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Facial Plastic Surgery Clinics of North... Feb 2024Pediatric facial palsy is rare but severely debilitating and results in profound functional, developmental, psychosocial, and esthetic consequences. Identifying the... (Review)
Review
Pediatric facial palsy is rare but severely debilitating and results in profound functional, developmental, psychosocial, and esthetic consequences. Identifying the specific cause of the palsy is important in directing the treatment course. The most common etiologies of pediatric facial palsy are distinct from those of adults. Facial reanimation interventions are targeted to address the zones of the face, with oral/smile rehabilitation the most common region requiring intervention in pediatric patients. Gracilis microneurovascular free tissue transfer is safe and highly effective in the pediatric population, providing significant functional, psychosocial, and esthetic benefits.
Topics: Adult; Humans; Child; Facial Paralysis; Esthetics
PubMed: 37981412
DOI: 10.1016/j.fsc.2023.07.003 -
Otolaryngologic Clinics of North America Jun 2023Facial nerve paralysis is a debilitating clinical entity that presents as a complete or incomplete loss of facial nerve function. The etiology of facial nerve palsy and... (Review)
Review
Facial nerve paralysis is a debilitating clinical entity that presents as a complete or incomplete loss of facial nerve function. The etiology of facial nerve palsy and sequelae varies tremendously. The most common cause of facial paralysis is Bell's palsy, followed by malignant or benign tumors, iatrogenic insults, trauma, virus-associated paralysis, and congenital etiologies.
Topics: Humans; Facial Paralysis; Bell Palsy; Facial Nerve
PubMed: 37003859
DOI: 10.1016/j.otc.2023.02.020 -
Advances in Oto-rhino-laryngology 2020Laryngeal electromyography (LEMG) is an important diagnostic and prognostic tool in neurolaryngology. This chapter presents the advances in LEMG in the last 5 years... (Review)
Review
Laryngeal electromyography (LEMG) is an important diagnostic and prognostic tool in neurolaryngology. This chapter presents the advances in LEMG in the last 5 years based on clinical trials. LEMG is in most cases an office-based procedure for decision making in neurolaryngology. When performed in a standardized way, LEMG helps to differentiate abnormal function of the vocal folds from nonorganic disorders. It is mainly used to confirm the diagnosis of vocal fold paralysis (VFP) and is less frequently used for the diagnosis of myopathies and motor neuron disorders. Also, the value of LEMG for other diseases than VFP is presented. First consensus recommendations for standard performance of LEMG have been published. This will facilitate the comparison of results from different researchers in the future. For many years, LEMG focused on the thyroarytenoid muscle. Data are presented showing that now more and more studies are performed including other laryngeal muscles, most importantly the posterior cricoarytenoid muscle and cricothyroid muscle. Diagnostics and estimating the prognosis for patients with VFP remains the most important issue for LEMG. First meta-analyses are now available analyzing which LEMG parameters are the best prognosticators for recovery or persistent palsy. Due to the advances in multichannel LEMG, laryngeal nerve monitoring can now control the recurrent laryngeal nerve and the external branch of the superior laryngeal nerve during thyroid surgery. Finally, also the advances of LEMG for laryngeal pacing, guided laryngeal injections, laryngeal electrostimulation, and other indications beyond otolaryngology are discussed.
Topics: Electromyography; Humans; Laryngeal Muscles; Vocal Cord Paralysis
PubMed: 33166978
DOI: 10.1159/000456680 -
Laryngo- Rhino- Otologie Jun 2018There are numerous reasons for facial palsy, which range from idiopathic palsy (Bell's palsy) to destruction of the facial nerve by a malignant salivary gland tumor. If...
There are numerous reasons for facial palsy, which range from idiopathic palsy (Bell's palsy) to destruction of the facial nerve by a malignant salivary gland tumor. If the chance of spontaneous recovery is low or there is no drug therapy available, surgery is a therapeutical option. Recently, larger studies were published by specialized centers which enable a more individualized therapeutical concept to achieve tone, symmetry and movement of the paralyzed face based on a detailed preoperative assessment. An important therapy target is the improvement of patient´s quality of life. In the present article, we systematically review the important diagnostic steps and, directly derived from this, the indications for surgical options for reanimation of the mimic function. Furthermore, we provide an overview about a variety of postoperative adjuvant measures as well as on new objective assessment tools to evaluate the therapy results.
Topics: Facial Paralysis; Humans; Quality of Life
PubMed: 29890531
DOI: 10.1055/a-0588-6622 -
Otolaryngologic Clinics of North America Dec 2018
Topics: Facial Expression; Facial Paralysis; Humans
PubMed: 30228002
DOI: 10.1016/j.otc.2018.08.018 -
Neurology India 2021
Topics: Humans; Paralysis; Water Sports
PubMed: 34979728
DOI: 10.4103/0028-3886.333512 -
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke... Oct 2019Congenital facial palsy is unilateral or bilateral facial nerve palsy at birth due to genetic or different pathogenic factors. It can be divided into syndromic type and...
Congenital facial palsy is unilateral or bilateral facial nerve palsy at birth due to genetic or different pathogenic factors. It can be divided into syndromic type and non-syndromic type according to its accompanying symptom. The pathogeny and symptom of each type are different, in part with genetic heterogeneity. Congenital facial palsy cannot recover spontaneously. Different types of congenital facial palsy have different treatment schemes. The treatment is significant to the improvement of life quality and physical and mental development of children with congenital facial palsy.
Topics: Facial Nerve Diseases; Facial Paralysis; Humans; Infant, Newborn; Quality of Life
PubMed: 31606995
DOI: 10.3760/cma.j.issn.1673-0860.2019.10.016 -
Pediatrics Jun 2022To describe the etiology and clinical course of pediatric acute-onset unilateral peripheral facial palsy (FP), to define factors that distinguish Bell's palsy from...
