Sir Charles Bell
















Research & Current Literature

December 2011

List compiled by Robin Lindsay, M.D.

Terzis, J. K. and K. Anesti (2012). "Experience with Developmental Facial Paralysis: Part II. Outcomes of Reconstruction." Plast Reconstr Surg 129(1): 66e-80e.

BACKGROUND: : The purpose of this study was to document the 30-year experience of the authors' center in the management of developmental facial paralysis and to analyze the outcomes of microsurgical reconstruction. METHODS: : Forty-two cases of developmental facial paralysis were identified in a retrospective clinical review (1980 to 2010); 34 (80.95 percent) were children (age, 8 +/- 6 years) and eight (19.05 percent) were adults (age, 27 +/- 12 years). Comparisons between preoperative and postoperative results were performed with electrophysiologic studies and video evaluations by three independent observers. RESULTS: : Mean follow-up was 8 +/- 6.3 years (range, 1 to 23 years). Overall, outcome scores improved in all of the patients, as was evident from the observers' mean scores (preoperatively, 2.44; 2 years postoperatively, 3.66; final, 4.11; p < 0.001, Kruskal-Wallis test) and the electrophysiologic data (p < 0.0001). The improvement in eye closure, smile, and depressor function was greater in children as compared with adults (p < 0.005, Mann-Whitney test). CONCLUSIONS: : Early targeted screening and diagnosis, with prompt specialized treatment, improves the physical and emotional development of children with developmental facial paralysis and reduces the prevalence of aesthetic and functional sequelae of the condition, thus facilitating reintegration among their peers. The experience of this center should serve as a framework for the establishment of accurate and reliable guidelines that will facilitate early diagnosis and management of developmental facial paralysis and provide support and counseling to the family.



Vaidhiyalingam, P., H. O. Katherasapandian, et al. (2011). "Functional Training in the Management of Chronic Facial Paralysis." Phys Ther.

BACKGROUND AND PURPOSE:/b>Disability in patients with facial paralysis is the result of impairment or loss of complex and multidimensional functions of the face, including expression of emotions, facial identity and communication. However, the majority of interventions for facial paralysis are unidimensional and impairment-oriented. Thus, we devised a functional training program that addresses various dimensions of disability caused by facial paralysis. This patient-centered, multidimensional approach to rehabilitation of individuals with facial paralysis consists of patient education, functional training and complementary exercises. Our approach encourages context-specific facial functions, positive coping strategies and social interaction skills focusing on dimensions of disability including physical, emotional and social wellbeing. CASE DESCRIPTION: /b>The client was a 25-year-old woman with chronic complete right facial paralysis caused by a postoperative complication of ear surgery. Her problems were examined using the Facial Disability Index (physical function 45/100, social/well being function 28/100) and an informal interview exploring client experiences and priorities.OutcomeFollowing 8 weeks of functional training, the client showed considerable improvement in her facial functions (physical function 90/100, social/well being function 100/100) and reported positive changes in social interaction and interpersonal relationships. DISCUSSION:/b>The use of a functional training program was associated with positive changes in emotional expression, psychosocial function and social integration, thus contributing to reduced disability of an individual with chronic facial paralysis.



Marre, D. and B. Hontanilla (2012). "Brain plasticity in mobius syndrome after unilateral muscle transfer: case report and review of the literature." Ann Plast Surg 68(1): 97-100.

BACKGROUND: : Mobius syndrome is mainly characterized by bilateral facial palsy. Facial reanimation of these children is achieved by microsurgical techniques, namely free-gracilis muscle innervated by the masseteric nerve. Notorious commissure excursion and speech improvement are reported with such procedure. Several studies have demonstrated the presence of cortical reorganization after injury and repair of different segments of the body. Intensive training of a behaviorally relevant task is key in this process. CASE REPORT: : A 4-year-old patient with complete bilateral facial palsy secondary to Mobius syndrome was operated with left hemiface free-gracilis muscle transplant innervated by the masseteric nerve and submitted for postoperative physiotherapy. Eight months later, bilateral movement was noted. CONCLUSIONS: : Brain plasticity is likely to play an important role in smile restoration in patients with bilateral facial palsy. Intensive physiotherapy and psychosocial relevance of facial expression might be key in such phenomenon.



