Clinical Study of Etiopathogenesis and Management of Facial Nerve Palsy

INTRODUCTION: Facial nerve dysfunction causes physical, functional, and psychological impact on quality of life. So early evaluation and management is needed. This study was designed to know about various etiological factors and also to analyse outcome of medical and surgical intervention. AIM OF THE STUDY: To study about, etiopathogenesis and management of facial nerve palsy. OBJECTIVES: 1. To study the various etiopathological factors responsible for facial nerve palsy. 2. To analyse the outcome of medical and surgical management policy adapted. 3. To find out if early intervention can reduce the progression of disease. MATERIALS AND METHODS: A total of 40 cases were included. Detailed history, E.N.T, Head and Neck Examination, Pure Tone Audiometry and Imaging studies were done for all patients. Surgery has done to whom it is indicated. All patients were followed up to 6 months. RESULTS: Most common etiology was trauma (55%). Among the 40, 19 cases underwent Facial Nerve Decompression. 22 cases were managed conservatively. After surgery out of 19, 18 cases were improved to Grade I from Grade IV palsy. CONCLUSION: In Traumatic Facial Palsy Facial Nerve Decompression gives complete recovery even in patients with Grade IV palsy. In Chronic Suppurative Otitis Media patient without cholesteatoma and shorter duration of facial palsy gives good prognosis than patient with cholesteatoma and longer duration of facial palsy. In Tuberculous Otitis media recovery of facial palsy is possible after completion of Anti Tuberculous Treatment. In Malignant Otitis Externa Facial Palsy can improve after glycemic control and medical management. In some patients debridement is needed. In Herpes Zoster Oticus prognosis of Facial Nerve recovery is poor

Typical or atypical ramsay-hunt syndrome in delayed facial palsy after stapedectomy?

OBJECTIVES: The aim of this study was to define the typical pattern for varicella zoster virus (VZV) reactivation in delayed facial palsy (DFP) after stapedectomy for otosclerosis. MATERIALS and METHODS: Review of the relevant literature, personal casistics, and case-report RESULTS: In total, 48 cases of DFP after stapes surgery have been described so far, including the reported case with exclusive manifestation of atypical Ramsay Hunt syndrome (RH); in the personal series of 1253 stapedectomies, DFP occurred in only one case (0.08%). Complete DFP (House\u2013Brack-mann grade VI) rapidly developed 12 days after surgery; RH appeared 2 days later, confirming the role of VZV. The DFP started improving after 8 weeks and completely recovered 6 months later. CONCLUSION: Acute otalgia prior to DFP should raise the suspicion of VZV reactivation. Atypical RH is the most frequent pattern that occurs in DFP after stapedectomy

Clinical manifestations of Ramsay-Hunt Syndrome in a series of 20 cases.

Introducción y objetivo: la experiencia clínica nos ha mostrado las distintas formas de presentación y la variabilidad sintomatológica que puede revelar el síndrome de Ramsay-Hunt o herpes zóster ótico. Las descripciones que ofrece la literatura nos han servido para corroborar los hallazgos de un conjunto de pacientes, cuyas características y evolución hemos ido reuniendo en el tiempo. Dada la importancia del tratamiento precoz, el objetivo de este trabajo ha consistido en realizar una exposición estructurada de este complejo síndrome con sus diversas manifestaciones. Método: estudio retrospectivo. Resultados: 20 pacientes ejemplifican los diferentes aspectos de este proceso. Discusión: se trata de una patología infrecuente, con una tríada sintomática patognomónica que consiste en otalgia, erupción vesicular y parálisis facial. Sin embargo, este síndrome no siempre se expresa de forma completa ni con la aparición de los síntomas en el orden indicado, añadiéndose con frecuencia otros cocleovestibulares. La posibilidad de que la infección se propague de forma centrífuga y centrípeta facilita el que se afecten otros nervios sensitivos y motores, ocasionando una polineuropatía craneal (herpes zóster cefálico) y raquídea o incluso, con mucha menor frecuencia, la aparición de una meningoencefalitis. No conocemos con precisión los mecanismos por los que progresa este proceso ni los factores desencadenantes, aunque en ocasiones les haya predisponentes. Establecer un diagnóstico es fundamental para iniciar el tratamiento, cuya precocidad facilita la resolución del proceso. Conclusiones: siendo la sospecha clínica la principal herramienta de un diagnóstico precoz, nos ha parecido de interés realizar esta revisión, dada la infrecuencia del herpes zóster ótico.Introduction and objective: Clinical experience has shown us the different forms of presentation and the symptomatic variability that can be revealed by Ramsay-Hunt Syndrome or Herpes Zoster oticus. The descriptions offered by the literature have helped us to corroborate the findings of a group of patients, whose characteristics and evolution we have been gathering over time. Given the importance of early treatment, the objective of this work has been to carry out a structured exposition of this complex syndrome with its various manifestations. Method: retrospective study. Results: 20 patients exemplify the different aspects of this process. Discussion: It is an infrequent pathology, with a pathognomonic symptomatic triad consisting of ear pain, vesicular rash and facial paralysis. However, this syndrome is not always fully expressed or with the onset of symptoms in the order indicated, often adding cochleovestibular symptoms. The possibility that the infection spreading in a centrifugal and centripetal way, makes it easier for other sensory and motor nerves to be affected, causing cranial polyneuropathy (cephalic herpes zoster) and spinal or even, much less frequently, the appearance of a meningoencephalitis. The mechanisms by which this process progresses, or the triggers are not known with precision, although sometimes there are predisposing factors. Establishing a diagnosis is essential to start the treatment, whose precocity facilitates the resolution of the process. Conclusions: being the clinical suspicion the main tool of an early diagnosis, we have found it interesting to carry out this review, given the low frequency of herpes zoster oticus

