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1.
J Laryngol Otol ; 132(9): 842-845, 2018 Sep.
Article in English | MEDLINE | ID: mdl-30187838

ABSTRACT

BACKGROUND: Unilateral total facial palsy is a debilitating condition that can affect an individual's physical, social and emotional wellbeing. When this occurs bilaterally, the severity of impact is extreme, with significant cosmetic disfigurement and functional morbidity. A variety of facial reanimation techniques have been used for unilateral facial weakness of varying House-Brackmann grades, and these are also applicable in bilateral cases. In bilateral cases, it is difficult to gauge successful improvement in comparison to the contralateral side, which also is afflicted.Case reportThis paper presents our experience with a bilateral facial paralysis patient who had a complex otological history. The patient, who presented with bilateral debilitating grade VI facial palsy, achieved a good result from bilateral facial reanimation with sequential hypoglossal-facial anastomosis. This is considered a reasonable option in cases of bilateral facial paralysis.


Subject(s)
Anastomosis, Surgical/methods , Aspergillosis/microbiology , Bell Palsy/surgery , Ear, Middle/microbiology , Hypoglossal Nerve/surgery , Mastoidectomy/adverse effects , Otitis/microbiology , Aspergillosis/complications , Aspergillosis/drug therapy , Aspergillus fumigatus/isolation & purification , Bell Palsy/classification , Bell Palsy/etiology , Bell Palsy/rehabilitation , Ear, Middle/pathology , Humans , Hypoglossal Nerve/physiopathology , Iatrogenic Disease , Male , Middle Aged , Neurosurgical Procedures/methods , Otitis/complications , Otitis/drug therapy , Physical Therapy Modalities/adverse effects , Postoperative Complications/pathology , Quality of Life , Recovery of Function/physiology , Treatment Outcome
3.
Arch Pediatr ; 22(5): 476-9, 2015 May.
Article in French | MEDLINE | ID: mdl-25817175

ABSTRACT

BACKGROUND: Idiopathic facial palsy is the most common cause of facial nerve palsy in children. Controversy exists regarding treatment options. The objectives of this study were to review the epidemiological and clinical characteristics as well as the outcome of idiopathic facial palsy in children to suggest appropriate treatment. PATIENTS AND METHODS: A retrospective study was conducted on children with a diagnosis of idiopathic facial palsy from 2007 to 2012. RESULTS: A total of 37 cases (13 males, 24 females) with a mean age of 13.9 years were included in this analysis. The mean duration between onset of Bell's palsy and consultation was 3 days. Of these patients, 78.3% had moderately severe (grade IV) or severe paralysis (grade V on the House and Brackmann grading). Twenty-seven patients were treated in an outpatient context, three patients were hospitalized, and seven patients were treated as outpatients and subsequently hospitalized. All patients received corticosteroids. Eight of them also received antiviral treatment. The complete recovery rate was 94.6% (35/37). The duration of complete recovery was 7.4 weeks. DISCUSSION: Children with idiopathic facial palsy have a very good prognosis. The complete recovery rate exceeds 90%. However, controversy exists regarding treatment options. High-quality studies have been conducted on adult populations. Medical treatment based on corticosteroids alone or combined with antiviral treatment is certainly effective in improving facial function outcomes in adults. In children, the recommendation for prescription of steroids and antiviral drugs based on adult treatment appears to be justified. CONCLUSION: Randomized controlled trials in the pediatric population are recommended to define a strategy for management of idiopathic facial paralysis.


Subject(s)
Bell Palsy/diagnosis , Bell Palsy/drug therapy , Adolescent , Adrenal Cortex Hormones/therapeutic use , Ambulatory Care , Antiviral Agents/therapeutic use , Bell Palsy/classification , Bell Palsy/epidemiology , Child , Child, Preschool , Cross-Sectional Studies , Drug Therapy, Combination , Female , France , Hospitalization , Humans , Male , Prognosis , Treatment Outcome
4.
J Craniofac Surg ; 25(3): 944-5, 2014 May.
Article in English | MEDLINE | ID: mdl-24657977