Marre, D. and B. Hontanilla (2012). "Gender differences in facial paralysis reanimation." Plast Reconstr Surg 129(1): 190e-192e.



Hato, N., J. Nota, et al. (2011). "Facial nerve decompression surgery in patients with temporal bone trauma: analysis of 66 cases." J Trauma 71(6): 1789-1793.

BACKGROUND: : In the treatment of facial nerve paralysis after temporal bone trauma, it is important to appropriately determine whether nerve decompression surgery is indicated. The aim of this study was to examine the efficacy of facial nerve decompression surgery according to fracture location and the ideal time for surgery after trauma by analyzing the therapeutic outcome of traumatic facial nerve paralysis. METHODS: : In total, 66 patients with facial nerve paralysis after temporal bone trauma who were treated at our institution between 1979 and 2009 were studied retrospectively. The patients were divided into five subgroups, according to the fracture location and the period of time between trauma and surgery. RESULTS: : The number of patients who achieved complete recovery of House-Brackmann (H-B) grade 1 was 31 of 66 (47.0%). There was no difference in therapeutic outcomes among the subgroups classified by fracture location. The rate of good recovery to H-B grade 1 or 2 in patients undergoing decompression surgery within 2 weeks after trauma reached 92.9%, resulting in a significantly better outcome than that of patients undergoing later decompression surgery (p < 0.01). CONCLUSIONS: : The results of this study demonstrated that the ideal time for decompression surgery for facial nerve paralysis after temporal bone fracture was the first 2 weeks after trauma in patients with severe, immediate-onset paralysis. Our study also showed that surgery should be performed within 2 months at the latest. These findings provide useful information for patients and help to determine the priority of treatment when concomitant disease exists.



Hato, N., J. Nota, et al. (2011). "Facial Nerve Decompression Surgery Using bFGF-Impregnated Biodegradable Gelatin Hydrogel in Patients with Bell Palsy." Otolaryngol Head Neck Surg.

Objective. Basic fibroblast growth factor (bFGF) promotes the regeneration of denervated nerves. The aim of this study was to evaluate the regeneration-facilitating effects of novel facial nerve decompression surgery using bFGF in a gelatin hydrogel in patients with severe Bell palsy.Study Design. Prospective clinical study.Setting. Tertiary referral center.Subjects and Methods. Twenty patients with Bell palsy after more than 2 weeks following the onset of severe paralysis were treated with the new procedure. The facial nerve was decompressed between tympanic and mastoid segments via the mastoid. A bFGF-impregnated biodegradable gelatin hydrogel was placed around the exposed nerve. Regeneration of the facial nerve was evaluated by the House-Brackmann (H-B) grading system. The outcomes were compared with the authors' previous study, which reported outcomes of the patients who underwent conventional decompression surgery (n = 58) or conservative treatment (n = 43).Results. The complete recovery (H-B grade 1) rate of the novel surgery (75.0%) was significantly better than the rate of conventional surgery (44.8%) and conservative treatment (23.3%). Every patient in the novel decompression surgery group improved to H-B grade 2 or better even when undergone between 31 and 99 days after onset.Conclusion. Advantages of this decompression surgery are low risk of complications and long effective period after onset of the paralysis. To the authors' knowledge, this is the first clinical report of the efficacy of bFGF using a new drug delivery system in patients with severe Bell palsy.


Lim, H. K., J. H. Lee, et al. (2011). "MR Diagnosis of Facial Neuritis: Diagnostic Performance of Contrast-Enhanced 3D-FLAIR Technique Compared with Contrast-Enhanced 3D-T1-Fast-Field Echo with Fat Suppression." AJNR Am J Neuroradiol.