BACKGROUND AND OBJECTIVES
To describe the etiology and clinical course of pediatric acute-onset unilateral peripheral facial palsy (FP), to define factors that distinguish Bell's palsy from Lyme-related FP (LRFP), and to determine if early corticosteroid use impacts facial strength recovery in Bell's palsy or LRFP.
METHODS
Retrospective cohort study of children 1 to 18 years old who received clinical care within our pediatric clinical care network (Lyme-endemic region) between 2013 and 2018 for acute-onset unilateral peripheral FP.
RESULTS
The study included 306 children; 82 (27%) had LRFP, 209 (68%) had Bell's palsy, and 15 (5%) had FP of different etiology. Most children with LRFP presented between June and November (93%), and compared with Bell's palsy, more often had a preceding systemic prodrome, including fever, malaise, headache, myalgias, and/or arthralgias (55% vs 6%, P < .001). Neuroimaging and lumbar puncture did not add diagnostic value in isolated FP. Of the 226 children with Bell's palsy or LRFP with documented follow-up, FP was resolved in all but 1. There was no association between ultimate parent/clinician assessment of recovery and early corticosteroid use.
CONCLUSIONS
Bell's palsy and LRFP were common causes of pediatric FP in our Lyme endemic region. Systemic prodrome and calendar month may help distinguish LRFP from Bell's palsy at FP onset, guiding antibiotic use. Early corticosteroid use did not impact our measures of recovery, although subtle abnormalities may not have been appreciated, and time to recovery could not be assessed. Future prospective studies using standardized assessment tools at regular follow-up intervals are necessary.
Topics: Adolescent; Adrenal Cortex Hormones; Bell Palsy; Child; Child, Preschool; Facial Paralysis; Humans; Infant; Lyme Disease; Prospective Studies; Retrospective Studies
PubMed: 35586981
DOI: 10.1542/peds.2021-053992 -
Seminars in Neurology Dec 2021Facial palsy is a common neurologic concern and is the most common cranial neuropathy. The facial nerve contains motor, parasympathetic, and special sensory functions....
Facial palsy is a common neurologic concern and is the most common cranial neuropathy. The facial nerve contains motor, parasympathetic, and special sensory functions. The most common form of facial palsy is idiopathic (Bell's palsy). A classic presentation requires no further diagnostic measures, and generally improves with a course of corticosteroid and antiviral therapy. If the presentation is atypical, or concerning features are present, additional studies such as brain imaging and cerebrospinal fluid analysis may be indicated. Many conditions may present with facial weakness, either in isolation or with other neurologic signs (e.g., multiple cranial neuropathies). The most important ones to recognize include infections (Ramsay-Hunt syndrome associated with herpes zoster oticus, Lyme neuroborreliosis, and complications of otitis media and mastoiditis), inflammatory (demyelination, sarcoidosis, Miller-Fisher variant of Guillain-Barré syndrome), and neoplastic. No matter the cause, individuals may be at risk for corneal injury, and, if so, should have appropriate eye protection. Synkinesis may be a bothersome residual phenomenon in some individuals, but it has a variety of treatment options including neuromuscular re-education and rehabilitation, botulinum toxin chemodenervation, and surgical intervention.
Topics: Adrenal Cortex Hormones; Bell Palsy; Facial Paralysis; Herpes Zoster Oticus; Humans; Lyme Neuroborreliosis
PubMed: 34826871
DOI: 10.1055/s-0041-1726358 -
Child's Nervous System : ChNS :... May 2018The objectives of this study were to evaluate the demographic and clinical characteristics, causes, treatment patterns, outcome, and recurrence of childhood peripheral...
OBJECTIVE
The objectives of this study were to evaluate the demographic and clinical characteristics, causes, treatment patterns, outcome, and recurrence of childhood peripheral facial palsy.
METHODS
We performed a retrospective study of 144 peripheral facial palsy patients, under 18 years old in a tertiary care pediatric hospital. Medical charts were reviewed to analyze the age, gender, side of facial nerve paralysis, family history, cause, grading by the House-Brackmann Facial Nerve Grading Scale (HBS), results of diagnostic tests, therapies, outcomes, and recurrence.
RESULTS
Causes were as follows: 115 idiopathic (Bell's palsy) facial palsy (79.9%), 17 infections (11.8%) (9 otitis media, 4 varicella zoster virus (VZV) infection, 3 tooth abscess, and 1 group A β-hemolytic streptococcus infection), 7 trauma (4.9%), 4 congenital-syndrome (2.8%), and 1 (0.7%) arterial hypertension. There was no difference in age, sex, family history, grading, or outcome between idiopathic and cause-defined facial palsy. At the end of the first year, our recovery rates were 98.3%. No significant difference in recovery outcome was detected between the patients who were treated with and without steroid treatment. Thirteen (9%) patients had recurrent attacks, and no differences in the outcomes of patients with recurrent facial palsy were observed. Recurrence time ranged from 6 months to 6 years.
CONCLUSION
The results of this study indicate that both Bell's palsy and cause-defined facial palsy in children have a very good prognosis. Medical treatment based on corticosteroids is not certainly effective in improving outcomes in children. Recurrent attacks occurred in 6 years from the onset which leads to the conclusion that we should have a long-term follow-up of patients diagnosed with Bell's palsy.
Topics: Adolescent; Age Factors; Child; Child, Preschool; Facial Paralysis; Female; Humans; Infant; Magnetic Resonance Imaging; Male; Recurrence; Retrospective Studies; Severity of Illness Index; Sex Factors
PubMed: 29427137
DOI: 10.1007/s00381-018-3742-9