ABSTRACT

OBJECTIVE: The aim of this study was to investigate whether neutrophil-lymphocyte ratio (NLR) levels are elevated in patients with Bell palsy (BP). Moreover, we aimed to find out whether there is a correlation between NLR levels and the severity and prognosis of BP. MATERIALS AND METHODS: The study group consisted of 25 subjects who presented with BP and 25 control subjects with no evidence of facial nerve pathology. The subjects underwent a general physical examination; an assessment of laboratory blood parameters; and a cranial magnetic resonance imaging, using gadolinium as a contrast medium. RESULTS: The mean (SD) NLR values were 2.16 (0.80) in the patients with BP and 1.36 (0.48) in the control group. The mean NLR values in the patients with BP were significantly higher than in the control group (P = 0.0001). There was a positive correlation between NLR values and grade of facial paralysis (r = 0.661, P = 0.0001). The mean (SD) NLR values in the grades III, IV, V, and VI BP groups were 1.40 (0.54), 1.78 (0.44), 3.00 (0.63), and 2.60 (0.54), respectively. The mean NLR values in the grade V BP group were significantly higher than in the other groups (P = 0.0001). In addition, there was a positive correlation between NLR values and prognosis of facial paralysis (r = 0.239, P = 0.251). CONCLUSIONS: There is no previous study that investigated the association between NLR and BP in the literature. Higher NLR values in patients with BP may be a predictor of worse prognosis.


Subject(s)
Bell Palsy/immunology , Leukocyte Count , Lymphocyte Count , Neutrophils/immunology , Acyclovir/pharmacology , Acyclovir/therapeutic use , Adult , Aged, 80 and over , Anti-Inflammatory Agents/pharmacology , Anti-Inflammatory Agents/therapeutic use , Antiviral Agents/pharmacology , Antiviral Agents/therapeutic use , Bell Palsy/classification , Bell Palsy/diagnosis , Bell Palsy/drug therapy , Drug Therapy, Combination , Facial Nerve/drug effects , Facial Nerve/immunology , Female , Humans , Male , Middle Aged , Prednisolone/pharmacology , Prednisolone/therapeutic use , Prognosis , Statistics as Topic
5.
Eur J Phys Rehabil Med ; 48(4): 635-42, 2012 Dec.
Article in English | MEDLINE | ID: mdl-22522431

ABSTRACT

BACKGROUND: It is useful to perform neurophysiologic electromyography and electroneurography (EMG/ENG) on patients with peripheral facial palsy during the acute phase of paralysis in order to assess the severity of their nerve lesion and thus plan rehabilitation treatment and evaluate its results. AIM: To evaluate the motor recovery of patients with Bell's palsy with respect to the severity of their neurological lesion and to compare the results of two different rehabilitation treatments, with electromyographic biofeedback (EMG-BFB) and mirror visual biofeedback (mirror-BFB), in patients with Bell's palsy and neurophysiologic pattern of axonotmesis. STUDY DESIGN: Cohort study on retrospective clinical records. POPULATION: 102 patients with Bell's facial palsy were clinically assessed according to the House scale both during the acute phase of paralysis and 12 months after onset. METHODS: All patients underwent EMG/ENG examination 3-4 weeks after the onset of paralysis; 29 patients had an EMG pattern of neurapraxia and were not given rehabilitation treatment; 73 patients who presented with signs of denervation had an EMG pattern of axonotmesis. The group, which was homogenous in terms of lesion severity, was divided into two parts: 38 patients were treated with electromyographic biofeedback (EMG-BFB) and 35 were treated with mirror visual feedback (mirror-BFB). RESULTS: All 29 patients with neurapraxia made a full spontaneous recovery; Although the 73 patients with axonotmesis received different types of rehabilitation treatment, they obtained similar results regarding quality of recovery, development of synkinesis, rehabilitation timing and resources used. CONCLUSION AND CLINICAL REHABILITATION IMPACT: Rehabilitation treatment is not necessary for patients with neurapraxia. The two biofeedback methods used to treat patients with axonotmesis resulted in similar rehabilitation outcomes.


