Facial Nerve Palsy: Evaluation by Contrast-enhanced MR Imaging

Kinoshita, Toshibumi; Ishii, Kiyoshi; Okitsu, Takuji; Okudera, Toshio; Ogawa, Toshihide

doi:10.1053/crad.2001.0730

Cited by 76 publications

(57 citation statements)

References 10 publications

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“…In fact, this enhancement may be confused with another process such as a small tumor of the facial nerve or other incidental findings, leading to further unnecessary testing. 55 In addition, imaging is costly and associated with potential risk. [56][57][58][59] Magnetic resonance imaging and CT scans do have some risks as well as considerable cost.…”

Section: Supporting Textmentioning

confidence: 99%

Clinical Practice Guideline: Bell's Palsy

Baugh

Basura

Ishii

et al. 2013

Otolaryngol.--head neck surg.

389

114

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Objective Bell’s palsy, named after the Scottish anatomist, Sir Charles Bell, is the most common acute mono-neuropathy, or disorder affecting a single nerve, and is the most common diagnosis associated with facial nerve weakness/paralysis. Bell’s palsy is a rapid unilateral facial nerve paresis (weakness) or paralysis (complete loss of movement) of unknown cause. The condition leads to the partial or complete inability to voluntarily move facial muscles on the affected side of the face. Although typically self-limited, the facial paresis/paralysis that occurs in Bell’s palsy may cause significant temporary oral incompetence and an inability to close the eyelid, leading to potential eye injury. Additional long-term poor outcomes do occur and can be devastating to the patient. Treatments are generally designed to improve facial function and facilitate recovery. There are myriad treatment options for Bell’s palsy, and some controversy exists regarding the effectiveness of several of these options, and there are consequent variations in care. In addition, numerous diagnostic tests available are used in the evaluation of patients with Bell’s palsy. Many of these tests are of questionable benefit in Bell’s palsy. Furthermore, while patients with Bell’s palsy enter the health care system with facial paresis/paralysis as a primary complaint, not all patients with facial paresis/paralysis have Bell’s palsy. It is a concern that patients with alternative underlying etiologies may be misdiagnosed or have unnecessary delay in diagnosis. All of these quality concerns provide an important opportunity for improvement in the diagnosis and management of patients with Bell’s palsy. Purpose The primary purpose of this guideline is to improve the accuracy of diagnosis for Bell’s palsy, to improve the quality of care and outcomes for patients with Bell’s palsy, and to decrease harmful variations in the evaluation and management of Bell’s palsy. This guideline addresses these needs by encouraging accurate and efficient diagnosis and treatment and, when applicable, facilitating patient follow-up to address the management of long-term sequelae or evaluation of new or worsening symptoms not indicative of Bell’s palsy. The guideline is intended for all clinicians in any setting who are likely to diagnose and manage patients with Bell’s palsy. The target population is inclusive of both adults and children presenting with Bell’s palsy. Action Statements The development group made a strong recommendation that (a) clinicians should assess the patient using history and physical examination to exclude identifiable causes of facial paresis or paralysis in patients presenting with acute-onset unilateral facial paresis or paralysis, (b) clinicians should prescribe oral steroids within 72 hours of symptom onset for Bell’s palsy patients 16 years and older, (c) clinicians should not prescribe oral antiviral therapy alone for patients with new-onset Bell’s palsy, and (d) clinicians should implement eye protection for Bell’s palsy patients with impaired eye closure. The panel made recommendations that (a) clinicians should not obtain routine laboratory testing in patients with new-onset Bell’s palsy, (b) clinicians should not routinely perform diagnostic imaging for patients with new-onset Bell’s palsy, (c) clinicians should not perform electrodiagnostic testing in Bell’s palsy patients with incomplete facial paralysis, and (d) clinicians should reassess or refer to a facial nerve specialist those Bell’s palsy patients with (1) new or worsening neurologic findings at any point, (2) ocular symptoms developing at any point, or (3) incomplete facial recovery 3 months after initial symptom onset. The development group provided the following options: (a) clinicians may offer oral antiviral therapy in addition to oral steroids within 72 hours of symptom onset for patients with Bell’s palsy, and (b) clinicians may offer electrodiagnostic testing to Bell’s palsy patients with complete facial paralysis. The development group offered the following no recommendations: (a) no recommendation can be made regarding surgical decompression for patients with Bell’s palsy, (b) no recommendation can be made regarding the effect of acupuncture in patients with Bell’s palsy, and (c) no recommendation can be made regarding the effect of physical therapy in patients with Bell’s palsy.

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Section: Supporting Textmentioning

confidence: 99%

Clinical Practice Guideline: Bell's Palsy

Baugh

Basura

Ishii

et al. 2013

Otolaryngol.--head neck surg.