Facial nerve palsy: Analysis of cases reported in children in a suburban hospital in Nigeria

Aim: The study describes the epidemiology, treatment, and treatment outcomes of the 10 cases of facial nerve palsy seen in children managed at the Obafemi Awolowo University Teaching Hospitals Complex, Ile‑Ife over a 10 year period. It also compares findings with report from developed countries.Methodology: This was a retrospective cohort review of pediatric cases of facial nerve palsy encountered in all the clinics run by specialists in the above named hospital. A diagnosis of facial palsy was based on International Classification of Diseases, Ninth Revision, Clinical Modification codes. Information retrieved from the case note included sex, age, number of days with lesion prior to presentation in the clinic, diagnosis, treatment, treatment outcome, and referral clinic.Findings: Only 10 cases of facial nerve palsy were diagnosed in the institution during the study period. Prevalence of facial nerve palsy in this hospital was 0.01%. The lesion more commonly affected males and the right side of the face. All cases were associated with infections: Mainly mumps (70% of cases). Case management include the use of steroids and eye pads for cases that presented within 7 days; and steroids, eye pad, and physical therapy for cases that presented later. All cases of facial nerve palsy associated with mumps and malaria infection fully recovered. The two cases of facial nerve palsy associated with otitis media only partially recovered.Conclusion: Facial nerve palsy in pediatric patients is more commonly associated with mumps in the study environment. Successes are recorded with steroid therapy.Key words: Children, facial nerve, malaria, mumps, Nigeria, pals

The Correlation Between MRI and Operative Finding in Bell’s Palsy and Ramsay-Hunt Syndrome

We investigated the correlation between gadolinium enhanced MRI finding and swelling segments of facial nerve in patients with in Bell’s Palsy and Ramsay-Hunt Syndrome. From 1995 to 2004, an MRI was performed on 13 patients with Bell’s Palsy or Ramsay-Hunt syndrome. These patients were offered a surgical decompression of facial nerve through middle cranial fossa. They were evaluated to assess the time to MRI and to operation after onset, the site of facial nerve enhancement, operative finding of facial nerve and initial/ postoperative severity of facial palsy. The swelling of facial nerve segments is found in patients with enhanced facial nerve during an MRI. In particular, the swelling of facial nerve is identified in all patients with enhanced facial nerves in the labyrinthine segment. Respectively, the swelling of geniculate ganglion and tympanic segment of the facial nerve accounts for 78% and 43% of patients with enhanced facial segment during an MRI (p<0.05). The incidence of swelling of tympanic segment, increases and decreases over the course of time following surgery after the onset of paralysis. In summary, an MRI enhancement of facial nerves in Bell’s Palsy and Ramsay-Hunt syndrome is well associated with the extent of intratemporal lesions in facial nerves.ope

Prediction of Tumor Origin in Intracanalicular Schwannoma

This study was performed to investigate the capability of preoperative evaluations in predicting the precise anatomic origin of intracanalicular tumors. We conducted a retrospective case review of 11 patients (8 male, 3 female; 26-70 yr of age) with intracanalicular tumors that were treated surgically. Data included preoperative pure tone audiogram, auditory brainstem response, caloric test, electroneurographies and temporal MRIs. Postoperatively, facial nerve schwannomas were diagnosed pathologically in two of 11 patients (18%). There were no clues suggesting facial nerve schwannoma in preoperative evaluations: A facial nerve schwannoma may be misdiagnosed as a vestibular schwannoma, especially when the tumor is confined to the internal auditory canal. There are no useful preoperative evaluation tools to predict the precise nerve origins of intracanalicular tumors. These emphasize the need to fully inform the patient preoperatively.ope