Subject(s)
Bell Palsy/rehabilitation , Electromyography/methods , Feedback, Sensory , Neurofeedback/methods , Adolescent , Adult , Aged , Bell Palsy/classification , Bell Palsy/physiopathology , Child , Female , Humans , Male , Middle Aged , Outcome and Process Assessment, Health Care , Recovery of Function , Severity of Illness Index , Young Adult
6.
Otolaryngol Head Neck Surg ; 144(4): 570-4, 2011 Apr.
Article in English | MEDLINE | ID: mdl-21493237

ABSTRACT

OBJECTIVES: To study the correlation between Sunnybrook and House-Brackmann facial grading systems at different time points during the course of peripheral facial palsy. STUDY DESIGN: Prospective multicenter trial. SETTING: Seventeen otorhinolaryngological centers. SUBJECTS AND METHODS: Data are part of the Scandinavian Bell's palsy study. The facial function of 1920 patients with peripheral facial palsy was assessed 5397 times with both Sunnybrook and House-Brackmann (H-B) facial grading systems. Grading was done at initial visit, at days 11 to 17 of palsy onset, and at 1 month, 2 months, 3 months, 6 months, and 12 months. Statistical evaluation was by Spearman correlation coefficient and box plot analysis. RESULTS: Spearman correlation coefficient varied from -0.81 to -0.96, with the weakest correlation found at initial visit. Box plot analysis for all assessments revealed that Sunnybrook scores were widely spread over different H-B grades. With 50% of the results closest to the median, Sunnybrook composite scores varied in H-B grades as follows: H-B I, 100; H-B II, 71 to 90; H-B III, 43 to 62; H-B IV, 26 to 43; H-B V, 13 to 25; and H-B VI, 5 to 14. CONCLUSION: Gradings correlated better in follow-up assessments than at initial visit. As shown by the wide overlap of the grading results, subjective grading systems are only approximate. However, a conversion table for Sunnybrook and H-B gradings was obtained and is included in the article. It can be used for further development of facial grading systems.


Subject(s)
Bell Palsy/classification , Facial Paralysis/classification , Acyclovir/analogs & derivatives , Acyclovir/therapeutic use , Adolescent , Adult , Aged , Antiviral Agents/therapeutic use , Bell Palsy/drug therapy , Bell Palsy/physiopathology , Facial Asymmetry/diagnosis , Facial Muscles/physiopathology , Facial Paralysis/drug therapy , Facial Paralysis/physiopathology , Glucocorticoids/therapeutic use , Humans , Middle Aged , Prednisolone/therapeutic use , Randomized Controlled Trials as Topic , Valacyclovir , Valine/analogs & derivatives , Valine/therapeutic use , Young Adult
7.
Acta otorrinolaringol. cir. cabeza cuello ; 38(2): 315-322, jun. 2010.
Article in Spanish | LILACS | ID: lil-605806

ABSTRACT

En la literatura no existe suficiente evidencia que soporte la asociación de un antiviral al corticoide sistémico; sin embargo, su uso es frecuente en la práctica clínica justificada por la posible etiología viral. Objetivo: Describir la frecuencia de recuperación completa de la parálisis facial periférica idiopáticaen los pacientes que reciben prednisolona o prednisolona/aciclovir.Métodos: Se realizó un estudio de cohorte histórica identificando los casos de parálisis facial periférica. Resultados: Se reportan 106 casos, 59 mujeres (55,7%) y 47 hombres (44,3%), con edad promedio 36.9 años (DE16.7). Al ingreso el 47,2% de los pacientes presentaron parálisis grado III. Recibieron prednisolona 32 pacientes (30,2%) y prednisolona-aciclovir 74 (69,8%). La recuperación completa (House Brackman I) con prednisolona se documentó en 23 (71,9%) y 52 (70,2%) pacientes tratados con prednisolona-aciclovir. El seguimiento mediano fue 39 días. En ambos grupos lafrecuencia de mejoría fue mayor en quienes ingresaron con grados II y III de parálisis. Conclusión: La tasa de mejoría reportada es superior a la descrita con el uso de placebo pero está por debajo de lo esperado para el uso de prednisolona a 3 meses. La frecuencia de recuperación completa fue similar con prednisolona y prednisolona-aciclovir.


