheral facial palsy) from 15 to 30 will not recover completely. Some residuals will remain, and some complications will develop. As residuals, one can name weakness of facial muscles, asymmetry of facial expressions, distortion of taste, hyperacusis, dry eye. Possible complications of long-standing Bell’s palsy (BP) are also numerous: contractures of facial muscles, pathological synkinesis, mass movements, crocodile tears, facial pains, headaches, emotional disbalance etc. Unresolved cases of Bell’s palsy require rehabilitation programs that will address both the issues of general nerve regeneration, complications and irregularities in mimetic movements, and psycho-emotional state of long-standing Bell’s palsy patients. There are several methods and systems to assess the condition of facial nerve and functioning of facial muscles. These scales and systems are either therapist- or patient-graded: House-Brackmann Facial Grading system, Sunnybrook Facial Grading system, Facial Clinimetric Evaluation Scale (FaCE Scale), Synkinesis Assessment Questionnaire (SAQ) and several others. At the same time, to compose a well-balanced and focused rehabilitation program, next to subjective assessments and test-photos of standard facial expressions, it is important to have an objective, instrumentally-measured picture of facial nerve recovery, as well as of the physiological ability of mimetic muscles to perform facial movements, to reflect emotions and to produce articulated speech. In that respect, the surface EMG or Nerve Conduction Study (NCS) is the modality of choice. NCS-examination is non-invasive and is relatively easy to perform. It records Compound Muscle Action Potentials (CMAPs) in response to external stimulation. The analysis of recorded graphs allows to evaluate the level of regeneration and maturity of recovering axons in main branches of the facial nerve. At the same time, the standard protocol of NCS does not offer a detailed assessment of each particular muscle of facial expression. It also requires additional time to swap the active electrode position when changing stimulation side from right to left and vice versa. At Crystal Touch Bell’s palsy clinic, we have developed an amended NCS protocol that addresses all mentioned issues. To allow a more detailed assessment of facial muscles, we have added mm.zygomatici (major et minor) and m.depressor anguli oris to the list of measured facial muscles. In order to perform a more focused stimulation and to receive a more “clean” motor responses from facial muscles, we changed the position of stimulating electrode. In the standard protocol, stimulating electrode is placed either pre- or post-auricularly. In Crystal Touch protocol, we position the stimulating electrode above each particular nerve branch that innervates the measured muscle. Therefore, we use six positions of stimulating electrode that correspond to the six measured facial muscles: m.frontalis, m.orbicularis oculi pars superioris, m.nasalis et m.levator labii superioris, mm.zygomatici (major et minor), m.orbicularis oculi pars superioris, m.depressor anguli oris et m.mentalis. To save time required for the examination, instead of placing reference electrode on the nasal bridge (standard protocol), we use contralateral electrode over the same as measured muscle, as a reference electrode. As there are no anastomoses between left and right facial nerves, stimulation of facial nerve on one side will not evoke CMAPs in contralateral facial muscles. This simple amendment allows to save about 15% of total time required for the examination. In this article we also briefly touch the following issues: distortion in reciprocal inhibition of facial muscles-antagonists, forming of the pathological mimetic patterns in the motor cortex due to lack of proprioceptive feedback during long recovery, and the necessity to further investigate from the electrotechnical, engineering and functional point of view the hypothesis of aberrant regeneration as possible cause of facial synkinesis.

scholarly journals Bell's palsy: а literature reference and own clinical case

2021 ◽  
pp. 83-87
Author(s):  
D.S. Khapchenkova ◽  
◽  
S.О. Dubyna ◽  
K.Yu. Yena ◽  
◽  
...  
Keyword(s):  
Facial Nerve ◽  
Facial Expressions ◽  
Muscle Weakness ◽  
Clinical Case ◽  
Bell’S Palsy ◽  
Motor Nucleus ◽  
Bell's Palsy ◽  
Facial Muscles ◽  
The Face ◽  
The Right

