The role of facial canal diameter in the pathogenesis and grade of Bell's palsy: a study by high resolution computed tomography / O papel do diâmetro do canal facial na patogenia e grau de paralisia de Bell: estudopor tomografia computadorizada de alta resolução

Abstract Introduction: The exact etiology of Bell's palsy still remains obscure. The only authenticated finding is inflammation and edema of the facial nerve leading to entrapment inside the facial canal. Objective: To identify if there is any relationship between the grade of Bell's palsy and diameter of the facial canal, and also to study any possible anatomic predisposition of facial canal for Bell's palsy including parts which have not been studied before. Methods: Medical records and temporal computed tomography scans of 34 patients with Bell's palsy were utilized in this retrospective clinical study. Diameters of both facial canals (affected and unaffected) of each patient were measured at labyrinthine segment, geniculate ganglion, tympanic segment, second genu, mastoid segment and stylomastoid foramen. The House-Brackmann (HB) scale of each patient at presentation and 3 months after the treatment was evaluated from their medical records. The paired samples t-test and Wilcoxon signed-rank test were used for comparison of width between the affected side and unaffected side. The Wilcoxon signed-rank test was also used for evaluation of relationship between the diameter of facial canal and the grade of the Bell's palsy. Significant differences were established at a level of p = 0.05 (IBM SPSS Statistics for Windows, Version 21.0.; Armonk, NY, IBM Corp). Results: Thirty-four patients - 16 females, 18 males; mean age ± Standard Deviation, 40.3 ± 21.3 - with Bell's palsy were included in the study. According to the HB facial nerve grading system; 8 patients were grade V, 6 were grade IV, 11 were grade III, 8 were grade II and 1 patient was grade I. The mean width at the labyrinthine segment of the facial canal in the affected temporal bone was significantly smaller than the equivalent in the unaffected temporal bone (p = 0.00). There was no significant difference between the affected and unaffected temporal bones at the geniculate ganglion (p = 0.87), tympanic segment (p = 0.66), second genu (p = 0.62), mastoid segment (p = 0.67) and stylomastoid foramen (p = 0.16). We did not find any relationship between the HB grade and the facial canal diameter at the level of labyrinthine segment (p = 0.41), tympanic segment (p = 0.12), mastoid segment (p = 0.14), geniculate ganglion (p = 0.13) and stylomastoid foramen (p = 0.44), while we found significant relationship at the level of second genu (p = 0.02). Conclusion: We found the diameter of labyrinthine segment of facial canal as an anatomic risk factor for Bell's palsy. We also found significant relationship between the HB grade and FC diameter at the level of second genu. Future studies (MRI-CT combined or 3D modeling) are needed to promote this possible relevance especially at second genu. Thus, in the future it may be possible to selectively decompress particular segments in high grade BP patients.

