Peripheral Facial Paralysis in People Living with Human Immunodeficiency Virus (HIV)

Introduction: Peripheral facial palsy (PFP) is a frequent reason for ENT consultations. It is a common complication of human immunodeficiency virus (HIV) infection. The aim of this study was to describe the diagnostic and therapeutic aspects and to establish the correlation between PFP and HIV in our context. Patients and Method: This was a retrospective descriptive study conducted in the ENT and CFS department of the HIAOBO, covering the medical records of patients hospitalized for taking a PFP on HIV terrain from January 1, 2016 to December 31, 2020. Results: The study involved 17 patients, 10 men (59%) and 7 women (41%), a sex ratio of 1.4. The average age was 39 years with the extremes of 11 and 69 years. Shopkeepers reported 9 cases (53%). The reason for consultation was facial asymmetry in 11 cases (100%). The delay in consultation during the first week was 82.4%. Clinical signs were unilateral facial asymmetry, the opening of the palpebral fissure and lacrimation. All patients received medical treatment for PFP and HIV. Evolution was favorable, with complete recovery and no sequelae in 82.4% of cases. Surgery was performed in one case. Conclusion: PFPs are common in HIV infection. Diagnosis is clinical and management is multidisciplinary. Progression depends on the length of time taken to treat the disease.

Literature study on clinical treatment of facial paralysis in the last 20 years using Web of Science Comparison between rehabilitation, physiotherapy and acupuncture

BACKGROUND： Facial paralysis is defined as severe or complete loss of facial muscle motor function. OBJECTIVE： The study was undertaken to explore a bibliometric approach to quantitatively assess the research on clinical treatment of facial paralysis using rehabilitation, physiotherapy and acupuncture using Web of Science from 1992 to 2011. DESIGN： Bibliometric approach. DATA RETRIEVAL： A bibliometric analysis based on the publications on Web of Science was performed using key words such as ＂facial paralysis＂, ＂rehabilitation＂, ＂physiotherapy＂ and ＂acupuncture＂. INCLUSIVE CRITERIA： （1） Research articles on the clinical treatment of facial paralysis using acupuncture or physiotherapy （e.g. exercise, electro-stimulation） and other rehabilitation methods; （2） researches on human and animal fundamentals, clinical trials and case reports; （3） Article types： article, review, proceedings paper, note, letter, editorial material, discussion, book chapter. （4） Publication year： 1992-2011 inclusive. Exclusion criteria： （1）Articles on the causes and diagnosis on facial paralysis; （2） Type of articles： correction; （3） Articles from following databases： all databases related to social science and chemical databases in Web of Science. MAIN OUTCOME MEASURES： （1） Overall number of publications; （2） number of publications annually; （3） number of citations received annually; （4） top cited paper; （5） subject categories of publication; （6） the number of countries in which the article is published; （7） distribution of output in journals. RESULTS： Overall population stands at 3 543 research articles addressing the clinical treatment of facial paralysis in Web of Science during the study period. There is also a markedly increase in the number of publications on the subject ＂facial paralysis treatments using rehabilitation＂ during the first decade of the 21 st century, except in 2004 and 2006 when there are perceptible drops in the number of articles published. The only other year during the study period saw such a drop is 1993. Specifically, there are 192 published articles on facial paralysis treated by rehabilitation in the past two decades, far more than the output of physiotherapy treatment. Physiotherapy treatment scored only 25 articles including acupuncture treatment, with over 80% of these written by Chinese researchers and clinicians. Ranked by regions, USA is by far the most productive country in terms of the number of publications on facial paralysis rehabilitation and physiotherapy research. Seeing from another angle, the journals that focus on otolaryngology published the most number of articles in rehabilitation and physiotherapy studies, whereas most acupuncture studies on facial paralysis were published in the alternative and complementary medicine joumals. CONCLUSION： Study of facial paralysis remains an area of active investigation and innovation. Further clinical studies in humans addressing the use of growth factors or stem cells continue to successful facial nerve regeneration.

