Search

ObjectivesWe characterize occult lesion diagnosis rates after initial Bell's palsy diagnoses.MethodsA de-identified database of all facial palsy patients who presented to an extensive health care system across 22 years was created using Epic SlicerDicer. Among patients with Bell's palsy diagnoses, we extracted demographic and any subsequent occult lesion diagnosis data across various clinical sites. Descriptive and multivariable regression analyses comparing patients with occult lesion diagnoses made at different time points were included.ResultsAmong the total 3912 facial palsy patients, 2240 had Bell's palsy diagnoses, of which 217 (9.7%) had subsequent lesion diagnoses at a median (IQR) of 12.3 (4.2, 23.8) months, consisting of cranial nerve neoplasms (62.2%), parotid gland neoplasms (34.1%), and cholesteatomas (3.7%). Although a large proportion of total lesions were diagnosed within the first 3 months (19.8%), 69.5% were diagnosed after 6 months. There were no demographic differences among patients diagnosed with different lesion types, but Asian patients were more likely to be diagnosed with occult lesions after 12 months after Bell's palsy diagnosis compared with white patients (odds ratio = 6.2, p = 0.001).ConclusionsIn one of the largest Bell's palsy cohorts to date, we identified a 9.7% occult lesion diagnosis rate at a median of 12.3 months after Bell's palsy diagnosis. These data underscore the importance of timely workup for occult lesions in cases of facial palsy with no signs of recovery after 3-4 months.Level of evidence4 Laryngoscope, 134:911-918, 2024.

AbstractBackgroundPurposeMethodsResultsConclusionFacial paralysis patients with normal hearing often require ossicular chain dislocation throughout the entire process of facial nerve decompression surgery, and their hearing tends to be slightly impaired after surgery. There is not detailed explanation of hearing changes after facial nerve decompression with preserving intact ossicular chain.This study aimed to determine the efficacy and hearing outcomes of facial nerve decompression with preserving ossicular chain intact transmastoid supralabyrinthine recess pathway in Bell’s palsy.A retrospective study comparing the pre- and post-operative facial nerve HB functional grades and hearing results of 12 patients with Bell’s palsy who underwent facial nerve decompression.Preoperative and postoperative mean House-Brackmann (HB) scores respectively were 4.41 ± 0.67 and 1.58 ± 0.79 grades; The recovery rate to HB grade I, II was 100% or to grade III or lower was 83.3% (10/12). The pre- and post-operative mean PTAs (0.125, 0.25, 0.5, 1, 2, 4, 8KHz) were 19.1 ± 1.9 dB and 36.8 ± 4.1 dB; The pre- and postoperative low frequencies (0.125, 0.25KHz) were 18.5 ± 2.3 dB and 26 ± 3.8 dB; The pre- and postoperative speech frequencies (0.5, 1, 2KHz) mean PTAs were 18.5 ± 1.9 dB and 21.5 ± 2.9 dB; Comparison of pre- and post-operative hearing outcomes at all frequencies, low frequencies, and speech frequencies showed no statistically significant differences (p < 0.05); The pre- and postoperative high frequencies (4, 8KHz) were 20.6 ± 4.7 dB and 70.4 ± 11.6 dB and the hearing outcomes were statistically significant (p >0.05).Subtotal facial nerve decompression with preserving ossicular chain intact transmastoid supralabyrinthine recess pathway does not cause the verbal frequency hearing loss of Bell’s palsy, but it has high frequency sensorineural hearing loss, which tend to be unavoidable and independent of the skill of the surgical operator. [ABSTRACT FROM AUTHOR]

This study investigates the relationship between serum magnesium levels and recovery outcomes in Bell's Palsy patients, aiming to elucidate magnesium's potential neuroprotective role in this condition. Conducted as a prospective cohort study at a tertiary care hospital, 50 Bell's Palsy patients had their serum magnesium levels measured at diagnosis and at 1 week, 1 month, 3 months, and 6 months post-diagnosis. Recovery was assessed using the House-Brackmann scale. The findings indicated an initial average serum magnesium level of 1.8 ± 0.3 mg/dL, increasing to 2.1 ± 0.3 mg/dL over six months. Higher baseline magnesium levels were significantly associated with improved recovery outcomes, with an Odds Ratio of 2.0 (p < 0.001). Longitudinal analysis revealed that increases in serum magnesium levels significantly correlated with improvements in the House-Brackmann grade (p < 0.001). These results suggest that rising serum magnesium levels are linked to better recovery in Bell's Palsy, advocating for further research into magnesium supplementation as a therapeutic strategy to enhance recovery in these patients. [ABSTRACT FROM AUTHOR]

The "Summary of Japanese clinical practice guidelines for Bell's palsy (idiopathic facial palsy) - 2023 update edited by the Japan Society of Facial Nerve Research" aims to review the latest evidence regarding the treatment of Bell's palsy and to provide appropriate recommendations. Regarding the treatment of Bell's palsy, a guideline panel identified key clinical questions using an analytic PICO framework. The panel produced recommendations following the standards for trustworthy guidelines and the GRADE approach. The panel considered the balance of benefits, harm, and preferences when making recommendations. The panel identified nine key clinical questions: systemic (high/standard dose) corticosteroids, intratympanic corticosteroids, systemic antivirals, decompression surgery, acupuncture, physical therapy, botulinum toxin, and reanimation surgery. These guidelines strongly recommend systemic standard-dose corticosteroids for the clinical management of Bell's palsy. Other treatments are weakly recommended due to insufficient evidence. The absolute risk reduction of each treatment differed according to the disease severity. Therefore, physicians and patients should decide on treatment based on the disease severity. [ABSTRACT FROM AUTHOR]

YouTube has emerged as an important source for obtaining information regarding health issues.The study aimed to assess the reliability and quality of facial paralysis exercise videos that are accessible on the YouTube platform.The investigation was carried out on Youtube, utilizing the keyword “facial paralysis exercises”. We listed the first 100 videos based on relevancy. The quality and reliability of the videos were assessed using DISCERN, the Journal of the American Medical Association (JAMA) Benchmark Criteria, the Global Quality Scale (GQS), and the Video Power Index (VPI).Out of 100 studies, we excluded 52 and included the remaining 48. The scores we obtained for the videos were as follows: DISCERN Quality (2.92±0.91), DISCERN Total (39.16±6.75), JAMA (2.09±0.55), and GQS (3.00±0.89). Our study also revealed that videos uploaded by healthcare professionals had significantly higher DISCERN total, JAMA and VPI scores compared to those uploaded by non-healthcare professionals (p = 0.018, 0.001 and 0.023, respectively). Additionally, we observed a positive and statistically significant correlation between the DISCERN quality score, total score, JAMA, and video features.The facial paralysis exercise videos were determined to be of medium to low quality. Higher-quality videos need to be produced. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion We aimed to investigate the causes of acute peripheral facial palsy (PFP) in Danish children and to explore whether neuroborreliosis‐related PFP could be diagnosed without lumbar puncture using clinical symptoms and serum Borrelia burgdorferi (Bb) antibodies.This retrospective population‐based cohort study included children undergoing lumbar puncture for PFP between 2019 and 2023 in Denmark's Capital Region. Diagnostic performance measures for neuroborreliosis‐related PFP were compared between serum Bb IgG alone and clinical risk scores combining Bb IgG with clinical parameters.Of the 326 patients with PFP, 137 (42%) were diagnosed with neuroborreliosis and 151 (46%) had Bell's palsy. Positive predictive value for serum Bb IgG alone was 88% (95% CI 79–93) and negative predictive value was 83% (95% CI 75–88). The positive predictive value of a risk score with seven additional parameters was 90% (95% CI 81–95) and negative predictive value 87% (95% CI 80–92).The positive predictive value of serum Bb IgG alone was high in our setting, where nearly half of children with PFP had neuroborreliosis. In high endemic settings, lumbar punctures may be reduced by (i) treating all children with PFP with doxycycline or (ii) treating Bb IgG positive children and performing lumbar puncture in seronegative children. [ABSTRACT FROM AUTHOR]