Resumo Introdução: A etiologia exata da paralisia de Bell ainda permanece obscura. Os únicos achados confirmados são a inflamação e o edema do nervo facial (NF) que levam ao aprisionamento no canal facial. Objetivo: Identificar se há alguma relação entre o grau de paralisia de Bell e o diâmetro do canal facial e também estudar qualquer possível predisposição anatômica do canal facial para a paralisia de Bell incluindo as partes que ainda não foram estudadas. Método: Os prontuários médicos e exames de tomografia computadorizada de 34 pacientes com paralisia de Bell foram avaliados neste estudo clínico retrospectivo. Os diâmetros de ambos os canais faciais (acometidos e não acometidos) de cada paciente foram medidos no segmento labiríntico, gânglio geniculado, segmento timpânico, segundo joelho, segmento mastoideo e forame estilomastoideo. As escalas de House-Brackmann (HB) de cada paciente na apresentação inicial e três meses após o tratamento foram avaliadas a partir de seus prontuários. O teste t de amostras pareadas e o teste dos postos sinalizados de Wilcoxon foram usados para comparação de largura entre o lado acometido e o lado não acometido. O teste de postos sinalizados de Wilcoxon também foi usado para avaliação da relação entre o diâmetro do canal facial e o grau de paralisia de Bell. Diferenças significativas foram estabelecidas em um nível de p = 0,05 (IBM SPSS Statistics for Windows, versão 21.0; Armonk, NY, IBM Corp). Resultados: Foram incluídos 34 pacientes - 16 mulheres, 18 homens; idade média ± desvio padrão (DP), 40,3 ± 21,3 com paralisia de Bell. De acordo com o sistema de classificação do nervo facial de HB, oito pacientes eram de grau V, seis de grau IV, 11 de grau III, oito de grau II e um de grau I. A largura média no segmento labiríntico do canal facial no osso temporal acometido foi significativamente menor do que o equivalente no osso temporal não acometido (p = 0,00). Não houve diferença significativa entre os ossos temporais acometidos e não acometidos no gânglio geniculado (p = 0,87), segmento timpânico (p = 0,66), segundo joelho (p = 0,62), segmento mastoide (p = 0,67) e forame estilomastoideo (p = 0,16). Não houve relação entre o grau de HB e o diâmetro do canal facial no nível do segmento labiríntico (p = 0,41), segmento timpânico (p = 0,12), segmento mastoideo (p = 0,14), gânglio geniculado (p = 0,13) e forame estilomastoideo (p = 0,44), mas houve uma relação significativa no nível do segundo joelho (p = 0,02). Conclusão: O diâmetro do segmento labiríntico do canal facial foi um fator de risco anatômico para a paralisia de Bell. Também houve relação significativa entre o grau de HB e o diâmetro do CF no nível do segundo joelho. Estudos futuros (RM-TC combinadas ou modelagem 3D) são necessários para promover essa possível relevância especialmente no segundo joelho. Assim, no futuro, pode ser possível descomprimir segmentos específicos em pacientes com alto grau de PB.

Frontalis muscle flap suspension surgery for the treatment of blepharoptosis based on the anatomical study of the frontal muscle nerve in the third of the eyebrow / Cirugía de suspensión del colgajo muscular frontal en el tratamiento de blefaroptosis basado en el estudio anatómico del nervio del músculo occipitofrontal en el tercio de la ceja

The aim of this study was to investigate the course of the supraorbital nerve and temporal branch of the facial nerve, and to verify the clinical security of cutting the frontalis muscle flap to treat blepharoptosis in one-third of the eyebrow. Twenty cadavers were dissected. The relationship of the supraorbital nerve and the course of the frontotemporal branch of the facial nerve with the head and neck muscles was evaluated. Forty patients underwent clinical frontal muscular flap suspension surgery for the treatment of blepharoptosis. The postoperative curative and complication rates were determined. The courses of the supraorbital nerve and frontotemporal branch of the facial nerve were observed to determine a relatively safe area in one-third of the eyebrow. The average width of the zone was 25.0±3.5 mm. In forty cases, satisfactory results were achieved in correcting blepharoptosis by cutting the frontal muscular flap in the middle of eyebrow within the wide range of 17±2.1 mm. No secondary sensory and motor dysfunctions occurred. One-third of the eyebrow (eyebrow center, within 17±2.1 mm) was a relatively safe area and allowed for the prevention of damage to the temporal branch of the facial nerve inside the supraorbital nerve and supraorbital artery and the outer frontotemporal branch of the facial nerve.

El objetivo de este estudio fue investigar el curso del nervio supraorbital y la rama temporal del nervio facial, para verificar la seguridad clínica de cortar el vientre frontal del músculo occipitofrontal (colgajo de músculo frontal) para tratar la blefaroptosis en un tercio de la ceja. Veinte cadáveres fueron disecados. Se evaluó la relación del nervio supraorbital y el curso de la rama temporal del nervio facial con los músculos de la cabeza y cuello. Cuarenta pacientes fueron sometidos a la cirugía de confección del colgajo del músculo frontal para el tratamiento de la ptosis palpebral. Se determinaron las tasas de curación y de complicaciones postoperatorias. Se observaron los cursos del nervio supraorbital y la rama temporal del nervio facial para determinar un área relativamente segura en un tercio de la ceja. El ancho medio de la zona fue 25,0±3,5 mm. En cuarenta casos, se lograron resultados satisfactorios en la corrección de la blefaroptosis con el colgajo del músculo frontal en la mitad de la ceja en un rango de 17±2,1 mm. No se produjeron disfunciones sensoriales o motoras secundarias. El tercio de la ceja (centro del entrecejo, dentro de 17±2,1 mm) es una zona relativamente segura y permite la prevención de daños al ramo temporal del nervio facial ubicada medial al nervio supraorbitario y a la arteria supraorbitaria, además del ramo temporal lateral del nervio facial.