Bell's palsy is an acute peripheral paralysis of the facial nerve of unknown etiology. The facial nerve is the seventh cranial nerve. One part of the facial nerve is the motor fibers that innervate the facial muscles. The facial nerve emerges from the brain between the posterior edge of the pons and the medulla oblongata with two roots. The main motor nucleus is responsible for the voluntary control of facial muscles. There are central and peripheral paresis of the facial nerve. Central paresis occurs during а stroke. Peripheral paresis (unilateral muscle weakness of the entire half of the face) develops when the facial nerve is affected from the motor nucleus to the exit from the stylomastoid foramen. Among the various localizations of damage to the peripheral part of the facial nerve, the most common is Bell's palsy as a result of edema and compression of the nerve in the bone canal. Clinical symptoms of facial nerve neuropathy are characterized by acute paralysis or paresis of facial muscles: smoothed skin fold on the affected side of the face; swelling of the cheeks; an inability to close the eyelid, Bell's symptom; facial muscle weakness. The degree of damage is determined by the House Brackmann scale. Treatment with glucocorticosteroids, antiviral drugs, physiotherapy procedures. Purpose — to present a clinical case of a patient with Bell's palsy as an example of delayed diagnosis, treatment and, as a result, long-term restoration of the facial muscles functions. Clinical case. The boy after suffering from the flu, began to complain of acute ear pain, vomiting, lack of movement in the right half of the face, dizziness, insomnia. Asymmetry of the face, lack of movement of the right side of the face, inability to completely close the right eye, a symptom of sailing on the right, muscle weakness were revealed during examination. The general condition of the patient improved, facial expressions were restored, sleep was normalized after hormonal, metabolic therapy, physiotherapy procedures. Conclusions. The article describes a case of inflammation of the facial nerve or Bell's palsy in a teenager who developed on the background of the flu. Timely diagnosis and treatment of the above pathology is the key to a satisfactory prognosis for the restoration of facial expressions, prevention of negative consequences of the the disease. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: facial nerve, Bell's palsy, flu, inflammation.

Prognostic Factors Associated With Recovery in Children With Bell’s Palsy

2019 ◽  
Vol 34 (14) ◽  
pp. 891-896 ◽  
Author(s):  
Elif Karatoprak ◽  
Sila Yilmaz
Keyword(s):  
Prognostic Factors ◽  
Facial Nerve ◽  
Bell’S Palsy ◽  
Steroid Treatment ◽  
Grading System ◽  
Bell's Palsy ◽  
Early Recovery ◽  
Laboratory Findings ◽  
Distribution Width ◽  
Factors Affecting

Objectives: The aim of the study was to determine the prognosis of children with Bell’s palsy and analyze the prognostic factors affecting early recovery. Methods: The records of children with a diagnosis of Bell’s palsy were retrospectively analyzed. Demographic and clinical features including age, gender, House-Brackmann Facial Nerve Grading System House-Brackmann Grading Scale (HBGS) grade at admission and follow-up, and the dosage and onset of steroid treatment were reviewed. Laboratory findings such as red blood cell distribution width and neutrophil-to-lymphocyte ratio were noted. The patients who were recovered within the first month (early recovery) were compared with the patients who were recovered after first month (late recovery) in terms of demographic, clinical characteristics, laboratory findings and treatment modalities in order to determine the risk factors affecting early recovery. Results: A total of 102 children (65 girls and 37 boys) with a mean age of 10.37 ± 4.2 years were included in the study. The complete recovery was detected in 101 children (%99) with Bell’s palsy. Statistically significant difference was found in terms of dosage and time of onset of steroid treatment ( P = .04, P = .035, respectively) and House-Brackmann Facial Nerve Grading System grade on the 10th day ( P = .001) between the early and late recovery groups. Conclusion: The prognosis of Bell’s palsy in children was very good. The prognostic factors affecting the early recovery were being House-Brackmann Facial Nerve Grading System grade 2 or 3 on the 10th day and receiving steroid treatment in the first 24 hours. Neutrophil-to-lymphocyte ratio and red blood cell distribution width were not found to be predictive factors for early recovery.