An Experimental Study on the Optimal Timing for the Repair of Incomplete Facial Paralysis by Hypoglossal-facial‘Side'-to-side Neurorrhaphy in Rats

Objective To investigate the optimal timing for the repair of persistent incomplete facial paralysis by hypoglossal-facial ‘side＇-to-side neurorrhaphy in rats. Methods A total of 30 adult rats with crushed and bulldog-clamped facial nerve injury were randomly divided into 5 groups（n = 6 each） that were subjected to injury without nerve repair or with immediate repair, 2-week-delayed repair, 4-week-delayed repair, or 8-week-delayed repair. Three months later, the effects of repair in each rat were evaluated by facial symmetry assessment, electrophysiological examination, retrograde labeling, and axon regeneration measurement. Results At 3 months after injury, the alpha angle significantly increased in the group of rats with 4-week-delayed repair compared with the other four groups. Upon stimulation of the facial nerve or Pre degenerated nerve, the muscle action potentials MAPs were recorded in the whisker pad muscle, and the MAP amplitude and area under the curve in the 4-week-delayed repair group were significantly augmented at 3 months post-injury. Similarly, the number of retrograde-labeled motor neurons in the facial and hypoglossal nuclei was quantified to be significantly greater in the 4-week-delayed repair group than in the other groups, and a large number of regenerated axons was also observed. Conclusion The results of this study demonstrated that hemi HN-FN neurorrhaphy performed 4 weeks after facial nerve injury was most effective in terms of the functional recovery of axonal regeneration and activation of facial muscles.

The research progress of acupuncture and moxibustion in the treatment of peripheral facial paralysis

As a common and frequently-occurring disease in clinic,peripheral facial paralysis is worth paying attention to.In fact,as one of the methods for the treatment of peripheral facial paralysis,acupuncture has been widely promoted and applied in clinic,and has been recognized by doctors at home and abroad.However,there are many other factors that affect the curative effect in clinic due to their different operating methods.Therefore,there are still many disputes in the treatment of peripheral facial paralysis.The relevant literatures in recent years were searched and consulted in order to understand the current situation and provide routine treatment methods for clinical acupuncturists to treat this disease.And we intended to analyze and introduce from acupuncture manipulation,warm acupuncture,electroacupuncture,giant acupuncture,fire acupuncture,acupuncture combined with massage,acupuncture timing and other treatments,and different classification of acupuncture points and methods.

Facial paralysis in cerebral infarction:A case of misdiagnosis and literature review

Facial paralysis can be classified as central or peripheral facial paralysis based on the location of the underlying lesion,both of which demonstrate facial motor dysfunction.In the currently report,a patient admitted to the department of otology,First People’s Hospital of Qinhuangdao,presented with facial asymmetry as the initial symptom of a cerebral infarction and was first misdiagnosed as peripheral facial paralysis.The case is reported as follows.

Combined Subtemporal-Supralabyrinthine Approach to Geniculate Ganglion for Management of Facial Paralysis in Temporal Bone Fracture

Objective To investigate the clinical outcomes of facial never decompression via a combined subtemporal-su- pralabyrinthine approach to geniculate ganglion for management of facial paralysis in temporal bone fracture. Methods Eighteen patients with unilateral facial paresis due to temporal bone fracture were treated between March 2003 and March 2011. Facial function was House-Braekmann（HB） grade m in 6 patients, HB grade V in 9 patients and HB grade VI in 3 patients. The preoperative mean air conduction threshold was 52 dB HL for the 15 cases with longitudinal temporal bone fracture and showed severe sensorineural heating loss in the 3 cases with transverse temporal bone fracture. Fracture lines were detected in 15 cases on temporal bone axial CT scans and ossicular disruption was determined in 11 cases by virtual CT endoscopy. The geniculate ganglion or the tympanic mastoid segment of the facial nerve showed an irregular morphology on curved planar reformation images of the facial nerve canal. After an intact canal wall mastoi- do-epitympanectomy, the ossicular chain recess was opened by drilling through the was disrupted, the incus was removed to damage was evaluated. If the ossicular chain was intact, the supralabyrinthine cells between the tegmen tympani and ossicular chain. If the ossicular chain access the supralabyrinthine recess. The geniculate ganglion and the distal labyrinthine segment of the facial nerve were exposed. After completing facial nerve decompression, the dislocated incus was replaced, or a fractured incus was reshaped to bridge the space between the malleus and the stapes. Results Pronounced ganglion geniculatum swelling was found in 15 cases of longitudinal temporal bone fracture, with greater petrosus nerves damage in 3 cases and bleeding in 5 cases. Disrupted ossicular chains were seen in 11 cases, including dislocated incus resulting in crushing of the horizontal portion of the facial nerve in 3 cases and fracture of the incus long process in 1 case. In 3 cases of transverse fractures, dehiscence on the promontory, semicircular canal or oval window was found. All cases had primary healing with no complication. At follow-ups ranging from 0.5 to 3 years （average 1.2 years）, facial nerve function recovered to HB grade I in 11 cases, 11 in 5 cases and m in 2 cases. Overall hearing recovery was 33 dB. Conclusion The clinical outcomes concerning facial nerve function and hearing recovery are satisfactory via a combined subtemporal-supralabyrinthine approach to the geniculate ganglion for facial nerve decompression in temporal bone fracture patients with facial paralysis.