Objective: The exact cause of idiopathic facial paralysis (Bell's palsy) is not clear. The objective of our study was to investigate the relationship between certain hemogram parameters and the clinical prognosis in pediatric patients with facial paralysis. Material and Methods: The files of patients with Bell's palsy under the age of 18 who applied to our hospital were evaluated retrospectively. Leukocyte, neutrophil, lymphocyte, platelet count, red cell distribution width, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and monocyte to lymphocyte ratio were compared between patients with Bell's palsy and the control group. Information about their last health status recorded. Results: A total of seventeen children with Bell's palsy and 17 control groups were included in the study. There were 7 boys (41.20%) and 10 girls (58.70%) in each group, the mean age was 11.80±4.40 (minimum 3.0-maximum 17.9) years. While the median neutrophil-lymphocyte ratio was 1.25 (0.41-7.63) in patients with Bell's palsy and 1.40 (0.422.52) in the control group, the median mean platelet volume level was 9.30 fL (8.20-12.30) in patients with Bell's palsy and 9.95 fL (9.30-11.70) in the control group, and the median red cell distribution width level was 12.75 % (11.50-26.30) in patients with Bell's palsy and 12.70% (12.10-26.30) in the control group. None of them were statistically significant. There were six patients with Bell's palsy with low mean platelet volume levels and no patients with low mean platelet volume levels in the control group (p=0.007). There was a positive correlation between the neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and monocyte-lymphocyte ratio and the recovery time of patients with Bell's palsy. Conclusion: Bell's palsy may show a better prognosis in girls. High neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and monocyte-lymphocyte ratio may be indicators of delayed recovery, inflammation, and microvascular ischemia in Bell's palsy. [ABSTRACT FROM AUTHOR]

Introduction: Reliable, noninvasive early diagnostics of neuromuscular function in Bell's palsy, which causes facial paralysis and reduced quality of life, remain to be established. Here, we aimed to evaluate the utility of the motor unit number index (MUNIX) for the quantitative electrophysiological assessment of early‐stage Bell's palsy, its correlation with clinical assessments, changes following treatment, and association with clinical prognosis. Methods: MUNIX measures were recorded from the bilateral zygomaticus, orbicularis oculi, and orbicularis oris muscles of 10 healthy individuals and 64 patients with Bell's palsy. The patients were assessed by two specialist neurologists using the House–Brackmann and Sunnybrook Facial Grading Systems. Repeat assessments were performed on 20 patients with Bell's palsy who received treatment. Additionally, the 64 patients were reassessed using clinical scales after a 1‐month interval. Results: The MUNIX values of the main affected muscles on the affected side were lower than those on the healthy side in patients with Bell's palsy (p <.05). The MUNIX measurements significantly correlated with the clinical facial nerve palsy scale scores (p <.05). Significant improvements were observed in the MUNIX values on repeat testing following treatment (p <.05). The baseline motor unit size index (the compound muscle action potential amplitude divided by MUNIX) was positively associated with improved clinical presentation after 1 month (p <.05). Conclusion: MUNIX can be used as an electrophysiological biomarker for the quantitative assessment of facial nerve palsy and treatment response, and as a prognostic biomarker, in patients with early Bell's palsy, and is recommended as a complement to conventional neurophysiological examinations. [ABSTRACT FROM AUTHOR]

Purpose: This paper describes a new surgical procedure with electrical stimulation of the facial nerve for unresolved Bell's palsy and compares the facial nerve recovery with another group who underwent traditional middle cranial fossa decompression. Recent Findings: All patients with total unilateral facial paralysis had surgery by the senior author 3 months from onset of Bell's Palsy. Surgical decompression was performed in 13 patients between 1992–2012 (Group 1). Surgical exposure with intraoperative electrical stimulation of the facial nerve in the peri-geniculate region was performed in 47 patients between 2012–2022 (Group 2). The facial recovery at 1 month and 3 month were significantly better in Group 2. The degree of synkinesis was significantly less in Group 2. Summary: The trans-mastoid electrical stimulation of the facial nerve is less invasive, requires no hospital stay, and less time off work compared to the middle cranial fossa approach. The earlier facial movement at one month results in less long-term unwanted faulty regeneration or synkinesis. [ABSTRACT FROM AUTHOR]

Aims/Background The systemic inflammatory response index (SIRI), an emerging hematological marker of inflammation, has shown promise as a promising biomarker for a variety of inflammatory conditions. This study aims to explore the diagnostic role of SIRI in Bell's palsy (BP). Methods For this retrospective study, 73 people diagnosed with BP between January 2021 and December 2023 were recruited, along with 73 healthy controls who were age- and sex-matched. The SIRI and other blood inflammatory markers, including the systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), were determined for all participants, by enumerating their peripheral blood cell counts. Facial nerve function was assessed upon admission and after one month of treatment using the House-Brackmann Facial Nerve Grading System (H-B). According to this system, patients with an H-B grade of 1–2 are considered recovered, while those with an H-B grade of 3–6 are regarded as not recovered. Results The SIRI (0.94 vs 0.48, p < 0.001), SII (480.3 vs 329.12, p < 0.001), NLR (2.42 vs 1.41, p < 0.001), and PLR (141.05 vs 117.28, p = 0.001) showed a significant increase in the BP group compared to the control group. The receiver operating characteristic (ROC) curve analysis revealed that the area under the curve (AUC) for SIRI was higher than those for SII, NLR, and PLR, respectively. Upon one-month follow-up, significant differences in the values of SIRI, SII, and NLR were observed between the favorable prognosis group and the poor prognosis group (SIRI: 1.07 vs 0.87, p = 0.011; SII: 647.85 vs 422.11, p = 0.005; NLR: 3.31 vs 2.11, p = 0.013). The AUC of ROC curve for SIRI was found to be lower than that of SII but higher than that of NLR. Conclusion The SIRI has the potential to be an important BP diagnostic and prognostic marker. [ABSTRACT FROM AUTHOR]

We were tasked by Canada's COVID-19 Immunity Task Force to describe severe adverse events (SAEs) associated with emergency department (ED) visits and/or hospitalizations in individuals with immune-mediated inflammatory diseases (IMIDs). At eight Canadian centres, data were collected from adults with rheumatoid arthritis (RA), axial spondyloarthritis (AxS), systemic lupus (SLE), psoriatic arthritis (PsA), and inflammatory bowel disease (IBD). We administered questionnaires, analyzing SAEs experienced within 31 days following SARS-CoV-2 vaccination. About two-thirds (63%) of 1556 participants were female; the mean age was 52.5 years. The BNT162b2 (Pfizer) vaccine was the most common, with mRNA-1273 (Moderna) being second. A total of 49% of participants had IBD, 27.4% had RA, 14.3% had PsA, 5.3% had SpA, and 4% had SLE. Twelve (0.77% of 1556 participants) SAEs leading to an ED visit or hospitalization were self-reported, occurring in 11 participants. SAEs included six (0.39% of 1556 participants) ED visits (including one due to Bell's Palsy 31 days after first vaccination) and six (0.39% of 1556 participants) hospitalizations (including one due to Guillain-Barré syndrome 15 days after the first vaccination). Two SAEs included pericarditis, one involved SLE (considered a serious disease flare), and one involved RA. Thus, in the 31 days after SARS-CoV-2 vaccination in our IMID sample, very few serious adverse events occurred. As SARS-CoV2 continues to be a common cause of death, our findings may help optimize vaccination acceptance. [ABSTRACT FROM AUTHOR]