Facial Nerve Antidromic Recordings in Patients with Bell's Palsy

1988 ◽  
Vol 99 (6) ◽  
pp. 584-589 ◽  
Author(s):  
Garrett D. Herzon ◽  
David L. Zealear
Keyword(s):  
Clinical Trials ◽  
Facial Nerve ◽  
Tympanic Membrane ◽  
Action Potentials ◽  
Reference Electrode ◽  
Normal Subjects ◽  
Bell’S Palsy ◽  
Canal Wall ◽  
Bell's Palsy ◽  
Temporal Dispersion

Antidromic facial nerve action potentials have been recorded noninvasively from the tympanic membrane (TM) of patients with Bell's palsy. A standardized approach has been developed in normal subjects that involves differential recording between the TM and adjacent canal wall. A metal annulus on the tip of an ear speculum served as the reference electrode. The speculum was held in place by an adjustable headband. A conductive sponge electrode inserted through the speculum served as the active TM electrode. In clinical trials, nerve potentials recorded from the paralyzed side were abnormal in all patients tested, indicating that nerve pathology could be monitored with this technique. Abnormalities were evident at the first test, within the first day of paralysis for some patients, and well in advance of any abnormality in the electroneuronography (ENoG) response. There appeared to be a relationship between specific waveform abnormalities (e.g., increased peak latency, waveform temporal dispersion, decreased area) and the tendency for a patient to recover from paralysis. These observations suggest that the technique described could serve as a means for early prognosis, at a stage in which nerve damage could still be effectively treated.

Yanagihara Facial Nerve Grading System as a Prognostic Tool in Bell’s Palsy

2014 ◽  
Vol 35 (9) ◽  
pp. 1669-1672 ◽  
Author(s):  
Naohito Hato ◽  
Takashi Fujiwara ◽  
Kiyofumi Gyo ◽  
Naoaki Yanagihara
Keyword(s):  
Facial Nerve ◽  
Bell’S Palsy ◽  
Grading System ◽  
Bell's Palsy ◽  
Prognostic Tool

scholarly journals Clinical Case of Facial Muscles Function Recovery in a Patient With Idiopathic Lesions of the Facial Nerve With Unfavorable Myographic Predictors

2021 ◽  
Vol 10 (1) ◽  
pp. 216-223
Author(s):  
K. I. Chekhonatskaya ◽  
L. B. Zavaliy ◽  
M. V. Sinkin ◽  
L. L. Semenov ◽  
G. R. Ramazanov ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Clinical Case ◽  
Complete Recovery ◽  
Correct Choice ◽  
Clinical Situation ◽  
Bell’S Palsy ◽  
Negative Consequences ◽  
Bell's Palsy ◽  
Facial Muscles ◽  
Choice Of Treatment

The facial nerve (fn) palsy is a disease of the peripheral nervous system that leads to aesthetic, organic and functional disorders. The causes of the disease are different, the most common is the idiopathic form bell’s palsy. With a conservative approach to therapy, up to 80% of patients note the complete recovery of the lost functions of facial muscles, the others have the likelihood of severe consequences. Electroneuromyography is used to assess the risk of a negative outcome of the disease. In cases of confirmation of severe nerve damage, surgical treatment is suggested. The article presents a clinical case of complete recovery of the function of facial muscles in a patient with severe damage to the a nerve and an unfavorable prognosis. The course of the disease, complications of bell’s palsy and methods of their correction are described. Timely correct choice of treatment tactics and prevention of complications minimizes negative consequences. When working with a patient, a differentiated approach is important depending on the clinical situation.

