Facial Neuropathy With Imaging Enhancement of the Facial Nerve: A Case Report

Mumtaz, Sehreen; Jensen, Matthew B.

doi:10.2217/fnl.14.55

Cited by 7 publications

(8 citation statements)

References 26 publications

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“…Although imaging is among the first‐line diagnostic methods for lesion detection, it is not recommended for Bell's palsy, and a clinical diagnosis is considered sufficient 31 . A common MRI finding in acute Bell's palsy is facial nerve labyrinthine segment enhancement, which can persist for several months or longer after symptom onset 32,33 . Notably, there are rare cases of malignancy with perineural invasion that can present simply as facial nerve enhancement without a mass, such as in adenoid cystic carcinoma, which is indistinguishable from typical nerve enhancement 34 .…”

Section: Discussionmentioning

confidence: 99%

The Rate of Occult Lesion Diagnosis in a Large Bell's Palsy Cohort

Kalavacherla

Cos

et al. 2023

The Laryngoscope

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ObjectivesWe characterize occult lesion diagnosis rates after initial Bell's palsy diagnoses.MethodsA de‐identified database of all facial palsy patients who presented to an extensive health care system across 22 years was created using Epic SlicerDicer. Among patients with Bell's palsy diagnoses, we extracted demographic and any subsequent occult lesion diagnosis data across various clinical sites. Descriptive and multivariable regression analyses comparing patients with occult lesion diagnoses made at different time points were included.ResultsAmong the total 3912 facial palsy patients, 2240 had Bell's palsy diagnoses, of which 217 (9.7%) had subsequent lesion diagnoses at a median (IQR) of 12.3 (4.2, 23.8) months, consisting of cranial nerve neoplasms (62.2%), parotid gland neoplasms (34.1%), and cholesteatomas (3.7%). Although a large proportion of total lesions were diagnosed within the first 3 months (19.8%), 69.5% were diagnosed after 6 months. There were no demographic differences among patients diagnosed with different lesion types, but Asian patients were more likely to be diagnosed with occult lesions after 12 months after Bell's palsy diagnosis compared with white patients (odds ratio = 6.2, p = 0.001).ConclusionsIn one of the largest Bell's palsy cohorts to date, we identified a 9.7% occult lesion diagnosis rate at a median of 12.3 months after Bell's palsy diagnosis. These data underscore the importance of timely workup for occult lesions in cases of facial palsy with no signs of recovery after 3–4 months.Level of Evidence4 Laryngoscope, 2023

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Section: Discussionmentioning

confidence: 99%

The Rate of Occult Lesion Diagnosis in a Large Bell's Palsy Cohort

Kalavacherla

Cos

et al. 2023

The Laryngoscope

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“…Medical practitioners who strongly suspect Bell’s palsy as the cause for facial paralysis do not need to request radiological imaging for confirmation of the diagnosis [ 28 ]. Although magnetic resonance imaging (MRI) often shows facial nerve enhancement, it does not influence the medical management and therefore it is not recommended [ 32 , 33 ].…”

Section: Diagnosismentioning

confidence: 99%

Acute Facial Nerve Palsy in Children: Gold Standard Management

et al. 2022

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Facial nerve palsy (FNP) is a common illness in the paediatric emergency department. Missed or delayed diagnosis can have a serious impact on a patient’s quality of life. The aim of this article is to give a recent overview of this pathology in terms of the causes, diagnosis, red flag symptoms, complementary examinations, treatments and follow-up in the child population. In cases of acquired, acute onset and isolated FNP, Bell’s palsy can be assumed, and no further investigation is required. In any other scenario, complementary examinations are required. Treatment depends on the aetiology. Corticosteroids, in addition to antiviral medication, are recommended to treat Bell’s palsy whenever a viral infection is suspected. However, the lack of randomised control trials in the paediatric population does not allow us to comment on the effectiveness of these treatments. In all cases, treated or not, children have a very good recovery rate. This review emphasises the necessity of randomised control trials concerning this frequent neurological pathology in order to better treat these children.