Objectives: Depressor anguli oris (DAO) excision can improve clinician‐graded, objective, and patient‐reported smile outcomes in patients with nonflaccid facial paralysis (NFFP). However, no prior research has studied changes in perceived emotions after surgery. This study quantifies changes in perceived emotions with smiling after DAO excision in the largest case series presented to date. Methods: Prospectively collected data from patients with NFFP who underwent DAO excision at a tertiary care facial nerve center were reviewed. Patient‐reported, clinician‐graded, and objective smile metrics were compared before and after surgery. Videos of faces at rest and while smiling were analyzed by artificial intelligence‐derived facial expression analysis software to quantify perceived emotions. Results: Sixty‐eight patients underwent isolated DAO excision between August 2021 and August 2023. Patients conveyed significantly more perceived happiness with smile and at rest after surgery (p < 0.001 and p = 0.012, respectively). DAO excision improved oral commissure excursion (p < 0.001), dental show (p < 0.001), and smile angle (p < 0.001) symmetry. Patients reported significant improvements in smiling and social function after surgery. Conclusions: This study demonstrates DAO excision increases perceived happiness conveyed by patients with NFFP while smiling and at rest. It confirms improved objective, clinician‐graded, and patient‐reported smile outcomes after surgery. Level of Evidence: 4 Laryngoscope, 134:4028–4035, 2024 [ABSTRACT FROM AUTHOR]

Purpose: To perform a scoping review to investigate the psychosocial impact of having an altered facial expression in five neurological diseases. Methods: A systematic literature search was performed. Studies were on Bell's palsy, facioscapulohumeral muscular dystrophy (FSHD), Moebius syndrome, myotonic dystrophy type 1, or Parkinson's disease patients; had a focus on altered facial expression; and had any form of psychosocial outcome measure. Data extraction focused on psychosocial outcomes. Results: Bell's palsy, myotonic dystrophy type 1, and Parkinson's disease patients more often experienced some degree of psychosocial distress than healthy controls. In FSHD, facial weakness negatively influenced communication and was experienced as a burden. The psychosocial distress applied especially to women (Bell's palsy and Parkinson's disease), and patients with more severely altered facial expression (Bell's palsy), but not for Moebius syndrome patients. Furthermore, Parkinson's disease patients with more pronounced hypomimia were perceived more negatively by observers. Various strategies were reported to compensate for altered facial expression. Conclusions: This review showed that patients with altered facial expression in four of five included neurological diseases had reduced psychosocial functioning. Future research recommendations include studies on observers' judgements of patients during social interactions and on the effectiveness of compensation strategies in enhancing psychosocial functioning. IMPLICATIONS FOR REHABILITATION: Negative effects of altered facial expression on psychosocial functioning are common and more abundant in women and in more severely affected patients with various neurological disorders. Health care professionals should be alert to psychosocial distress in patients with altered facial expression. Learning of compensatory strategies could be a beneficial therapy for patients with psychosocial distress due to an altered facial expression. [ABSTRACT FROM AUTHOR]

Background: To evaluate prognostic factors and the effects of pharmacologic and non-pharmacologic therapeutic interventions on the recovery of patients with Bell´s Palsy (BP). Methods: Cross-sectional study of patients admitted to a tertiary hospital with a diagnosis of BP between January 2010 and December 2020. Variables assessed: affected hemiface, degree of BP, comorbidities, smoking history, pharmacological treatment, physiotherapy and degree of recovery at third month. Results: A total of 87 patients were enrolled. No statistically signifcant difference was found between patients treated with corticosteroids and those treated with corticosteroids in combination with antivirals. Similarly, no statistically signifcant difference was observed between patients who received physiotherapy and those who did not. Hypertension, smoking, and higher grade H-B were associated with incomplete recovery (P=.042, .014, .028, and .037, respectively) and were identifed as predictors of poor prognosis. A hypertensive patient is 3.020 times more likely to have an incomplete recovery than a normotensive patient (P=.047, CI: 1.017-8.967), while a smoker is 3.897 times more likely to have an incomplete recovery than a non-smoker (P=.018, CI: 1.263-12.208). Patients with H-B grade V are 10.714 times more likely to have an incomplete recovery than patients with H-B grade II (P=.046, CI: 1.046-109.784). Conclusion: Hypertension, smoking, and higher H-B grade were signifcantly associated with incomplete recovery and poor prognosis. Patients treated with corticosteroids alone or in combination with antivirals showed no signifcant difference in the recovery rate. Similarly, no statistically signifcant difference was observed between patients who received physiotherapy and those who did not. [ABSTRACT FROM AUTHOR]

Postparalysis facial synkinesis (PPFS) can develop in any facial palsy and is associated with significant functional and psychosocial consequences for affected patients. While the prevention of synkinesis especially after Bell's palsy has been well examined, much less evidence exists regarding the management of patients with already established synkinesis. Therefore, the purpose of this review is to summarize the available literature and to provide an overview of the current therapeutic options for facial palsy patients with established synkinesis. A systematic literature review was undertaken, following the Preferred Reporting Items of Systematic Reviews and Meta-analyses 2020 guidelines. MEDLINE via PubMed and Cochrane Library were searched using the following strategy: ([facial palsy] OR [facial paralysis] OR [facial paresis]) AND (synkinesis) AND ([management] OR [guidelines] OR [treatment]). The initial search yielded 201 articles of which 36 original papers and 2 meta-analyses met the criteria for inclusion. Overall, the included articles provided original outcome data on 1,408 patients. Articles were divided into the following treatment categories: chemodenervation (12 studies, 536 patients), facial therapy (5 studies, 206 patients), surgical (10 studies, 389 patients), and combination therapy (9 studies, 278 patients). Results are analyzed and discussed accordingly. Significant heterogeneity in study population and design, lack of control groups, differences in postoperative follow-up, as well as the use of a variety of subjective and objective assessment tools to quantify synkinesis prevent direct comparison between treatment modalities. To date, there is no consensus on how PPFS is best treated. The lack of comparative studies and standardized outcome reporting hinder our understanding of this complex condition. Until higher quality scientific evidence is available, it remains a challenge best approached in an interdisciplinary team. An individualized multimodal therapeutic concept consisting of facial therapy, chemodenervation, and surgery should be tailored to meet the specific needs of the patient. [ABSTRACT FROM AUTHOR]

In Eastern nations, interventions like acupuncture and herbal medicine are often first-line for patients presenting with facial paralysis. Despite the rising popularity of Eastern medicine in Western nations, the literature assessing whether Eastern medicine interventions should be recommended for patients with facial paralysis is lacking. This meta-analysis aims to define what Eastern medicine interventions exist for the management of facial paralysis and assess whether current research supports these approaches as safe and effective. The PubMed and Cochrane databases were reviewed in accordance with PRISMA guidelines. Inclusion criteria consisted of peer-reviewed studies published between 2000 and 2023 that reported on Eastern medicine, also described as, "complementary" or "alternative" interventions for facial paralysis. Effective and cured rates were the primary outcomes extracted from the literature. Interventions within these studies were categorized into six groups: (1) standard acupuncture, (2) special needle therapies, (3) needle therapy + other alternative treatments, (4) herbal medicine, (5) alternative treatments + Western medicine, and (6) Western medicine alone. A multiple-treatment meta-analysis was performed to assess differences in effective and cured rates. Fifteen studies involving Eastern medicine for the treatment of facial paralysis met the inclusion criteria. No significant differences were found in effective and cured rates across groups. Multiple quality concerns were noted, such as the lack of control groups, blinding, and randomization noted in several studies. Many studies failed to report complications, preventing conclusions from being drawn on the safety of these Eastern medicine interventions. This meta-analysis was unable to support the recommendation of Eastern medicine approaches for patients with facial paralysis. No Eastern medicine treatments, combination of Eastern medicine treatments, or Eastern medicine treatments given with Western medicine were seen to be more effective than Western medicine alone. [ABSTRACT FROM AUTHOR]

