Facial Nerve Palsy: Clinical Practice and Cognitive Errors

George, Elizabeth; Richie, Megan B.; Glastonbury, Christine M.

doi:10.1016/j.amjmed.2020.04.023

Cited by 29 publications

(23 citation statements)

References 25 publications

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“…In facial paralysis patients, a thorough physical examination together with the patient’s history is a highly valuable diagnostic tool. Other modalities such as laboratory examination are recommended in the case of symptoms or risk factors characteristic for Lyme diseases or HIV and may involve complete blood count, erythrocyte sedimentation rate tests, C-reactive protein tests, rheumatoid factor tests, antinuclear antibody tests, antineutrophil cytoplasmic antibody tests, antiphospholipid antibody tests, angiotensin-converting enzyme tests, HIV testing, Lyme serology, and cerebrospinal fluid (CSF) analysis [ 6 ].…”

Section: Resultsmentioning

confidence: 99%

“…A thorough physical examination together with the patient’s history should identify clinical symptoms, the duration of dysfunction, and possible causes. The assessment of unilateral facial paralysis in a neonate should be performed promptly after birth in order to distinguish between a congenital and developmental etiology [ 6 ]. The duration of symptoms is crucial information, given that the length of time of denervation of the facial muscle is a predictor of the reversibility of the facial paralysis and that defects resulting from neuropraxic or axonotmetic injuries may resolve after 12 months or longer without reconstructive procedures [ 3 ].…”

Section: Resultsmentioning

confidence: 99%

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A Comprehensive Approach to Facial Reanimation: A Systematic Review

Pinkiewicz

Dorobisz

Zatoński

2022

JCM

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Purpose: To create a systematic overview of the available reconstructive techniques, facial nerve grading scales, physical evaluation, the reversibility of paralysis, non-reconstructive procedures and medical therapy, physical therapy, the psychological aspect of facial paralysis, and the prevention of facial nerve injury in order to elucidate the gaps in the knowledge and discuss potential research aims in this area. A further aim was to propose an algorithm simplifying the selection of reconstructive strategies, given the variety of available reconstructive methods and the abundance of factors influencing the selection. Methodological approach: A total of 2439 papers were retrieved from the Medline/Pubmed and Cochrane databases and Google Scholar. Additional research added 21 articles. The primary selection had no limitations regarding the publication date. We considered only papers written in English. Single-case reports were excluded. Screening for duplicates and their removal resulted in a total of 1980 articles. Subsequently, we excluded 778 articles due to the language and study design. The titles or abstracts of 1068 articles were screened, and 134 papers not meeting any exclusion criterion were obtained. After a full-text evaluation, we excluded 15 papers due to the lack of information on preoperative facial nerve function and the follow-up period. This led to the inclusion of 119 articles. Conclusions: A thorough clinical examination supported by advanced imaging modalities and electromyographic examination provides sufficient information to determine the cause of facial palsy. Considering the abundance of facial nerve grading scales, there is an evident need for clear guidelines regarding which scale is recommended, as well as when the postoperative evaluation should be carried out. Static procedures allow the restoral of facial symmetry at rest, whereas dynamic reanimation aims to restore facial movement. The modern approach to facial paralysis involves neurotization procedures (nerve transfers and cross-facial nerve grafts), muscle transpositions, and microsurgical free muscle transfers. Rehabilitation provides patients with the possibility of effectively controlling their symptoms and improving their facial function, even in cases of longstanding paresis. Considering the mental health problems and significant social impediments, more attention should be devoted to the role of psychological interventions. Given that each technique has its advantages and pitfalls, the selection of the treatment approach should be individualized in the case of each patient.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

A Comprehensive Approach to Facial Reanimation: A Systematic Review

Pinkiewicz

Dorobisz

Zatoński

2022

JCM

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“…Previous findings indicate that inflammation and edema of the facial nerve are part of the pathogenesis in patients with BP ( 19 , 20 ). Similar to the effect of corticosteroids on BP, the effect of acupuncture may be related to its anti-inflammatory effect.…”

Section: Discussionmentioning

confidence: 98%

Early intervention with acupuncture improves the outcome of patients with Bell's palsy: A propensity score-matching analysis

Yang

Zhou²,

Zheng³

et al. 2022

Front. Neurol.