Schwannoma del nervio facial y sus ramas en el oído medio: reporte de 3 casos y revisión de literatura / Schwannoma of the facial nerve and its branches in the middle ear: a report of 3 cases and literature review

El schwannoma del nervio facial (SNF) es un tumor infrecuente, sin embargo es el tumor más frecuente del nervio facial. Son tumores benignos de crecimiento lento que producen sintomatología otológica no específica y pueden asociar parálisis facial. No existen exámenes preoperatorios que nos permitan diagnosticar con certeza el SNF. El estudio de elección se realiza con TC de alta resolución y RM con gadolinio. El diagnóstico definitivo es histopatológico pero se puede hacer diagnóstico presuntivo si la clínica, imágenes y hallazgo intraoperatorios son concordantes. El objetivo del tratamiento debe intentar preservar la función del nervio facial por el mayor tiempo posible. En casos de pacientes asintomáticos, o sin compromiso del nervio facial, se prefiere la observación. Se presentan en este artículo casos de schwannomas del facial intratimpánico y de cuerda del tímpano.

The facial nerve schwannoma (SNF) is a rare tumor, however it is the most common tumor of the facial nerve. They are slow-growing benign tumors that produce non-specific otologic symptoms and may be associated facial paralysis. There are no preoperative tests that allow us to accurately diagnose the SNF. The study of choice is made with high resolution CT and MRI with gadolinium. Definitive diagnosis is histopathological but the physician may make a presumptive diagnosis if clinical images and intraoperative findings are consistent. The goal of treatment should try to preserve facial nerve function for as long as possible. In cases of asymptomatic patients, without facial nerve involvement, observation is prefered. Cases of schwannomas of intratympanic facial and chorda tympani are presented in this article.

Paralisia facial: quantos tipos clínicos você conhece? Parte I / Facial falsy: how many clinical types do you know? Part I

A presente revisão aborda 17 tipos clínicos de paralisias/paresias faciais divididos em três grupos (grupo I: paralisias faciais periféricas; grupo II: paralisias faciais centrais; grupo III: outros tipos de paralisia facial). Devido à extensão do tema, ele é apresentado em duas partes. Neste primeiro artigo são comentados aspectos clínicos das paralisias faciais periféricas e centrais.

The present review discusses 17 different clinical types of facial paralysis/paresis. They were divided into three groups (group I: peripheral facial paralysis; group II: central facial paralysis; and group III: other types of facial paralysis). Because of the extension of this theme it is presented in two parts. In this first article the peripheral and central facial paralysis are addressed.

Ultraestrutura do nervo facial intratemporal em pacientes com paralisia facial idiopática: estudo de evidências de infecção viral / Intratemporal facial nerve ultrastructure in patients with idiopathic facial paralysis: viral infection evidence study

A etiologia da paralisia facial periférica idiopática (PFPI) ainda é uma incógnita, no entanto, alguns autores aventam a possibilidade de ser uma infecção viral. OBJETIVO: Analisar a ultraestrutura do nervo facial procurando evidências virais que possam nos fornecer dados etiológicos. MATERIAL E MÉTODO: Foram estudados 20 pacientes com PFP, com graus de moderado a severo, de ambos os sexos, entre 18-60 anos, provenientes de Ambulatório de Distúrbios do Nervo Facial. Os pacientes foram divididos em dois grupos: Estudo, onze pacientes com PFPI e Controle, nove pacientes com Paralisia Facial Periférica Traumática ou Tumoral. Foram estudados fragmentos de bainha do nervo facial ou fragmentos de seus cotos, que durante a cirurgia de reparação do nervo facial, seriam desprezados ou encaminhados para estudo anatomopatológico. O tecido foi fixado em glutaraldeído 2 por cento e analisado em Microscopia Eletrônica de Transmissão. RESULTADO: Observamos no grupo estudo atividade celular intensa de reparação com aumento de fibras colágenas, fibroblastos com organelas desenvolvidas, isentos de partículas virais. No grupo controle esta atividade de reparação não foi evidente, mas também não foram observadas partículas virais. CONCLUSÃO: Não foram encontradas partículas virais, no entanto, houve evidências de intensa atividade de reparação ou infecção viral.