Evidence on facial rehabilitation therapy (FRT) for acute facial paralysis (FP) remains limited. We present a retrospective review of patients with acute FP who have received FRT with physical therapists within 1 year of FP onset as determined by Sunnybrook Facial Grading Scale (SFGS) composite scores. A total of 702 patients with a clinical diagnosis of FP were referred to a university rehabilitation program between January 1, 2015 and January 1, 2022. Seventy-six patients met the criteria, defined as FP diagnosis <12 months before FRT initiation, ≥3 therapy sessions, and sufficient follow-up data. Average number of treatment sessions between SFGS scores was 7.7. History of cancer, sex, number of treatment sessions, and initial SFGS score were correlated with change in SFGS. Time to treatment was not correlated with change in SFGS score. SFGS improved with each additional treatment session (p < 0.01). Each additional point in the initial SFGS was correlated with less change in the final SFGS score (p < 0.01). FRT can provide meaningful improvement in functionality for patients with acute FP, regardless of time to treatment. Furthermore, patients who present with poorer functionality at baseline and those who undergo more treatment are most likely to see SFGS improvement. Research comparing the effect of facial rehabilitation with other treatment modalities and to a control cohort is warranted. [ABSTRACT FROM AUTHOR]

Neurolymphomatosis (NL) is a rare complication of non-Hodgkin's lymphoma, characterized by the infiltration of lymphoma cells into the peripheral nerves. A 54-year-old woman initially presented with right facial palsy without any other significant symptoms and was diagnosed with Bell's palsy. Despite initial improvement, her condition recurred, prompting further evaluation. Magnetic resonance imaging (MRI) revealed contrast enhancement from the tympanic segment to the surface of the masseter muscle along the right facial nerve and an adjacent mass lesion. Biopsy of the mass revealed a diagnosis of T-cell/histiocyte-rich large B-cell lymphoma. Chemotherapy resulted in complete resolution of facial palsy. Follow-up MRI confirmed the absence of contrast enhancement along the facial nerve. Facial palsy was considered to be caused by NL. This case was classified as that of primary NL because the facial palsy was the first manifestation of a hematologic malignancy. Recurrent facial palsy, which is atypical in Bell's palsy, led to further evaluation with MRI, which finally resulted in the diagnosis of malignant lymphoma. In cases of recurrent facial palsy, clinicians should consider various diagnoses, including that of NL, and advocate early imaging tests and biopsy, if possible, for accurate diagnosis and improved outcomes. [ABSTRACT FROM AUTHOR]

Introduction: The benign nature of Bell’s palsy has led to a lack of a standardized work-up, and dangerous underlying mimics are at risk of being missed.Case Report: An 84-year-old female with a history of vertigo presented to the emergency department with a left-sided facial droop consistent with Bell’s palsy. After further work-up, the patient was diagnosed with bilateral necrotizing mastoiditis.Conclusion: Unilateral facial weakness involving the forehead and palpebral fissures is often diagnosed as idiopathic Bell’s palsy. Various pathologies can present with unilateral facial weakness, and the differential needs to remain broad.

Alaa M Albishi, Hanan M Al-Ageel, Sami S AlAbdulwahab Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Alaa M Albishi; Hanan M Al-Ageel, King Saud University, P.O. Box 10219, Riyadh, 11433, Saudi Arabia, Email aalbeshi@ksu.edu.sa; hanan4pt@gmail.comBackground: Bell’s Palsy (BP) is an acute lower motor nerve impairment of the facial nerve, causing sudden paralysis on one side of the face and significantly affecting the patient’s quality of life. Physiotherapy is critical for rehabilitation after BP, aiding functional recovery. Various physical therapy interventions, such as dry needling, taping, and nerve mobilization, have proven effective in treating BP. However, different rehabilitation approaches and knowledge levels among therapists can result in varying treatment outcomes. Therefore, understanding rehabilitation specialists’ knowledge and attitudes towards BP is essential for ensuring effective treatment. To date, no studies have examined the knowledge and attitudes of rehabilitation professionals in Saudi Arabia regarding BP.Objective: This study aims to evaluate the knowledge and attitudes of physical therapists in Saudi Arabia regarding the rehabilitation of BP.Methods: A cross-sectional observational study was conducted with 150 licensed physical therapists in Saudi Arabia, selected via convenience sampling. Participants completed an anonymous online survey covering demographics, knowledge of, and attitudes toward BP rehabilitation techniques. Descriptive and inferential statistics were used to analyze the data.Results: The participants had a mean age of 33.13 ± 6.85 years, with 68.7% being female. Most held Bachelor’s degrees (65.3%) and worked in general hospitals (72.7%). The average knowledge score was 8.99 ± 1.95, indicating moderate knowledge levels. Attitudes towards BP rehabilitation were positive, particularly regarding early intervention, emotional support, and coordination exercises. Significant differences in knowledge and attitudes were observed based on gender, experience, and practice location.Conclusion: Physical therapists in Saudi Arabia demonstrate moderate knowledge and positive attitudes toward BP rehabilitation. Continued professional education and collaboration are recommended to improve clinical standards in treating BP.Keywords: Bell’s palsy, facial palsy, mime therapy, physical therapist, rehabilitation, knowledge, Attitudes, Saudi Arabia

Peripheral facial nerve palsy (PFP) is a rare occurrence after dental extraction. Early onset PFP after the procedure can be caused by trauma and/or local anesthesia, whereas delayed onset PFP has more speculative etiologies. The latter has a certain affiliation to Bell's palsy and is therefore primarily treated with corticosteroids, and long-term follow-up is often warranted. This article reports a unique case of a 30-year-old woman developing a delayed onset right-sided PFP after local intraoral anesthetic injection for molar extraction. Facial nerve injury was identified with signs of denervation and neuritis and the patient was treated with nonsteroidal anti-inflammatory drug, corticosteroids, vitamin B supplements, and mime therapy. After 9 months, the patient showed an improvement of the facial muscle activity and went from a grade IV to a grade III on the House-Brackmann grading scale. [ABSTRACT FROM AUTHOR]

Bell's palsy is the most common cause of facial weakness involving the facial nerve. While brain MRI is often acquired to evaluate for pathology along the intracranial course of the facial nerve, evaluation of inflammation affecting the extracranial segments of the facial nerve, particularly the intraparotid segments, is uncommon. We present a case report of acute Bell's palsy in a 35-year-old pregnant patient at 38 weeks’ gestation. A double-echo steady state MR neurography technique, MENSA (Multi-Echo iN Steady-state Acquisition), acquired with a conformable prototype neck coil, was utilized to visualize abnormal enlargement and signal hyperintensity of the left intraparotid facial nerve. The case highlights a presentation of Bell's palsy affecting the extracranial segments of the facial nerve. This technique may be useful for longitudinal monitoring of Bell's palsy, planning of targeted treatments, and for evaluating other pathologies affecting the facial nerve.

Highlight: The COVID-19 vaccination is one of the methods used to combat the COVID-19 pandemic. Bell's palsy is one of the unwanted side effects of the COVID-19 vaccination. The benefits and protective impacts of the COVID-19 vaccine exceed the dangers. ABSTRACT Introduction: TOne way to fight the COVID-19 pandemic is through vaccination. Indonesia widely uses a number of vaccines. The inactivated virus vaccine (Sinovac-CoronaVac), the recombinant adenovirus vector vaccine ChAdOx1-S/nCoV-19 (AstraZeneca), the mRNA-1273 vaccine (Moderna), and the BNT162b2 mRNA vaccine (Pfizer-BioNTech) are some of these. The COVID-19 vaccination has reported several cases of acute facial nerve paralysis as an adverse event. Case: A 34-year-old female patient complained of drooping lips to the left side and being unable to close the right eyelid three days after receiving the first dose of the COVID-19 vaccine inactivated virus type (CoronaVac). Physical examination revealed obesity, right lagophthalmos, and right peripheral facial nerve paralysis, but no extremity paresis. The patient was clinically diagnosed with Bell's palsy and received corticosteroid therapy. The patient's complaints improved after 2 weeks of treatment. Reports indicate that several types of COVID-19 vaccines have resulted in acute facial nerve paralysis. The mRNA-type COVID-19 vaccine led to the most widely reported cases of Bell’s palsy. The incidence of Bell's palsy after the COVID-19 vaccine is very rare. Conclusion: Overall, the advantages and protective effects of the COVID-19 vaccine outweigh the risks.