389

114

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“…However, the major disadvantage of EPS is its inability to detect diagnostic abnormalies of the nerve distal to the stylomastoid foramen within 1 week of symptom onset. 1 Although the potential of MR imaging has been studied as part of the effort to find other helpful diagnostic techniques over the past 20 years, [2][3][4][5][6][7][8][9][10] its results have been largely disappointing. Gd-DTPA-enhanced T1-weighted spin-echo and 3D spoiled gradient-echo sequences have shown significant limitations in diagnosing and predicting outcomes in patients with facial neuritis; the geniculate ganglion, tympanic, or mastoid segment of the normal facial nerve can be significantly enhanced in up to 76% of patients due to the distribution of arteriovenous plexus along the facial nerve, which, in turn, may inhibit evaluation of the pathologic enhancement of the nerves resulting from breakdown of the blood nerve barrier.…”

mentioning

confidence: 99%

“…Gd-DTPA-enhanced T1-weighted spin-echo and 3D spoiled gradient-echo sequences have shown significant limitations in diagnosing and predicting outcomes in patients with facial neuritis; the geniculate ganglion, tympanic, or mastoid segment of the normal facial nerve can be significantly enhanced in up to 76% of patients due to the distribution of arteriovenous plexus along the facial nerve, which, in turn, may inhibit evaluation of the pathologic enhancement of the nerves resulting from breakdown of the blood nerve barrier. [10][11][12] Thus, MR imaging plays a limited role in the diagnosis and provision of prognostic information of facial neuritis. 3,7 Recently, a new isotropic 3D-T2-weighted imaging technique, the 3D turbo spin-echo sequence with variable flip angles (VISTA, sampling perfection with application optimized contrast using different flip angle evolution [SPACE], or Cube), was introduced on the 3T MR system.…”

mentioning

confidence: 99%

MR Diagnosis of Facial Neuritis: Diagnostic Performance of Contrast-Enhanced 3D-FLAIR Technique Compared with Contrast-Enhanced 3D-T1-Fast-Field Echo with Fat Suppression

Lim¹,

Lee²,

Hyun³

et al. 2011

AJNR Am J Neuroradiol

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“…For example, the geniculate ganglion, tympanic or mastoid segment of the normal facial nerve may be significantly enhanced in up to 76% of patients due to the distribution of arteriovenous plexus along this facial nerve (6,7). This, in turn, may block evaluation of the relatively minor pathologic enhancement of the nerves resulting from breakdown of the blood nerve barrier on conventional MR images (6,7). Thus, compared with EPS, MRI plays a limited role in the diagnosis and evaluation of patients with facial neuritis (8).…”

Section: Original Articlementioning

confidence: 99%

Enhancement Pattern of the Normal Facial Nerve on Three - Dimensional (3D) - Fluid Attenuated Inversion Recovery (FLAIR) Sequence at 3.0 T MR Units

Hyun

Lim

Park

et al. 2012

J Korean Soc Magn Reson Med

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Purpose :To compare the enhancement pattern of normal facial nerves on 3D-FLAIR and 3D-T1-FFE-F) sequences at 3.0 T MR units. Materials and Methods:We assessed 20 consecutive subjects without a history of facial nerve abnormalities who underwent temporal bone MRI with contrast enhancement between January 2008 and March 2009. Two neuroradiologists independently reviewed pre-/post-enhanced 3D-T1-FFE-FS and 3D-FLAIR images respectively with 2-week interval to assess the enhancement of normal facial nerves divided into five anatomical segments. The degree of enhancement in each segment was graded as none, mild or strong, and the results of 3D-FLAIR and 3D-T1-FFE-FS image sets were compared.Results: On 3D-FLAIR images, one of the two reviewers observed mild enhancement of the genu segment in two (10%) subjects. On 3D-T1-FFE-FS images, at least one segment of the facial nerve was enhanced in 13 (65%) subjects. At least one reviewer found that 17 of the 100 segments showed enhancement on 3D-T1-FFE-FS images, with the mastoid segment being the most commonly enhanced. Interobserver agreement on 3D-T1-FFE-FS images was good for enhancement of the normal facial nerve (κ= 0.589). Conclusion:In contrast to 3D-T1-FFE-FS, normal facial nerve segments rarely showed enhancement on 3D-FLAIR images.

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Facial Nerve Palsy: Evaluation by Contrast-enhanced MR Imaging

Cited by 76 publications

References 10 publications

Clinical Practice Guideline: Bell's Palsy

Clinical Practice Guideline: Bell's Palsy

MR Diagnosis of Facial Neuritis: Diagnostic Performance of Contrast-Enhanced 3D-FLAIR Technique Compared with Contrast-Enhanced 3D-T1-Fast-Field Echo with Fat Suppression

Enhancement Pattern of the Normal Facial Nerve on Three - Dimensional (3D) - Fluid Attenuated Inversion Recovery (FLAIR) Sequence at 3.0 T MR Units

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