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“…Труднощі в лікуванні нейропатій черепних і периферичних нервів вимагають від морфологів комплексного вивчення їх компонентів (нервових волокон, мікросудин і сполучнотканинних елементів) як у нормі, так і за патології (Gitik et al, 2011;Ali et al, 2015;Hamel and Logigian, 2017). При цьому вивчення гісто-ультраструктури лицевого нерва посідає одне з провідних місць у нейроморфології (Reina et al, 2015), оскільки його нейропатії складають 2-3% всіх захворювань периферичної нервової системи (Mumtaz and Jensen, 2014) і зустрічаються найчастіше серед уражень черепних нервів (Fayad and Linthicum, 2014;Azizzadeh et al, 2014).…”

Section: вступunclassified

“…У літературі існує протиріччя щодо характеру патологічних змін у мієлінових нервових волокнах за холодової нейропатії (Nawaz et al, 2013;Mumtaz and Jensen, 2014;Cohen et al, 2015). Одні дослідники відносять ці зміни до первинних, визнаючи при цьому виражений характер деструкції, швидкоплинність і зворотність процесів (Achiron and Miron, 2007).…”

Section: вступunclassified

“…Такі зміни нервових волокон, як це доведено Mumtaz and Jensen (2014), Tuhrim (2016), Hamel and Logigian (2017),результат не тільки їх безпосереднього ушкодження холодовим фактором, а й впливу механічного подразнення (компресія розширеними кровоносними судинами та навколишніми тканинами, які перебувають у стані локального набряку, а також внаслідок розтягування та розшарування міжм'язових сполучнотканинних прошарків). Оскільки тварин цієї серії досліду досліджували в ранній термін, в який ще не могло відбутися суттєвих органічних змін внутрішньої структури нервових волокон, виникнення їх локальних потовщень і потоншень у даному випадку можна розглядати як результат дії на нерв винятково змін, що відбуваються в навколишніх м'язах (Popel', 2017).…”

Section: обговоренняunclassified

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Hysto-ultrastructure of the facial nerve and mimic muscles in the norm and in the conditions of eхperimental neuropathy

Myhailiuk¹,

Mykhailiuk²,

Hembarovskyi³

et al. 2017

Regul. Mech. Biosyst.

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We studied the structural components of the facial nerve in the norm and with cold neuropathy, indicating morphological changes in neuromuscular endings and muscle fibers at 10, 15, 30 and 60 days from the beginning of the simulation of experimental neuropathy, which was caused by local supercooling of the projection portions of the extracranial parts of the facial nerve on the background of the preliminary introduction of Freud’s complete adjuvant. We established that the pathomorphological changes in the endonevral microcirculatory bed have a phase character: the initial spasm (up to 10 days) changes in paralytic vasodilation, and its residual effects remain until the end of the experiment (60 days). Changes in hemomicrocirculation conditions lead to marked disturbances in the structure of myelinic nerve fibers, which have the character of segmental demyelination with signs of delay in axonal transport and reactive restructuring of neuromuscular endings. The change in the metric composition of myelinated nerve fibers is due to an increase in the number of nerve fibers of medium and large diameters (up to 30 days) and small diameter (after 30 days). In different periods of the experiment, a decrease in the branching area of the terminal branches of the motor axon is observed in the nerve cells, local edema of the endonevria, degenerative changes in a part of the nerve fibers develop. Due to the fine-grained decay of the final nerve branches, degeneration of the motor endings took place two weeks after the start of the experiment. Neuropathy for 30 days caused a pronounced inhibition of spotting in the peripheral parts of the motor nerve fibers. After 60 days of experiment, a large number of muscle fibers underwent destructive changes. The size of a significant part of the neuromuscular endings was reduced. In all terms of cold neuropathy, neurolematocytes reacted in the same way: cytoplasm was swollen, argyrophilic grains appeared in the nuclei, fine-grained decay of individual nuclei occurred.

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Facial Neuropathy With Imaging Enhancement of the Facial Nerve: A Case Report

Cited by 7 publications

References 26 publications

The Rate of Occult Lesion Diagnosis in a Large Bell's Palsy Cohort

The Rate of Occult Lesion Diagnosis in a Large Bell's Palsy Cohort

Acute Facial Nerve Palsy in Children: Gold Standard Management

Hysto-ultrastructure of the facial nerve and mimic muscles in the norm and in the conditions of eхperimental neuropathy

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