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History Stations
Published in Peter Kullar, Joseph Manjaly, Livy Kenyon, Joseph Manjaly, Peter Kullar, Joseph Manjaly, Peter Kullar, ENT OSCEs, 2023
Peter Kullar, Joseph Manjaly, Livy Kenyon, Joseph Manjaly, Peter Kullar, Joseph Manjaly, Peter Kullar
The most common causes of facial weakness areBell's palsy (idiopathic facial nerve palsy)Ramsay Hunt syndrome (herpes zoster oticus)Neoplasia, e.g. parotid malignancyTrauma, e.g. birth trauma or skull base fractureInfection, e.g. AOM/CSOM or Lyme diseaseCongenitalCentral nervous system dysfunction, e.g. stroke
Neurological Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Bell's palsy is a benign, self-limiting, lower motor neurone facial weakness of unknown cause and is the most common lesion of a single cranial nerve. All facial muscles on that side are affected. It needs to be differentiated from more serious causes of a peripheral lesion, and from facial weakness resulting from a central lesion (e.g. hemisphere or brainstem), by the absence of other symptoms or signs.
Neurologic disorders in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Robert Burger, Terry Rolan, David Lardizabal, Upinder Dhand, Aarti Sarwal, Pradeep Sahota
Risk for Bell’s palsy is three times higher during late pregnancy and early puerperium, probably related to increased tendency for reactivation of herpes virus infection. Corresponding incidence is lower in early pregnancy and therefore overall frequency of Bell’s palsy is unaffected during pregnancy (30). Typical presentation is unilateral acute facial weakness, which progresses over 3 to 7 days. Increased lacrimation, alteration of taste, or hyperacusis may be present. There is no increase in recurrence rate during subsequent pregnancies. Gestational facial palsy is associated with increased occurrence of hypertension and pre-eclampsia, and close monitoring of affected women is recommended (30,31). Standard treatment with short course of prednisone, 1mg/kg for 5 days and acyclovir 400mg five times daily for 10days, is recommended except in the first trimester of pregnancy. Lubricating eye drops and eye patching are used to prevent corneal injury. Prognosis for recovery is excellent in patients with incomplete facial weakness; however, worse prognosis during pregnancy, noted in some reports, may reflect higher chance of severe facial palsy in third trimester.
Development of an open-source and free facial rehabilitation website for severe bell’s palsy: a within-subject study on user experience and patient’s compliance with the MEPP-website
Published in Disability and Rehabilitation, 2022
Sarah Martineau, Camille Rivest, Akram Rahal, Karine Marcotte
Bell’s palsy (BP) is one of the most common causes of abrupt onset of unilateral facial weakness in addition to stroke [1]. It is well documented that BP can have dramatic impacts on the lives of those affected, especially in incomplete recovery, when patients may be left with permanent disfiguring facial weakness, hemifacial spasms, and synkinesis [1,2]. Facial rehabilitation programs such as neuromuscular retraining (NMR; [3]) and mime therapy [4] have long been recognized as efficient for the treatment of permanent sequelae in chronic BP [5]. Additionally, a growing body of research has demonstrated the beneficial effects of early facial rehabilitation (combined with drug therapy) to support the recovery of BP [6–8]. If provided as early as two weeks after onset, facial rehabilitation could lead to better recovery with long-lasting effects [6].
Computer vision technology-based face mirroring system providing mirror therapy for Bell’s palsy patients
Published in Disability and Rehabilitation, 2020
Li Ding, Li Li, Zhimin Xu, Jing Tian, Shugeng Chen, Hewei Wang, Ming Yang, Xiao Cui, Lianying Cao, Jie Jia
Bell’s palsy (BP) engenders idiopathic paralysis, which is the most common cause of unilateral peripheral facial weakness [1]. The weakness generally spontaneously recovers within 6 months, but approximately 30% of patients without appropriate treatments may suffer from permanent facial disfigurement [2]. Regardless of the poor prognosis, even temporary deficit would affect physical and psychological health and emotional expression of patients during the repair process. Facial exercise, like mime therapy, is effective in enhancing facial function and shortening the treatment duration [3]. During the facial exercise, a mirror was used to enable the subjects to observe their movements, and increase their motor control and perception [4–7]. However, this kind of feedback acted as a motor observation which presented visual information during exercises.
Comparison of the efficacy of various doses of steroids for acute facial palsy
Published in Acta Oto-Laryngologica, 2019
Kuk Jin Nam, Mun Soo Han, Yong Jun Jeong, YoonChan Rah, June Choi
Although Bell palsy may be resolved spontaneously in most patients [1–4], physicians should focus on minimizing the risk of development of sequelae, including severe facial weakness, spasms, contraction of facial tissues, and the possibility of incomplete resolution. The treatment options for patients with Bell palsy include corticosteroids, antiviral agents, vasodilators, vitamins, cromolyn sodium, and dextran. Although corticosteroids may have adverse effects, including renal disorders, gastric ulcers, and hepatic disorders, they are the most effective therapeutic agents according to many physicians [5]. In contrast, combination therapy of corticosteroids and antiviral agents is usually preferred for Ramsay Hunt syndrome. Antiviral agents are widely prescribed with or without corticosteroids; however, to date, no consensus has been reached regarding the need for antiviral agents, and further studies are required to establish an optimal treatment for facial palsy [6–8]. In addition, corticosteroids are effective for the treatment of traumatic facial palsy [9]. Additional therapeutic approaches for severe traumatic facial palsy include surgical decompression of the facial nerve, acupuncture, physical therapy, and administration of hyperbaric oxygen [3].