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Evaluation of Clinical Outcome in Traumatic Facial Nerve Paralysis
2021
Introduction The facial nerve is the most commonly paralyzed nerve in the human body, resulting in far-reaching functional, aesthetic and emotional concerns to the patient. Objective Evaluation of the clinical outcome of 47 patients with traumatic facial nerve paralyses, with respect to clinical recovery and audiological sequelae. Methods A descriptive longitudinal study was conducted over 24 months between January 2017 and December 2018 at a tertiary center with detailed clinical, topodiagnostic, audiometric and radiological evaluation and regular follow-up after discharge. Results Road traffic accidents constituted 82.98% of the trauma cases, out of which 76.60% were found to be under the influence of alcohol. Delayed facial paralysis was observed in 76.60% cases. Temporal bone fracture was reported in 89.36%, with otic capsule (OC) sparing fractures forming 91.49% of the cases. Topologically, the injury was mostly at the suprachordal region around the second genu. The majority of...
Nonsurgical Treatment for Posttraumatic Complete Facial Nerve Paralysis
JAMA otolaryngology-- head & neck surgery, 2018
Current recommendations envisage early surgical exploration for complete facial nerve paralysis associated with temporal bone fracture and unfavorable electrophysiologic features (response to electroneuronography, <5%). However, the evidence base for such a practice is weak, with the potential for spontaneous improvement being unknown, and the expected results from alternative nonsurgical treatment also undefined. To document the results of nonsurgical treatment for posttraumatic complete facial paralysis with undisplaced temporal bone fracture and unfavorable electrophysiologic features. Prospective cohort study recruiting from April 2010 to April 2013 at a tertiary care university hospital. Follow-up continued until 9 months or until complete recovery if earlier. Study group included 28 patients with head injury-associated complete unilateral facial nerve paralysis with unfavorable results of electroneuronography (<5% response) with or without undisplaced temporal bone fract...
Recovery of Facial Nerve Paralysis After Temporal Nerve Reconstruction: A Case Report
Trauma Monthly, 2015
Introduction: Facial paralysis is common following accidents, trauma, viral infection or tumors. Case Presentation: A 24-year-old male patient was referred to us with a history of sharp penetrating trauma to the right temporal region causing unilateral paralysis of the muscles of the right forehead. He was unable to scowl or elevate his right eyebrow and there were no folds on his right forehead. Anastomosis of branches of the temporal nerve was done one month after trauma following regular physical therapy sessions, outcome was good and paralysis of the muscles of the right forehead improved after several months. Conclusions: Immediate repair of the facial nerve injury will improve the process of recovery and rehabilitation of the face and forehead muscles and may play a very important role in the patient's mental satisfaction and improve their quality of life.
Facial Paralysis after Trauma: A Simplified Method to Find and Repair the Facial Nerve
Otolaryngology, 2018
This study aims to identify the digastric nerve as an alternative to access the facial nerve in case of post-traumatic facial nerve paralysis. Study design Retrospective study. Setting Tertiary care hospital. Subjects and Methods Eleven peripheric facial paralysis cases between 2005-2016 following trauma to the parotid gland are presented. Initial emergency treatments were done elsewhere but all returned back to treat facial paralysis after 11-18 months to our institute. The digastric nerve was identified and a facial-hypoglossal nerve anastomosis was performed. Results Pre-operative House-Brackmann scores were 6 for all cases. Post-operative scores were between 3 and 4. Pre-operative needle electromyography revealed no motor unit action potentials; after 7 months post-operatively, we had motor unit action potentials in every case. Conclusion In cases of trauma and secondary approaches of the parotid gland, a safe step for finding the facial nerve is to find the digastric nerve and follow it through the main trunk.
International Journal of Surgery Case Reports, 2021
INTRODUCTION: Facial nerve (the seventh cranial nerve) injury causes functional, aesthetic, and psychological difficulties. The second most common cause of facial nerve palsy is trauma. PRESENTATION OF CASES: A previously healthy 21-year-old worker, was brought to emergency room after car accident, with complete paralysis of all muscles of the left side of his face. He was transferred to operating room. After anatomical determining the nerve, end-to-end manner was done. After nine month of follow up an excellent repair was seen. DISCUSSION: Traumatic facial nerve injury is usually accompanied by temporal bone fracture (up to 70 percent) but in some cases facial nerve is damaged without any fractures, and damage of facial nerve branches can happen due to laceration. Management of an injured facial nerve depends on its etiology. There are three main options for facial nerve repair; direct end-to-end coaptation, coaptation with an interposition graft and nerve transfer. Surgery exploration is indicated in patients with complete and immediate facial nerve paralysis and denervation more than 90 % electrophysiological findings. CONCLUSION: Traumatic facial nerve paralysis management is challenging considering operation in low resources countries. In this case early repair of facial nerve is beneficial and has a good to excellent prognosis in immediate complete damage of facial nerve even without accessibility to electroneurography or electromyography to estimate the severity of injury.
Facial Nerve Paralysis Caused by Birth Trauma
Folia Medica Indonesiana, 2004
Objective: To report a patient with lagophtalmos, shortening of the eyelids and blinking reflex disorders caused by birth trauma. Methods: A case report of a two-months-old baby girl was referred to our outpatient department with the main complain of blinking disorders since she was born. From heteroanamnesis the baby was born aterm, helped by midwife with forceps extraction technique. After birth baby was referred to the hospital due to severe asphyxia. Two weeks after the baby discharged from the hospital, her parents realized that there was abnormality in the baby 's eyelids such as shortening of the eyelids, blinking reflex disorders, the eyelids cannot be closed properly and there is no tears when the baby cries. The suckling reflex was good, but the baby showed typical mask like face. From the physical examination revealed poor visual acuity, but light reflex and ocular motility were normal. There were lagophtalmos, exposure keratitis, nebula cornea and negative Schirmer test in both eyes. Direct ophtalmoscope examination was normal in both eyes. EEG and MRI were normal but EMG revealed negative blinking reflex in both eyes. The baby is treated with artificial tears eye ointment and underwent surgery procedure (ANTERIOR LAMELLA REPOSITION and LEVATOR RESSES) to protect the cornea. Results: Although the exposure keratitis has disappeared with the treatment, unfortunately negative blinking reflex and other sequale caused by facial nerve paralysis remains occurred. Conclusion: A rare and difficult case of facial nerve paralysis caused by birth trauma has been reported. The treatment has successfully decreased the exposure keratitis. But the treatment of facial nerve paralysis is not in the realm of any one specialty. The intracranial, intra temporal and extra temporal lesion of the facial nerve required the skill and cooperation of multidisciplinary team.