The etiology of idiopathic peripheral facial palsy (IPFP) is still uncertain; however, some authors suggest the possibility of a viral infection. AIM: to analyze the ultrastructure of the facial nerve seeking viral evidences that might provide etiological data. MATERIAL AND METHODS: We studied 20 patients with peripheral facial palsy (PFP), with moderate to severe FP, of both genders, between 18-60 years of age, from the Clinic of Facial Nerve Disorders. The patients were broken down into two groups - Study: eleven patients with IPFP and Control: nine patients with trauma or tumor-related PFP. The fragments were obtained from the facial nerve sheath or from fragments of its stumps - which would be discarded or sent to pathology exam during the facial nerve repair surgery. The removed tissue was fixed in 2 percent glutaraldehyde, and studied under Electronic Transmission Microscopy. RESULTS: In the study group we observed an intense repair cellular activity by increased collagen fibers, fibroblasts containing developed organelles, free of viral particles. In the control group this repair activity was not evident, but no viral particles were observed. CONCLUSION: There were no viral particles, and there were evidences of intense activity of repair or viral infection.

[Adenoid cystic carcinoma of the parotid with facial nerve invasion]

Adenoid cystic carcinoma comprises approximately 10% of all epithelial salivary neoplasms and most frequently involves the parotid. Perineural invasion is a common feature but intraneural invasion and spread is less common. The authors report a case of parotid adenoid cystic carcinoma with invasion and spread via the facial nerve with an emphasis on radiologic features. We report a case of a 47-year-old man presenting with a right submandibular mass evolving for 4 years. On physical examination, the mass was firm painless, well delineated. There was no facial paralysis. The magnetic resonance imaging [MRI] examination showed a right parotid gland solid mass located in the deep lobe of the parotid gland with mastoid bony involvement.The mass was heterogenously enhanced. High resolution non contrast computed tomographie [CT] scan of the temporal bone showed in the axial and coronal cuts, a widening of the mastoid segment of the facial canal with involvement of the facial nerve. Pathologic examination of the resected specimen revealed histological features of adenoid cystic carcinoma with intra neural invasion of the mastoid segment of the facial nerve. The surgical margins were free. The evolution was favourable 5 years later. This study confirms that multiplanar approach of MRI allows rapid detection of adenoid cystic carcinoma. The influence of intraneural invasion and spread on survival remains controversial

Features of Facial Asymmetry Following Incomplete Recovery from Facial Paralysis

PURPOSE: The purpose of this study is to investigate peculiar patterns of facial asymmetry following incomplete recovery from facial paralysis that require optimal physical therapy for effective facial rehabilitation, and to decrease the incidence of avoidable facial sequelae. MATERIALS AND METHODS: This study involved 41 patients who had facial sequelae following the treatment of various facial nerve diseases from March 2000 to March 2007. All patients with a follow-up of at least 1 year after the onset of facial paralysis or hyperactive function of the facial nerve were evaluated with the global and regional House-Brackmann (HB) grading systems. The mean global HB scores and regional HB scores with standard deviations were calculated. Other factors were also analyzed. RESULTS: Four patterns of facial asymmetry can be observed in patients with incomplete facial recovery. The most frequently deteriorated facial movement is frontal wrinkling, followed by an open mouth, smile, or lip pucker in patients with sequelae following facial nerve injury. The most common type of synkinesis was unintended eye closure with an effort to smile. CONCLUSION: We described common configurations of facial asymmetry seen in incomplete recovery following facial nerve injury in an attempt to develop an optimal strategy for physical therapy for complete and effective facial recovery, and to decrease the incidence of avoidable sequelae.