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ObjectiveAlthough acupuncture is widely used as a complementary therapy in the treatment of Bell's palsy (BP) when to initiate acupuncture is still controversial. This study aims to determine the efficacy of the early intervention by acupuncture on BP.MethodsWe retrospectively gathered clinical data from the Third Affiliated Hospital of SUN-YAT SEN University between 2016 and 2021. We selected newly diagnosed patients with BP who were diagnosed by registered neurologists or acupuncturists formally. The qualified patients were divided into two groups according to whether or not initial acupuncture treatment was given within 7 days from the onset of palsy. Cohorts were balanced using 1:1 propensity score matching (PSM). Cox proportional hazards modeling and Kaplan–Meier analysis were applied to determine the differences between the two groups. The outcome included time to complete recovery of facial function, the rate of complete recovery, and the occurrence of sequelae in 24 weeks.ResultsA total of 345 patients were eligible for this study and were divided into the manual acupuncture/electroacupuncture (MA/EA) group (n = 76) and the EA group (n = 125). In the propensity score-matched cohort, the time to complete recovery was significantly shorter in the MA/EA group compared with the patients in the EA group (hazard ratio 1.505, 95% CI 1.028–2.404, p <0.05). The MA/EA group had a higher rate of favorable outcomes at 12 weeks than the EA group (93.4 vs. 80.3%, p = 0.032), and the occurrence of sequelae at 24 weeks showed a greater reducing trend in the MA/EA group than the EA group (6.6 vs. 16.4%, p = 0.088).ConclusionAcupuncture intervention at the acute stage of BP could shorten the time to recovery and improve the outcome.Clinical trial registrationhttp://www.chictr.org.cn, identifier ChiCTR 2200058060.

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“…Although a diagnosis of exclusion, a sufficient level of diagnostic certainty is achieved with a thorough clinical history, physical examination, and appropriate follow up to eliminate alternative causes of seventh cranial nerve palsy. 1,2 Most patients show signs of improvement within 2-3 months. Failure to improve or the development of atypical or new symptoms or signs requires investigation.…”

Section: Discussionmentioning

confidence: 99%

“…Failure to improve or the development of atypical or new symptoms or signs requires investigation. 2,5,6 Eye physicians are in a unique position to detect cases that do not fit the profile of idiopathic facial paralysis because they are called upon to manage the ocular complications of impaired eyelid closure. Table 1 provides select observations of the clinical history, head and face examination, and follow up that suggest diagnoses other than idiopathic facial nerve paralysis.…”

Section: Discussionmentioning

confidence: 99%

Bell’s Palsy and the Peril of Eponyms

Margo¹

2021

Ophthalmic Plastic &Amp; Reconstructive Surgery

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The seemingly mundane management of a Bell's palsy can have devastating consequences if the diagnosis of nonidiopathic cranial nerve palsy is not kept in perspective. The case of an elderly man mislabeled by a primary care physician as having a Bell's palsy illustrates how eye physicians can prevent an adverse outcome. Unilateral incomplete eyelid exposure and ipsilateral progressive pain were this patient's main problems for roughly 18 months during which time ophthalmologists managed his corneal exposure but failed to appreciate a parotid gland tumor. Eye physicians are in a unique position to recognized if a nonidiopathic cause of seventh cranial nerve palsy exists because they manage problems with corneal exposure. Replacing Bell's palsy with the term idiopathic facial nerve palsy may heighten awareness that other causes of seventh cranial nerve palsy must be considered, but recounting an adverse outcome may also be a valuable learning experience.

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Facial Nerve Palsy: Clinical Practice and Cognitive Errors

Cited by 29 publications

References 25 publications

A Comprehensive Approach to Facial Reanimation: A Systematic Review

A Comprehensive Approach to Facial Reanimation: A Systematic Review

Early intervention with acupuncture improves the outcome of patients with Bell's palsy: A propensity score-matching analysis

Bell’s Palsy and the Peril of Eponyms

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