Values of blink reflex and electroneurography in diagnosis of facial paralysis

BACKGROUND： The electrophysiological test was mainly achieved by the reaction of nerve fiber to electrical stimulus, usually expressed by the amplitude and latency. Blink reflex and electroneurography （ENOG） are widely applied in facial paralysis, the amplitude would step down, and the latency would prolong when the facial nerve was injured. OBJECTIVE： To compare the value of blink reflex and ENOG in the diagnosis of facial paralysis （Bell＇s palsy）. DESIGN： A controlled trial. SETTINGS： Affiliated Hospital, Chengdu University of Traditional Chinese Medicine; West China Hospital of Sichuan University; Mianyang Hospital of Traditional Chinese Medicine; Sichuan People＇s Hospital. PARTICIPANTS： The patients who had finished the tests of blink reflex （n =207） and ENOG （n =205） were selected from the Affiliated Hospital, Chengdu University of Traditional Chinese Medicine; West China Hospital of Sichuan University; Mianyang Hospital of Traditional Chinese Medicine; Sichuan People＇s Hospital from September 2001 to July 2003. After treatment for 4 weeks, the patients finished tests of blink reflex （n =207） and ENOG （n =205） were randomly divided into primary treatment group （n =68, 69）, acupuncture group （n =71, 66） and comprehensive treatment group （n =68, 70）, respectively. Approval was obtained from the ethic committee of hospital. METHODS： Patients in the primary treatment group and acupuncture group were treated with western medicine, acupuncture and moxibustion alone respectively, and those in the comprehensive treatment group were treated with acupuncture and moxibustion based on western medicine. The whole period of treatment was 4 weeks. The tests of blink reflex and ENOG were carried out using Japanese light and electricity MEB-2200 electromyogram/induced potential instrument for once before and after treatment respectively. The normal value of the latency period of wave RI was within 13 ms, and the difference was 1 - 1.2 ms between the left and right sides. MAIN OUTCOME MEASURES： The latency of wave RI of blink reflect and the latency and wave amplitude of ENOG on the affected and healthy sides before and after treatment were observed. RESULTS： Totally 207 and 205 patients received tests of blink reflex and ENOG, but 17 and 16 cases respectively did not finish the second measurement, finally 190 and 189 cases were involved in the analysis of results. The latencies of wave R 1 on the affected side after treatment were significantly longer than those before treatment （t = - 6.253, P 〈 0.01）; The latencies of wave RI on the normal side were in the normal range before and after treatment; The latencies of wave RI before treatment on the affected side was significantly longer than that on the normal side （t =- 5.896, P 〈 0.01）, but there were no significant differences between the affected and normal sides after treatment （P 〉 0.05）. It was indicated that the latencies of wave RI on the affected side had restored normally, and the blink reflex was improved obviously after treatment. The latency of ENOG on the affected side before treatment was significantly prolonged as compared with that on the normal side （t =2.247, P 〈 0.01）; After treatment, the difference between the affected and normal side became smaller, but remarkable significance still existed （t =10.810, P 〈 0.01）. In spite of the obvious improvement of affected side before and after treatment, there were still significant differences （t =- 8.110, P 〈 0.05）. The wave amplitude on the affected side was decreased after treatment, which was not significantly different from that before treatment （P 〉0.05）. CONCLUSION： After treatment of facial paralysis, blink reflect was greatly improved, there was an obvious hysteresis in the latency of ENOG. Therefore, blink reflect was better than ENOG in the early diagnosis, while ENOG was suitable for evaluating the prognosis. The ENOG examination was better than blink reflex at middle and late period.

