Facial Paralysis: Diagnosis and Management

doi:10.1055/s-0028-1089913

Paper

Facial Paralysis: Diagnosis and Management

Published Feb 1, 1999 · P. Kileny, M. J. Disher, H. El‐Kashlan

Seminars in Hearing

Q1 SJR score

5

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0

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Abstract

Facial paralysis is a condition frequently seen in otology and audi-ology clinics. Its most common etiologies are idiopathic, trauma and infection. This article deals with the pathophysiology of facial paralysis, diagnostic tech nique and treatment modalities illustrated with case studies. The section on pathophysiology includes a discussion of the classification of nerve injury: neu-ropraxia that may be associated with a compressional injury, axonotmesis as sociated with an interruption of the myelin layer and axon and neurotmesis in volving a complete transection. Among diagnostic techniques, evoked facial electromyography or electroneuronography and needle EMG are discussed and compared. Needle EMG in particular is useful in cases with complete fa cial paralysis and an evoked EMG reduction of 90% or more. Among patients with idiopathic facial paralysis approximately 71% recover completely and ap proximately 16% remain with serious sequelae. In terms of treatment, cortico steroids and antiviral medications may be used. Surgical decompression may be used in selected cases to relieve intraneural pressure.

Study Snapshot

Key takeawayFacial paralysis is often caused by idiopathic, trauma, and infection, and can be diagnosed and treated with corticosteroids, antiviral medications, and surgical decompression.

PopulationOlder adults (50-71 years)

Sample size24

MethodsObservational

OutcomesBody Mass Index projections

ResultsSocial networks mitigate obesity in older groups.

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Facial Paralysis: Diagnosis and Management

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References

A comparison of facial grading systems.

The House-Brackman system is the most reliable and simple method for grading facial palsy severity, with interobserver variation significantly affecting consistency.

Facial electroneurography: Analysis of techniques and correlation with degenerating motoneurons

Facial electroneurography is a reliable and valid method for quantifying nerve degeneration, with optimized and standardized recording lead techniques yielding consistent results.

Correlation of the nerve excitability test and electroneurography in acute facial paralysis.

The nerve excitability test and electroneurography are complementary in establishing facial nerve integrity in acute paralysis, with higher correlation coefficients for optimized lead placement.

Surgical decompression of idiopathic facial palsy.

Surgical decompression of the meatal foramen in the middle cranial fossa may benefit severely affected patients with Bell's palsy due to entrapment at the fallopian canal.

Medical management of idiopathic (Bell's) palsy.

The term idiopathic (Bell's) palsy should be replaced with Antoni's palsy, as the disease results from a viral geniculate ganglionitis and can be effectively treated with corticosteroids and acyclovir.

The comparison of facial grading systems.

Objective and subjective facial grading systems differ in patient discrimination, interobserver variability, and objectivity, offering selective advantages in clinical definition.

Prognostic value of electrical tests in acute facial paralysis.

Electroneurography, performed as soon as the facial paralysis becomes complete, is the best prognostic tool for acute facial paralysis, with the time course, maximum value, and early deblocking being key indicators.

Clinical advantages of electroneurography in patients with Bell's palsy within two weeks after onset.

Electroneurography (ENoG) can accurately reveal wallerian degeneration in patients with Bell's palsy within 7 days, allowing for early treatment and prognostic diagnosis.

Citations

Electrophysiological measures in facial paresis and paralysis

Electroneuronography and electromyography are effective tools for identifying individuals requiring intervention and predicting those recovering spontaneously in facial nerve injuries.

Effectiveness of the gold weight trial procedure in predicting the ideal weight for lid loading in facial palsy: a prospective study.

The gold weight trial procedure effectively predicts ideal eyelid closure in facial palsy patients, but undercorrection occurs in 30% of cases and is common in patients with preoperative lagophthalmos of more than 8 mm.

Facial Nerve Palsy

Proper diagnosis and treatment of facial paralysis can significantly improve clinical outcomes.

Exposure Keratopathy Due to Facial Palsy

Exposure keratopathy due to facial palsy requires definitive surgical treatment to regain normal eye position and prevent blindness.