Surgery for Bell's Palsy

Fisch, Ugo

doi:10.1001/archotol.1981.00790370003001

Cited by 242 publications

(151 citation statements)

References 3 publications

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“…MRI enhancement of the facial nerve in Bell's palsy after administration of gadopentetate dimeglumine has been explained by hypervascularity of the perineural structures and formation of an increased vascular pool of contrast material, and/or disruption of the blood-nerve barrier by acute inflammation [12]. The strangulation of the nerve is more likely to take place at its labyrinthine portion and probably at the meatal foramen (the canalicular entrance to the labyrinthine segment of the facial nerve canal), which is the narrowest site of the bony canal where the loosely arranged intrameatal fibers of the facial nerve are constricted by a fibrous ligament [13,14].…”

Section: Discussionmentioning

confidence: 99%

Is There a Relationship Between Bell’s Palsy and Internal Auditory Canal?

Yılmaz

Yalcin

Çakan

et al. 2014

Indian J Otolaryngol Head Neck Surg

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In the present study, we evaluated the diameter of internal acoustic canal in patients with Bells palsy to investigate the role of anatomical differences of the temporal bone in etiology of Bell's palsy. Sixty-four patients who were diagnosed as Bells Palsy and temporal bone computed tomography imagings of them were included into the study group (Group 1). The control group (Group 2) was consisted of 35 healthy subjects without Bell's Palsy. All patients had temporal bone computed tomography imaging. The internal auditory canal inlet, mid-canal, outlet and canal lengths were measured at the most distinctive cross-section of the seventh and eighth cranial nerves bifurcation. In the study group, Bells palsy was on the right side in 26 patients (40.6 %) and on the left side in 38 patients (59.4 %). Initial House-Brackmann (HB) score was HB-2 in 29 patients (45.3 %), HB-3 in 18 patients (28.1 %), HB-4 in 13 patients (20.3 %) and HB-5 in 4 patients (6.2 %). At 6-month evaluation, HB-score of the patients were HB-1 in 37 patients (57.8 %), HB-2 in 25 patients (39.1 %) and HB-3 in 2 patients (3.1 %). Internal auditory canal (IAC) measurements of the groups showed that there were no significant differences between the measurements of right-mid canal, right canal length; and left canal outlet and left canal length of the study and control groups. Right inlet and outlet; and left inlet and mid-canal values of the study group (Bell's palsy) were significantly lower than those of the control group. In Bell's palsy group, left inlet, outlet and canal length values were significantly higher than those of the right ones. Correlation analysis showed that there were no significant correlation between paralysis side; initial HB stage; and IAC measurement results. In patients with higher initial HB score, their 6-month later HB-score was also higher. In patients with higher 6-month HB score; R canal inlet, R mid-canal, L-canal inlet, and L-mid canal values were lower. Lower IAC inlet and mid-canal values were detected in patients with Bell's palsy. Therefore narrow IAC inlet and mid-canal values may be one of the risk factors for Bell's palsy.

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Section: Discussionmentioning

confidence: 99%

Is There a Relationship Between Bell’s Palsy and Internal Auditory Canal?

Yılmaz

Yalcin

Çakan

et al. 2014

Indian J Otolaryngol Head Neck Surg

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“…[8] When the translabyrinthine or middle fossa approach is used for tumor resection, decompression of the IAC from the meatal foramen to the geniculate ganglion may help to prevent delayed "entrapment" of the facial nerve. [5,7] Fisch [3] has described the meatal foramen as the narrowest segment of the IAC and suggested it was the site of greatest compression during Bell's palsy. This same pathophysiological mechanism may be used to explain why delayed facial nerve palsy is seen after acoustic surgery.…”

Section: Discussionmentioning

confidence: 99%

Late-onset facial nerve degeneration after vestibular schwannoma surgery: incidence, putative mechanisms, and prevention

Sampath

Rhines²,

Holliday³

et al. 1998

FOC

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Delayed facial nerve dysfunction after vestibular schwannoma surgery is a poorly understood phenomenon that has been reported to occur in 15 to 29% of patients undergoing microsurgery. It is a condition characterized by spontaneous deterioration of facial nerve function in a patient who has otherwise normal or near-normal facial function in the immediate postoperative period. This delayed paralysis is generally reported to occur in the first few days postsurgery, with the majority of patients eventually recovering their immediate postoperative facial function. However, infrequently, it can also occur more than 1 week after surgery (so-called late-onset facial nerve palsy). The authors reviewed facial nerve outcome in 611 patients who underwent microsurgery between 1973 and 1994. The facial nerve was anatomically preserved in 596 patients (97.5%), and 90% of patients had House-Brackmann[6] Grade 1 or 2 function 1 year after surgery. Late-onset facial dysfunction was seen in 13 patients (2.1%). All of these had significant deterioration in facial nerve function between 1 and 4 weeks postoperatively, and all showed improvement by 1 year. In this study, the focus on these patients who developed late-onset facial palsy. The incidence, treatment strategies, and outcomes will be discussed with emphasis on possible pathophysiological mechanisms that contribute to this relatively rare condition.

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“…This conclusion has been based on previous findings in perioperative and magnetic resonance imaging studies, as well as the significantly better outcome after corticosteroid administration compared with placebo. [27][28][29][30] Peripheral nerves are vascularized by a longitudinal network of vessels linked by many anastomoses between the longitudinal vessels, allowing the blood flow to continue when individual segmental arteries are occluded. This is also the reason why a major impairment in blood flow is necessary to produce experimental ischemic nerve lesions.…”

Section: -26mentioning

confidence: 99%

The Role of Diabetes Mellitus in the Clinical Presentation and Prognosis of Bell Palsy

Riga

Kefalidis

Danielides

2012

The Journal of the American Board of Family Medicine

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Background: Bell palsy is considered to be an entrapment neuropathy resulting from inflammation, edema, and strangulation. Diabetes, hypertension, and hypercholesterolemia have all been related to microangiopathies. However, the relationship between the frequency, severity, and recovery course of Bell palsy in patients with these pathologies is a matter of controversy.Methods: Fifty-six patients with Bell palsy were evaluated according to the House-Brackmann grading system a few days after the onset of the disease and 6 months later and correlated to their hypertension, hypercholesterolemia, and diabetes records. Diabetes was evaluated by the use of serum glycosylated hemoglobin (HbA1c).Results: The 20 patients with abnormal HbA1c values were more frequently diagnosed with Bell palsy of grade V/VI (P ‫؍‬ .008; odds ratio, 4.7; 95% CI, 1.4 -15.2). However, their House-Brackmann scores were not found to be worse at the 6-month follow-up visit (P ‫؍‬ .9). No correlations were found for hypertension and hypercholesterolemia.Conclusions: A relationship between the severity of Bell palsy and abnormal HbA1c values seems to be demonstrated. However, the prognosis of these patients does not seem to be worse because at the 6-month follow-up visit they present similar scores to nondiabetic patients. (J Am Board Fam Med 2012;25:819 -826.)

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Surgery for Bell's Palsy

Cited by 242 publications

References 3 publications

Is There a Relationship Between Bell’s Palsy and Internal Auditory Canal?

Is There a Relationship Between Bell’s Palsy and Internal Auditory Canal?

Late-onset facial nerve degeneration after vestibular schwannoma surgery: incidence, putative mechanisms, and prevention

The Role of Diabetes Mellitus in the Clinical Presentation and Prognosis of Bell Palsy

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