Parálisis facial periférica / Peripheral facial palsy

La parálisis facial periférica (PFP) es una patología frecuente que habitualmente es unilateral, que genera deformidad estética facial y alteraciones funcionales. Se describe la anatomía del nervio facial (NF) en sus segmentos supranuclear, nuclear e infranuclear; describiendo con mejor definición surelación en el hueso temporal. Se hace una breve mención de la fisiopatología de PFP y de los grados de lesión: neuropraxia, axonotmesis y neurotmesis. Especial énfasis se da al diagnóstico en la PFP. Se mencionan las pruebas de topodiagnóstico: Test de Shirmer, Test del Reflejo Estapedial y Test de Blatt con Gustometría que brindan la posibilidad de ubicar topográficamente el lugar de la lesión en el NF Asimismo, se describen las pruebas electrodiagnósticas: Prueba de Excitabilidad del Nervio; - Prueba de Excitabilidad Máxima; - Electroneuronografía y - Electromiografía, todas pruebas que brindan un pronóstico en la evolución de la PFP Se hace mención de las principales causas de PFP vinculándolo a los diferentes segmentos del NF Por último, se plantean las opciones terapéuticas en la PFP, tanto el tratamiento médico donde tiene importante presencia la cortico terapia y el tratamiento quirúrgico, que sobre todo en las causales traumáticas tiene su indicación.

Peripheral facial palsy (PFP) is a common disease, that usually presents as an unilateral form, with facial esthetic deformity, and functional changes. The article describes the anatomy of the facial nerve ( FN), the intranuclear, nuclear and supranuclearsegments, and its relation with the temporal bone. A brief mention of the pathophysiology lesions of the PFP and the type od neurological damage : neuropraxya, axonotmesys and neurotmesys. A special emphasize in the diagnosis of PFP is made and the topodiagnosis tests : Shirmer tests, Estapedial Reflex tests, and Blatt tests with tastemeter, that makes possible to locate topographically the injury zone in the facial nerve. A description is made of the electrodiagnosis tests: Nerve excitabillity test - Maximum excitabillity test - Electroneuronography and eletromiography. All these tests can provide a prognostic information of the PFP. Is mention the underlying explanation of the PFP, associated with the different facial nerve segments. At last, is represented the therapeutic options of the PFP, medical treatment where the corticotherapy is important, and the surgical treatment, specially at the traumatic causes is indicated.

Síndrome de Guillain Barre: interés desde el punto de vista odontológico: presentación de un caso y revisión de la literatura / Guillain Barre Syndrome: interest from the dental viewpoint: case report and literature review

El objetivo de esta investigación es presentar un caso clínico de una paciente diagnosticada con el Síndrome de Guillain Barre, la cual cursaba con parálisis facial bilateral, debilidad distal de los cuatro extremidades, mononuclesosis infecciosa y fiebre, poniendo de manifiesto la importancia que reviste el conocimiento de esta enfermedad para el odontólogo y estudiante de odontología debido a que en este caso el séptimo par craneal es el nervio principalmente involucrado, además de tener entre sus funciones regir el estimulo gustativo de la lengua en sus dos tercios anteriores, permitir el estimulo secretor de las glándulas salivales sublingual, submaxilar, nasales, lagrimales y palatinas , inerva el músculo del martillo importante para la audición y por ultimo es el responsable de la movilidad de todos los músculos cutáneos de la cara, todas esta estructuras anatómicas relacionadas con el odontólogo. Aunque La parálisis facial de Bell ó parálisis facial idiopática, es considerada la patología mas frecuente de este nervio y esta descrita como una enfermedad benigna de la porción infratemporal que consiste en la pérdida temporal de la función contráctil de la musculatura mímica de la cara, de causa desconocida, pero puede ser secundaria a un traumatismo, compresión o tumor presentándose generalmente unilateral y es de etiología indeterminada , es necesario conocer otras patologías que aunque no son las mas frecuentes afectan importantemente al nervio como lo es el Síndrome de Guillain Barre

