Search

Keywords: Facial Clinimetric Evaluation scale; facial comfort; facial palsy; quality of life; social function; synkinesis EN Facial Clinimetric Evaluation scale facial comfort facial palsy quality of life social function synkinesis 790 793 4 08/17/23 20230901 NES 230901 Key points The Facial Clinimetric Evaluation (FaCE) scale, consisting of six subscales, measures facial palsy-specific quality of life. In 80 patients, we analysed the subscales' correlations with a validated Visual Analogue Scale (VAS) score that quantifies overall facial palsy-related burden. This VAS validation group completed both the FaCE scale and the VAS on two occasions (T1 and T2), 1-week apart. Patients were asked to complete the validated Dutch FaCE questionnaire and, using a novel Visual Analogue Scale (VAS), to holistically score how physically and mentally burdensome their facial palsy had been in the past week. [Extracted from the article]

Objectives: Needle electromyography (EMG) may be used to characterise the severity of the injury in acute peripheral facial nerve palsy (FNP) to predict recovery and guide management, but its prognostic value and clinical utility remain controversial. The aim of this systematic review was to evaluate the role of EMG to prognosticate the recovery of facial motor function in patients with acute peripheral FNP. Design: A comprehensive search strategy was applied in PubMed, Embase, and Web of Science based on Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. The main outcome measure was the accuracy of EMG in predicting long‐term facial function at least 6 months following symptom onset. Results: Eleven studies were included comprising 3837 participants, with 91.6% of these diagnosed with Bell's palsy (BP). In BP patients, the positive predictive value and negative predictive value for a good outcome based on EMG findings ranged from 82.1% to 100% and 66.7% to 80.5%, respectively, with two out of three studies finding that EMG remained a significant predictor of the outcome on multivariate analysis. Three studies addressed the role of EMG in non‐idiopathic FNP with two of these studies supporting EMG to predict prognosis. Conclusions: EMG is a useful tool to gain insight into the likely outcome to guide management decisions and counsel patients on their expectations, particularly in BP. However, given inconsistencies in its application and lack of evidence around non‐idiopathic FNP, it should not currently be relied on to predict recovery. Ultimately, its prognostic value and widespread adoption are dependent on the implementation of a clear and standardised protocol in future high‐quality studies and routine clinical settings. [ABSTRACT FROM AUTHOR]

Objectives: Data on the association between Bell's palsy (BP) and pregnancy is scarce and there is an ongoing debate regarding the association of BP and pregnancy. Main Outcome Measures: We aimed to investigate the prevalence of BP among pregnant patients and determine the frequency of pregnant women in BP cohorts and vice versa, assess which term of the pregnancy and peripartum bears a higher risk for BP occurrence, and determine the prevalence of maternal comorbidities associated with BP during pregnancy. Design: Meta analysis. Settings: Screening standard articles and extracting data from Ovid MEDLINE (1960–2021), Embase (1960–2021), and Web of Science (1960–2021). All study types were included except for case reports. Measures: Data were pooled by means of both fixed and random‐effects models. Results: The search strategy identified 147 records. Twenty‐five of the studies that met our inclusion criteria described 809 pregnant patients with BP in a total of 11,813 BP patients and they were included in the meta‐analysis. The incidence of BP among the pregnant patients was 0.05%; The incidence of pregnant patients among all BP patients was 6.62%. Most of the BP occurrences were during the third trimester (68.82%). The pooled incidence of gestational diabetes mellitus; hypertension; pre‐eclampsia/eclampsia and fetal complications among the pregnant patients with BP was 6.3%, 13.97%, 9.54%, and 6.74%, respectively. Conclusions: This meta‐analysis revealed a low incidence of BP during pregnancy. A Higher proportion occurred during the third trimester. The association of BP and pregnancy warrants further exploration. [ABSTRACT FROM AUTHOR]

Objectives: Facial nerve decompression is a salvage treatment for Bell's palsy patients for whom a poor prognosis is anticipated with standard medical treatment. The transmastoid approach is a frequently performed approach, but it remains unknown if this surgery is effective when the ossicular chain is preserved. This study aimed to determine the efficacy of facial nerve decompression using the transmastoid approach in Bell's palsy. Design, setting and participants: This retrospective study included patients who had undergone transmastoid facial nerve decompression with ossicular chain preservation and patients who met the criteria for surgery, but received only medical treatment between January 2007 and May 2019, at a single centre. Main outcome measures: Attainment of House‐Brackmann grade I at 12 months after onset of facial palsy. Results: The recovery rate to House‐Brackmann grade I in the decompression group in the early phase (≤18 days after onset) was higher than that of the medical treatment group, although the difference was not significant (70% vs 47%, P =.160). However, within this early surgery group, a subgroup of cases with ≥95% facial nerve degeneration demonstrated a significant improvement in recovery rate (73% vs 30%, P =.018). Among surgeries performed in the late phase (≥19 days), only a subgroup with ≥95% facial nerve degeneration was available for analysis, and the difference in recovery rate was not significant compared with medical treatment alone (26% vs 30%, P = 1.00). Post‐surgical hearing evaluation demonstrated that average hearing deterioration was 1.3 dB which was non‐significant, suggesting this procedure does not cause hearing loss. Conclusions: Transmastoid facial nerve decompression with ossicular chain preservation in the early phase after symptom‐onset is an effective salvage treatment for severe Bell's palsy with ≥95% facial nerve degeneration. [ABSTRACT FROM AUTHOR]