Abstract Background Idiopathic (IF) and nonidiopathic facial (NIF) nerve palsies are the most common forms of peripheral facial nerve palsies. Various risk factors for IF palsies, such as weather, have been explored, but such associations are sparse for NIF palsies, and it remains unclear whether certain diagnostic procedures, such as contrast agent-enhanced cerebral magnetic resonance imaging (cMRI), are helpful in the differential diagnosis of NIF vs. IF. Methods In this retrospective, monocentric study over a five-year period, the medical reports of 343 patients with peripheral facial nerve palsy were analysed based on aetiology, sociodemographic factors, cardiovascular risk factors, consultation time, diagnostic procedures such as cMRI, and laboratory results. We also investigated whether weather conditions and German Google Trends data were associated with the occurrence of NIF. To assess the importance of doctors’ clinical opinions, the documented anamneses and clinical examination reports were presented and rated in a blinded fashion by five neurology residents to assess the likelihood of NIF. Results A total of 254 patients (74%) had IF, and 89 patients (26%) had NIF. The most common aetiology among the NIF patients was the varicella zoster virus (VZV, 45%). Among the factors analysed, efflorescence (odds ratio (OR) 17.3) and rater agreement (OR 5.3) had the highest associations with NIF. The day of consultation (Friday, OR 3.6) and the cMRI findings of contrast enhancement of the facial nerve (OR 2.3) were also risk factors associated with NIF. In contrast, the local weather, Google Trends data, and cardiovascular risk factors were not associated with NIF. Conclusion The findings of this retrospective study highlight the importance of patient history and careful inspections to identify skin lesions for the differential diagnosis of acute facial nerve palsy. Special caution is advised for hospital physicians during the tick season, as a surge in NIF cases can lead to a concomitant increase in IF cases, making it challenging to choose adequate diagnostic methods.

Abstract The purpose of the study was to assess the effects of a novel technique involving facial stretching of the unaffected side along with a structured exercise for the affected side on facial symmetry and facial functions as compared to conventional exercise. A hospital-based parallel-group randomized trial was completed among patients with acute Bell’s palsy in Mangalore, India. Participants were randomized to receive facial stretching and a structured exercise program (experimental group) or the conventional exercise regimen (conventional group). Primary outcomes were facial symmetry and voluntary movement; assessed by the Sunnybrook Facial Grading System (SFGS). Both regimens were given for 3 weeks, with baseline, 10th day, and 20th day assessments. Out of 31 participants screened, 24 were eligible and 12 participants each were assigned to experimental and conventional groups. Change scores revealed greater improvement in the SFGS score (p = 0.002) for the experimental group participants. Facial stretching and structured exercise program exhibited promising results in enhancing facial symmetry and function in acute Bell’s palsy when compared to conventional exercise regimen.

Background: Idiopathic (IF) and nonidiopathic facial (NIF) nerve palsies are the most common forms of peripheral facial nerve palsies. Various risk factors for IF palsies, such as weather, have been explored, but such associations are sparse for NIF palsies, and it remains unclear whether certain diagnostic procedures, such as contrast agent-enhanced cerebral magnetic resonance imaging (cMRI), are helpful in the differential diagnosis of NIF vs. IF. Methods: In this retrospective, monocentric study over a five-year period, the medical reports of 343 patients with peripheral facial nerve palsy were analysed based on aetiology, sociodemographic factors, cardiovascular risk factors, consultation time, diagnostic procedures such as cMRI, and laboratory results. We also investigated whether weather conditions and German Google Trends data were associated with the occurrence of NIF. To assess the importance of doctors' clinical opinions, the documented anamneses and clinical examination reports were presented and rated in a blinded fashion by five neurology residents to assess the likelihood of NIF. Results: A total of 254 patients (74%) had IF, and 89 patients (26%) had NIF. The most common aetiology among the NIF patients was the varicella zoster virus (VZV, 45%). Among the factors analysed, efflorescence (odds ratio (OR) 17.3) and rater agreement (OR 5.3) had the highest associations with NIF. The day of consultation (Friday, OR 3.6) and the cMRI findings of contrast enhancement of the facial nerve (OR 2.3) were also risk factors associated with NIF. In contrast, the local weather, Google Trends data, and cardiovascular risk factors were not associated with NIF. Conclusion: The findings of this retrospective study highlight the importance of patient history and careful inspections to identify skin lesions for the differential diagnosis of acute facial nerve palsy. Special caution is advised for hospital physicians during the tick season, as a surge in NIF cases can lead to a concomitant increase in IF cases, making it challenging to choose adequate diagnostic methods. [ABSTRACT FROM AUTHOR]

Rheumatoid meningitis (RM) is a rare extra-articular manifestation of rheumatoid arthritis (RA) that has been increasingly recognized by neurologists. However, the diversity of its clinical manifestations makes its diagnosis difficult. RM does not have a unified diagnostic standard, and its link with RA needs to be studied further. Here we report two cases of RM without a history of RA. The first patient, an 80-year-old woman, presented with sudden unilateral limb weakness, with brain MR showing abnormal signals in the leptomeningeal of the right frontal parietal. Subarachnoid hemorrhage was excluded after imaging examination, and infectious meningitis was ruled out after cerebrospinal fluid (CSF) examination. The patient was diagnosed as having RM, she had increased levels of CCP and AKA, the markers of RA, but no history of the disease or other clinical manifestations of it. Another case, a 65-year-old man, was hospitalized with Bell's palsy. We found that he had intracranial imaging changes highly consistent with those characteristic of RM during his routine examination. Except for the left peripheral facial palsy, the patient had no other neurological signs or symptoms and no RA history. After a careful physical examination, we found no joint or other manifestations or serological abnormalities consistent with RA (RF, CCP, AKA, etc.). However, after excluding infection meningitis and considering the patient's unique imaging results, we diagnosed him as having RM. We report these two cases as references for clinical diagnosis and treatment of RM, providing a discussion of our rationale. [ABSTRACT FROM AUTHOR]

