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AIM 1. To study the clinical presentation of facial nerve palsy (FNP) in paediatric age group. 2. To determine the outcome of FNP in children treated with steroids and antivirals. METHODOLOGY Tertiary Hospital based study carried out in patients attending outpatient Department-ENT, GIMS-Gadag, between June 2022 and September 2023. 50 children under the age 16 years with acute unilateral FNP were selected. House-Brackmann grading scale is used. Patients treated with steroids, antivirals then outcomes are noted. RESULTS • Out of 50 patients→40 idiopathic (80%) and 10 infection induced FNP (7 otitis media, 3 varicella-zoster virus infection) (20%). • Improvement is noted in the outcomes of idiopathic and infection induced FNP after treatment with steroids and antivirals. • There is no difference in the gender, age-group, family history, grading between idiopathic and infection induced FNP. • There is no significant difference noted in the recovery outcome between who were treated with and without steroids. CONCLUSION: • Idiopathic and infection induced facial nerve palsy in children have better prognosis following treatment with steroids and antivirals. • There is no difference in the gender, age-group, family history, HBS grading between the idiopathic and infection induced FNP. [ABSTRACT FROM AUTHOR]

Aim: The aim of the present study is to share our experience in managing high-grade posttraumatic facial nerve paralysis using both surgical as well as nonsurgical approaches. Materials and Methods: A retrospective analysis of 31 cases of high-grade (House–Brackmann [HB]: V/VI) facial nerve paralysis following undisplaced temporal bone fracture treated at our tertiary care hospital between 2016 and 2019 was done. Patients' assessment included clinical, audiological, computer tomography scans, and electromyography (EMG) evaluation. Fourteen of the cases presenting between February 2016 and November 2017 underwent surgical decompression of the facial nerve based on our prevailing institutional protocol during that period. However, the next 17 patients presenting between January 2018 and May 2019 were managed conservatively on the basis of our surgical experience in managing such patients before this period and some contemporary data suggesting good results with conservative management, using oral steroids and facial physiotherapy. The patients were assessed clinically and using EMG at 4 weekly intervals as a standard institutional protocol. Results: Among the 14 patients who underwent surgical decompression, lesions were predominantly found in the perigeniculate region. Analysis of results after 12 months revealed 86% (12 out of 14) of cases who underwent surgery had a satisfactory recovery (HB Grade I-II). A satisfactory recovery was achieved in 94% (16 out of 17) of conservatively managed patients (HB Grade I-II). However, there was no statistically significant difference identified between the outcomes of the two groups. Conclusion: The outcome of patients presenting with high-grade facial paralysis with unfavorable EMG findings secondary to undisplaced temporal bone fractures is generally good with or without surgical intervention. The recovery may take around 2–3 months to initiate. We recommend giving nonsurgical conservative management to such patients with regular clinical and electrophysiological monitoring. Clinical Significance: The outcomes and our experience of managing such cases may be useful for clinicians in deciding the course of action in patients presenting with high-grade facial nerve palsy following temporal bone fractures. [ABSTRACT FROM AUTHOR]

Introduction House–Brackmann (HB) grading had been described to quantify the facial nerve involvement in cerebellopontine angle (CPA) tumors, a very common tumor in neurosurgical practice. Very few studies have specifically looked into the factors predicting the facial nerve morbidity and its severity. Here, we try finding these while going through the clinicoradiologic factors and its natural course to help us prognosticate the patients. Objective To analyze the size of tumor and duration of symptoms to predict the severity of HB status of facial nerve presentation and outcome, and to study the course of the disease to help prognosticate the patients with respect to facial nerve status. Materials and Methods This was a retrospective analysis of 126 operated CPA tumors, where we studied the natural course of HB status with respect to size and duration of symptoms of patients at our institute between December 2016 to February 2020. Results Average duration of symptoms were 33.8 days with increasing risk of HB outcome after 36 days of symptoms. All patients improved to their preoperative facial nerve status at 3 months and only 18 maintained the worsened HB status. Average size of tumor was 3.53 cm, and size higher than 3.8 cm was associated with poorer HB outcome. Conclusion Although there can be a significant deterioration of HB status in immediate postoperative period, it improves to preoperative status in due time. Tumor larger than 3.8 cm and symptom duration more than 36 days are two important factors predicting poorer HB outcome.