Doenças infecciosas específicas manifestando paralisia facial: revisão da literatura / Specific infectious diseases manifesting facial paralysis: a literature review

A paralisia facial otogênica decorre devido à interrupção do influxo nervoso no nervo facial em seu trajeto pelo interior do osso temporal, em consequência de diferentes e variados fatores etiológicos. A etiologia infecciosa não é uma das mais frequentes em nosso meio, no entanto deve ser levada em consideração e bem investigada. Existem várias doenças infecciosas que manifestam paralisia facial. Neste trabalho, foi realizada uma revisão da literatura de doenças infecciosas que manifestam paralisia facial.

Correlation between MRI and Operative Findings in Bell's Palsy and Ramsay Hunt Syndrome

PURPOSE: To investigate the correlation between gadolinium enhanced magnetic resonance image (MRI) results and surgical findings of facial nerves in Bell's palsy and Ramsay Hunt syndrome. MATERIALS AND METHODS: From 1995 to 2004, MRI was performed on 13 patients with Bell's palsy or Ramsay Hunt syndrome, who were offered with surgical decompression of the facial nerve through the middle cranial fossa approach. Gadolinium enhanced MRI was performed on all patients and the enhancement of the facial nerve was evaluated by radiology specialists. Operative findings including the degree of the facial nerve segment swelling were examined. Furthermore, the time interval from the onset of palsy to surgery was evaluated. RESULTS: Swelling of facial nerve segments was found in patients with enhanced facial nerves from MRI. The swelling of the facial nerve in the labyrinthine segment in particular was identified in all patients with enhanced labyrinthine segments in MRI. The intraoperative swelling of geniculate ganglion of facial nerve was found in 78% of patients with enhanced facial segment in MRI (p=0.01). The intraoperative swelling of tympanic segment was observed from fourth to ninth weeks after the onset of palsy. CONCLUSION: MRI enhancement of facial nerves in Bell's palsy and Ramsay Hunt syndrome is associated with the extent of intratemporal lesions of facial nerves, especially in the labyrinthine segment.

Modelo experimental comportamental e histológico da regeneração do nervo facial em ratos / Behavioral and histologic experimental model of facial nerve regeneration in rats

O estabelecimento de modelos experimentais é o passo inicial para estudos de regeneração neural. OBJETIVO: Estabelecer modelo experimental de regeneração do nervo facial. MATERIAIS E MÉTODOS: Ratos Wistar com secção completa e sutura do tronco do nervo facial extratemporal, com análise comportamental e histológica até 9 semanas. FORMA DE ESTUDO: Estudo prospectivo experimental. RESULTADOS: Progressiva recuperação clínica e histológica dos animais. CONCLUSÃO: Estabelecemos um método aceitável para o estudo de regeneração do nervo facial em ratos.

To setup an experimental model is the first step to study neural regeneration. AIM: Setting up an experimental model on facial nerve regeneration. MATERIAL AND METHODS Wistar rats with complete sectioning and suturing of the extratemporal facial nerve trunk; with a behavioral and histological analysis for 9 weeks. STUD DESIGN: Experimental prospective study. RESULTS: Progressive clinical and histological recovery of the animals. CONCLUSION: Our method is acceptable to study facial nerve regeneration in rats.

Cranial nerve involvement in patients with leprous neuropathy.

BACKGROUND: Leprosy is one of the most common causes of peripheral neuropathy, perhaps closely matched by diabetic neuropathy. Patterns of peripheral neuropathy in leprosy can be varied, which may include mononeuropathy, mononeuritis multiplex and symmetric polyneuropathy. Cranial nerves, especially facial and trigeminal nerves, are also commonly involved in leprosy. AIMS: To find out the pattern and spectrum of cranial nerve involvement in a consecutive series of patients with leprous neuropathy. SETTINGS AND DESIGN: A retrospective review of patients admitted with leprosy to the Neurology Department of a tertiary care center. MATERIALS AND METHODS: All consecutive patients admitted during an 8-year period (1995-2003) and diagnosed to have leprosy were included. They were clinically evaluated to determine the frequency and pattern of cranial nerve involvement. RESULTS: About 18% (9/51) of the leprosy patients seen during that period had clinical evidence of cranial nerve involvement. Facial and trigeminal nerves were the most commonly affected (five and four patients respectively). CONCLUSIONS: Cranial nerve involvement is common in leprosy, which emphasizes the need to carefully examine them. Also, one should exclude leprosy in patients presenting with isolated cranial neuropathies.