Objective: Rare disease Background: Morvan fibrillary chorea (Morvan syndrome) is a rare disorder marked by a collection of neurological symptoms such as myokymia, peripheral nerve excitability, neuromyotonia, autonomic instability, memory impairment, and delirium. Morvan syndrome is suspected to occur through antibodies directed against voltage gated potassium channels (VGKC), and has been linked with several autoimmune conditions and hematologic malignancies. We present a case of Morvan syndrome in association with monoclonal B cell lymphocytosis. Upon our literature review, we believe this to be the first documented case of Morvan syndrome associated with monoclonal B cell lymphocytosis. Case Report: The present case report describes a 75-year-old man with Morvan's syndrome. The patient had a diverse neurologic presentation with encephalopathy, progressive neuropathic pain, muscle fasciculations, myokymia, sensory deficits, and Bell's palsy. Ultimately, a paraneoplastic antibody panel revealed a positive titer of contactinassociated protein-like IgG (CASPR) and VGKC antibody. Flow cytometry showed a small population of abnormal lambda-restricted B cells. Given his symptoms, positive CASPR antibody, and flow cytometry findings, he was diagnosed with Morvan syndrome associated with monoclonal B cell lymphocytosis. He was treated with IV methylprednisolone and IVIG, with immediate improvement in neurologic symptoms. Conclusions: Morvan syndrome presents with a spectrum of neurologic symptoms and is associated with autoantibodies against VGKC through anti-CASPR2 antibodies. Classically, Morvan syndrome presents as a paraneoplastic disease secondary to thymomas. Our case demonstrates that there is an association between B cell lymphoproliferative disorders and Morvan syndrome. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to explore the relationship between climatic parameters and the daily cases of Bell's palsy (BP) among hospital outpatients, providing ecological evidence for understanding BP etiology and prevention. Methods: Retrospective analysis was conducted on data from 2187 BP patients who attended Kunshan First People's Hospital Outpatient Clinic from January 1, 2020, to December 31, 2022. Meteorological data, including temperature, relative humidity, precipitation, wind speed, sunshine duration, and atmospheric pressure, were collected and combined with daily BP case records. Additionally, air quality index was used as a covariate. Results: The number of new BP cases among outpatients showed a negative correlation with average daily temperature. A nonlinear relationship between daily average temperature and BP cases was observed through the generalized additive model (GAM). A significant negative correlation was identified between daily average temperature and BP cases, with inflection points at temperatures above 4.2°C, suggesting a potential decrease in BP risk with temperature rise beyond this threshold. Conclusion: This study provides ecological evidence of a link between climatic factors and BP occurrence. Temperature demonstrated a significant nonlinear negative correlation with daily BP incidence, highlighting temperature and cold exposure as key targets for BP prevention in Kunshan. [ABSTRACT FROM AUTHOR]

Introduction: Several studies have reported that the number of patients with Bell's palsy varied significantly by month and season. However, few studies have reported the monthly variation in Bell's palsy based on the whole population. We investigated the monthly variation in Bell's palsy in Korea during a long-term period based on whole population data. Methods: This retrospective study used the data of the National Health Insurance Service of Korea, which included the entire Korean population from 2008 to 2020. The monthly incidence of Bell's palsy per 100,000 was evaluated in total and according to sex, age, and residence. Results: The total average monthly incidence differed significantly by month, with the highest observed in January (9.1 per 100,000) and the lowest in June (7.7 per 100,000) (p < 0.001). The average monthly incidence according to sex, age, and residence also varied significantly by month, with most of the highest values noted in January and the lowest in June. Conclusion: There was significant monthly variation in the incidence of Bell's palsy, with the highest in January during the winter and the lowest in June during the summer, based on whole population data over a long-term period in Korea. [ABSTRACT FROM AUTHOR]

Introduction: Bell's palsy is one of the most concerning complications of the COVID vaccine that has impacted vaccine acceptance among the general population. These vaccines were introduced to provide immunity against the SARS-CoV-2 coronavirus and have been found to be quite effective. Little did we know that Bell's palsy could be one of its serious complications. Materials and Methods: We used various search engines to gather data in the form of a case series and case reports related to patients who were affected by the vaccine and had developed Bell's palsy. Results: A total of eleven case reports and 4 case series were included in the analysis. The vaccines mentioned in the case reports were Pfizer, Moderna, Sinovac, AstraZeneca, and Janssen, while the case series included Pfizer and Sinovac. The majority of patients were female and aged between 31-40 years. Rightsided laterality was observed in 45.45% of patients, left-sided laterality in 45.45% of patients, and bilateral laterality in 9.1% of patients. Three patients had a history of Bell's palsy or stroke. After treatment, three patients showed partial improvement, six patients fully recovered, and the status of two patients was unknown. Conclusions: Bell's palsy is a rare complication that can occur after receiving the COVID-19 vaccine. This review aims to increase awareness about this rare adverse event of the vaccine so that it can be properly addressed and managed. Additionally, it will serve as a foundation for future research on the administration of the COVID-19 vaccine. [ABSTRACT FROM AUTHOR]

Background: The prognosis of Bell's palsy is favorable. However, many patients still have residual facial weakness and sequelae such as synkinesis and hemifacial spasm. Currently, there is no adequate information on treatment response and sequelae of Bell's palsy in Thai adult patients. Objective: 1) To determine clinical characteristics, treatment response, and sequelae of Bell's palsy including synkinesis and hemifacial spasm in Thai adult patients and 2) to find factors associated with early recovery and sequelae of Bell's palsy. Materials and Methods: A retrospective chart review of patients diagnosed with Bell's palsy between January 1, 2015 and December 31, 2022, was performed. Results: Three hundred two Bell's palsy patients were identified. Females were predominant at 63.2%. The mean age at onset was 49.3 years, and the median disease duration was two days. Nineteen-point five percent of the patients had diabetes, 31.8% had associated symptoms, and the most common symptom was postauricular pain at 21.5%. Additionally, 11.9% had recurrent Bell's palsy in which two attacks of Bell's palsy were noted. The median time from the previous episode was three years. Most patients received oral prednisolone within one week for 96.7%. Seventynine-point eight percent of the patients had partial recovery within four weeks after onset. Most associated symptoms were resolved in 12 weeks for 91%. The overall recovery rate was not different between diabetic and non-diabetic patients at 100% versus 99.2%. Severe steroid side effects were not present. Seven-point nine percent of the patients had synkinesis, which started at 24 weeks and 3.6% had hemifacial spasm, which started at 12 weeks. Factors related to synkinesis and hemifacial spasm were no improvement of facial muscle movement at four weeks after the onset. Conclusion: Factors related to synkinesis and hemifacial spasm were no improvement of facial muscle movement at four weeks after onset. Longer follow-up, for at least one year, is needed to detect the sequelae of Bell's palsy especially in delayed recovery patients. [ABSTRACT FROM AUTHOR]

Background: Facial synkinesis can result in facial tightness, smile dysfunction, and eyelid aperture narrowing due to overactive and uncoordinated muscle activity. We hypothesized that the outcome of a selective neurectomy could rely on the patient's chief complaints. Methods: We retrospectively reviewed 122 patients who underwent selective neurectomy at our hospital. Preoperatively, the patients were asked nine questionnaires to identify their two major chief complaints (treatment priorities). Postoperatively, facial tightness, limited mouth movement, and eyelid aperture narrowing were measured. Results: The most common chief complaints in our series were facial tightness (n=38), eyelid narrowing (n=32), and limited mouth movement (n=28); the second most common chief complaints (second priority) were limited mouth movement (n=47), facial tightness (n=21), and eyelid narrowing (n=20). The mean score for facial tightness significantly improved from 4.3 to 1.1 in the first priority group. Among the 28 patients whose corners of the mouth constituted the top priority of surgical correction, the vertical inclination on the affected side significantly improved from 74.1 ± 7.6° to 55.5 ± 6.0°, and the horizontal angles were changed from 4.2 ± 2.7° to 2.0 ± 1.3° after selective neurectomy without statistically significant. Among the 32 patients for whom eyelid narrowing constituted the top priority, the mean eyelid narrowing score improved from 4.5 ± 1.1 to 1.5 ± 1.2. Conclusions: Selective neurectomy can provide a significantly satisfactory outcome regarding facial tightness and eyelid aperture narrowing. The vertical inclination of the mouth corner can be significantly improved, while the improvement of horizontal angles can be suboptimal. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