There is not enough evidence in the literature available that supports the addition of an anti viral to the systemic corticoid. However, it is frequently used in clinical practice where it is justified by the probable viral etiology. Objective: To describe the full recovery frequency of idiopathic peripheral facial paralysis in patients to whom prednisolone or prednisolone / acyclovir is given. Methods: A historical cohort study was conducted and the cases of peripheral facial paralysis were identified. Results: 106 cases were reported, 59 women (55,7%) and 47 men (44,3%), with an average age of 36.9 years of age (DE 16.7). 47,2% of the patients showed paralysis of the III degree upon admission. 32 of the patients (30,2%) were administered prednisolone and 74 (69,8%) were given prednisolone / acyclovir. Full recovery (House Brackman I) with prednisolone was documented in 23 (71,9%) and 52(70,2%) of the patients that had been treated with prednisolone-acyclovir. The average follow – up was 39 days. Recovery frequency was higher in both groups among the patients that were admitted to the hospital with degree II and III paralysis. Conclusion: The reported recovery rate is above the one described when using placebo but it is stillbelow the expected rate when using prednisolone for 3 months. Full recovery frequency was similar with prednisolone and with prednisolone-acyclovir.


Subject(s)
Bell Palsy/classification , Bell Palsy/diagnosis , Bell Palsy/psychology , Bell Palsy/rehabilitation , Bell Palsy/therapy
8.
Managua; s.n; abr. 2008. 66 p. ilus, graf.
Thesis in Spanish | LILACS | ID: lil-501267

ABSTRACT

Se realizó un estudio en el Hospital de Rehabilitación Aldo Chavarría, de la ciudad de Managua, Nicaragua. Con un total de 486 pacientes con parálisis facial idiopática. La investigación tuvo como objetivo conocer la prevalencia de los grados de parálisis facial idiopática según la escala de House- Brackmann y a la ves la rehabilitación indicada por el medico fisiatra. El estudio se realizo encuestando a los pacientes, por medio del llenado de una ficha, esta se procedía a llenar al momento de la consulta o bien ya había sido atendido por otro medico, pero en la misma semana de su primera consulta, corroborando la información con el expediente clínico. Encontrando que el sexo femenino fue el más afectado, en comparación con el masculino, en edades entre los 20 y 40 años, siendo las mas afectadas las amas de casa seguidas por los trabajadores de guardas de seguridad, tal como lo reporta la bibliografía internacional. La hemicara con mayor frecuencia afectada fue el lado derecho, y de la escala de House- Brackmann los grados mas frecuentes fueron III y IV, siendo estos grados los de mayor presentación en los pacientes de la tercera edad. La parálisis fue en si el signo que con mayor frecuencia se encontró en los pacientes, seguido por las alteraciones de la sensibilidad, a diferencia de lo que plantean los estudios internacionales; los trastornos del gusto y la audición fueron muy pocos. El 52% de los pacientes llegaron en la etapa aguda de la enfermedad y con un tratamiento medico ya instaurado. La clasificación de los pacientes al momento de su ingreso no es realizada por todos los médicos, por lo que no se puede valorara posteriormente su evolución. El tratamiento rehabilitador se prescribió de manera completa, y el electroestímulo se indica aun en la etapa aguda de la enfermedad, sin embargo los estudios de neuroconducción no están dentro del protocolo diagnostico incluso en aquellos casos en los cuales la recuperación es mínima...


Subject(s)
Physical and Rehabilitation Medicine , Bell Palsy/classification , Bell Palsy/diagnosis , Bell Palsy/rehabilitation , Bell Palsy/therapy
11.
Acta odontol. venez ; 45(3): 384-387, 2007. tab
Article in Spanish | LILACS | ID: lil-502088