Metastatic sweat gland carcinoma.

Sweat gland tumours are very rare. They lack distinctive clinical features and the histological appearences are often varied. Hence, diagnosis is difficult and usually late. We report a case of sweat gland adenocarcinoma with bony and lymphnode metastases, and possibly secondary involvement of 7th cranial nerve. This is probably the first case in Indian literature.

Facial nerve neurinoma presenting as middle cranial fossa and cerebellopontine angle mass: a case report.

Facial nerve neurinomas are rare. The tumours arising from the geniculate ganglion may grow anteriorly and superiorly and present as a mass in the middle cranial fossa. Only a few cases of facial nerve neurinomas presenting as middle cranial fossa mass have so far been reported. These tumours present with either long standing or intermittent facial palsy along with cerebellopontine angle syndrome.

Bloqueo del Ganglio Esfenopalatino como tratamiento para la neuralgia esfenopalatina con expresión del Glosofaríngeo / Sphenopalatine ganglion blockade for sphenopalatine neuralgia with glossopharyngeal expression

La historia del bloqueo nervioso del ganglio esfenopalatino data de 1908, cuando Greenfield Sluder, describió por primera vez al tratamiento de una variedad de cefaleas y síntomas de dolor facial a través del bloqueo del ganglio con anestésicos locales. Esta técnica también ha sido útil en el tratamiento de migraña, cefaleas y Síndrome de Dolor Facial Atípico. En este estudio se realizó una revisión retrospectiva de tres casos, dos mujeres y un hombre, con un rango de edad de 36-47 años, con antecedentes de Rinitis Alérgica y cuadros gripales crónicos. En los 3 casos, los pacientes presentaban sintomatología de neuralgia esfenopalatina con componente de neuralgia glosofaríngea, tales como: odinofagia, rinorrea, lagrimeo unilateral, refiriendo episodios de dolor laríngeo súbito, a la deglución (en dos casos) y seguido de un acceso de tos (un caso), tipo punzante, paroxístico, con duración de segundos, sin predominio de horario, con mala respuesta a tratamiento farmacológico a base de carbamazepina. Dicha sintomatología se fue incrementando en frecuencia e intensidad. En los 3 casos, se realizó bloqueo del ganglio esfenopalatino analgésico-desinflamatorio, diangóstico-pronóstico, presentando mejoría hasta la remisión total de los síntomas clínicos

Bell's Palsy in north of Jordan

A prospective study was carried out at Prince Rashid Ben Al- Hassan Military Hospital in north of Jordan to assess the incidence and the clinical profile of idiopathic facial nerve paralysis. [Bell's palsy] over the period of two years. Eighty-six patients, inhabitants of Irbid Governorate, 40 males and 46 females, in whom the diagnosis of Bell's palsy was established constituted the study population. Basic data related to the age, sex, time of onset and side of paralysis. Associated conditions and duration of clinical improvement were recorded. The mean age of the patients was 32 years, females were affected more than males. There was also an approximately equal side distribution Right: Left 39:47. Eleven patients [12.7%] had history of recurrence of Bell's palsy, ipsilateral in six patients, contralateral in three and undetermined in two. The mean duration after which clinical improvement occurred was 11 weeks. Complete improvement occurred in 84.8% and no improvement in 2.3%. 67% of cases occurred in the period between October to April [cold season] with a peak frequency during January [16.2%]. Identified associated clinical disorders or presumed predisposing factors were diabetes mellitus [5.8%], history of exposure to cold [44/%], and history of upper respiratory tract infection [5.8%]. Bell's palsy is not an infrequent clinical disorder. The prognosis is relatively good and very few patients are left with severe deficit