With the continuous progress of technology, the subject of life science plays an increasingly important role, among which the application of artificial intelligence in the medical field has attracted more and more attention. Bell facial palsy, a neurological ailment characterized by facial muscle weakness or paralysis, exerts a profound impact on patients' facial expressions and masticatory abilities, thereby inflicting considerable distress upon their overall quality of life and mental well-being. In this study, we designed a facial attribute recognition model specifically for individuals with Bell's facial palsy. The model utilizes an enhanced SSD network and scientific computing to perform a graded assessment of the patients' condition. By replacing the VGG network with a more efficient backbone, we improved the model's accuracy and significantly reduced its computational burden. The results show that the improved SSD network has an average precision of 87.9% in the classification of light, middle and severe facial palsy, and effectively performs the classification of patients with facial palsy, where scientific calculations also increase the precision of the classification. This is also one of the most significant contributions of this article, which provides intelligent means and objective data for future research on intelligent diagnosis and treatment as well as progressive rehabilitation. [ABSTRACT FROM AUTHOR]

Background: Conservative therapy is currently the elective treatment for peripheric facial palsy according to scientific literature. The success of conservative therapy is due to physiotherapy and the application of its methods. The aim of this systematic review was to assess mirror therapy, a physiotherapeutic method. Objectives: The aim of the following systematic review is to evaluate the effectiveness of using mirror therapy in patients with peripheral paralysis of the seventh cranial nerve. Methods: This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The screening of literature was carried out on Cochrane, PEDro, PubMed/Medline, Scopus and Web of Science databases up until August 2022. All studies were randomized controlled trials (RCTs) and 5 articles met the inclusion criteria and were included in this study. The risk of bias was evaluated with PEDro and Jadad scales. Discussion: In the present study, we reviewed 5 RCTs that compared mirror therapy with other physiotherapy treatments or placebo to reduce pain, depression and improve range of motion in patients with peripheric facial nerve palsy. Conclusions: Further studies are needed to determine the effectiveness of this type of treatment, but nevertheless the data obtained are very encouraging. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Melkersson–Rosenthal syndrome can cause recurring bilateral facial paralysis. When steroids fail, surgical decompression of facial nerve is recommended, with endoscopic trans‐canal decompression as a safe, minimally invasive, and effective option. Melkersson–Rosenthal syndrome (MRS) is a rare neuro‐mucocutaneous disorder, clinically diagnosed by a triad of orofacial swelling, recurrent facial palsy, and fissured tongue. Due to the lack of a comprehensive understanding of MRS, there is no accepted standard of care. In this study we report a 30‐year‐old female patient, who was referred to the otolaryngology clinic of Rasool Akram Hospital, with classical triad of MRS that was managed by endoscopic trans‐canal facial nerve decompression. Bilateral endoscopic trans‐canal facial nerve decompression was done when we did not find any improvement with systemic steroids. Endoscopic trans‐canal facial nerve decompression could be a safe, reliable minimal invasive treatment of facial paralysis in MRS patients. It needs no external incision or temporal bone drilling which makes this method more convenient for patients with shorter recovery time. [ABSTRACT FROM AUTHOR]

The prognostic value of electroneurography (ENoG) for predicting the incidence of synkinesis is reportedly about 40 % using the formal standard method (ENoG-SM). However, the prognostic value of ENoG using the newly developed midline method (ENoG-MM) has not been determined. The aim of this study was to demonstrate the optimal prognostic value and advantages of ENoG-MM for predicting the incidence of synkinesis. Participants were 573 patients treated for peripheral facial palsy including Bell's palsy or Ramsay Hunt syndrome. We investigated the clinical presence of any oral-ocular or ocular-oral synkinesis from the medical records. ENoG-MM and ENoG-SM were performed 10–14 days after symptom onset. In ENoG-MM, compound muscle action potentials were recorded by placing the anode on the mental protuberance and the cathode on the philtrum. In ENoG-SM, electrodes were placed on the nasolabial fold. Synkinesis was clinically assessed at the end of follow-up or at >1 year after onset. The sensitivity and specificity of ENoG values for predicting the incidence of synkinesis were compared between ENoG-MM and ENoG-SM at every 5 % around 40 % (range, 30–50 %). At every 5 % of ENoG values around 40 %, ENoG-MM provided higher sensitivity and lower specificity for predicting the incidence of synkinesis compared with ENoG-SM. In particular, when the cut-off value was set at 45 %, sensitivity was 100 % and 95.3 % with ENoG-MM and ENoG-SM, respectively. In peripheral facial palsy, ENoG-MM offered higher sensitivity than ENoG-SM for predicting synkinesis. ENoG-MM is useful for screening patients at risk of developing synkinesis. In clinical practice, an ENoG-MM cut-off value of 45 % must be the optimal prognostic value because of the 100 % sensitivity. [ABSTRACT FROM AUTHOR]

Introduction: Diagnosis with facial palsy (FP) has been linked to increased psychosocial distress and communication disorders, but limited data exist on the temporal development of depression and anxiety after diagnosis. In a large cohort of FP patients, we characterize the rates of depression and anxiety at several timepoints post-FP diagnosis. Methods: A de-identified database of all FP patients who presented to a single healthcare system over 22 years was created using Epic SlicerDicer. Demographics and comorbidities were collected and depression and anxiety diagnosis rates at three timepoints (non-inclusive lower bounds) post-FP diagnosis were examined. Results: 3,910 FP patients were identified, with a median age of 59. 56% were female and 51% were white. At 0-6, 6-12-, and 12-36-month post-FP diagnosis, 156 (4%), 58 (1.4%), and 205 (5.2%) individuals were diagnosed with depression, and 171 (4.4%), 84 (2.1%), and 237 (6.1%) were diagnosed with anxiety. At each time point, the median time between FP and depression diagnosis (2.1, 3.4, and 11.4 months) or anxiety diagnosis (2.5, 4.0, and 11.1 months) was similar. Dual depression and anxiety diagnoses were observed in 52 (1.3%), 32 (0.8%), and 122 (3.1%) patients at each time point. Compared to the overall cohort, more patients with anxiety were female (65 vs. 56%, p < 0.001) and younger (57 vs. 59, p = 0.002), and more depressed patients were Black (7.3 vs. 3.3%, p = 0.02). Conclusions: Facial palsy may lead to increased risk of depression and/or anxiety in the first year after diagnosis as demonstrated here in one of the largest FP cohorts to date. We report high rates of depression (5.5%), anxiety (6.5%), and comorbid depression and anxiety (2.1%) occurring within 1 year after FP diagnosis. Of these, the majority occurred within the first 6 months (72%, 67%, 62%, respectively). Anxiety was more common in young female patients and depression more common in Black patients, which can inform targeted mental health resources within the first 6 months post-FP diagnosis. [ABSTRACT FROM AUTHOR]

Objectives : Facial nerve palsy causes blurred vision and ocular discomfort due to deficits in blinking and eye closure. The objective of this study was to determine whether eye-blinks could be elicited by electrical stimulation and whether electrically induced blink would have an effect on the visual acuity and ocular symptoms in patients with acute facial nerve palsy. Methods : The zygomatic branch of the facial nerve of fifteen participants with acute facial nerve palsy was electrically stimulated in order to elicit a blink. In successful cases, the participant proceeded with a two-hour TV watching session in which an electrically induced blink was delivered every 5 seconds. The control condition consisted of an otherwise similar TV watching session without electrically induced blinking. Subjective ocular symptoms were evaluated with a Dry Eye Questionnaire and visual acuity was assessed with a Logarithm of the Minimum Angle of Resolution (LogMAR) chart before and after both sessions. Results : The stimulation produced a blink in 8 participants (53%). The visual acuity in the affected eye decreased during the control session, whereas no significant change occurred during the stimulation session. The ocular symptoms were significantly reduced during the stimulation session. Conclusions : Electrically elicited blink is a promising method for reducing the eye symptoms in individuals with acute facial nerve palsy. [ABSTRACT FROM AUTHOR]