ABSTRACT

Se realizó un estudio descriptivo de prevalencia en pacientes diagnosticados con Parálisis de Bell ó Parálisis Facial Idiopática según la Clasificación Internacional de Enfermedades Aplicadas a la Odontología y Estomatología (CIE-AO 1985) que Acudieron al Servicio de neurología sección de Rehabilitación del Hospital Clínico Universitario de Caracas. Periodo noviembre 2003 - Marzo 2004. Estos datos fueron analizados de acuerdo a la clasificación clínica de la parálisis según (House y Brackmann)1.Se estudiaron 79 pacientes relacionándolos con la edad, sexo, lado anatómico afectado, tiempo de evolución, antecedentes personales, hábitos tabáquicos, alcohólicos, usos de drogas y presencia ó no de dolor. De la totalidad el 37,97 por ciento de los pacientes se ubicaron en el grado 4 según la clasificación clínica de la parálisis según House y Brackmann, la cuarta década de la vida fue la más frecuentemente afectada, con 20 pacientes (25.3 por ciento). Es más frecuente en mujeres (64,56 por ciento), el 53,16 por ciento tenía el lado izquierdo afectado, 29 por ciento de los pacientes presentaron dolor auricular previo a la parálisis.


The goal of this research is to present preliminary results on the prevalence of patients with diagnosis of Bell's paralysis (idiopathic facial paralysis),in accordance with the international classification of diseases applied to Dentistry and Stomatology (CIE - AO,1985),whom were consulted in the Service of Physiatry of the University Hospital between November 2003 and March 2004.The data were analized according to the Clinical Classification of the Paralysis (House and Brackmann),age,gender,anatomical side most frequently affected,evolution time,individual antecedents,habits,and presence or abscense of pain.37.97% was regarded as grade IV facial paralysis (House and Brackmann Clinical Classification).Seventynine patients were studied and is more frequent in the fourth decade of life { 20 (25.3%) patients}.It is seen more often in females (64,55%),with 53,16%affected in the left side of the face.Twentynine per cent of the patients had auricular pain before the presentation of the lesion.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged, 80 and over , Bell Palsy/complications , Bell Palsy/epidemiology , Age and Sex Distribution , Age Factors , Cross-Sectional Studies , Epidemiology, Descriptive , Bell Palsy/classification , Risk Factors , Venezuela/epidemiology
12.
Otolaryngol Head Neck Surg ; 135(6): 865-71, 2006 Dec.
Article in English | MEDLINE | ID: mdl-17141075

ABSTRACT

OBJECTIVE: To assess repeatability and agreement of the House-Brackmann (H-B FGS) and the Sunnybrook (SFGS) Facial Grading Systems. STUDY DESIGN AND SETTING: Eight video-recorded facial palsy patients were graded in 2 sittings by 28 doctors. Repeatability and agreement for SFGS were measured by intraclass correlation coefficient (ICC) and coefficient of repeatability (CR), and for H-B FGS by agreement percentage and kappa coefficients. RESULTS: Repeatability for SFGS was from good to excellent and for H-B FGS from fair to good. Agreement between doctors for SFGS was moderate by CR and nearly perfect by ICC. For H-B FGS, the agreement percentage was 50%, and generalized kappa indicated only fair agreement. CONCLUSIONS: SFGS was at least as good in repeatability as H-B FGS and showed more reliable results in agreement between doctors. SIGNIFICANCE: While waiting for an ideal scale for facial grading, the usage of SFGS can be encouraged over H-B FGS.


Subject(s)
Facial Paralysis/classification , Observer Variation , Bell Palsy/classification , Bell Palsy/physiopathology , Facial Expression , Facial Paralysis/physiopathology , Humans , Internship and Residency , Medical Staff, Hospital , Otolaryngology , Reproducibility of Results , Severity of Illness Index , Video Recording
14.
Otol Neurotol ; 25(6): 1020-6, 2004 Nov.
Article in English | MEDLINE | ID: mdl-15547437