Objectives: There is a lack of data on patients' and diagnostic factors for prognostication of complete recovery in patients with Bell's palsy. Design and setting: Cohort register‐based study of 368 patients with Bell's palsy and uniform diagnostics and standardised treatment in a university hospital from 2007 to 2017 (49% female, median age: 51 years). Main outcome measures: Clinical data, facial grading, electrodiagnostics, motor function tests, non‐motor function tests and onset of prednisolone therapy were assessed for their impact on the probability of complete recovery using univariable and multivariable statistics. Results: Median onset of treatment was 1.5 days. 46% of patients had a House‐Brackmann scale at baseline of ≥ III. The median recovery time was 2.6 months (95% confidence interval [CI] = 2.1‐3.0). 54.9% achieved a complete recovery. If prednisolone therapy started later than 96 hours after onset, the recovery rate decreased significantly. Beyond less severe palsy, no abnormal electroneurography side difference, no pathological spontaneous activity in electromyography and normal stapedius reflex testing were the most powerful tool for prognostication of recovery after Bell's palsy. Conclusion: Beyond severity of the palsy, facial electrodiagnostics and stapedius reflex testing are the most powerful tool for prognostication of recovery time after Bell's palsy. Prednisolone therapy should have started at best within a time window of 96 hours after onset to reach the highest probability of complete recovery. [ABSTRACT FROM AUTHOR]

The aim of this study was to carry out a radio-clinical assessment in order to identify CT and clinical prognostic criteria in Bell's palsy. For all patients admitted for Bell's palsy, we searched our hospital's Picture Archiving and Communication System (PACS) for those patients who had a petrous CT scan. 1 Abbreviations: BMI, Body Mass Index; BP, Bell's palsy. 1 Hervochon R, Seiller I, Trunet S, Nguyen Y, Tankéré F. Morphometric analysis of CT scans of the facial canal in Bell's palsy: a study of 51 patients. [Extracted from the article]

The article discusses a study to compare the anatomical criteria ofthe facial canal on petrous computed tomography (CT) scans from Bell's palsy (BP) patients and controls. Topics discussed include the measurement of the size of the bony canal of the facial nerve on CT scans, several aetiological factors causing BP such as viral infections, autoimmune reactions or ischaemic neuropathy of the vasa nervorum, and angles of the first and second genu.

Objective: Although recurrent facial palsy was first reported in 1871, the aetiology, definitions, classifications, pathogenesis, treatment options and prognosis have not been clearly determined. There have been no systematic reviews and meta‐analyses of recurrent Bell's palsy. The purpose of this study was to evaluate the clinical manifestations of recurrent Bell's palsy through a systematic review and meta‐analysis. Design: The SCOPUS, PubMed, Cochrane Library and EBSCO databases were searched through 1 May 2018, using the search terms "recurrent Bell's palsy" and "recurrent facial palsy," for studies involving patients with recurrent Bell's palsy. Reference lists of eligible studies were also reviewed. Results: A search of titles and abstracts in these four databases identified 222 studies; of these, 27 studies, involving 1041 patients from 13 countries, were analysed. The mean percentage of patients who experienced recurrence of Bell's palsy ranged from 0.8% to 19.4%. Five studies that included 191 patients were included in the meta‐analysis. Conclusions: Among patients previously affected by Bell's palsy, the mean incidence of recurrent Bell's palsy was 6.5%. Sidedness of recurrent disease, relative to the side of the original disease, had no effect on patient prognosis. Of all patients with Bell's palsy, 66.0% recovered completely, with the recovery rate lower in patients with recurrent than with primary Bell's palsy. [ABSTRACT FROM AUTHOR]

Objectives To determine the inpatient management for patients with acute idiopathic facial palsy ( IFP) in Thuringia, Germany. Design Population-based study. Setting All inpatients with IFP in all hospitals with departments of otolaryngology and neurology in 2012, in the German federal state, Thuringia. Main outcome measures Patients' characteristics and treatment were compared between departments, and the probability of recovery was tested. Results A total of 291 patients were mainly treated in departments of otolaryngology (55%) and neurology (36%). Corticosteroid treatment was the predominant therapy (84.5%). The probability to receive a facial nerve grading (odds ratio [ OR=12.939; 95% confidence interval [ CI]=3.599 to 46.516), gustatory testing ( OR=6.878; CI=1.064 to 44.474) and audiometry ( OR=32.505; CI=1.485 to 711.257) was significantly higher in otolaryngology departments, but lower for cranial CT ( OR=0.192; CI=0.061 to 0.602), cerebrospinal fluid examination ( OR=0.024; CI=0.006 to 0.102). A total of 131 patients (45%) showed a recovery to House-Brackmann grade≤ II. A pathological stapedial reflex test (Hazard ratio [ HR]=0.416; CI=0.180 to 0.959) was the only independent diagnostic predictor of worse outcome. Prednisolone dose >500 mg ( HR=0.579; CI 0.400 to 0.838) and no adjuvant physiotherapy ( HR=0.568; CI=0.407 to 0.794) were treatment-related predictors of worse outcome. Conclusions Inpatient treatment of IFP seems to be highly variable in daily practice, partly depending on the treating discipline and despite the availability of evidence-based guidelines. The population-based recovery rate was worse than reported in clinical trials. [ABSTRACT FROM AUTHOR]