Introduction House–Brackmann (HB) grading had been described to quantify the facial nerve involvement in cerebellopontine angle (CPA) tumors, a very common tumor in neurosurgical practice. Very few studies have specifically looked into the factors predicting the facial nerve morbidity and its severity. Here, we try finding these while going through the clinicoradiologic factors and its natural course to help us prognosticate the patients. Objective To analyze the size of tumor and duration of symptoms to predict the severity of HB status of facial nerve presentation and outcome, and to study the course of the disease to help prognosticate the patients with respect to facial nerve status. Materials and Methods This was a retrospective analysis of 126 operated CPA tumors, where we studied the natural course of HB status with respect to size and duration of symptoms of patients at our institute between December 2016 to February 2020. Results Average duration of symptoms were 33.8 days with increasing risk of HB outcome after 36 days of symptoms. All patients improved to their preoperative facial nerve status at 3 months and only 18 maintained the worsened HB status. Average size of tumor was 3.53 cm, and size higher than 3.8 cm was associated with poorer HB outcome. Conclusion Although there can be a significant deterioration of HB status in immediate postoperative period, it improves to preoperative status in due time. Tumor larger than 3.8 cm and symptom duration more than 36 days are two important factors predicting poorer HB outcome. [ABSTRACT FROM AUTHOR]

Facial paralysis can be a devastating consequence resulting from blunt and penetrating trauma to the head and neck, as well as surgical injury, either accidental or due to involvement by tumor. In addition, the etiology can be attributed to a variety of other causes, ranging from infectious to metabolic, and is frequently idiopathic in nature. The incidence of facial nerve injury during temporomandibular joint (TMJ) surgeries varies among surgeons. There are many factors that could contribute to the injury of the temporal and zygomatic branches of the facial nerve. These nerves lie in a confluence of superficial fascia, temporalis fascia, and periosteum and may be injured by any dissection technique that attempts to violate the integrity of these regions. Excessive or heavy-handed retraction causes compression and/or stretching of nerve fibers resulting in neuropraxia. The facial nerve then enters the parotid gland, where the main trunk branches into the upper and lower divisions at the pes anserinus. The nerve further divides into five main branches: the temporal, zygomatic, buccal, marginal mandibular, and cervical. The temporal branch lies within the superficial muscular aponeurotic system at the level of the zygomatic arch. In this paper, we evaluate the facial nerve function based on the House–Brackmann grading index after the preauricular approach for the treatment of condylar fractures, pathologies, and TMJ ankylosis cases. The nerve functional regeneration postfacial nerve injury has been evaluated and reported in this retrospective study. [ABSTRACT FROM AUTHOR]

Abstract: We evaluated the facial nerve function in 136 patients who had had retrograde nerve dissection during parotidectomy for benign disease. One week after the operation 90 patients (66%) had some weakness of the facial nerve. After 1 month 52 (38%) had facial nerve paresis. After 3 months 114 (84%) had recovered fully and 21 (16%) had minor nerve paresis. After 6 months 135 (99%) had normal nerve function. One patient had persistent marginal mandibular nerve paresis. [Copyright &y& Elsevier]

OBJECTIVE The aim in this study was to review the technique and outcomes of cable graft interpositioning of the facial nerve (FN) in lateral skull base surgeries. METHODS The authors retrospectively evaluated data from patients who had undergone cable graft interpositioning after nerve sacrifice during skull base tumor removal between June 1987 and May 2015. All patients had undergone lateral skull base approaches to remove tumors at a quaternary referral center in Italy. Facial nerve function was evaluated before and after surgery using the House-Brackmann (HB) grading system. RESULTS Two hundred thirteen patients were eligible for study. The mean follow-up was 44.3 months. The most common pathology was vestibular schwannoma (83 cases [39%]), followed by FN tumor (67 cases [31%]). Facial nerve tumors had the highest incidence of nerve interruption (67 [66%] of 102 cases). Preoperative FN function was normal (HB Grade I) in 105 patients (49.3%) and mild (HB Grade II) in 19 (8.9%). At the last postoperative follow-up, 108 (50.7%) of the 213 patients had recovered to Grade III nerve function. Preoperative HB grading of the FN was found to have a significant effect on outcome (p = 0.002). CONCLUSIONS Cable graft interpositioning is a convenient and well-accepted procedure for immediate restoration of the FN. The study results, over a large number of patients, showed that the stitch-less fibrin glue-aided coaptation technique yields good results. The best possible postoperative result achieved was an HB Grade III. The chances of a good postoperative result increase when FN function is normal preoperatively. Slow-growing tumors of the cerebellopontine angle had a favorable outcome after grafting.