Objective: Guillain–Barré Syndrome (GBS) is an autoimmune degenerative disease commonly presenting with acute progressive sensorimotor paralysis, sometimes associated with dysautonomia, facial diplegia and severe respiratory distress. Gastroenteritis due to Campylobacter jejuni and respiratory infection secondary to Epstein–Barr virus usually precede GBS; however, vaccination or recent dengue infection as temporal causes are rarely reported. Case Presentation: Here, we present a 20‐year‐old man, who complained of a 5‐day history of a progressively worsening tingling sensation isolated in the hands and feet, and unilateral Bell's palsy on the left side of his face, which occurred 2 weeks after his severe acute respiratory syndrome coronavirus 2 vaccination and 6 weeks from his recent hospitalization from Dengue fever. Except for the left complete unilateral facial paralysis, weakness in the intrinsic hands and feet muscles, and sensory ataxia, the rest of his physical examination was unremarkable. On work‐up, the findings of albuminocytological dissociation and distal sensorimotor demyelinating polyneuropathy in the nerve conduction study supported the diagnosis of GBS. Conclusion: The enhanced immune response from a recent dengue infection and severe acute respiratory syndrome coronavirus 2 vaccination might increase the risk of GBS. The predominantly distal GBS phenotype has rarely been reported in the literature, adding to the peculiarity of this case. [ABSTRACT FROM AUTHOR]

Objectives: In several disorders, the monocyte to high-density lipoprotein ratio (MHR) has been considered a biomarker of systemic inflammation and oxidative stress. However, its role in Bell's palsy (BP) remains unclear. This study investigates the relationship between elevated MHR and poor recovery in BP patients. Methods: The clinical data of 729 BP patients were analyzed retrospectively. The House-Brackmann Facial Nerve Grading System (H-B) was utilized to assess the severity of facial motor dysfunction during admission and the follow-up period after discharge. According to the 6 months follow-up data, H-B grades 1–2 were classified as recovered (n = 557), and H-B grades 3–6 as unrecovered (n = 172). The patients were split into MHR ≤ 0.26 (n = 361) and MHR > 0.26 (n = 368) groups based on the median MHR to further analyze the connection between different MHRs and prognosis. Results: The level of MHR was substantially greater in the unrecovered group of BP patients than in the restored group (medians[interquartile range], 0.32[0.20, 0.49] vs 0.24[0.11, 0.39], P < 0.001). MHR was an independent risk factor for BP prognosis as indicated by the multivariate logistic regression analysis (OR = 4.467, 95% CI = 1.875–10.646, P = 0.001). The area under the curve (AUC) was 0.615 (95% CI = 0.566–0.664, P < 0.001). The initial H-B score did not differ significantly between MHR ≤ 0.26 (n = 361) and MHR > 0.26 (n = 368) groups. However, after 6 months of follow-up, the high-MHR group's H-B score was considerably greater than the low-MHR group's. Conclusions: MHR is expected to be an accessible and effective biomarker of BP. In BP patients, elevated MHR is related to an increased chance of poor recovery. [ABSTRACT FROM AUTHOR]

Abstract Introduction Reliable, noninvasive early diagnostics of neuromuscular function in Bell's palsy, which causes facial paralysis and reduced quality of life, remain to be established. Here, we aimed to evaluate the utility of the motor unit number index (MUNIX) for the quantitative electrophysiological assessment of early‐stage Bell's palsy, its correlation with clinical assessments, changes following treatment, and association with clinical prognosis. Methods MUNIX measures were recorded from the bilateral zygomaticus, orbicularis oculi, and orbicularis oris muscles of 10 healthy individuals and 64 patients with Bell's palsy. The patients were assessed by two specialist neurologists using the House–Brackmann and Sunnybrook Facial Grading Systems. Repeat assessments were performed on 20 patients with Bell's palsy who received treatment. Additionally, the 64 patients were reassessed using clinical scales after a 1‐month interval. Results The MUNIX values of the main affected muscles on the affected side were lower than those on the healthy side in patients with Bell's palsy (p

The article describes the case of a 74-year old woman diagnosed with granulomatosis with polyangiitis (GPA) and showed multiple cranial nerve manifestations and nasopharyngeal pseudotumor. The patient demonstrated left facial nerve palsy, hypoesthesia, inflammation and swelling at the left nasopharyngreal area, bilateral sensorineural hearing loss, and mass at the left lateral wall of nasopharynx. She was treated with methylprednisone and cyclosphosphamide. Other symptoms of GPA are indicated.

Peripheral facial palsy, characterized by sudden weakness or paralysis of the facial muscles, can arise from various etiologies, including viral infections. While Ramsay Hunt syndrome is well-established in clinical practice, Varicella Zoster Virus (VZV) infection leading to facial nerve palsy in pediatric patients remains relatively uncommon.This comprehensive case report documents the clinical presentation, diagnostic evaluation, treatment, and outcomes of a 10-year-old boy who developed left peripheral facial palsy following a primary Varicella infection. The report underscores the importance of timely recognition and tailored management approaches in achieving a complete remission of symptoms in pediatric patients. [ABSTRACT FROM AUTHOR]

Abstract Background Prior studies have reported a potential relationship between depressive disorder (DD), immune function, and inflammatory response. Some studies have also confirmed the correlation between immune and inflammatory responses and Bell’s palsy. Considering that the pathophysiology of these two diseases has several similarities, this study investigates if DD raises the risk of developing Bell’s palsy. Methods This nationwide propensity score-weighting cohort study utilized Taiwan National Health Insurance data. 44,198 patients with DD were identified as the DD cohort and 1,433,650 adult subjects without DD were identified as the comparison cohort. The inverse probability of treatment weighting (IPTW) strategy was used to balance the differences of covariates between two groups. The 5-year incidence of Bell’s palsy was evaluated using the Cox proportional-hazard model, presenting results in terms of hazard ratios (HRs) and 95% confidence intervals (CIs). Results The average age of DD patients was 48.3 ± 17.3 years, and 61.86% were female. After propensity score-weighting strategy, no significant demographic differences emerged between the DD and comparison cohort. The Cox proportional hazards model revealed a statistically significant adjusted IPTW-HR of 1.315 (95% CI: 1.168–1.481) for Bell’s palsy in DD patients compared to comparison subjects. Further independent factors for Bell’s palsy in this model were age (IPTW-HR: 1.012, 95% CI: 1.010–1.013, p

Khabab Abbasher Hussien Mohamed Ahmed,1 Amira Siddig,2 AlHussien Abbashar,3 Mohammed Abbasher,4 Abubaker Alsedig Abbasher,5 Abbasher Hussien,6 Gaffar Alemam A Manhal1 1Faculty of Medicine, University of Khartoum, Khartoum, Sudan; 2Department of Community Medicine, Faculty of Medicine, AlNeelain University, Khartoum, Sudan; 3AlYarmouk College, Khartoum, Sudan; 4Faculty of Medicine, AlNeelain University, Khartoum, Sudan; 5Zamzam University College, Khartoum, Sudan; 6Department of Internal Medicine and Neurology, Faculty of Medicine, University of Khartoum, Khartoum, SudanCorrespondence: Khabab Abbasher Hussien Mohamed Ahmed, Faculty of Medicine, University of Khartoum, Khartoum, 11111, Sudan, Tel +249907712134, Email khabab9722@gmail.comAbstract: Bell’s palsy is a lower motor neuron lesion rarely associated with COVID-19 infection or vaccinations. We documented two cases of Bell’s palsy in this report, one after contracting COVID-19 infection and the other after administration of AZD1222 Vaxzervria (AstraZeneca) Vaccine. After excluding all possible causes of Bell’s palsy in both cases, we determined that COVID-19 infection and the AZD1222 Vaxzervria (AstraZeneca) vaccine were the causes. Thus, we believe COVID-19 and the AZD1222 Vaxzervria (AstraZeneca) vaccine should be considered as causes of Bell’s palsy.Keywords: COVID-19, SARS-CoV-2 virus, Bell’s palsy, AZD1222 Vaxzervria (AstraZeneca) vaccine, Sudan