BACKGROUND AND PURPOSE:Current MRI with the CE T1-weighted sequence plays a limited role in the evaluation of facial neuritis due to prominent normal facial nerve enhancement. Our purpose was to retrospectively investigate the usefulness of the CE 3D-FLAIR sequence compared with the CE 3D-T1-FFE sequence in facial neuritis patients.MATERIALS AND METHODS:We assessed 36 consecutive patients who underwent temporal bone MR imaging at 3T for idiopathic facial palsy. Two readers independently reviewed CE 3D-T1-FFE and CE 3D-FLAIR images to determine the degree of enhancement in each of 5 segments of the facial nerve. We compared AUCs using the Z-test, compared diagnostic performance of 2 MR techniques with the McNemar test, and evaluated interobserver agreement. The Pearson chi(2) test was used for each segment of the facial nerve.RESULTS:The AUC of CE 3D-FLAIR (reader 1, 0.754; reader 2, 0.746) was greater than that of CE 3D-T1-FFE (reader 1, 0.624; reader 2, 0.640; P < .001). The diagnostic sensitivities, specificities, and accuracies were 97.2%, 86.1%, and 91.7%, respectively, for CE 3D-FLAIR, and 100%, 56.9%, and 78.5%, respectively, for CE 3D-T1-FFE. The specificity and accuracy of CE 3D-FLAIR were greater than those of CE 3D-T1-FFE (specificity, P = .029; accuracy, P = .008). The interobserver agreements for CE 3D-FLAIR (kappa-value, 0.831) and CE 3D-T1-FFE (kappa-value, 0.694) were excellent. Enhancement of the canalicular and anterior genu segments on CE 3D-FLAIR were significantly correlated with the occurrence of facial neuritis (P < .001 for canalicular; P = .032 and 0.020 for anterior genu by reader 1 and reader 2, respectively).CONCLUSIONS:CE 3D-FLAIR can improve the specificity and overall accuracy of MR imaging in patients with idiopathic facial palsy.



Fu, L., C. Bundy, et al. (2011). "Psychological distress in people with disfigurement from facial palsy." Eye (Lond) 25(10): 1322-1326.

AIMS: Psychological distress is well documented in people with facial disfigurement. However, the prevalence of psychological distress in patients with facial palsy has not been studied. This study aims to establish the prevalence of psychological distress and the extent of anxiety and depression in a sample of facial palsy patients from the Northwest of England. METHOD: A total of 103 participants with facial palsy completed a questionnaire pack comprising the Illness Perception Questionnaire-Revised (IPQ-R), a demographic questionnaire, and the Hospital Anxiety and Depression Scale (HADS). The severity of participants' facial palsy was measured by the House-Brackmann scale. RESULTS: In all, 32.7 and 31.3% of the sample had significant levels of anxiety and depression, respectively. The mean age of participants was 59, and 35.9% had grade 6 facial palsy. Significant associations were found between participants' perception of consequences, duration, timeline, and the level of distress. No significant associations were found between clinical severity of facial palsy and levels of distress. Females had significantly higher levels of anxiety compared with males. CONCLUSIONS: There was a significant level of distress in this study group. The levels of psychological distress were higher than the levels found in other outpatient attenders. There were significant associations between participants' illness perceptions and their level of distress.


Sadiq, S. A., H. A. Usmani, et al. (2011). "Effectiveness of a multidisciplinary facial function clinic." Eye (Lond) 25(10): 1360-1364.