Surgical Management of Traumatic Facial Paralysis:A Case Review Study

Objective To evaluate efficacy of surgical treatment in traumatic facial paralysis.Methods:Thirty-three cases were reviewed,including temporal bone fracture and iatrogenic facial nerve injury.All the patients were treated with various surgical methods according to their pathogeny.Results The mean percentage facial function improvement (House-Brackmann GradeⅠ-Ⅱ) was 86% in temporal bone fracture and function was improved after proper operation to iatrogenic facial nerve injury.Conclusions Patients with traumatic facial paralysis receive proved outcomes itreaed with proper surgical methods according to their particular condition of nerve injury.

SURGICAL TREATMENT OF PERIPHERAL FACIAL PARALYSIS

The facial nerve passes through the temporal bone and is the longest nerve that travels in a bony canal with a complex course and high susceptibility to injury.When facial nerve becomes swollen from insults such as trauma, inflammation, tumor or iatrogenic injury, its distal

Traditional Chinese Medicine nursing protocols for facial paralysis

Facial paralysis is defined as severe or complete loss of facial muscle motor function possibly due to peripheral or central lesions.Currently,there are no effective treatment modalities for facial paralysis in western medicine.In Traditional Chinese Medicine(TCM),it is believed to be associated with malnutrition of facial muscles caused by qi stagnation and blood stasis due to wind-cold invasion.This article primarily investigated the key points of common syndromes,TCM nursing methods and healthy guidance of facial paralysis,aiming at maintaining and developing the strengths of TCM,improving its efficacy and standardizing its behavior.

COMBINED TREATMENT OF 200 CASES OF PERIPHERY FACIAL PARALYSIS WITH ACUPUNCTURE AND CHINESE MEDICINAL HERBS

In the present study, 200 cases of periphery facial paralysis were treated with combined therapies of handle needle, electroacupuncture (EA), electronic moxibustion and oral administration of Supplemented Qianzheng San. After treatment, of the 200 cases, 176 were cured, 15 had marked improvement and 9 had improvement. Two groups of acupoints were chosen and used alternately for keeping the excitement of acupoints, preventing acupoint fatigue and raising the therapeutic effect. In the acute stage of periphery facial palsy, acupuncture treatment was performed using shallow needling, mild manipulation and no needling penetration. In the convalescence stage and sequela stage, penetration needling was adopted and stronger stimulation given. During acute period and when facial muscular spasm appeared, EA stimulation was not suitable for facial acupoints. Over use of vision should be avoided.

Impact of early eyelid weight placement on the development of synkinesis and recovery in patients with idiopathic facial paralysis

Determine the impact of upper eyelid weight placement at 3 months post onset of idiopathic facial paralysis(IFP)on the recovery of facial function in patients with lagophthalmos.Methods:This is a retrospective review of patients with incomplete recovery of IFPddefined as a Sunnybrook Facial Grading Scale(FGS)score of less than 100,3 months after onset.Only patients with FGS and Facial Clinimetric Evaluation(FaCE)scores recorded at 3 and 12 months were included.Patients were categorized into 3 groups:Group A,lagophthalmos with eyelid weight placement;Group B,lagophthalmos without eyelid weight placement;Group C,complete eye closure(CEC)without eyelid weight placement.The eye comfort domain and composite score of the FaCE questionnaire were analyzed.Voluntary eye closure,synkinesis with eye closure,overall synkinesis and the composite score of the FGS were also analyzed.Paired two-tailed t-test was used to evaluate the data comparing the 3 and 12 month FaCE and FGS scores within and between the 3 groups.Results:The change in composite FGS score significantly increased from month 3 to month 12 in Group A as compared to Group B(37 vs 4.25,P=0.01).While Group A had significantly lower eye comfort(-12.5,P=0.01),voluntary eye closure(-1.75,P=0.05)and overall FGS scores(-28.75,P=0.04)at 3 months compared to those in Group C,there were no differences between these two groups at 12 month follow-up.Conclusions:For patients with lagophthalmos at 3 months,early eyelid weight placement may lead to improved facial function at 12 months.

