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The Facial Nerve
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Christopher Skilbeck, Samuel MacKeith
Management of facial nerve paralysis following trauma is often deferred until the patient is medically stable. Facial nerve paralysis can result from stab wounds to the face or mandibular fractures. If possible, it is advisable to explore the region within 3 days as a nerve stimulator may be used to identify the distal nerve branches. With gunshot wounds care must be taken when assessing facial nerve function as there is often significant facial oedema and both muscle tone and eye closure appear adequate when in fact they are not. For temporal bone fractures see Chapter 19.
Common otology viva topics
Published in Joseph Manjaly, Peter Kullar, Advanced ENT Training, 2019
Patients with acute onset, complete facial nerve paralysis should be reassessed around 10 days after the injury to allow for Wallerian degeneration to take place. The degree of injury can be assessed clinically with facial motion and electrodiagnostic tests using the facial nerve stimulator, ENoG or EMG. EMG is the gold standard.
Facial nerve—a clinical and anatomical review
Published in J. Belinha, R.M. Natal Jorge, J.C. Reis Campos, Mário A.P. Vaz, João Manuel, R.S. Tavares, Biodental Engineering V, 2019
Fernand Gentil, J.C. Reis Campos, Marco Parente, C.F. Santos, Bruno Areias, R.M. Natal Jorge
The study of facial nerve becomes extremely complex for your anatomy and pathophysiology. Despite the diagnostic tests present some limitations are of particular interest in guiding therapy, prognosis and recovery of facial nerve paralysis. A good knowledge of facial nerve anatomy is very important to avoid its inadvertent injury during procedures such as maxillofacial and other related with the oral cavity (Myckatyn & Mackinnon, 2004).
Oral competence following facial nerve paralysis: Functional and quality of life measures
Published in International Journal of Speech-Language Pathology, 2021
There are a diverse range of approaches which seek to address the deficits arising from facial nerve paralysis. Their complexity has been reviewed in Sahovaler, Yeh, & Yoo, 2017, where multiple variables lead to inconsistencies in the outcomes reported, particularly in the oncology setting. Synkinesis, the involuntary activation of unrelated facial muscular units along with an intended movement also requires consideration and management by the intervening clinician for those with non-flaccid facial paralysis. Although a combined approach of physiotherapy and botulinum toxin has been found to reduce synkinesis and enhance facial function, there are inconsistencies in the outcome data due to number and differences in variables relating to dose and treatment intervals. Evaluation of functional outcomes following facial nerve restoration is further complicated by an inconsistency in the measurement tools implemented by clinicians. In a review conducted by Dong et al. (2018), the majority of studies used subjective ratings of facial expression which did not adequately examine other features such as oral competence, speech and quality of life.
Bilateral facial palsy
Published in Acta Oto-Laryngologica, 2019
Junyang Jung, Dong Choon Park, Su Young Jung, Myung Jin Park, Sang Hoon Kim, Seung Geun Yeo
Age at onset of bilateral facial paralysis ranged from 8–67 years. Of the 49 patients identified by sex, 33 (67.3%) were male and 16 (32.6%) were female. The causes of the disease were trauma, infectious, systemic, autoimmune, idiopathic, toxic, iatrogenic, metabolic, genetic, congenital, and others (Table 1). Of the 75 patients, 65 (86.6%) had symmetric and 10 (13.3%) has asymmetric facial paralysis. Six of 10 patients had more severe facial paralysis on the right side and four had more severe facial paralysis on the left side. Bilateral facial paralysis was accompanied by paralysis of other cranial nerves; of the 43 patients analyzed, 21 (49%) had facial nerve paralysis, and 22 (51%) had paralysis of other nerves. The sixth nerve (16 patients) was the most common accompanying cranial nerve, followed by the fifth (6 patients), twelfth (6 patients), third (5 patients), fourth (2 patients), eighth (1 patient), and eleventh (1 patient) nerve.
Successful Treatment of Interdigitating Dendritic Cell Sarcoma Presenting as Multiple Parotid Tumors
Published in Acta Oto-Laryngologica Case Reports, 2019
Yasuyuki Kajimoto, Naoki Otsuki, Masanori Teshima, Yukiko Morinaga, Tomoo Itoh, Ken-Ichi Nibu
An 82-year-old woman presented at our hospital with one month-long history of painful masses in her right parotid gland without other symptoms. She had no history of smoking or alcohol consumption. On physical examination, two elastic, hard, and mobile masses in her right parotid gland; one was in the upper pole and the other was in the lower pole of the parotid gland. Facial nerve paralysis was not observed and no remarkable findings were observed in ears, nose, oral cavity, and laryngopharynx. Compute tomography (CT) showed three solid masses in the parotid gland (Figure 1(A,B)). No malignant findings were obtained from fine needle aspiration cytology from the mass of the lower end. Based on these findings, we suspected Warthin’s tumor and decided to follow up with the patient’s wishes carefully. However, the mass in the lower pole of the parotid gland had enlarged over the course of 3 months after her first visit. Magnetic resonance imaging (MRI) showed enlarged masses in the parotid gland and lymphadenopathy in Level IIA (Figure 1(C,D,E,F)). Since the malignant tumor was suspected from the clinical course, we initially planned total parotidectomy with facial nerve preservation and modified radical neck dissection. However, the upper tumor invaded the zygomatic branch (Figure 2(A)) and the lower tumor was very close to the mandibular branch. Intraoperative frozen section of the lymph node of level IIA suggested the non-epithelial malignant tumor. Considering these findings, we decided to enucleate the tumor in the lower end and to resect the tumor in the upper-end part.