OBJECTIVES: To analyse the usefulness of a multidisciplinary facial function clinic (FFC). DESIGN: Retrospective case-note review. SETTING: The FFC was established in July 2006 at the Manchester Royal Eye Hospital with attending consultants from Ophthalmology, Skull-Base Otolaryngology, Plastic Surgery, and Physiotherapy. PARTICIPANTS: We retrospectively reviewed the case notes for 59 consecutive patients seen at the FFC from July 2006 to February 2009. MAIN OUTCOME MEASURES: We documented demographic data, including distance travelled and average journey time. RESULTS: The 59 patients (mean age 46 years) made a total of 106 clinical visits (mean 1.8). The mean distance travelled by a patient was 31.9 miles with an estimated journey time of 47 min, each way. At presentation the average House-Brackmann grade of facial nerve weakness was IV. Ophthalmologist's advice was needed for 58 (98.3%), otolaryngologist's for 57 (96.6%), plastic surgeon for 49 (83.0%), physiotherapist for 58 (98.3%), and 4 (6.8%) were referred for psychological counselling. In all, 47 (79.7%) of our patients needed input from all four consultants during their visit at the FFC. By combining the presence of several consultants in one clinic, we saved an average of 5.1 visits (325.4 miles; 8 h travel time) for each patient. CONCLUSION: We and our patients feel our multidisciplinary facial function clinic has been an effective service and has continued to work.



Wenhao, Z., C. Minjie, et al. (2012). "Prognostic value of facial nerve antidromic evoked potentials in bell palsy: a preliminary study." Int J Otolaryngol 2012: 960469.

To analyze the value of facial nerve antidromic evoked potentials (FNAEPs) in predicting recovery from Bell palsy. Study Design. Retrospective study using electrodiagnostic data and medical chart review. Methods. A series of 46 patients with unilateral Bell palsy treated were included. According to taste test, 26 cases were associated with taste disorder (Group 1) and 20 cases were not (Group 2). Facial function was established clinically by the Stennert system after monthly follow-up. The result was evaluated with clinical recovery rate (CRR) and FNAEP. FNAEPs were recorded at the posterior wall of the external auditory meatus of both sides. Results. Mean CRR of Group 1 and Group 2 was 61.63% and 75.50%. We discovered a statistical difference between two groups and also in the amplitude difference (AD) of FNAEP. Mean +/- SD of AD was -6.96% +/- 12.66% in patients with excellent result, -27.67% +/- 27.70% with good result, and -66.05% +/- 31.76% with poor result. Conclusions. FNAEP should be monitored in patients with intratemporal facial palsy at the early stage. FNAEP at posterior wall of external auditory meatus was sensitive to detect signs of taste disorder. There was close relativity between FNAEPs and facial nerve recovery.



McRackan, T. R., A. Rivas, et al. (2012). "Facial nerve outcomes in facial nerve schwannomas." Otol Neurotol 33(1): 78-82.

OBJECTIVE: To better understand the characteristics and outcomes of facial nerve schwannomas (FNSs) over a 30-year period. STUDY DESIGN: Retrospective study. SETTING: Subspecialty practice at a tertiary hospital. PATIENTS: Fifty-six patients diagnosed with FNS over a 30-year period. METHODS: Preoperative data (audiologic data, facial nerve [FN] function, and patient symptoms), intraoperative data (tumor location, total versus subtotal resection, and FN status), and postoperative data (audiologic data, FN function, and recurrence) were collected. Mann-Whitney and chi analyses were done to determine which factors correlated with poor FN outcomes (defined as House-Brackmann >/=4). RESULTS: Of the 56 patients in this study, 53 (94.6%) underwent surgical resection of their FNS. Of those patients, 45 (84.9%) underwent total resection, and 8 (15.1%) underwent subtotal resection. Subtotal resection was associated with a statistically significant decreased risk of having postoperative HB grade >/=4 (odds ratio, 0.09; 95% confidence interval, 0.01-0.77; p = 0.028). Of those undergoing a subtotal resection, no patient had further tumor growth seen on postoperative magnetic resonance imaging (average time of last magnetic resonance imaging since operation, 44.9 mo). Tumor location was not statistically associated with poor FN outcome (all p > 0.05). Preoperative FN paralysis was the only preoperative clinical finding statistically associated with poor FN outcomes (p = 0.004). CONCLUSION: We have identified multiple characteristics of FNS as well as multiple factors associated with increased statistical risk of poor FN outcomes.













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