Correlation between cerebrospinal fluid protein and facial paralysis in patients with Guillain-Barre syndrome

Objective To explore the correlation between the cerebrospinal fluid protein and facial paralysis in patients with Guillain-Barre syndrome(GBS).Methods Clinical and biochemical data of 111 patients with GBS in department of neurology from January 2005 to September 2015were retrospectively analyzed.GBS patients were

Mechanisms and Management of Postparalysis Facial Synkinesis

Facial synkinesis is one of the most severe sequelae of facial nerve paralysis,and it can result in facial movement disorders,abnormal facial expressions,and even problems of social communication.The underlying mechanism of postparalysis facial synkinesis remains unclear.In recent years,researchers have demonstrated several possible mecha­nisms of facial synkinesis,including aberrant regeneration,ephaptic transmission,over­acting of the facial nucleus in the pons,and changes in the cerebral cortex.Management includes botulinum toxin type A(BTX-A)injection,surgery,and neuromuscular reeduca­tion.

Artificial facial nerve reflex restores eyelid closure following orbicularis oculi muscle denervation

To date, treatment of peripheral facial paralysis has focused on preservation of facial nerve integrity. However, with seriously damaged facial nerve cases, it is difficult to recover anatomical and functional integrity using present therapies. Therefore, the present study utilized artificial facial nerve reflex to obtain orbicularis oculi muscle （OOM） electromyography signals on the uninjured side through the use of implanted recording electrodes. The implanted electrical chips analyzed facial muscle motion on the uninjured side and triggered an electrical stimulator to emit current pulses, which resulted in stimulation of injured OOM contraction and maintained bilateral symmetry and consistency. Following signal recognition, extraction, and computer analysis, electromyography signals in the uninjured OOM resulted in complete eyelid closure, which was consistent with the voltage threshold for eye closure. These findings suggested that artificial facial nerve reflex through the use of implanted microelectronics in unilateral peripheral facial paralysis could restore eyelid closure following orbicularis oculi muscle denervation.

Structural remodeling in related brain regions in patients with facial synkinesis

Facial synkinesis is a troublesome sequelae of facial nerve malfunction.It is difficult to recover from synkinesis,despite improved surgical techniques for isolating the peripheral facial nerve branches.Furthermore,it remains unclear whether long-term dysfunction of motor control can lead to irreversible plasticity-induced structural brain changes.This case-control study thus investigated the structural brain alterations associated with facial synkinesis.The study was conducted at Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine,China.Twenty patients with facial synkinesis(2 male and 18 female,aged 33.35±6.97 years)and 19 healthy volunteers(2 male and 17 female,aged 33.21±6.75 years)underwent magnetic resonance imaging,and voxel-based and surface-based morphometry techniques were used to analyze data.There was no significant difference in brain volume between patients with facial synkinesis and healthy volunteers.Patients with facial synkinesis exhibited a significantly reduced cortical thickness in the contralateral superior and inferior temporal gyri and a reduced sulcal depth of the ipsilateral precuneus compared with healthy volunteers.In addition,sulcal depth of the ipsilateral precuneus was negatively correlated with the severity of depression.These findings suggest that there is a structural remodeling of gray matter in patients with facial synkinesis after facial nerve malfunction.This study was approved by the Ethics Review Committee of the Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine,China(approval No.2017-365-T267)on September 13,2017,and was registered with the Chinese Clinical Trial Registry(registration number:ChiCTR1800014630)on January 25,2018.

Major Ear Aplasia and Cochleovestibular Dysplasia: Rare Congenital Malformation about a Case

Introduction: The congenital malformations of the ear are rare and often isolated, may be unilateral or bilateral, and can be associated with another syndromic malformation. Such malformations so not necessarily impact aesthetics and social relations. Case Presentation: The authors report the case of Samuel M, male born at 38 WA, who is the first child of healthy parents from the same socio-cultural area. His birth weight was 2800 g and he did not have any risk factors for deafness or concept of obstetrical trauma. He presented with congenital malformation manifesting as bilateral ear aplasia with unilateral facial paralysis. Computed tomography revealed abnormalities of the inner ear;functional explorations, such as PEA and OEA, showed findings in favor of bilateral cophosis. ASSR (Auditory Steady-State Responses) was not performed. The announcement of the serious diagnosis of deafness requires multidisciplinary care in order to plan a therapeutic program to limit the impact on the development of language, schooling, and consequently, the socio-professional future of children. Conclusion: This clinical case underlines the fact that interest of the clinical interview before possible multiple surgery does not always guarantee the satisfaction of the desire for repair in this type of patient.