Treatment for facial palsy

1968 ◽  
Vol 6 (7) ◽  
pp. 25-26
Keyword(s):  
Facial Nerve ◽  
Facial Palsy ◽  
Nerve Conduction ◽  
Conduction Block ◽  
Bell’S Palsy ◽  
Bell's Palsy ◽  
Facial Muscles ◽  
Nerve Conduction Block

There is controversy on the management of the idiopathic facial nerve palsies (Bell’s palsy). About two out of every three patients have a nerve conduction block alone and recover completely in less than one month.1 The rest develop denervation of the facial muscles to a varying degree and never recover completely. In addition, contracture of the facial muscles may occur, with severe disfigurement. About 10% of all patients with facial palsy have complete denervation and serious sequelae.2 Using electromyography3 and measurement of the anodal galvanic threshold4 an accurate prognosis can be given within the first week.

Prednisolone for idiopathic (bell’s) facial palsy

1973 ◽  
Vol 11 (18) ◽  
pp. 69-70
Keyword(s):  
Facial Nerve ◽  
Facial Palsy ◽  
Bell’S Palsy ◽  
Bell's Palsy ◽  
Facial Muscles ◽  
Oral Corticosteroids ◽  
Aberrant Regeneration

When we discussed facial palsy in 19681 corticotrophin therapy was advocated. Since then oral corticosteroids have been tried and this article discusses their efficacy. Permanent clinical denervation of the affected facial muscles occurs in about a third of patients after Bell’s palsy2 3 and leads to persistent weakness. Some of the patients develop associated movements, or very rarely crocodile tears, due to aberrant regeneration. The movements can be very distressing. The incidence and severity of permanent denervation is related both to the severity of the damage to the facial nerve and to the age of the patient. It is very common over the age of 70 years, but rare below the age of 10 years.

Late Surgical Decompression of Facial Nerve in Bell's Palsy: A Case Report

2012 ◽  
Vol 73 (S 02) ◽  
Author(s):  
L. M. Marques ◽  
J. Pimentel ◽  
P. Escada ◽  
G. Neto D'Almeida
Keyword(s):  
Case Report ◽  
Facial Nerve ◽  
Bell’S Palsy ◽  
Surgical Decompression ◽  
Bell's Palsy

scholarly journals Intratympanic steroid therapy for Bell’s palsy with poor prognostic results

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Akira Inagaki ◽  
Sachiyo Katsumi ◽  
Shinji Sekiya ◽  
Shingo Murakami
Keyword(s):  
Facial Nerve ◽  
Steroid Therapy ◽  
Standard Dose ◽  
Neuroprotective Effect ◽  
Bell’S Palsy ◽  
Control Group ◽  
Average Dose ◽  
Test Results ◽  
Bell's Palsy ◽  
Intratympanic Dexamethasone

AbstractIn Bell’s palsy, electrodiagnosis by electroneurography (ENoG) is widely used to predict a patient’s prognosis. The therapeutic options for patients with poor prognostic results remain controversial. Here, we investigated whether early intervention with intratympanic steroid therapy (ITST) is an effective treatment for Bell’s palsy patients with poor electrodiagnostic test results (≤ 10% electroneurography value). Patients in the concurrent ITST group (n = 8) received the standard systemic dose of prednisolone (410 mg total) and intratympanic dexamethasone (16.5 mg total) and those in the control group (n = 21) received systemic prednisolone at the standard dose or higher (average dose, 605 ± 27 mg). A year after onset, the recovery rate was higher in the ITST group than in the control group (88% vs 43%, P = 0.044). The average House-Brackmann grade was better in the concurrent ITST group (1.13 ± 0.13 vs 1.71 ± 0.16, P = 0.035). Concurrent ITST improves the facial nerve outcome in patients with poor electroneurography test results, regardless of whether equivalent or lower glucocorticoid doses were administered. This may be ascribed to a neuroprotective effect of ITST due to a higher dose of steroid reaching the lesion due to dexamethasone transfer in the facial nerve.

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