ABSTRACT

OBJECTIVE: To assess the agreement between the Sunnybrook facial nerve grading system and the House-Brackmann and Yanagihara systems. STUDY DESIGN: Prospective clinical facial nerve grading. SETTING: Tertiary referral center. PATIENTS: One-hundred assessments, 94 in patients with Bell's palsy and 6 with herpes zoster. INTERVENTION: Diagnostic. MAIN OUTCOME MEASURES: Evaluation according to the weighted regional Sunnybrook system, the gross House-Brackmann system, and the unweighted regional Yanagihara system. Weighted kappa statistics was used to measure agreement between the grading systems. RESULTS: The average weighted kappa value between the Sunny-brook, House-Brackmann, and Yanagihara grading systems was 0.65; kappa values increased temporally (but not statistically significantly) up to day 180. The highest agreement value, 0.72, was found between the Sunnybrook and Yanagihara grading systems. The weighted kappa value between the Sunnybrook and House-Brackmann systems was 0.59. In Sunnybrook gradings less than 63, there was an overlap between House-Brackmann scores of III to VI. Reliable conversion tables between the gross House-Brackmann system and the regional Sunnybrook and Yanagihara systems could not be established. CONCLUSION: The Sunnybrook system scores at the same agreement level as the House-Brackmann and Yanagihara grading systems. There is an evaluative difference between the weighted regional Sunnybrook and the gross House-Brackmann systems. Substantial agreement was found between the regional Sunnybrook and Yanagihara scales. Sunnybrook grading is easy and quick. By adding objective measurements and additional secondary defects, the Sunnybrook system can be an alternative to the other predominating grading systems.


Subject(s)
Bell Palsy/classification , Bell Palsy/physiopathology , Electrodiagnosis/methods , Facial Nerve/pathology , Nerve Degeneration/classification , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Nerve Degeneration/physiopathology , Neural Conduction/physiology , Prognosis , Prospective Studies , Regression Analysis
15.
Am J Phys Med Rehabil ; 82(1): 28-32, 2003 Jan.
Article in English | MEDLINE | ID: mdl-12510182

ABSTRACT

OBJECTIVE: The aim of this retrospective case review was to investigate serologic evidence of cytomegalovirus, rubella virus, and hepatitis A, B, and C viruses in patients with Bell's palsy. DESIGN: A total of 24 patients with idiopathic facial paralysis, without a history of trauma, any evidence of a tumor on high-resolution computed tomographic imaging, or any otologic disease, and 33 healthy individuals as a control group were included in this study. Facial paralysis of the patient was evaluated with the House-Brackmann grading scale. Specific immunoglobulin G and M titers were determined for cytomegalovirus, rubella, hepatitis A, hepatitis B, and hepatitis C by enzyme-linked immunosorbent assay. RESULTS: Serologic positivity for hepatitis B was found in 15 of 21 Bell's palsy patients, compared with 32.1% in the control group. The difference was statistically significant. There was no difference in the prevalence of serologic positivity for cytomegalovirus, hepatitis A, and rubella between the patient and control groups. In one Bell's palsy patient, serologic evidence of recent cytomegalovirus infection was indicated by changes in antibody titers between samples taken on presentation and on the 16th day. There was no serologic evidence of hepatitis C in either Bell's palsy patients or the control group. CONCLUSION: There seems to be an association between hepatitis B and idiopathic facial paralysis. In addition, cytomegalovirus might contribute to the development of Bell's palsy in some ceases with Bell's palsy. Further studies are required to confirm these data.


Subject(s)
Bell Palsy/virology , Cytomegalovirus Infections/complications , Hepatitis A/complications , Hepatitis B/complications , Hepatitis C/complications , Rubella/complications , Adolescent , Adult , Age Distribution , Aged , Bell Palsy/classification , Bell Palsy/diagnosis , Cytomegalovirus Infections/blood , Cytomegalovirus Infections/diagnosis , Cytomegalovirus Infections/epidemiology , Enzyme-Linked Immunosorbent Assay , Female , Hepatitis A/blood , Hepatitis A/diagnosis , Hepatitis A/epidemiology , Hepatitis B/blood , Hepatitis B/diagnosis , Hepatitis B/epidemiology , Hepatitis C/blood , Hepatitis C/diagnosis , Hepatitis C/epidemiology , Humans , Male , Middle Aged , Retrospective Studies , Rubella/blood , Rubella/diagnosis , Rubella/epidemiology , Seroepidemiologic Studies , Severity of Illness Index , Sex Distribution , Time Factors
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